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Cognitive slippage is a symptom which can be found in several psychiatric and mental disorders associated with cognition and formal thought disorders. This phenomenon occurs when a group of objects are categorized in an over generalized way, in other words, objects that are not related are put in the same category. Cognitive slippage is a result of tangential thinking where, because of loose associations individuals are incorrect when categorizing due to the mental representations slips, causing this type of thought disorder where each of a series of thoughts will be less closely related to the first original thought than the one before it. For example we ask a patient to list types of cars and he says: “oak, pine, dogwood, maple, syrup, pancake, breakfast”. In this case, the slippage occurs due to the loose association between maple which indeed is a tree that is used to produce the syrup that we put on pancakes which we usually have for breakfast. Here the patient includes things that are not trees in the same category as trees, in other words he is overgeneralizing. The cognitive slippage causes the patient to pass by these unusual connections and results in these patterns of speech shown in the example.

Eugen Bleuler states that the main characteristics of schizophrenia are the symptoms which relate with thought disorder, but this formal thought disorder is not unique to psychosis. You can often find these symptoms in mania and less often in other mental disorders like depression. Clouded consciousness, for example in delirium can also have this thought disorder. Clanging or echolalia can be present in Tourette syndrome. The clinical difference between schizophrenia or psychosis and patients with a clouded consciousness is that on one hand patients with psychosis are less likely to show awareness about their disordered thinking due to the inability to use logic thinking as others, whiles on the other hand patients with a clouded consciousness do show awareness and usually complain about feeling they are unable to think straight and that they are constantly confused. This could be explained by the fact that their thought disorder appears from various cognitive deficits (Deborah L. Levy. et al, 2010).

Cognitive slippage is one of the mildest symptoms that affect individuals with schizophrenia. Schizophrenia is a mental illness that affects the way people think and causes a big impact on the way you cope with day to day life. Schizophrenia is a common illness which affects around one in a hundred people during their lifetime. This disorder usually develops during young adulthood. During the early stages they suffer changes in their sleep patterns, communication, emotions, motivation and ability to think clearly. Before getting diagnosed with schizophrenia they usually have to have symptoms of psychosis such as hallucinations and delusions.

The result of schizophrenia is most likely due to several factors. Some people are more vulnerable to developing the illness and some of the factors for this vulnerability are brain chemistry, birth complications, genetics, urban upbringing, migration and adversity. All these factors put together with experiencing a stressful event which triggers the illness such as loss of a love one or loss of a job will cause the development of the disorder. Also, they have found a link between the use of cannabis and the development of schizophrenia.

The diathesis-stress theory formulated by Meehl suggests that schizophrenia is product of predisposition (genetics) and stress (significant event). He also talks about hypokrisia, which is an abnormality of nerve conductions where neurons fire too frequently in response to incoming stimulation. Cognitive slippage is the practical consequence of hypokirisia (Beck AT, Rector AN, Stolar N and Grant P, 2009).

An objective measurement that is used for cognitive slippage is semantic priming. This is related to implicit memory by which prior exposure to certain stimuli, such as a word, influences the response to stimuli presented afterwards, in this case other words. In the semantic primming, the primacy stimulus and the target correspond to the same semantic category and share some characteristics. It has been proposed that the semantic primming works by spreading of neural activation networks. When a person thinks of an item in a particular category, other similar items are stimulated by the brain. Primming effects may be more durable than recognition memory. Unconscious effects of primming may affect the choice of a particular word in a word completion test, even after conscious recollection of primed words has been forgotten. When cognitive slippage increased it could be caused by a less discriminating priming of associations and connections between words and ideas.

The Cognitive Slippage Scale is another instrument used to measure this symptom. It is a scale composed of 35-item and it is designed to measure cognitive slippage, which is a primary characteristic of schizophrenia. Additionally, this symptom is used as an indicative of genetic predispositions to predict a schizophrenic personality. Delusions, attentional disorders, hallucinations, speech deficits and confused thinking are different ways cognitive slippage can manifest. The Cognitive Slippage Scale focuses mainly on these two last ones, speech deficits and confused thinking. This scale can be useful to identify cognitive disorders in other population, although it was developed to identify szhizotypic characteristics (Corcoran, K and Fisher, J, 1987).

Gooding, Tallent and Hegyi conducted a study to assess thought disorder in psychotic individuals with social anhedonia. In this study they expected to find that psychotic individual with elevated scores in perceptual aberration and magical ideation scale would have higher levels of cognitive slippage (Gooding, Tallent and Hegyi, 2001). Cognitive slippage is associated with both positive and negative symptoms. The main feature of formal thought disorder is disorganization, which is an aspect of positive symptomatology, and for this reason they hypothesized that positive schizotypal such as magical ideation and perceptual aberration would have higher scores in the Cognitive Slippage Scale than individual with negative schizotypal characteristics such as anhedonia. The results in the Cognitive Slippage Scale showed that subtle thought disorder is found in individuals with high scores on the Perceptual Aberration Scale. They also found that psychotic individuals who were characterized by predominantly negative schizotypy (presenting social anhedonia) experience cognitive slippage aswell. The results in this study suggest that the combined use of negative and positive schizotypy indicators could identify individuals with more cognitive disturbance. In summary, the findings support the idea that individuals with social anhedonia show schizotypic characteristic such as cognitive slippage (Gooding, Tallent and Hegyi, 2001).

Researches on patients with schizophrenia have shown that thought disorder is multidimensional. One of the researchers who have studied this is Andreasen. He distinguished between positive and negative categories of thought disorder (Andreasen, 1979; Andreasen and Olsen, 1982). On the one hand, derailment, tangentiality and incoherence are included in the positive thought disorder and on the other hand poverty of speech and poverty of content of speech are characteristics of the negative thought disorder.

Reference.

Deborah L. Levy, Michael J. Coleman, Heejong Sung, Fei Ji, Steven Matthysse, Nancy R. Mendell, and Debra Titone, (2010). The Genetic Basis of Thought  Disorder and Language and Communication Disturbances in Schizophrenia. J Neurolinguistics. Vol 23, nº 3, Doi: 10.1016/j.jneuroling.2009.08.003.

Beck AT, Rector AN, Stolar N, Grant P, (2009). Schizophrenia. Cognitive Theory, Reaserch, and Therapy. The Guilford Press.

Kevin Corcoran and Joel Fisher, (1987). Measures for clinical practice. The Free Press. A division of Macmillan.

Gooding, CD; Tallent, K.A.; and Hegyi J.V. (2001). Cognitive Slippage in Schizotypic Individuals.The Journal of Nervous and Mental Disease, vol. 189, nº 11, pp. 750-756.

Andreasen NC, (1979). Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluations of their reliability. Arch Gen Psychiatry, vol. 36, pp. 1315-1321.

Andreasen NC, Olsen S, (1982). Negative v. Positive schizophrenia. Arch Gen Psychiatry, vol. 39, pp. 789-794.