Flight of Ideas
Flight of ideas is a rapid stream of thought in which one idea tumbles into the next with no overall direction, the links between them being driven by chance rather than by any guiding purpose. The connections themselves — a rhyme, a pun, something noticed in the room — usually make sense in isolation, even though the train of thought as a whole goes nowhere in particular.
This has traditionally been described as resembling a chain of dominoes, where each new thought is drawn out by some small, incidental link to the one before it, rather than by any sustained goal directing the sequence as a whole.
Also known as
- Prolixity (ordered flight of ideas)
- A milder variant, typical of hypomania, in which the patient wanders through many irrelevant side-thoughts but is able to find their way back to the original topic.
Recognition features
- Rapid, pressured generation of thoughts and speech
- No sustained overall direction or goal to the train of thought
- Successive ideas are linked by superficial, chance associations — rhyme, resemblance in sound, something in the immediate surroundings — rather than by meaning or purpose
- In its most severe form, thoughts arrive faster than they can be put into words, and speech may become incoherent
Eliciting it at interview
- Let the patient speak with minimal interruption for a period and note whether their speech keeps returning to a topic or continually branches off onto new, loosely associated ones
- Listen specifically for rhyme, alliteration, and word-play driving the changes in topic, which is characteristic of the more severe forms
- Distinguish the milder, ordered form by checking whether the patient can still be steered back to the original question despite frequent detours
Distinguishing features
- Differs from circumstantiality, in which the point is eventually reached by a slow, over-detailed but logically connected route, rather than being lost amid rapid, chance-driven associations
- Differs from formal thought disorder of the schizophrenic type in that the individual links between ideas in flight of ideas remain, on close inspection, comprehensible, even though the overall sequence has no direction
- The presence of rhyme- and sound-driven associations, rather than purely idiosyncratic or bizarre links, favours flight of ideas over other causes of disorganised speech
Common misconceptions
- That flight of ideas is simply 'talking fast'; the defining feature is the chance-driven, directionless linkage between successive ideas, not speed alone
- That flight of ideas only occurs in mania; while classically associated with mania, milder or occasional presentations have also been described in excited states of schizophrenia and in some organic conditions
Related phenomena
Practice this
Asked how she has been sleeping, a 34-year-old woman in an elated mood replies, "Sleeping, sheep, I counted sheep, sheep go to the meadow, meadow like the perfume my mother wore, my mother's coming to visit, visit, a visit to the seaside would be lovely wouldn't it," continuing in this vein for several minutes without ever returning to the original question, though each individual link is easy enough to follow. What is this? · A 41-year-old man in a hypomanic episode wanders through several unrelated topics when asked a simple question, but each time, after a minute or two of tangents, he laughingly says "anyway, back to your question" and gives a reasonably direct answer. Before revealing the answer: is this flight of ideas, and what specific feature of his speech tells you which variant this is? · A patient's speech takes a long, roundabout path before reaching a point. Before revealing the answer, decide what distinguishes circumstantiality from flight of ideas. · A patient takes a long, winding route through many side-topics before finishing their answer. Before revealing the answer, decide what would tell flight of ideas apart from circumstantiality. · A patient's speech is difficult to follow. Before revealing the answer, decide what distinguishes formal thought disorder from flight of ideas. · You suspect a patient in an elated mood state may have flight of ideas. Before revealing the answer, decide how you would assess for it during the interview. · Explain why flight of ideas is often compared to a chain of dominoes, and why this image is a useful way to understand it.
Illustration
Asked how she has been sleeping, a 34-year-old woman in an elated mood replies, "Sleeping, sheep, I counted sheep, sheep go to the meadow, meadow like the perfume my mother wore, my mother's coming to visit, visit, a visit to the seaside would be lovely wouldn't it," continuing in this vein for several minutes without ever returning to the original question, though each individual link is easy enough to follow.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 4, 'Disorders of Thought and Speech'.