MSE: Thought Process and Content Explained

Ever wondered how the intricacies of thought processes and thought content can unlock the mysteries of mental health diagnoses? Join me, Stacey Frost, on the Licensure Exams podcast as we demystify the Mental Status Exam (MSE), focusing on the nuances of how thoughts are formed and expressed. In this episode, we'll break down clinical terms like circumstantiality, tangentiality, flight of ideas, loose associations, perseveration, and thought blocking, shedding light on their roles in diagnosing bipolar disorder, psychotic disorders, ADHD, and neurocognitive disorders.

We'll then shift gears to explore the captivating world of thought content, where we'll discuss delusions, obsessions, suicidal ideation, phobias, and magical thinking. Learn how these themes can be pivotal in diagnosing conditions such as schizophrenia, OCD, major depressive disorder, and anxiety disorders. Through detailed case studies, including that of Joseph, a 65-year-old client, you'll see how these observations can lead to accurate diagnoses and effective treatment plans. Don't miss this comprehensive guide designed to enrich your clinical practice and exam preparation.

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This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.

Transcript

STACY: 0:05

Hello all of you extraordinary therapists out there and welcome to our Licensure Exams podcast.

STACY: 0:10

I'm Stacey Frost, your host for today's episode, where we're taking a close look at the Mental Status Exam, or MSE. 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.

STACY: 1:37

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.

STACY: 2:43

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.

STACY: 3:42

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.

STACY: 4:36

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.

STACY: 6:32

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.

STACY: 7:30

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.

STACY: 7:55

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.

STACY: 8:41

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.

STACY: 9:30

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.

STACY: 10:15

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.