Theory. Disorders Of The Associative Process

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Disorders of the associative process include a number of violations of the way of thinking, expressed in a change in pace, mobility, harmony, purposefulness. The following clinical phenomena are distinguished

Acceleration of thinking is characterized not only by the abundance and speed of the emergence of associations, but also by their superficiality. This leads to the fact that patients are easily distracted from the main topic of conversation, the speech becomes inconsistent, "jumping" character. Any remark of the interlocutor gives rise to a new stream of superficial associations. Speech pressure is noted, the patient seeks to express himself as soon as possible, does not listen to the answers to the questions asked.

A patient diagnosed with manic-depressive psychosis, meeting the doctor in the morning, rushes to him, starting the conversation with compliments: “You look great, doctor, and the shirt is right! Doctor, I'll give you a good tie and a mink hat. My sister works in a department store. Have you been in a department store in Presnya, on the fourth floor? Do you know what floors are high there? As I go, my heart pounds. Can I have an electrocardiogram? No! Why torture you in vain? It's time for me to check out. I'm so healthy. In the army he was engaged in a barbell. And at school he danced in an ensemble. Do you, doctor, love ballet? I'll give you ballet tickets! I have connections everywhere …”.

Extreme acceleration is denoted as "The jump is coming" (fuga idearum) … In this case, speech breaks up into separate shouts, it is very difficult to understand the connection between them ("verbal okroshka"). However, later, when the painful condition passes, patients can sometimes restore a logical chain of thoughts that they did not have time to express during psychosis.

Speeding up thinking - a characteristic manifestation of manic syndrome, can also be observed when taking psychostimulants.

Slow down thinking it is expressed not only in the slowed-down tempo of speech, but also in the poverty of the emerging associations. Because of this, speech becomes monosyllabic, there are no detailed definitions and explanations in it. The process of forming inferences is complicated, therefore, patients are not able to comprehend complex issues, do not cope with counting, and give the impression of being intellectually reduced. However, slowing down of thinking in the overwhelming majority of cases acts as a temporary reversible symptom, and with the resolution of psychosis, mental functions are fully restored. Slowing down of thinking is observed in patients in a state of depression, as well as with a slight disorder of consciousness (stunning).

Pathological thoroughness (viscosity) - manifestation of stiffness of thinking. The patient speaks with thoroughness not only slowly, drawing out words, but also verbose. It is prone to over-detailing. The abundance of insignificant clarifications, repetitions, random facts, introductory words in his speech prevents the listeners from understanding the main idea. Although he constantly returns to the topic of conversation, he gets stuck on detailed descriptions, gets to the final thought in a complex, confusing way ("labyrinthine thinking"). Most often, pathological thoroughness is observed in organic brain diseases, especially in epilepsy, and indicates a long course of the disease, as well as the presence of an irreversible personality defect. In many ways, this symptom is associated with intellectual disorders: for example, the reason for the detail lies in the lost ability to distinguish the main from the secondary.

A patient with epilepsy answers the doctor's question what he remembers about the last seizure: “Well, there was one seizure somehow. Well, I'm at my dacha there, they dug up a good garden. As they say, maybe from fatigue. Well, it was there … Well, I actually don't know anything about the seizure. Relatives and friends said. Well, and they say that, they say, there was an attack … Well, as they say, my brother was still alive, he also died here from a heart attack … He told me that he was still alive. Says: "Well, I dragged you." This nephew is there … The men dragged me to the bed. And I was unconscious without that."

The thoroughness of patients with delirium should be distinguished from the pathological thoroughness of the associative process. In this case, detailing is not a manifestation of irreversible changes in the patient's way of thinking, but only reflects the degree of relevance of the delusional idea for the patient. A patient with delirium is so fascinated by the story that he cannot switch to any other topic, he constantly returns to the thoughts that excite him, but when discussing everyday events that are of little importance to him, he is able to answer briefly, clearly and concretely. Prescribing drugs can reduce the relevance of painful delusional ideas and, accordingly, leads to the disappearance of delusional thoroughness.

Resonance also manifests itself in verbosity, but thinking loses focus. Speech is replete with complex logical constructions, fanciful abstract concepts, terms that are often used without understanding their true meaning. If a patient with thoroughness seeks to answer the doctor's question as fully as possible, then for patients with reasonableness it does not matter whether the interlocutor understood them. They are interested in the process of thinking itself, and not in the final thought. Thinking becomes amorphous, devoid of clear content. Discussing the simplest everyday issues, patients find it difficult to accurately formulate the subject of the conversation, express themselves ornate, consider problems from the point of view of the most abstract sciences (philosophy, ethics, cosmology, biophysics). Such a penchant for lengthy, fruitless philosophical reasoning is often combined with ridiculous abstract hobbies (metaphysical or philosophical intoxication). Resonance is formed in patients with schizophrenia with a long-term current process and reflects irreversible changes in the way of thinking of patients.

At the final stages of the disease, the violation of the purposefulness of the thinking of patients with schizophrenia can reach a degree of disruption, reflected in the decay of speech (schizophasia), when it completely loses any meaning. The associations used by the patient are chaotic and random. It is interesting that, at the same time, the correct grammatical structure is often preserved, which is expressed in speech by the exact coordination of words in gender and case. The patient speaks in a measured manner, emphasizing the most significant words. The patient's consciousness is not upset: he hears the doctor's question, correctly follows his instructions, builds answers taking into account the associations voiced in the speech of the interlocutors, but cannot fully formulate a single thought.

A schizophrenic patient tells about himself: “Whoever I worked with! I can be an orderly, and the line turns out to be even. As a boy, he used to make a chair and make rounds with Professor Banshchikov. Everyone is sitting like this, and I say, and everything turns out congruently. And then in the mausoleum everyone carried bales, such heavy ones. I’m lying in a coffin, holding my hands like this, and they all drag and fold. Everyone says: they say, foreign countries will help us, but I can work here as an obstetrician too. For so many years I have been giving birth in Gorky Park … well, there are boys, girls … We take out the fruit and fold it. And what the chefs do is also necessary, because science is the greatest path to progress ….

Incoherence (incoherence) - a manifestation of the gross disintegration of the entire process of thinking. With incoherence, the grammatical structure of speech is destroyed, there are no complete phrases, you can hear only individual fragments of phrases, phrases and meaningless sounds. The incoherence of speech usually occurs against the background of a severe disorder of consciousness - amentia. At the same time, the patient is inaccessible to the contact, does not hear and does not understand the speech addressed to him.

A manifestation of thought disorder can be speech stereotypes, characterized by the repetition of thoughts, phrases or individual words. Speech stereotypes include perseverations, verbigerations, and standing turns.

Perseveration most often found in dementia caused by vascular damage to the brain, with age-related atrophic processes in the brain. At the same time, due to a violation of the intellect, the patients cannot comprehend the next question and, instead of answering, they repeat what was said earlier.

A patient diagnosed with Alzheimer's disease, at the request of the doctor, with some delay, but in the correct order, names the months of the year. Fulfilling the doctor's request to name the fingers, she shows her hand and lists: "January … February … March … April …".

Verbigeration only conditionally can they be attributed to thinking disorders, since they in many ways resemble violent motor acts.

Patients stereotypically, rhythmically, sometimes in rhyme, repeat individual words, sometimes meaningless combinations of sounds. Often this symptom is accompanied by rhythmic movements: patients sway, shake their heads, wave their fingers and at the same time repeat: “I lie, I lie … between, between … Verbigerations are most often a component of the catatonic or hebephrenic syndromes characteristic of schizophrenia.

Standing revolutions - these are stereotyped expressions, similar thoughts, to which the patient repeatedly returns during the conversation. The appearance of standing turns is a sign of a decrease in intelligence, devastation of thinking. Standing turns are quite common in epileptic dementia. They can also be observed in atrophic diseases of the brain, for example, in Pick's disease.

A 68-year-old patient suffering from epilepsy since adolescence, constantly uses the expression "mental system" in speech

"These pills help with the mental-head system", "The doctor advised me to lie down more for the mind-head system", "I now hum all the time, because the mind-head system is recovering."

A 58-year-old patient with a diagnosis of Pick's disease answers the doctor's questions:

- What is your name? - No way.

- How old are you? - Not at all.

- What do you do? - Nobody.

- Do you have a wife? - There is.

- What is her name? - No way.

- How old is she? - Not at all.

- What do they work for? - Nobody …

In some cases, patients have a feeling that some processes in thinking occur against their will and they are unable to control their thinking. Examples of this symptomatology are the influx of thoughts and breaks in thinking. Influx of thoughts (mentism) It is expressed as a painful state of a chaotic stream of thoughts rushing through the head, usually arising in the form of an attack. At this moment, the patient is unable to continue his usual work, is distracted from the conversation. Painful thoughts do not represent any logical series, therefore a person cannot express them coherently, complains that “thoughts go in parallel rows”, “jump”, “intersect”, “cling to one another”, “get confused”.

Breaks in thinking (sperrung, stopping, or blockage, thoughts) cause the feeling that “thoughts have flown out of my head,” “my head is empty,” “I thought and thought and suddenly it was as if I was buried in a wall. The violent nature of these symptoms can plant in the patient the suspicion that someone specifically controls his thinking, prevents him from thinking. Mentism and Sperrung are a manifestation of ideational automatism, which is most often observed in schizophrenia. Difficulties in thinking arising from fatigue (for example, with asthenic syndrome), in which patients cannot concentrate, concentrate on work, involuntarily begin to think about something insignificant, should be distinguished from attacks of mentism. This state is never accompanied by a feeling of alienation, violence.

The most diverse disorders of the associative process are typical for schizophrenia, in which the entire figurative mindset can radically change, acquiring an autistic, symbolic and paralogical character.

Autistic thinking it is expressed in extreme isolation, immersion in the world of one's own fantasies, detachment from reality. Patients are not interested in the practical significance of their ideas, they can ponder a thought that is obviously contrary to reality, draw conclusions from it that are as meaningless as the initial premise. Patients do not care about the opinions of others, they are not talkative, secretive, but they are happy to express their thoughts on paper, sometimes writing thick notebooks. Observing such patients, reading their notes, one can be surprised that patients who behave passively, speak colorlessly, indifferently, in reality are engulfed in such fantastic, abstract, philosophical experiences.

Symbolic thinking characterized by the fact that patients use their own, incomprehensible symbols to others to express their thoughts. These can be well-known words that are used in an unusual sense, making the meaning of what is said becomes incomprehensible. Patients often invent their own words (neologisms).

A 29-year-old patient with a diagnosis of schizophrenia divides his hallucinations into “objective” and “subjective”. When asked to explain what he means, he declares: "Subjection is color, movement, and objects are books, words, letters … Solid letters … I can imagine them well, because I had a surge of energy …".

Paralogical thinking is manifested in the fact that patients, through complex logical reasoning, come to conclusions that are clearly contrary to reality. This becomes possible, since in the speech of patients, at first glance, as if coherent and logical, there is a shift in concepts (slipping), a substitution of the direct and figurative meaning of words, a violation of cause-and-effect relationships. Often, paralogical thinking is the basis of a delusional system. At the same time, paralogical constructions seem to prove the validity of the patient's thoughts.

A 25-year-old patient, talking about her family, emphasizes that she is very fond of her mother, who is now 50 years old and who looks quite healthy. However, the patient is very worried that the mother may get sick and die in front of her, so she intends to kill her as soon as she turns 70 years old.

Autistic, symbolic and paralogical thinking is not a specific manifestation of schizophrenia. It is noticed that among the relatives of schizophrenic patients more often than in the population, there are people without a current mental illness, but endowed with an unusual character (sometimes reaching the degree of psychopathy) and a subjective mindset, with unexpected logical constructions, a tendency to be fenced off from the outside world and symbolism.