Subjective Experience of Thought Overactivation in Mood Disorders: Beyond Racing and Crowded Thoughts

Keizer, Ineke
Piguet, Camille
Favre, Sophie
Aubry, Jean-Michel
Dayer, Alexandre
Gervasoni, Nicola
Gex-Fabry, Marianne
Bertschy, Gilles

^aDivision of General Psychiatry and ^bMood Disorder Program, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, and ^cDepartment of Neurosciences, Faculty of Medicine, University of Geneva, Geneva, and ^dClinique La Métairie, Nyon, Switzerland; ^eDepartment of Psychiatry and Mental Health, Strasbourg University Hospital, University of Strasbourg, INSERMu1114, Strasbourg, France

^*Ineke Keizer, Division of General Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 2 chemin du Petit-Bel-Air, CH-1225 Chêne-Bourg (Switzerland), E-Mail [email protected]

Received February 28, 2013; Accepted August 04, 2013; previously published online October 02, 2013

Psychopathology 47(3):p 174-184, April 2014. | DOI: 10.1159/000354781

Abstract

Background:

Racing thoughts, crowded thoughts and flight of ideas are frequent symptoms in mood disorders, but the underlying subjective experience of overactivation of thought processes remains poorly documented.

Methods:

Qualitative analysis of audiotaped interviews explored subjective experience of thought overactivation in patients with mood disorders (sample 1, n = 45). Quantitative analysis considered the properties of a newly developed rating scale in sample 1, in an additional sample of patients with mood disorders (sample 2, n = 37) and in healthy subjects (sample 3, n = 38).

Results:

Qualitative analysis of individual interviews revealed that 5 conceptual categories characterized thought overactivation: sequential thought flow, overstimulation, competition for resource allocation, unexpected/unexplained onset, and association with mood and emotions. A principal component analysis of the initial 16-item rating scale indicated that a single component explained 55.9% of the variance, with major and exclusive contributions from 9 items, which were retained in the final 9-item Subjective Thought Overactivation Questionnaire (STOQ; Cronbach's α = 0.95). Total score correlated significantly with activation, depression and perceived conflict subscales of the Internal State Scale (ISS; r_s = 0.57-0.66, p < 0.001). It was associated with decreased well-being (ISS; r_s = -0.48, p = 0.001) and increased state anxiety (State-Trait Anxiety Inventory; r_s = 0.60, p < 0.001). The STOQ score was significantly higher in patients than in healthy subjects. It allowed distinguishing between ISS mood states, with the highest median score in mixed states.

Limitations:

Sample size, representativeness, possible bias in qualitative analysis, and quality of expert consensus.

Conclusions:

Qualitative analysis of clinical interviews, together with a new short rating scale, contributed to a documentation of subjective thought overactivation, an important but often undetected feature in mood disorders.