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Disorganized Thinking it may be a disturbance in the way a person organizes and expresses their thoughts. It could be recognized through speech because we may not directly observe thoughts themselves.

Common features include:

• Loose associations (derailment): Ideas shift from one topic to another with little or no logical connection.
• Tangentiality: Answers may be related to the question but never actually reach the point.
• Circumstantiality: Speech may include excessive unnecessary details before eventually answering the question.
• Incoherence (“word salad”): Words and sentences may become so disorganized that they are difficult or impossible to understand.
• Illogical thinking: Conclusions may not logically follow from the information presented.
• Thought blocking: The person may suddenly stop speaking because their train of thought seems to disappear.

Disorganized thinking may be associated with conditions such as:

• Schizophrenia
• Bipolar disorder during severe manic episodes
• Severe depression with psychotic features
• Delirium
• Some neurological disorders or substance intoxication: “Please, Consult with a Medical Doctor, Neurologist or a Psychiatrist.”

For example:

• Question: “Why did you come to the hospital?”
• Response: “Well, hospitals have windows. Windows let in sunshine. Sunshine grows flowers. My neighbor likes flowers.”

The response may contain a chain of loosely connected ideas rather than a logical answer to the question.

It could be important to distinguish disorganized thinking from simply being distracted, anxious, or speaking in a rambling style. Disorganized thinking is typically severe enough to interfere with effective communication and may indicate an underlying psychiatric or neurological condition that requires evaluation: “Please, Consult with a Medical Doctor, Neurologist or a Psychiatrist.”

Shervan K Shahhian

Word Salad is a term used in mental health to describe speech or writing in which individual words may be real words, but they are arranged in a way that lacks logical meaning or coherent connections.

For example:

“The blue happiness jumped because television sleeps under the sandwich.”

The sentence contains recognizable words, but they don’t fit together in a meaningful way.

Word salad may occur in conditions that affect thinking and language, including:

Schizophrenia (possibly, during episodes of psychosis)

Severe Mania

Possibly in certain forms of Aphasia (after a stroke or brain injury): Consult with a Medical Doctor, Psychiatrist, and Neurologist.

Possibly in certain types of Dementia: Consult with a Medical Doctor, Psychiatrist, and Neurologist.

It’s different from:

Rambling or tangential speech, where a person goes off topic but their speech still has some meaning.

Using complex vocabulary, which may be difficult to follow but is still logically connected.

If someone suddenly develops word salad, especially if it’s accompanied by confusion, weakness, or other neurological symptoms, it should be treated as a medical emergency because it could be a sign of a stroke or another serious brain condition: Please, “Consult with a Medical Doctor, Psychiatrist, and Neurologist, ASAP.”

Shervan K Shahhian

Flight of Ideas could be a disturbance in the organization of thinking in which a person’s thoughts move very rapidly from one idea to another.

The connections between ideas may be understandable, but the person shifts topics so quickly that it becomes difficult for others to follow the conversation.

Example

“I need to go to the store because I need milk. Milk comes from cows, and cows are on farms. Farms are beautiful in the spring. Spring is my favorite season. I used to play baseball in spring, and baseball is America’s pastime. America has great cities…”

The person may move rapidly from milk to cows to farms to spring to baseball to America, with each idea triggering the next.

Key characteristics

• Rapid flow of thoughts
• Frequent topic changes
• Associations between ideas are often present
• Speech may be pressured and difficult to interrupt
• The person may be highly distractible
• The conversation may become difficult to follow

Flight of Ideas vs. Loose Associations

These are related but different:

• Flight of ideas: The ideas change rapidly, but there is usually some understandable connection between them.
• Loose associations: The connection between ideas becomes weak, illogical, or difficult to understand.

Common clinical association

Flight of ideas could be, classically associated with mania or hypomania, particularly in Bipolar I or Bipolar II Disorder, although rapid thinking and speech can occur in other conditions as well.

In simple terms: 

Flight of ideas is when thoughts move so quickly from one subject to another that the person’s speech seems to “fly” from idea to idea.

Shervan K Shahhian

“A disturbance in the organization of thinking” may refer to a disruption in the way a person’s thoughts are structured, connected, and logically organized.

In mental health, this could be called disorganized thinking or a formal thought disorder.

What it may look like

A person may have difficulty:

• Keeping thoughts organized and connected
• Following a logical sequence
• Staying on topic
• Expressing ideas clearly
• Connecting conclusions to evidence or reality
• Communicating thoughts in a way others may easily understand

Examples

Loose associations:

“I went to the store. Stores have doors. Doors can be locked. Locked rooms remind me of prison.”

The ideas may shift from one topic to another with weak or unclear connections.

Tangential thinking:

A person is asked, “Did you sleep well?” and responds with a long discussion about their neighbors, politics, and the weather without directly answering the question.

Circumstantial thinking:

The person provides excessive, unnecessary details but eventually returns to the original point.

Illogical thinking:

“I failed the test, therefore the government must be controlling my thoughts.”

The conclusion does not logically follow from the premise.

Word salad:

Speech becomes so severely disorganized that the words and phrases are largely incomprehensible.

Important clinical point

A disturbance in the organization of thinking may be assessed by examining a person’s speech and thought process during a Mental Status Examination (MSE). It describes how thoughts are organized, not necessarily what the person is thinking about.

It may occur in conditions such as schizophrenia spectrum disorders, mania, severe psychosis, substance induced states, delirium, and some neurological conditions: please, consult a Neurologist. However, the symptom alone may not establish a diagnosis.

Shervan K Shahhian

Tangential speech maybe a pattern of speaking in which a person wanders off the topic and never returns to answer the original question. Their thoughts are loosely related to the question but become increasingly irrelevant.

It could be considered a thought process disorder (a disturbance in the organization of thinking) and may be observed during a mental status examination.

Example

Question: “Have you been sleeping well?”

Tangential response: “Sleep is interesting because people dream. Dreams remind me of movies I watched as a child. My favorite actor was Tom Hanks. Movies have changed a lot over the years…”

Notice that the person never answers whether they have been sleeping well.

How it differs from related speech patterns

• Tangential speech: Goes off on related topics and never returns to answer the question.
• Circumstantial speech: Includes excessive, unnecessary detail but eventually comes back to answer the question.
• Flight of ideas: Rapidly shifts from one idea to another with understandable associations, may often seen in mania.
• Loose associations (derailment): Ideas jump from one topic to another with weak or illogical connections, making the conversation difficult to follow.

Possible conditions associated with tangential speech

Tangential speech may occur in several psychiatric and neurological conditions: (Please consult with a Neurologist and/or Psychiatrist), including:

• Schizophrenia and other psychotic disorders
• Mania (as part of bipolar disorder)
• Some neurocognitive disorders (such as dementia): Please consult with a Neurologist.
• Certain brain injuries or neurological conditions: Please consult with a Neurologist.

By itself, tangential speech may not diagnose any specific condition. It must be interpreted in the context of the person’s overall symptoms and clinical evaluation.

A simple way to remember it is:

Tangential speech: “goes off on a tangent” and never gets back to the point.

Shervan K Shahhian

Circumstantial Speech could be a pattern of communication in which a person gives excessive, unnecessary, or irrelevant details before eventually reaching the main point.

The person may not eventually answer the question or reach the intended point, but the response takes a long, indirect route.

Example

Question: “Why were you late to work?”

Circumstantial response:

“Well, I woke up at 7:00, which is earlier than I usually do. My alarm clock is an older one, and I’ve been thinking about replacing it. Then I went to make coffee, but we were out of coffee, so I had to go to the store. The store was crowded because it was a Tuesday, and Tuesdays are usually busy… Anyway, I was late because I had car trouble.”

The person eventually gets to the point:

“I had car trouble.”

Key characteristic

Circumstantiality: excessive detail, eventual return to the main point.

It may often be considered a type of thought process or speech abnormality observed during a Mental Status Examination (MSE).

Circumstantial vs. Tangential Speech

Simple way to remember it:

Circumstantial speech takes the long way around, but eventually gets there.

Circumstantial speech may occur in many contexts, including anxiety, certain personality styles, ADHD, mania, psychosis, and other psychiatric or neurological conditions: Please, consult with a Neurologist. By itself, it does not establish a diagnosis.

Sherevan K Shahhian

Loose Associations (it could be called derailment) is a disturbance in the organization of thought and speech in which a person’s ideas shift from one topic to another with weak, unclear, or only loosely understandable connections.

Example

Question: “What did you do today?”

Response:

“I went to the store to buy some milk. Milk comes from cows. Cows are sacred in some cultures. Culture is changing because of technology. My phone needs to be charged.”

The person may move from one idea to another, but the connections become increasingly weak or difficult to follow.

Key characteristics

• The person may begin with a relevant topic.
• The conversation gradually drifts away from the original subject.
• Connections between ideas may be difficult for the listener to understand.
• Speech may remain grammatically understandable, unlike word salad, where speech may become largely incoherent.
• The person may not realize that their thinking has become difficult to follow.

Loose Associations vs. Tangential Speech

Possible Clinical Significance

Loose associations may occur in conditions involving disorganized thinking, including schizophrenia spectrum disorders, severe psychosis, mania, and sometimes substance induced psychosis. However, the presence of loose associations alone may not establish a diagnosis?

A useful way to remember it:

Loose associations:

The connections between thoughts may become loose, weak, and difficult to follow.

Shervan K Shahhian