Racing and crowded thoughts in mood disorders: A data-oriented theoretical reappraisal

Development and validation of a Disorganised Thoughts Scale: a new measure to assess thinking difficulties in the general population

BACKGROUND

Disordered thinking is a condition that can manifest in not only clinical cases (e.g., psychotic disorders), but also the wider general population. However, there is no current method to measure the specific cognitive processes experienced during such a condition. Therefore, this study aimed to develop a new self-report measure, the Disorganised Thoughts Scale (DTS), that can assess disorganised thinking in the general population.

METHODS

To achieve this aim, a survey was developed and shared online with four independent samples, including a sample of Australians in the general population (N = 321) and three samples (N = 200 each) that were controlled for their substance use (i.e., frequent alcohol and cannabis use; non-frequent substance use). Exploratory and confirmatory factor analyses, and reliability analyses, were used to test the internal validity, whilst correlational analyses were implemented to examine the external validity.

RESULTS

The exploratory factor analysis revealed a two-factor structure (10 items each) measuring Positive thought disorder (i.e., accelerated, uncontrollable, and incongruent thinking) and Negative thought disorder (i.e., inhibited, disjointed, and disorientated thinking). This internal structure was confirmed with subsequent confirmatory factor and reliability analyses (α = 0.90 to 0.97) in the three substance-controlled groups. Concurrent validity was also supported, as the DTS exhibited strong correlations with established measures of general cognitive difficulties, specific self-regulatory dysfunctions, and psychopathological symptomology. Finally, the measure was also shown to be significantly higher in cohorts who exhibited a higher degree of psychological distress and who frequently used substances (i.e., alcohol and cannabis).

CONCLUSIONS

Overall, this study provided preliminary evidence to suggest that the DTS is a sound measure of disorganised thought that is linked to psychopathology and substance use in non-clinical populations. The measure could be used in future research which seeks to better understand how thinking effects, and is affected by, various psychological conditions.

Spanish validation of the short version of the racing and crowded thoughts questionnaire (RCTQ-13)

BACKGROUND

The Racing and Crowded Thoughts Questionnaire (RCTQ-13) is the most widely used specific scale for the measurement of racing thoughts, but there is currently no Spanish version that allow the evaluation in Spanish-speaking patients. The objective of this study is to translate, adapt, and validate the RCTQ-13 in a Colombian population with affective disorders.

METHODS

The questionnaire was translated and back-translated, and corrections were implemented following a pilot test to improve comprehensibility. We included patients with Bipolar I Disorder and with Major depressive disorder seen in three centers in the city of Medellín, Colombia. We evaluate structural validity with confirmatory factor analysis, internal consistency, and test-retest reliability. Construct validity was also assessed with the comparison between euthymic, maniac, and depressive episodes and the correlation with worry, rumination, and mania scales. Responsiveness was measured 1 month after the first evaluation. Based on item response theory (IRT), we also estimated item difficulty, discrimination, and fit using a generalized partial credit model.

RESULTS

Two hundred fifty subjects were included. Confirmatory factor analysis revealed that the three-factor structure of the scale was appropriate. Internal consistency was adequate for the entire scale (Cronbach's alpha = 0.95, 95% CI: 0.94-0.96) and for each factor. Test-retest reliability was good (intraclass correlation coefficient = 0.82, 95%IC: 0.70-0.88). For construct validity, we observed differences between patients with different types of affective episodes, a moderate positive correlation with the Penn State Worry Scale (r = 0.55) and the Ruminative Response Scale (r = 0.42), and a low negative correlation with the Young Mania Rating Scale (r = - 0.10). Responsiveness was proved to be adequate. Under IRT, the response thresholds for the response options are organized for all items. The infit was adequate for all items and the outfit was acceptable.

CONCLUSIONS

The Spanish version of the RCTQ-13 is a reliable, valid, and responsive scale and can be used for the clinical assessment of the construct of racing and crowded thoughts in patients with the spectrum of affective disorders in whom this experience can be expressed with different nuances. Further research is needed to expand the relationship with rumination and worry.

Editorial: What is computational psychopathology, and why do we need it?

Computational Psychopathology is an emerging discipline, which is based around the theoretical and mechanistic focus of explanatory psychopathology and computational psychiatry, and reflects the general move in psychiatric research away from whole disorders to component symptoms or transdiagnostic processes. In this Editorial, we present a brief summary of these disciplines and how they combine together to form a 'Computational Psychopathology', and present a brief possible taxonomy. We highlight the papers that form part of this Special Issue, along with their place in our putative taxonomy. We conclude this Editorial by highlighting the benefits of a Computational Psychopathology for research into mental health.

Psychopathological Dissection of Bipolar Disorder and ADHD: Focussing on Racing Thoughts and Verbal Fluency

In the present study, we propose a review and a synthesis of the work of our group about the phenomenology and the cognitive mechanisms of racing thoughts in bipolar disorder (BD) and ADHD. Contrary to the mainstream idea according to which racing thoughts are pathognomonic of BD, our work suggests that racing thoughts are enhanced in ADHD compared to hypomanic episodes of BD, whereas in euthymic episodes of BD self-reported racing thoughts are similar to the rates reported by healthy controls. Using verbal fluency tasks, we found many similarities between bipolar and ADHD subjects with one clear difference: lexical search strategy in hypomania is based on phonemic similarities rather than semantic-relatedness. However, this distinction observed in this cognitive task is certainly difficult to grasp during a clinical interview aiming to differentiate mild hypomania from combined ADHD presentation. The main landmark to distinguish them remains the episodic nature of bipolar disorders as opposed to the lifelong presentation of ADHD symptoms, a dichotomous view that is not so clear-cut in clinical practice.

Investigating racing thoughts via ocular temporal windows: deficits in the control of automatic perceptual processes

BACKGROUND

Racing thoughts have been found in several states of bipolar disorder (BD), but also in healthy populations with subclinical mood alterations. The evaluation of racing thoughts relies on subjective reports, and objective measures are sparse. The current study aims at finding an objective neuropsychological equivalent of racing thoughts in a mixed group of BD patients and healthy controls by using a bistable perception paradigm.

METHOD

Eighty-three included participants formed three groups based on participants' levels of racing thoughts reported via the Racing and Crowded Thoughts Questionnaire. Participants reported reversals in their perception during viewing of the bistable Necker cube either spontaneously, while asked to focus on one interpretation of the cube, or while asked to accelerate perceptual reversals. The dynamics of perceptual alternations were studied both at a conscious level (with manual temporal windows reflecting perceptual reversals) and at a more automatic level (with ocular temporal windows derived from ocular fixations).

RESULTS

The rate of windows was less modulated by attentional conditions in participants with racing thoughts, and most clearly so for ocular windows. The rate of ocular windows was especially high when participants with racing thoughts were asked to focus on one interpretation of the Necker cube and when they received these instructions for the first time.

CONCLUSIONS

Our results indicate that in subjects with racing thoughts automatic perceptual processes escape cognitive control mechanisms. Racing thoughts may involve not only conscious thought mechanisms but also more automatic processes.

An overactive mind: Investigating racing thoughts in ADHD, hypomania and comorbid ADHD and bipolar disorder via verbal fluency tasks

BACKGROUND

Adults with Attention Deficit Hyperactivity Disorder (ADHD) often report mental restlessness akin to racing thoughts found in hypomanic and mixed episodes of bipolar disorder (BD). Past research has suggested that racing thoughts in BD can be tackled via process-oriented verbal fluency measures. In ADHD, it is still unknown whether racing thoughts is due to comorbid BD, and its neuropsychological underpinnings remain to be investigated. To this aim, this study investigates process-oriented verbal fluency measures in adults with ADHD compared to adults with BD in a hypomanic episode, adults with ADHD + BD and healthy controls.

METHODS

Three verbal fluency tasks, i.e., the free, the letter and the semantic conditions, were administered to 37 adults with ADHD, 25 adults with BD in a hypomanic episode, 22 adults with comorbid ADHD + BD (euthymia) and 31 healthy subjects. Word production, clustering, and switching were analysed in verbal fluency tasks.

RESULTS

Adults with ADHD, ADHD + BD and hypomania showed increased switches in the free verbal fluency task, compared to healthy controls, despite equivalent number of words produced. Unlike the ADHD and ADHD + BD groups, phonological clustering measures in the semantic task were increased in the hypomanic group compared to healthy controls.

LIMITATIONS

BD groups were under medication.

CONCLUSIONS

Semantic overactivation, reflected by increased switches in the unconstrained verbal fluency task, appear to be a common mechanism involved in racing thoughts in both ADHD and BD. By contrast, unusual sounds-based associations are specific of hypomanic speech and might contribute to the distinction trait and state racing thoughts.

Investigating racing thoughts in insomnia: A neglected piece of the mood-sleep puzzle?

BACKGROUND

Cognitive arousal is thought to play a key role in insomnia disorder. However, although patients frequently complain about racing thoughts appearing at bedtime, studies have considered 'cognitive arousal' as a synonym of rumination and worry, but not as racing thoughts per se. The latter have been mainly linked to hypomanic/manic episodes of bipolar disorder (BD). Here we aimed at investigating self-reported racing thoughts in insomnia disorder, and their specific contribution to insomnia severity, as compared to worry and rumination.

METHODS

72 adults with insomnia disorder, 49 patients with BD in a hypomanic episode and 99 healthy individuals completed the Racing and Crowded Thoughts Questionnaire (RCTQ). Mood symptoms were assessed in patients with insomnia disorder.

RESULTS

RCTQ scores were overall higher in insomnia disorder, especially in sleep-onset insomnia, compared to the hypomanic and healthy groups. Moreover, racing thoughts showed an increase in the evening and at bedtime in sleep-onset insomnia. Importantly, racing thoughts at bedtime, but not rumination and worry, were associated with insomnia severity.

DISCUSSION

Our results are the first to show that racing thoughts is a transdiagnostic symptom in mood and sleep disorders. Racing thoughts, not only rumination and worry, might contribute to the maintenance of sleep difficulties in insomnia. Clinical trials' registration number: NCT04752254.

Beyond motor hyperactivity: Racing thoughts are an integral symptom of adult attention deficit hyperactivity disorder

Adults with ADHD experience mental restlessness, akin to racing thoughts, but data on this symptom in ADHD remain scarce. Our study aims at investigating self-reported racing thoughts in adults with ADHD, and its relationship with affective dysregulation and insomnia. We were also interested in whether racing thoughts may aid differential diagnosis with bipolar disorder (BD). 182 adults with ADHD, 30 ADHD+BD, 31 hypomanic BD, and 20 euthymic BD patients completed the Racing and Crowded Thoughts Questionnaire (RCTQ). ADHD, anxiety, insomnia and depression symptoms, as well as affective temperament were also assessed in ADHD and ADHD+BD subjects. Results show that RCTQ scores were higher in ADHD compared to hypomania and euthymia and were associated with cyclothymic traits and anxiety. Moreover, in ADHD and ADHD+BD, racing thoughts increased in the evening and at bedtime and were associated with insomnia severity. In conclusion, self-reported racing thoughts are a neglected but an intrinsic feature of adult ADHD that is particularly related to cyclothymia and anxiety, but cannot differentiate ADHD and BD.