page_title: Mental status examination
section_title: Thought process
hierarchical_section_title: Mental status examination / Domains / Thought process
context_page_description: The mental status examination is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood, and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.
  The purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient's mental state, which, when combined with the biographical and historical information of the psychiatric history, allows the clinician to make an accurate diagnosis and formulation, which are required for coherent treatment planning.
  The data are collected through a combination of direct and indirect means: unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, and formalised psychological tests.
context_section_description: Thought process in the MSE refers to the quantity, tempo (rate of flow) and form (or logical coherence) of thought. Thought process cannot be directly observed but can only be described by the patient, or inferred from a patient's speech. Form of the thought is captured in this category. One should describe the thought from as thought directed A→B(normal) vs formal thought disorders. A pattern of interruption or disorganization of thought processes is broadly referred to as formal thought disorder, and might be described more specifically as thought blocking, fusion, loosening of associations, tangential thinking, derailment of thought, or knight's move thinking. Thought may be described as circumstantial when a patient includes a great deal of irrelevant detail and makes frequent diversions, but remains focused on the broad topic. Regarding the tempo of thought, some people may experience flight of ideas (a manic symptom), when their thoughts are so rapid that their speech seems incoherent, although in flight of ideas a careful observer can discern a chain of poetic, syllabic, rhyming associations in the patient's speech. (i.e. I love to eat peaches, beach beaches, sand castles fall in the waves, braves are going to the finals, fee fi fo fum. Golden egg.) Alternatively an individual may be described as having retarded or inhibited thinking, in which thoughts seem to progress slowly with few associations. Poverty of thought is a global reduction in the quantity of thought and one of the negative symptoms of schizophrenia. It can also be a feature of severe depression or dementia. A patient with dementia might also experience thought perseveration. Thought perseveration refers to a pattern where a person keeps returning to the same limited set of ideas. Circumstantial thinking might be observed in anxiety disorders or certain kinds of personality disorders.
caption: The paintings of the outsider artist Adolf Wölfli could be seen as a visual representation of formal thought disorder.[citation needed]
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