A schizophrenic patient was asked how many members were there in his family. He replied, "Oh, maybe seven-since many people tell me because it is too hot-Raju is a very good boy-Punjabi-how about it." This is an example of which of the following?

1. A

   Perseveration

2. B

   Clang association

3. C

   Circumstantiality

4. D

   Incoherence

Appeared in: DSSSB October 2024

Explanation

• Incoherence, also known as 'word salad', is a thought disorder characterized by speech that is a completely illogical and incomprehensible mixture of words and phrases.
• The patient's response jumps from a number ('seven') to unrelated statements about heat, a person named Raju, and a language ('Punjabi'), demonstrating a lack of meaningful connections between thoughts.
• This severe disruption in thought process is a hallmark symptom of psychosis, often seen in conditions like schizophrenia.

Why Other Options Were Wrong

• Option A: The patient is not repeating the same word or idea; instead, they are jumping between multiple unrelated topics.
• Option B: The patient's word choices are not based on sound or rhyming patterns.
• Option C: The patient never answers the question or even circles back to the topic. The speech is completely derailed and does not eventually reach a goal.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of formal thought disorders in schizophrenia to guide bedside assessment, documentation, and the next nursing action.
• Recognizing specific thought disorders is crucial for nurses to accurately assess a patient's mental state, track the severity of psychosis, and evaluate the effectiveness of antipsychotic medications.
• When communicating with a patient experiencing incoherence, nurses should use simple, concrete language, avoid abstract questions, and focus on non-verbal cues and immediate needs to maintain a therapeutic and safe environment.
• What if the patient had said, 'I have a big family. Families are important. My mother was a great cook. She used to make the best biryani. We had a big kitchen...'? This would be an example of tangentiality, as the patient drifts away from the original question without ever answering it.

How to Approach the Question

• First, carefully analyze the structure and content of the patient's speech provided in the stem.
• Identify the core characteristic of the speech: Is it repetitive? Is it rhyming? Does it wander but eventually return? Or is it a completely random jumble?
• Recall the definitions of the thought disorders listed in the options: Perseveration (repetition), Clang Association (sound-based), Circumstantiality (excessive detail but returns to point), and Incoherence (no logical connection).
• Match the characteristic of the patient's speech to the correct definition. The patient's reply is a jumble of unrelated ideas, which directly matches the definition of incoherence.

Concept Tested & Keywords

• Concept Tested: Identification of formal thought disorders in schizophrenia.
• Stem keywords: schizophrenic patient, thought disorder, incomprehensible speech
• Lead-in keywords: example of which of the following
• Clinical cues: Patient's reply is a jumble of unrelated phrases, indicating a disturbance in thought process.
• Negative lead-in flag: false

Question ID

QrG7ubft-Vr-OUQFoQ5NQJ

Copy ID

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 3795-3797

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 50-52, 51-53