Examination and Disturbance of Thinking — Content (MSE)

1. Overview & Epidemiology

Thought content = what the patient believes and is preoccupied by — as distinct from thought process/form (how thoughts are linked, Topic 29). On the oral exam the examiner will repeatedly test whether you can place a symptom in the right box: e.g. delusion is a disorder of content, not form (cf. PSY - 3.14).

The four content abnormalities you must know cold:

• Delusion — fixed false belief (psychotic).
• Obsession — intrusive, ego-dystonic, resisted thought (non-psychotic; insight preserved).
• Overvalued idea — single dominating belief, intermediate between the two; the patient can be argued out of it.
• Special preoccupations — phobias, hypochondriacal ideas, suicidal/homicidal ideation.

Epidemiology of delusions (where they appear). Delusions are a transnosological sign: they occur in schizophrenia spectrum disorders, affective disorders (psychotic depression, mania), organic brain disease (incipient dementia, delirium, brain tumour, frontal-lobe syndrome), substance use (amphetamine, alcohol), and isolated delusional (paranoid) disorder. They do NOT typically occur in panic disorder or the anxiety/neurotic disorders (PSY - 3.31) — a classic exam discriminator.

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