MSE: Thought Process and Content Explained

Now , as you all know , the MSE is our kind of go-to assessment tool when it comes to evaluating a client's current state of mind , cognitive abilities and overall psychological functioning . The MSC allows us to assess a variety of areas , but today we're focusing this episode on two specific domains that are often confused thought process and thought content .

Now , besides , its practical application in your everyday practice , chances are you may be given information about the MSC on your exam , and you need to know how to interpret that information to determine possible diagnoses , create an effective treatment plan and evaluate your client's progress in therapy .

Today we'll cover some of the clinical terms that are used to describe the client's thought process and thought content , how those observations can be used when formulating a diagnosis , and then we'll dive into a few detailed case studies . So first let's talk about the terms associated with thought process .

Thought process refers to the ways that thoughts are formed and expressed . It's really all about the how of thinking rather than the what , and here are some key terms and their associated diagnoses . It's really all about the how of thinking rather than the what . And here are some key terms and their associated diagnoses . Number one circumstantiality .

This is where the client includes an excessive amount of unnecessary and irrelevant details when communicating . Instead of a direct and to-the-point response , they take that long wondering path before eventually arriving at the main point or answer to your question . This type of thinking can be observed in bipolar 1 disorder and psychotic disorders .

Now , normally , your brain filters and prioritizes information to help you focus on what's important . However , during a manic episode or a psychotic episode , this filtering mechanism becomes impaired and everything seems to be equally important . Number two tangentiality .

This is similar to circumstantiality , where the client goes off on a tangent , but instead of eventually reaching the point with tangential thinking , the client never returns to the original topic or question , and this feature is commonly associated with manic episodes , psychotic disorders and some cases of ADHD . Number three flight of ideas .

This involves the rapid shifting from one idea to another , with only superficial associations between them . Flight of ideas is typically seen in manic episodes and psychotic disorders . It's also associated with a few neurocognitive disorders , like Alzheimer's disease and Parkinson's . Number four loose associations .

This occurs when there's a series of ideas presented with loosely apparent or completely inapparent logical connections , and this feature is often found in psychotic disorders . Number five perseveration . This involves the repetition of a particular response , such as a word or a phrase , despite the absence or cessation of a stimulus .

Perseveration is commonly seen in neurocognitive disorders like a traumatic brain injury and dementia , as well as autism spectrum disorder . Number six thought blocking . This is where the client abruptly stops in the middle of a train of thought and they may not recall what they were saying . This is often associated with psychotic disorders .

So those six terms circumstantiality , tangentiality , flight of ideas , loose associations , flight of ideas , loose associations , perseveration and thought blocking are all used to describe one's thought process . Next , let's review the terms related to thought content . Thought content refers to the themes and ideas that occupy a person's mind .

Whereas thought process was all about the how of thinking , thought content is all about the what of thinking , and here are some key terms in their associated diagnoses . Number one delusions .

These are strongly held false beliefs that are not based in reality , and there are different types of delusions , including paranoid delusions , grandiose , persecutory , somatic , et cetera , and delusions are typically seen in psychotic disorders like schizophrenia and delusional disorder , as well as bipolar and depressive disorders that have some sort of psychotic feature .

Number two obsessions . Feature Number two obsessions . These are intrusive unwanted thoughts , urges or images that cause significant anxiety or distress , and obsessions are primarily associated with you guessed it obsessive compulsive disorder . Number three suicidal ideation .

This term is used to describe a client who's having thoughts about self-harm or suicide , which can range from passive wishes to active planning , and suicidal ideation is often found with major depressive disorder , bipolar disorder and sometimes borderline personality disorder . Number four is phobias .

These are persistent irrational fears of specific objects , activities or situations , and the presence of phobias is commonly seen in anxiety disorders such as specific phobia and social anxiety disorder .

Number five is magical thinking , and this refers to a belief that one's thoughts , words or actions can cause or prevent specific outcomes in a way that defies common sense . Magical thinking is associated with schizotypal personality disorder and obsessive compulsive disorder .

So that wraps up the thought content terms Delusions , obsessions , suicidal ideation , phobias and magical thinking . Now that you understand the terms , let's take a look at a case study and see how evaluating a client's thought process and thought content can help us in the diagnostic process .

Our first case is about Joseph , who is a 65-year-old client who presents with disruptions in thought process . Now , during the mental status exam , you ask John how he got to your office today and his response goes something like this Well , first I woke up at 6 am , then I brushed my teeth and had breakfast .

You know , I usually have oatmeal , but today I decided to have eggs . After breakfast I got dressed and I put on my favorite blue shirt . I thought it might rain it is Michigan after all so I took an umbrella with me . Then I took the bus .

There was this lady sitting next to me who had really strong perfume on , and I was hoping she'd get off before me , but no such luck . So here I am , and when you ask him to tell you more about how he's been feeling lately , he says you know , I've been feeling really on top of the world , like I can do anything .

Just yesterday I decided to rearrange my entire living room . It took hours , but it looks amazing now . You know , rearranging furniture is like rearranging your life . Life's full of changes . Change can be scary , but also exciting . Excitement is what keeps us going . Going places is something I love . I love traveling , especially to places with beaches .

Beaches are calming . Calmness is what I need sometimes , but it's hard to find when you're always busy . Now , on your mental status exam for Joseph , you'd note that in regard to thought process , he exhibits circumstantiality and flight of ideas . Process , he exhibits circumstantiality and flight of ideas .

Remember , circumstantiality is where the client includes a lot of unnecessary details before eventually reaching the point , and flight of ideas is the term used to describe when the client rapidly shifts from one topic to another . So when you've listened to joseph's , responses to any particular diagnosis spring to mind at this point .

If you're thinking about mania or bipolar one disorder , you're on the right track . Now let's take a look at another case with a 28-year-old client named Sarah .

When you ask her to tell you about some of the thoughts that have been bothering her lately , she says Well , I have this constant fear that if I don't check the locks on my doors exactly five times before going to bed , something terrible is going to happen to my husband .

And you ask her to go on to explain what she means by something bad happening to her husband and she replies well , my husband's in the military and if I don't check the locks exactly five times , I just know he's going to get hurt while he's on duty .

I know it sounds irrational , but I can't shake the feeling that my actions here at home directly affect his safety overseas . It's like some kind of cosmic balance or something . If I don't do it right , something bad is going to happen to him . Balance or something If I don't do it right , something bad is going to happen to him .

So in our MSE we could note that Sarah's thought content is dominated by obsessions about her husband's safety and magical thinking that her lock checking has a direct influence on her husband's safety , even though there's no logical connection between the two . So what diagnosis comes to mind in Sarah's case ? So what diagnosis comes to mind in Sarah's case ?

Well , this seems like a pretty straightforward case of obsessive compulsive disorder . But , as with the diagnostic process , it's really important that you rule out other potential disorders , and in this case , other potential disorders that can feature obsessive thoughts and compulsive behaviors .

All right , well , that brings us to the end of this episode on the mental status exam and thought process and thought content .

Here's a brief recap of what we talked about . Thought process refers to the way that thoughts are formed and expressed . It's all about the how of thinking .

Thought content refers to the themes and ideas that occupy a person's mind , and it's all about the what of thinking , and the terms associated with thought process include circumstantiality , tangentiality , flight of ideas , loose associations , perseveration and thought blocking , and the terms used to describe thought content are delusions , obsessions , suicidal ideation , phobias and

magical thinking , and we looked at a couple of cases and how . A client's presentation and your observations on the mental status exam can kind of clue you into a possible diagnosis . All right , thank you very much for listening and until we meet again , best of luck to you with your studies and remember it's in there .