[MUSIC] Description of the thought process in the mental state examination can be one of the most challenging aspects of psychiatry. Firstly, the range of abnormalities reported in the literature is extensive, secondly, the terminology can be quite confusing, and thirdly, the abnormalities can be quite subtle. This part of the mental state examination attempts to describe the patient's connectivity of ideas and is frequently referred to as the form of thought. To make it less confusing, we can divide the form of thought into those abnormalities with normal connections and those whose understandability of connections is impaired. In flight of ideas, there's an increased generation of ideas at a rapid pace, commonly seen in mania. Because of the speed of thought generation, the patient is prone to jumping over ideas, which may be thought logically, but not articulated, resulting in a drift in the understandability of the stream of ideas. One thing that can be tried is to slow the patient's thinking down and the form of the thought may appear much more understandable. Circumstantiality refers to the over-inclusion of ideas, resulting in an overly detailed, laborious train of thought. The patient may appear to be going off on a tangent, but given time, will eventually return to the point. This can take some time and much patience is required. This form of thought is frequently seen in anxious and obsessional individuals and is not necessarily abnormal. Disorders in the logical connection of thoughts can range from very subtle, vague, imprecise thinking, sometimes referred to as woolly thinking, to such severely disconnected thoughts that they are almost unintelligible. The description of these thought abnormalities in the psychiatric literature are bewildering, so I will recommend you begin with the following basic descriptions. Logical disconnects in the ideas may be seen in a spectrum from woolly at one end, to increasingly disturbed. Tangential thoughts, also called loosening of associations, occur when the logical connections between thoughts are tenuous. The overall effect is that the patient begins to move off topic and unlike circumstantial patients, never really return. A more severe form of this occurs in derailment, when there is a sudden, illogical jump between thoughts. The most severe form is now rarely seen and is termed a word salad, which involves the complete loss of grammatical structure, and is a string of disconnected words. Other curious abnormalities of language include neologisms, that is new words, idiosyncratic use of words, rhyming speech, echoing of the interviewer's words and clanging, where the sound of the word rather than its meaning is used. As logical disconnection of thought in disorders of thought form are so hard to remember, I recommend you write it verbatim at the time of the interview.