Appendix II: Construction of TALD Definitions
The table shows TALD Items and Definitions as compared to previous psychopathological symptom descriptions. If source is
originally not in English, translation by the authors.
1
Italics: newly added/defined in TALD Definition; different from source
2
Bold: parts of TALD Definition identical with source
3
Common print: parts from source not included in TALD Definition
TALD-Item TALD Definition 1, 2
1 Circumstantiality Thinking is circuitous; minor matters
cannot be separated from essential
matters. The main point gets lost in
the description of details, without
losing the intentional goal completely
(long-winded speech). Insufficient
capacity to process abstract information
might be one of several causes for
Circumstantiality, as well as the inability
to omit minor matters even when the
patient knows them to be inessential.
2 Derailment A pattern of spontaneous speech in
which ideas slip “off the track” onto
other thoughts which are clearly but
obliquely related. Things may be said
Source Definition 2, 3
Thinking is circuitous; minor matters
are not separated from essential
matters. The main point gets lost in the
description of details, without losing
the intentional goal completely (long-
winded speech).
Das Denken ist weitschweifig,
Nebensächliches wird nicht vom
Wesentlichen getrennt. Die Hauptsache
geht in der Schilderung von
unwesentlichen Details unter, ohne
vom Ziel gänzlich abzukommen.
(Möller et al., 2009) (p. 48)
A pattern of spontaneous speech in
which the ideas slip off the track onto
another one which is clearly but
obliquely related, or onto one which is
Related Definitions
Umständlichkeit / Circumstantiality
(Andreasen, 1984b; Andreasen,
1986; Bleuler, 1916; Bleuler, 1979;
David et al., 2009; Ebert und
Loew, 2008; Fish und Hamilton,
1984; Huber, 2005; Kaplan und
Sadock, 1991; Möller et al., 2008;
Payk, 2010; Scharfetter, 2010;
Semple und Smyth, 2009; Trabert
und Stieglitz, 2007)
Loose associations/ flight of ideas/
Ideenflucht / Entgleisung /
Looseness
in juxtaposition which lack a
meaningful relationship, or the patient
may shift idiosyncratically from one
frame of reference to another. At
times there may be vague
connections between the ideas. The
objective characteristic of Derailment
should be coded as if the interviewer
were talking to the patient for the first
time (unaware of potential personal
associative connections between the
thoughts). One manifestation of this
disorder is a slow steady slippage,
with no single Derailment being
particularly severe, so that the
speaker gets farther and farther off
the track with each Derailment without
any awareness that his reply no
longer has any connection to the
question being asked.
completely unrelated. Things may be
said in juxtaposition which lack a (Bleuler, 1916; Ebert und Loew,
meaningful relationship, or the patient 2008; Fish und Hamilton, 1984;
may shift idiosyncratically from one Huber, 2005; Jaspers, 1919;
frame of reference to another. At times Johnston und Holzman, 1979;
there may be a vague connection Kaplan und Sadock, 1991; Liddle
between the ideas, and at others none et al., 2002b; Payk, 2010;
will be apparent. This pattern of speech is Scharfetter, 2010; Schneider, 1946
often characterized as sounding ; Semple und Smyth, 2009; Talbott
"disjointed. ' Perhaps the commonest et al., 1988; Trabert und Stieglitz,
manifestation of this disorder is a slow, 2007)
steady slippage, with no single
derailment being particularly severe, so
that the speaker gets farther and
farther off the track with each
derailment without showing any
awareness that his reply no longer has
any connection with the question which
was asked. This abnormality is often
characterized by lack of cohesion between
clauses and sentences and by unclear
pronoun referents.
Although less severe derailments (i.e.,
those in which the relationship between
juxtaposed ideas is oblique) have
sometimes been referred to in the past as
tangentiality or as flight of ideas when in
the context of mania, such distinctions are
not recommended because they tend to
be unreliable. Flight of ideas is a
derailment which occurs rapidly in the
context of pressured speech. Tangentiality
has been defined herein as a different
phenomenon in that it occurs as the
immediate response to a question.

3 Tangentiality
4 Dissociation of Thinking
(Incoherence/Distraction)
Ideas do not follow a straight path. Within
longer speech passages, content slowly
drifts away from where it originally
started. The patient does not return to
the initial topic.
The content of a phrase, sentence or
thought has no reference to what has
been said before. In contrast to
Derailment (Item 2) where associative
bridges are still recognizable,
Dissociation of Thinking refers to the
state in which words, sentences and
thoughts have no relation to each other.
In less severe occurrences, single
sentences may still make sense;
however, coherence between sentences
is absent. In the severest occurrences,
coherence within a sentence or even
within individual words is absent
(scattered speech).
(Andreasen, 1986) (Item 6)
- Tangentialität / Ziel- und
In case of „Denkzerfahrenheit“
(Dissociation of Thinking), the
examiner is not able to comprehend
the reference of thought to the
preceding one.
Bei der Denkzerfahrenheit
(Denkdissoziation) ist für den
Untersucher der Zusammenhang eines
Gedankens mit dem vorhergehenden
nicht mehr nachvollziehbar.
(Huber, 1994) (p. 270)
Gedankenlosigkeit / weakening of
goal /Tangentiality
(Andreasen, 1984b; Andreasen,
1986; Bleuler, 1911; David et al.,
2009; Kaplan und Sadock, 1991;
Liddle et al., 2002a)
Denkdissoziation / Inkohärenz /
Zerfahrenheit / Assoziative
Auflockerung / Incoherence /
Dissociation of Thinking /
Distraction
(Andreasen, 1984b; Andreasen,
1986; Berger, 2009; Bleuler, 1911,
1916; Bleuler, 1979; David et al.,
2009; Ebert und Loew, 2008; Fish
und Hamilton, 1984; Huber, 2005;
Johnston und Holzman, 1979;
Kaplan und Sadock, 1991; Möller
et al., 2009; Payk, 2010;
Scharfetter, 2010; Schneider, 1946
; Trabert und Stieglitz, 2007)
5 Crosstalk The response of the patient misses
the point at hand, although he has
understood the question. The
evaluation of this item does not
depend on whether the answer to the
question is wrong or not (like a wrong
answer in an examination), but that
the patient is talking past the
question.
If the interviewer has any kind of
suspicion with regard to the presence
of Crosstalk, it must be verified that
the patient has understood the
question correctly. Therefore, the
patient should be asked to repeat the
question. Intentional ignoring of the
question (“beating around the bush”)
should not be considered.
The response of the patient misses the Vorbeireden
point at hand, although he has
understood the question. The (Berger, 2009; Fish und Hamilton,
evaluation of this item does not depend 1984; Huber, 2005; Möller et al.,
on whether the answer to the question 2009)
is wrong or not (like a wrong answer in
an examination), but that the patient is
talking past the question.
An example for patient’s crosstalk is: “Why
did you come to the hospital?” –
“Yesterday the weather was nice.”
If the interviewer has any kind of
suspicion with regard to the presence
of Crosstalk, it must be verified that the
patient has understood the question
correctly. Therefore, the patient should
be asked to repeat the question.
Intentional ignoring of the question
(“beating around the bush”) should not
be considered.
Der Patient verfehlt mit seiner Antwort
das Thema der Frage, obwohl er die
Frage verstanden hat. Entscheidend für
die Beurteilung ist nicht, ob die
Antwort falsch ist (wie z.B. bei einer
falschen Prüfungsantwort), sondern
dass der Patient am Thema der Frage
vorbei redet. Ein Beispiel für das
Vorbeireden eines Patienten ist: “Warum
sind Sie in die Klinik gekommen?“ –
„Gestern war schönes Wetter.“
Bei Verdacht auf Vorbeireden muss
sich der Untersucher vergewissern, ob
der Patient die Frage richtig verstanden
hat. Deshalb sollte der Patient sie noch

6 Perseveration Adherence to previously mentioned
ideas and topics that no longer fit the
current context.
7 Verbigeration Unnecessary repetition of a single word.
8 Rupture of Thought Objectively observed sudden
interruption of a previously fluid line
of thought. The phenomenon may occur
in the middle of a sentence and for no
apparent reason.
9 Pressured Speech The speed of speech production is
einmal wiederholen. Absichtliches
Nichteingehen auf eine Frage („Um-
den-heißen-Brei-Reden) wird hier nicht
markiert.
(Trabert and Stieglitz, 2007) (p. 50)
Adherence to previously mentioned
ideas and topics that no longer fit the
current context.
Haftenbleiben an zuvor gebrauchten
Angaben oder Themen, die im
aktuellen Zusammenhang nicht mehr
sinnvoll sind.
(Trabert and Stieglitz, 2007) (p. 47)
- (Payk, 2010)
Thought Blocking/Rupture of Thought:
Sudden interruption of a previously
fluid line of thought, at times in the
middle of a sentence, for no apparent
reason.
„Sperrung des
Denkens/Gedankenabreißen: Plötzlicher
Abbruch eines zunächst flüssigen
Gedankenganges, zuweilen mitten im
Satz, ohne erkennbaren Grund“
(Arolt et al., 2004) (p. 35)
- Sprechbeschleunigung /
Perseveration
(Andreasen, 1986; Bleuler, 1916;
Bleuler, 1979; Ebert und Loew,
2008; Fish und Hamilton, 1984;
Johnston und Holzman, 1979;
Liddle et al., 2002a; Möller et al.,
2009)
Gedankenabreißen / Gesperrt /
Sperrung / Blocking
(Berger, 2009; Bleuler, 1979; Ebert
und Loew, 2008; Fish und
Hamilton, 1984; Huber, 2005;
Kaplan und Sadock, 1991; Möller
et al., 2009; Payk, 2010;
Scharfetter, 2010; Semple und
Smyth, 2009; Trabert und Stieglitz,
2007)
 increased. Sprachtrieb

(Berger, 2009; Bleuler, 1911)

10 Logorrhoea An excessively strong urge to speak.
Logorrhoeic speech itself may be
coherent and logical. Accelerated
speech production need not be
present. Communication with the patient
is hindered. The patient is either not able
to recognize when he is being interrupted
or simply ignores such interruptions.
Increased flow of words. Logorrhoeic Rededrang / Sprachdruck /
speech itself may be coherent and Pressure of speech / Sprachtrieb
logical. Accelerated speech production
need not be present. Communication (Andreasen, 1984b; Andreasen,
with the patient is hindered. 1986; Bleuler, 1911; Horn et al.,
1993)
Verstärkter Redefluss. Logorrhoisches
Sprechen kann stringent und logisch
sein. Es muss nicht in jedem Falle
beschleunigt sein.

(Trabert and Stieglitz, 2007) (p. 112)

11 Manneristic Speech For the observer, speech (word
selection, sentence structure, articulation
or prosody) seems affected and ornate,
eccentric, unnatural, pompous,
overblown, fancy, stylized or flowery.
Everyday movements and actions
(gesture, mimics and speech) seem,
ornate, eccentric, and unnatural for the
observer and are sometimes conducted
with a markedly playful touch. For
instance, patients behave particularly
conspicuous (bizarre) and this behavior
contrasts with culture or group specific
talk, movement or physical appearance.
Manieriertheit / stilted speech /
Peculiar use of words / stilted
expression
(Andreasen, 1986; Bleuler, 1979;
Johnston und Holzman, 1979;
Kraepelin, 1910-1915; Liddle et al.,
2002a; Trabert und Stieglitz, 2007)

Terms also used to describe manneristic

speech include unnatural, grandiloquent,
overblown, in the sense of pompous,
toploftiness. Other descriptions include
affected and contrived, inhibited,
stylized, flowery.

Die alltäglichen Bewegungen und

Handlungen (Gestik, Mimik und Sprache)
erscheinen dem Beobachter

12 Semantic Paraphasia Substitution of an inappropriate word
(the substitute is semantically related to
the appropriate word.) The speaker may
or may not recognize his error and
attempt to correct it.
verstiegen, verschroben, posenhaft
und verschnörkelt, werden manchmal
mit einer ausgesprochen spielerischen
Note ausgeführt. Die Patienten benehmen
sich z.B. besonders auffällig (bizarr) und
dieses Verhalten steht im Kontrast zum
landes- und gruppenüblichen Sprechen,
Sich-Bewegen oder der äußeren
Erscheinung. Unter manieriert versteht
man auch unnatürlich, schwülstig,
aufgeblasen, und zwar im Sinne von
hochtrabend und wichtigtuerisch.
Darunter fallen auch Bezeichnungen wie
geziert, affektiert und gekünzelt,
verkrampft, stilisiert, floskelhaft.
(Trabert and Stieglitz, 2007) (p.110)
Substitution of an inappropriate word
when trying to say something specific.
The speaker may or may not recognize
his error and attempt to correct it. This
typically occurs in both Broca's and
Wernicke's aphasia. It may be difficult to
distinguish from incoherence since
incoherence may also be due to semantic
substitutions which distort or obscure
meaning; when this differential decision
must be made, it is suggested that formal
testing for aphasia be completed; if the
testing is positive, then the semantic
substitutions may be considered due to
semantic paraphasia, and if negative to
incoherence.
(Andreasen, 1986) (Item 20)
13 Phonemic Paraphasia Mispronunciation (with regard to
phonetic articulation) of a word. Milder
forms may occur as “slips of the
tongue” in everyday speech. The
speaker usually recognizes his error
and may attempt to correct it.
Recognizable mispronunciation of a
word because sounds or syllables have
slipped out of sequence. Severe forms
occur in aphasia, but milder forms may
occur as "slips of the tongue" in
everyday speech. The speaker usually
recognizes his error and may attempt
to correct it.

(Andreasen, 1986) (Item 19)

14 Neologisms New word formations, which do not
correspond to lexical conventions.
Most Neologisms are not directly
intelligible. In extreme cases a new
artificial language can be formed or
used by the patient. Expressions or
slang words used in particular groups
or subcultures (e.g. youth culture, the
drug scene) are not to be classified as
Neologisms. Insufficient language
abilities (e.g. in a non-native speaker)
should be excluded as well.
New word formations, which do not
correspond to lexical conventions. Most
Neologisms are not directly intelligible.
A semantically uncommon word usage is
coded here as well. In extreme cases a
new artificial language can be formed
or used by the patient. Expressions or
slang words used in particular groups
or subcultures (e.g. youth culture, drug
scene) are not to be classified here.
Insufficient language abilities (e.g. in a
non-native speaker) should be
excluded as well.
Neologismen
(Andreasen, 1986; Berger, 2009;
Bleuler, 1979; Fish und Hamilton,
1984; Johnston und Holzman,
1979; Kaplan und Sadock, 1991;
Kraepelin, 1910-1915; Möller et
al., 2009; Möller et al., 2008; Payk,
2010; Trabert und Stieglitz, 2007)

Wortneubildungen, die der sprachlichen

Konvention nicht entsprechen und
oft nicht unmittelbar verständlich sind.
Hier ist auch der semantisch
ungewöhnliche Gebrauch von Worten
abzubilden. Im Extremfall kann vom
Patienten
eine künstliche Sprache gebildet oder
gebraucht werden. Begriffe, die in
bestimmten Kreisen oder Subkulturen
(Jugendszene, Drogenszene)

15 Clanging A pattern of speech in which sounds,
rather than meaningful relationships,
appear to govern word choice, so that
the intelligibility of the speech is
impaired and redundant words are
introduced. In addition to rhyming
relationships, this pattern of speech
may also include punning
associations, so that a word similar in
sound (polysemy/homophony) brings in
a new thought.
16 Echolalia Senseless repetitions of words and
sentences with no regard to their
meanings and semantic functions. The
patient echoes the words or
sentences of the interviewer.
Exclusion: Some people habitually
echo questions, apparently to clarify
the question and formulate their
answer. This is usually indicated by
rewording the question or repeating
the last several words.
gebräuchlich sind, sollen hier nicht
abgebildet werden. Unzureichende
Sprachkenntnis (bei Nicht-
Muttersprachlern) wird hier auch nicht
abgebildet.
(Trabert and Stieglitz, 2007) (p. 53)
A pattern of speech in which sounds Klangassoziationen / Clanging /
rather than meaningful relationships Clangs
appear to govern word choice, so that
the intelligibility of the speech is
impaired and redundant words are (Andreasen, 1986; Bleuler, 1916;
introduced. In addition to rhyming Horn et al., 1993; Johnston und
relationships, this pattern of speech Holzman, 1979; Kaplan und
may also include punning Sadock, 1991)
associations, so that a word similar in
sound brings in a new thought.
(Andreasen, 1986) (Item 9)
A pattern of speech in which the patient Echolalie
echoes the words or phrases of the
interviewer. Typical echolalia tends to be
repetitive and persistent. The echo is often (Bleuler, 1979; Fish und Hamilton,
uttered with a mocking, mumbling, or 1984)
staccato intonation. Echolalia is relatively
uncommon in adults, but more frequent in
children.
Exclusions. Some people habitually
echo questions, apparently to clarify
the question and formulate their
answer. This is usually indicated by
rewording the question or repeating
the last several words (i.e., from "What
did you wear yesterday?" to "What did I
wear yesterday?" or "Wear yesterday?").

17 Poverty of Content of Although replies are long enough that
Speech speech is adequate in amount, it
conveys little information. Language
tends to be vague, often overly abstract
or overly concrete, repetitive, and
stereotyped. The interviewer may
recognize this finding by observing
that the patient has spoken at some
length but has not given adequate
information to answer the question.
Alternatively, the patient may provide
enough information, but require many
words to do so, so that a lengthy reply
can be summarized in a sentence or
two.
18 Restricted Thinking (o) Restriction in the range of content,
adherence to one topic or a few
topics, or fixation on a few key ideas.
During the conversation, the patient
experiences difficulties in switching
from one topic to another, or
constantly returns to the initial topic.
For a successful exploration, it is
necessary that the examiner offers the
patient a variety of topics. This is
important since the topic of illness
always forms part of a psychiatric
exploration, but this should not
automatically be treated as resulting
(Andreasen, 1986) (Item 15)
Although replies are long enough so Poverty of content of speech
that speech is adequate in amount, it
conveys little information. Language (Andreasen, 1984a)
tends to be vague, often overabstract or
overconcrete, repetitive, and
stereotyped. The interviewer may
recognize this finding by observing
that the patient has spoken at some
length but has not given adequate
information to answer the question.
Alternatively, the patient may provide
enough information, but require many
words to do so, so that a lengthy reply
can be summarized in a sentence or
two. Sometimes the interviewer may
characterize the speech as "empty
philosophizing."
(Andreasen, 1986) (Item 2)
Restriction in the range of content, Einengung / Haften
adherence to one topic or a few topics,
or fixation on a few key ideas. During (Ebert und Loew, 2008; Möller et
the conversation, the patient al., 2009; Payk, 2010; Scharfetter,
experiences difficulties in switching 2010)
from one topic to another, or
constantly returns to the initial topic.
For a successful exploration, it is
necessary that the examiner offers the
patient a variety of topics. This is
important since the topic of illness
always forms part of a psychiatric
exploration, but this should not
automatically be treated as resulting
from Restricted Thinking. When
exploring the topic of illness, it is only
possible to refer to Restricted
Thinking when the patient is fixed on
single aspects of his illness, and
when he is not able to detach from
these aspects despite being offered
other topics of discussion (e.g. a
depressive patient who is
preoccupied with his indigestion).
from Restricted Thinking. When
exploring the topic of illness, it is only
possible to refer to Restricted Thinking
when the patient is fixed on single
aspects of his illness, and when he is
not able to detach from these aspects
despite being offered other topics of
discussion (e.g. a depressive patient
who is preoccupied with his
indigestion).
Einschränkung des inhaltlichen
Denkumfanges, Verhaftetsein an ein
Thema oder an wenige Themen,
Fixierung auf wenige Zielvorstellungen.
Im Gespräch hat der Patient Mühe, von
einem Thema auf ein anderes
überzugehen, oder er kommt immer
wieder auf das alte Thema zurück. In
der Exploration müssen
unterschiedliche Themen angeboten
werden. Dies ist wichtig, weil das
Thema Krankheit Gegenstand einer
psychiatrischen Exploration ist, dies
aber nicht automatisch einer
Denkeinengung entspricht. Innerhalb
des Themas Krankheit läge erst dann
eine Denkeinengung vor, wenn der
Patient auf einzelne Aspekte davon
fixiert ist, von denen er sich trotz
Angebot nicht oder nur schwer lösen
kann (z.B. der depressive Patient, der
auf das Thema der gestörten
Verdauung eingeengt ist).
(Trabert and Stieglitz, 2007) (p.46)
19 Slowed Thinking From the observer’s perspective, the
patient's thought process seems to be
slowed down (objective). As a result
of this sluggish thinking process, the
conversation is languid and torpid.
From the observer’s perspective, the
patient's thought process seems to be
slowed down (objective). As a result of
this sluggish thinking process, the
conversation is languid and torpid.
Das Denken erscheint dem Beobachter
verlangsamt und schleppend. Das
verlangsamte Denken führt zu einem
zähflüssigen, trägen Gesprächsablauf.
Verlangsamung und Erschwerung
der Denkvorgänge /
Denkverlangsamung
(Ebert und Loew, 2008; Gross et
al., 1987; Möller et al., 2009; Payk,
2010; Scharfetter, 2010)

(Trabert and Stieglitz, 2007) (p. 45)

20 Poverty of Speech (o) Restriction in the amount of
spontaneous speech, so that answers
to given questions tend to be brief,
concrete and unelaborated.
Unprompted additional information is
rarely provided. Replies may be
monosyllabic, and some questions
may be left unanswered altogether.
When confronted with this speech
pattern, the interviewer may find
himself frequently prompting the
patient in order to encourage
elaboration of replies. To elicit this
finding, the examiner must allow the
patient adequate time to answer and
to elaborate his answer.
Restriction in the amount of Spracharmut / Verstummen /
spontaneous speech, so that replies to Poverty of speech / mutistisch
questions tend to be brief, concrete,
and unelaborated. Unprompted (Andreasen, 1984a; Fish und
additional information is rarely Hamilton, 1984; Kraepelin, 1910-
provided. For example, in answer to the 1915; Liddle et al., 2002a; Trabert
question, "How many children do you und Stieglitz, 2007)
have?", the patient replies, "Two. A girl
and a boy. The girl is 13 and the boy 10."
'Two" is all that is required to answer the
question, and the rest of the reply is
additional information. Replies may be
monosyllabic, and some questions
may be left unanswered altogether.
When confronted with this speech
pattern, the interviewer may find
himself frequently prompting the
patient in order to encourage
elaboration of replies. To elicit this
finding, the examiner must allow the
patient adequate time to answer and to
elaborate his answer.

21 Concretism Concretism refers to difficulty in the
comprehension of abstract (figurative)
sentences or phrases (e.g. the
understanding/interpretation of proverbs,
metaphors, jokes). The patient adheres
to the concrete meaning of the
words/utterances.
22 Blocking Perceived and reported blocking of an
ongoing line of thought, also known as
“losing one’s train of thought”.
Blocking is subjectively noticed by
the patient. Included is the
phenomenon of “Fading”, which
refers to a slow dimming away of a
thought, as opposed to a sudden
termination (in the sense of “Rupture
of Thought,” Item 1). Fading can also
occur in a fluctuating manner, which
means that the thought becomes weaker
at first, then becomes clearer again, then
fades away once more. In contrast to a
loss of thought, Fading can only be
assessed if the patient himself reports
this phenomenon. Blocking and
Fading may occur either with or
without Thought Interference.
23 Rumination The patient is constantly occupied
with mostly unpleasant topics. These
thoughts center around the same
topics without leading to any
conclusion. For the patient, it is hard to
interrupt these negative thought
(Andreasen, 1986) (Item 1)
- Konkretismus / concrete thinking
Perceived and reported blocking of an
ongoing line of thought, also known as
“losing one’s train of thought”.
Blocking is subjectively noticed by the
patient. Included is the phenomenon of
“Fading”, which refers to a slow
dimming away of a thought, as
opposed to a sudden termination (in
the sense of “Rupture of Thought”). In
contrast to a loss of thought, Fading
can only be assessed if the patient
himself reports this phenomenon.
Blocking and Fading may occur either
with or without Thought Interference.
(Gross et al., 1987) (p. 50)
The patient is constantly occupied with
mostly unpleasant topics. These
thoughts center around the same
topics without leading to any
conclusion. It is difficult to interrupt
these thought processes. Rumination
(Arolt et al., 2004; Binswanger,
1957; Blankenburg, 1971; Fish
und Hamilton, 1984; Goldstein,
1944; Huber, 2005; Möller et al.,
2009; Trabert und Stieglitz, 2007)
Sperrung / Faden verlieren /
Denksperre / Gedankenabreißen /
Gedankensperrung / Thought
blocking / Fading
(Ackenheil et al., 1985;
Andreasen, 1984a; Andreasen,
1986; Berger, 2009; Bleuler, 1979;
Ebert und Loew, 2008; Huber,
1994; Kaplan und Sadock, 1991;
Möller et al., 2009; Payk, 2010;
Scharfetter, 2010; Semple und
Smyth, 2009; Trabert und Stieglitz,
2007)
Grübeln
(Ebert und Loew, 2008; Möller et
al., 2009)
 processes. Rumination is experienced
as unpleasant and in some cases even
torturous.
24 Poverty of Thought The patient has the sense that his
thinking is unimaginative and restricted
to just a few themes. This may or may
not be accompanied by unpleasant
feelings.
is experienced as unpleasant and
torturous.
Unablässiges gedankliches
Beschäftigtsein mit meist
unangenehmen Themen. Die Gedanken
des Patienten kreisen ohne Ergebnis
immer wieder um die gleichen Inhalte.
Sie sind nur mit Mühe zu unterbrechen.
Das Grübeln wird von den Patienten als
unangenehm und quälend erlebt.
(Trabert and Stieglitz, 2007) (p. 48)
(Gedankenarmut, -leere) Gedankenarmut / Verarmtes
Unimaginative, poorly connected Denken / Krankhafte Kürze der
thought, restricted to a few themes. This Assoziation
can be perceived subjectively,
introspectively (in particular in depression (Bleuler, 1916; Bleuler, 1979;
and beginning psychoorganic syndrome) Payk, 2010; Scharfetter, 2010;
or it may appear to the observer as (no Trabert und Stieglitz, 2007)
more perceivable by the patient himself)
sparseness and absence of thoughts, or
finally as vacuousness (in patients with
dementia, severe depressive inhibited
thinking).
Einfallsloses, verbindungsarmes
Denken, beschränkt auf wenige Inhalte.
Kann subjektiv introspektiv
wahrgenommen werden (besonders bei
der Depression und im beginnenden
psychoorganischem Syndrom) oder dem
Beobachter als (vom Patienten selbst
nicht mehr registrierte) Spärlichkeit und
Ausbleiben von Gedanken, schließlich

25 Inhibited Thinking The process of thinking is
experienced by the patient as being
slowed down, braked or inhibited, as
if he is thinking against an internal
resistance. The patient is not able to
overcome this inhibition of his
thoughts. Inhibited Thinking can
extend to the point that the patient
has the subjective experience of not
being able to think at all anymore.
26 Receptive Speech The meanings of words, word
Dysfunction sequences or sentences (for example,
in conversations, movies and radio
programs) can only be grasped or
understood incompletely, with effort,
or not at all. In some instances, the
phenomenon may only occur after
some time of mental strain. However,
in other instances, the rate of verbal
Leere erscheinen (in der Demenz,
schwerer depressiver Denkhemmung).
(Scharfetter, 2010) (p.141)
The process of thinking is experienced Hemmung / Gehemmtes Denken /
by the patient as being slowed down, Verlangsamung und Erschwerung
braked or inhibited, as if he is thinking der Denkvorgänge /
against an internal resistance. The Denkhemmung
patient is not able to overcome this (Bleuler, 1916; Bleuler, 1979;
inhibition of his thoughts. Inhibited Ebert und Loew, 2008; Fish und
Thinking can extend to the point that Hamilton, 1984; Gross et al., 1987;
the patient has the subjective Huber, 1994; Jaspers, 1919; Payk,
experience of not being able to think at 2010; Scharfetter, 2010;
all anymore. Schneider, 1946 ; Trabert und
Stieglitz, 2007)
Das Denken wird vom Patienten
subjektiv als gebremst, verlangsamt
oder blockiert (wie gegen einen inneren
Widerstand) empfunden. Der Patient
kann die Hemmung des Denkablaufes
nicht aufheben. Denkhemmung kann
sich bis zu dem subjektiven Erleben
ausweiten, überhaupt nicht mehr
denken zu können.
(Trabert and Stieglitz, 2007) (p. 44)
The meanings of words, word
sequences or sentences (for example,
in conversations, movies and radio
programs) can only be grasped or
understood incompletely, with effort, or
not at all. In some instances, the
phenomenon may only occur after
some time of mental strain. However, in
other instances, the rate of verbal,
 processing may already be reduced
from the start. As a result of the
disordered receptive speech abilities,
the patient may have problems with
interpersonal communication.
27 Expressive Speech The patient notices that it is difficult for
Dysfunction him to find the right words. While the
patient is speaking, he notices that
word choice, linguistic precision and
acoustic or visual processing (reading
speed) may already be reduced from
the start, as compared to earlier. Patients
try to cope with the dysfunction by reading
slowly, repetitively or loudly.
As a result of the disordered receptive
speech abilities, the patient may report
problems with interpersonal
communication.
Worte, Wortfolgen oder Sätze können z.
B. im Gespräch, in Filmen, im
Fernsehen oder Rundfunk in ihrer
Bedeutung nicht oder nur mit Mühe
oder unvollständig aufgefasst und
erkannt werden. Diese Störung tritt
zum Teil erst nach einiger Zeit der
Beanspruchung in Erscheinung; die
Geschwindigkeit der akustischen oder
visuellen Erfassung (Lesegeschwindigkeit)
von Sprachlichem kann aber auch von
Anfang an gegenüber früher reduziert
sein. Durch langsames, mehrfaches oder
lautes Lesen versuchen die Patienten, die
Störung zu bewältigen.
Eine vom Patienten berichtete Störung
der zwischenmenschlichen
Kommunikation kann auf einer Störung
der rezeptiven Sprache beruhen.
(Gross et al., 1987) (p. 54)
Self-perceived difficulty of language with
deficient updating of matching words.
While the patient is speaking, he
notices that word choice, linguistic
word fluency are affected. Appropriate
words are not quickly accessible or
are completely unavailable. In some
cases only imprecise and unclear
formulations come to mind. In severe
manifestations of this phenomenon,
self-experienced Crosstalk
phenomena can occur, which may
result in tactless or inappropriate
utterances. Some patients may try to
compensate for the disorder by
repeating empty phrases and
verbiages, or they may even avoid
conversation altogether.
precision and word fluency are
affected. Appropriate words are not
quickly accessible or are completely
unavailable. In some cases only
imprecise and unclear formulations are
availabe. In severe manifestations of
this phenomenon, self-experienced
Crosstalk phenomena can occur, which
may result in tactless or inappropriate
utterances, recognizable by the
inverviewer or caregiver. Patients may
try to compensate for the disorder by
repeating empty phrases and
verbiages, remain silent or they may
even avoid conversation altogether
(secondary autism).
Selbst wahrgenommene Erschwerung der
Sprache mit defizienter Aktualisierung
passender Worte. Der Patient registriert
beim eigenen Sprechen, dass
Wortauswahl, sprachliche Präzision
und Wortflüssigkeit beeinträchtigt sind.
Die treffenden Worte stehen nicht mehr
oder nicht mehr rasch genug zur
Verfügung; zum Teil werden nur lose
und unpräzis dem Kontext
entsprechende Worte aktiviert. Bei
stärkerer Ausprägung der Störung
kann es zu einem selbst
wahrgenommenen Vorbei- und
Danebenreden kommen, das dann
auch (wie ein Teil der
Blockierungssymptome) für den
Untersucher bzw. Bezugspersonen – als
nicht treffende und/oder taktlose

28 Dysfunction of Thought
Initiative and Intentionality
The patient subjectively experiences a
lack of thought initiative, “thought
energy” and intentionality; he is
aware of the dysfunction. The
impairment in initiating or structuring
the thought process may result (due
to the lack of an overarching concept)
in the inability to perform activities of
daily living (e.g. making coffee).
sprachliche Äußerung – erkennbar
wird. Die Patienten versuchen die
Störung zu kompensieren, z.B. durch
Wiederholen von eingeschliffenen
Wendungen und Floskeln oder
Schweigen in oder Vermeiden von
Gesprächen (sekundärer Austismus).
(Gross et al., 1987) (p. 56)
The patient subjectively experiences a
lack of thought initiative, “thought
energy” and intentionality to the extent
that the patient himself is able to
recognize the dysfunction; he is aware of
the dysfunction. The impairment is the
subjectively experienced counterpart of
the observable lack of “releasing of the
intentional bow” (deficiency of task-related
intention). Disturbances of thought
initiative and “energy” result in (due to the
lack of an overarching concept) an
impairment in initiating or structuring
the thought process may result (due to
the lack of an overarching concept) in
the inability to perform activities of
daily living (e.g. cooking).
Der Patient empfindet eine subjektive
Beeinträchtigung der Denkinitiative,
der „Denkenergie“ und der
gedanklichen Intentionalität, soweit die
Patienten die Störung selbst wahrnehmen;
er ist sich der Störung bewusst.
Die Störung ist das subjektiv-
erlebnismäßige Pendant der vom

29 Thought Interference Interfering thoughts or ideas that do
not belong to the current line of
thought. Thought Interference may or
may not be triggered by or linked to
external stimuli. The interfering
thoughts are more or less neutral in
terms of their affective weighting.
Untersucher festgestellten “Entspannung
des intentionalen Bogens” (Defekt der
gedanklich aufgabenbezogenen
Intentionalität).
Störungen der Denkinitiative und
Denkenergie kommen auch in einer
(durch das Fehlen eines übergreifenden
Konzeptes bedingten)
Beeinträchtigung der Fähigkeit zum
Ausdruck, bestimmte Tätigkeiten, z.B.
Kochen, frei zu initiieren und zu
strukturieren.
(Gross et al., 1987) (p. 63)
Interfering thoughts or ideas that do Ablenkbarkeit / Distractibility
not belong to the current line of
thought. Thought Interference may or (Andreasen, 1986; Bleuler, 1979;
may not be triggered by or linked to Jaspers, 1919; Liddle et al.,
external stimuli. The interfering 2002a)
thoughts have no particular affective
occupation. With respect to emotions
they are more or less neutral.
Ohne oder mit Anknüpfung an (bzw.
Auslösung durch) Außeneindrücke
(Umgebungsvorgänge: externe Stimuli)
interferierende nicht zum jeweiligen
Gedankengang gehörende
Bewusstseinsinhalte (Gedanken,
Vorstellungen, Impulse). Die jeweils
interferierenden Bewusstseinsinhalte
haben keine besondere affektive
Besetzung, sie sind emotional mehr
oder weniger neutral.

30 Pressure/Rush of Numerous thoughts with varied
Thoughts content jump into or impose on the
patient’s mind, alternating rapidly.
The patient is able to neither control
nor suppress these appearing and
disappearing thoughts.
(Gross et al., 1987) (p. 46)
Numerous thoughts with varied content
jump into or impose on the patient’s
mind, alternating rapidly. The patient is
able to neither control nor suppress
these appearing and disappearing
thoughts.
Gedankendrängen / Racing
thoughts
(Bleuler, 1979; Kaplan und
Sadock, 1991; Trabert und
Stieglitz, 2007)

Zahlreiche Gedanken (Vorstellungen)

mit unterschiedlichen Inhalten
schießen in raschem Wechsel ein und
drängen sich auf, ohne dass der
Patient darauf Einfluss nehmen, das
Auftauchen und Verschwinden immer
wieder neuer Bewusstseinsinhalte
unterdrücken oder steuern kann.

(Gross et al., 1987) (p. 49)