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Psychodynamic Psychological Testing in the Mental Health Inpatient Setting
Published in Meidan Turel, Michael Siglag, Alexander Grinshpoon, Clinical Psychology in the Mental Health Inpatient Setting, 2019
Christina Biedermann, Jeremy Ridenour, Spencer E. Biel
One particularly useful contribution of testing to these ends is its ability to detect discrete forms of thought disorder that, when present, often play a central role in patients’ struggles. Unrecognized differences between how a psychotherapist and patient perceive, make sense of, and respond to the treatment situation are often at play in the kinds of impasse that lead to treatments devolving and patients ultimately being deemed “treatment resistant.” These troubles are often difficult to detect without testing, especially for patients who are verbally gifted and able to hide their confusion beneath sophisticated verbiage. By thought disorder, we mean the processes underlying illogical thinking and reasoning (e.g., loose associations), perceptual confusion and impaired reality testing, linguistic disturbances and neologisms, and boundary disturbances. As noted earlier, we attend to the contexts in which these troubles occur, as well as to the conditions that help the patient recover. Perhaps more interpersonal structure, a less ambiguous environment, more interpersonal distance, or less affective stimulation might be helpful. Further, rather than conceptualizing disordered thinking as absolute or strictly indicative of deficit, we consider how apparent breakdowns in thinking might be breakthroughs, how lapses in organization might be on the way to reorganization that is more complex and adaptive, and how disorganization and disintegration might be serving protective functions (Leonhardt et al., 2016).
ISQ – Psyche-pathology
Published in Bhaskar Punukollu, Michael Phelan, Anish Unadkat, MRCPsych Part 1 In a Box, 2019
Bhaskar Punukollu, Michael Phelan, Anish Unadkat
Other types of thought disorder: — Metonym – An inappropriate or imprecise but related word is used in place of the correct word in a sentence.— Neologism – A new word that has no meaning is created,— Echolalia – Automatic and pointless repetition of another person’s words or phrases.— Verbigeration – Imitation of another person’s phrases in a stereotyped manner.— Palilalia – Repetition of a word from an individual’s own spoken words.— Logoclonia – Repetition of words or phrases, particularly the end syllables.— Logorrhoea: excessive flow of words or pressure of speech as occurs in mania.
Adolescent schizophrenia
Published in MS Thambirajah, Case Studies in Child and Adolescent Mental Health, 2018
Thought disorder: This refers to disorganised thinking expressed through abnormal spoken language. For example, the person jumps erratically from one topic to another during the conversation, grammatical structure of language breaks down and speech is generally speeded up and incoherent. Incoherent speech, disorganised thinking and derailment in the stream of thought and speech may occur. Patients with insight often say that their thoughts are mixed up and thinking is distorted. Patients with thought disorder may present with complaints of poor concentration or of their mind being blocked or emptied (thought block).
Professional Practice Guidelines for Personality Assessment
Published in Journal of Personality Assessment, 2022
Radhika Krishnamurthy, Giselle A. Hass, Adam P. Natoli, Bruce L. Smith, Paul A. Arbisi, Emily D. Gottfried
Like any healthcare service, the practice of personality assessment often requires prior authorization for reimbursement of the service. Generally, authorization is predicated on the medical necessity of the service. In the United States, for instance, medical necessity is defined as “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine” (U.S. Centers for Medicare & Medicaid Services, n.d.). Following this definition, other third-party payers establish medical necessity guidelines to determine insurance coverage for diagnostic and treatment services. Some examples are determination of thought disorder, differential diagnosis of psychiatric conditions not resolved by interview and observation processes, and determination of treatment options for optimal clinical outcomes. From the perspective of the third-party carrier, medical necessity will be reflected in the proper coding of the assessment service. The assessor should therefore be familiar with current coding procedures.
Clinical validation of the Symptom Self-rating Scale for Schizophrenia (4S) among inpatients
Published in Nordic Journal of Psychiatry, 2021
Pernille Kølbæk, Daniel Guinart, Mark Opler, Christoph U. Correll, Ole Mors, Søren D. Østergaard
Like the PANSS-6 items assessing the negative symptoms 'Lack of spontaneity and flow of conversation' and 'Blunted affect', scoring of the 'Conceptual disorganisation' item is based on observation. However, as opposed to the development of self-rated negative symptom scale, measures assessing thought disorder based on self-report are virtually non-existing [48,49]. In the present study, it seems that the 4S thought disorder item measures a different construct than the clinician-rated PANSS item P3 Conceptual disorganisation. This is supported by Lindström's original finding indicating that the 4S thought disorder item is most strongly correlated with the affective factor and therefore possibly assesses cognitive disturbances in relation to affective symptoms rather than thought disorder per se. The lack of agreement between the self-reported thought disorder item and the corresponding clinician-rating was also observed in the study of an electronic self-report questionnaire by Palmier-Claus et al. [13]. Taken together, these findings suggest that the greatest challenge to the validity of self-reported schizophrenia symptoms may be thought disorder. Future studies should assess what questions and/or cognitive and linguistic tasks tap into the construct of Conceptual disorganization in the PANSS [48].
Changing the treatment paradigm for Parkinson’s disease psychosis with pimavanserin
Published in Expert Review of Clinical Pharmacology, 2019
Kelly E. Lyons, Rajesh Pahwa, Neal Hermanowicz, Thomas Davis, Fernando Pagan, Stuart Isaacson
One study followed 48 patients with PD and documented ‘benign hallucinations,’ which referred to hallucinations with retained insight; these symptoms were scored a Unified Parkinson’s Disease Rating Scale (UPDRS) thought disorder score of 2 and considered ‘benign,’ not requiring treatment [34]. Over the follow-up period of at least 3 years, 81% of the patients in this study had progressed to UPDRS thought disorder scores of 3 (denoting loss of insight) or 4 (occurrence of delusions) with potentially serious consequences [34]. If a composite endpoint including any criteria for progression was applied, 96% of the patients had progressed, and only 2 of 48 had stable, untreated hallucinations. Based on these data, the authors stated that ‘benign hallucinations’ portended serious outcomes, and that, therefore, this term was prognostically misleading and unsound and should be discontinued from operative use [34]. Another study in 60 patients with PD who had never reported hallucinations at baseline and were followed for 10 years found that while isolated visual hallucinations were initially the most common psychotic symptoms, visual plus nonvisual hallucinations were reported in progressively higher proportions of patients over time, from 0% at 0.5 years to 60% at 10 years [35]. In addition, a recent study found that the course of PDP can be variable and fluctuate, with periods of remission and relapse [36].