Когнитивтік қабысу: Ұғым, диагностика және психикалық денсаулықтағы орны

Cognitive slippage is considered a milder and sub clinical presentation of formal thought disorder observed via unusual use of language. It is often identified when a person attempts to make tangential connections between concepts that are not immediately understandable to listeners. When observed repeatedly, this is taken as evidence for unusual, maladaptive or illogical thinking patterns. Cognitive slippage is typically assessed in the context of mental health evaluations, but there is ongoing debate about how to best quantify this type of unusual language usage in research settings. Cognitive slippage is supposed to exist on a continuum which can be observed in its most extreme forms among some individuals with schizophrenia (e. g., word salad). Several mental disorders are known to co occur with cognitive slippage.

In 1962, Paul E. Meehl emphasized that thought disorder was a critical component of schizophrenia diagnosis. He coined the term "cognitive slippage" to describe a more mild form of thought disorder that he believed was still relevant. He recognized that even in the absence of more severe forms of thought disorder, individuals with schizophrenia exhibited more cognitive slippage than non schizophrenic individuals. As a result, Meehl deemed thought disorder a necessary component of the disorder for diagnoses, regardless of severity. He declared that any characterization of either schizophrenia or schizotypy that lacked cognitive slippage as a component was unacceptable He also noted that the amount of slippage can vary from case to case, with some highly anxious individuals exhibiting less slippage than some minimally anxious individuals. This suggests that cognitive slippage may be affected by altering the affect of the individual, but Meehl mentions that this feature is not groundbreaking or unique to cognitive slippage. He also contemplated the possibility that cognitive slippage could stem from different underlying causes based on the disorder it was a part of. Higher scores on this test indicate a higher level of cognitive slippage. The test has been shown to be applicable and accurate to both clinical and non clinical populations. Examples of questions included on the test are, "Often when I am talking I feel that I am not making sense," and "Sometimes my thoughts just disappear.". Schizophrenia is a psychiatric illness defined by both abnormal behaviors and cognitive dysfunctions. Formal thought disorder (FTD) is characterized by problems with thought, language, and communication and is considered to be the key feature of the cognitive dysfunction component of schizophrenia. As Meehl suggested, cognitive slippage is a milder form of FTD, making it also a key component of schizophrenia. In considering the genetic element of schizophrenia, researchers have examined the presence of symptoms, such as cognitive slippage, in first degree relatives. For example, Oltmanns (1978) looked at the prevalence of cognitive slippage in the children of individuals with schizophrenia. For their purposes, they defined "cognitive slippage" to include associative disturbances, difficulties in thinking, and errors in reasoning. The researchers administered an object sorting task to 156 children of schizophrenic individuals, 102 children of depressed individuals, and 139 children of healthy parents. The task required participants to either sort objects or explain the reasoning behind a sorted group of objects. The task was designed to target responses that would differ noticeably between individuals with schizophrenia and without schizophrenia. All the participants were children between the ages of 6 and 15. Their responses were then sorted as either superordinate, complex, vague, or thematic. The children of parents with schizophrenia made fewer superordinate responses and more complex responses than the control children. Though small, the findings were reliable, and suggest that the children of individuals with schizophrenia are more prone to the cognitive dysfunctions associated with cognitive slippage. The loose definition of cognitive slippage can make the symptom difficult to identify, so Braatz (1970) designed a study to determine if preference intransitivity could be used as an indicator of cognitive slippage. He proposed that from a logical standpoint, intransitivities in preference would result from cognitive slippage. Preference intransitivity occurs when one's preferences and values lead to potentially unresolvable conflicts. He administered a scale of 120 items meant to judge preferences of both schizophrenia patients and healthy controls and found that individuals with schizophrenia endorse more intransitive judgments than healthy individuals. Though he acknowledges that the scale in its current form is underdeveloped, his findings suggest that further research into the connection between preference intransitivity and cognitive slippage could result in a scale powerful enough to aid schizophrenia diagnosis. He also suggests future research could expand the scale to apply in cases other than clinical schizophrenia. Kagan and Oltmanns (1981) also made an attempt to clear up some of the ambiguity surrounding cognitive slippage among individuals with schizophrenia. Their research sought to develop an objective index of cognitive slippage. They administered a word matching task to individuals with schizophrenia, individuals with affective disorders, and normal controls. They found that the individuals with schizophrenia did, in fact, perform differently on the task than the normal controls, but that they performed similarly to the individuals with affective disorders. This creates an issue as it complicates the feasibility of the task being used to measure cognitive slippage specifically to identify schizophrenia. Eckblad & Chapman (1983) identified magical ideation as the aspect of cognitive slippage critical to schizotypy. They define Magical Ideation as magical and superstitious beliefs about reality reliant on false causal relations between events. By this definition, cognitive slippage can manifest as fallacious, causal connections between correlated or unrelated events. Gooding, Tallent, And Hegyi (2001), found that in addition to greater cognitive slippage, schizotypic individuals performed worse on the Wisconsin Card Sorting Test, which was designed to assess overall high level cognitive functioning. Specifically, they found that individuals who only endorsed the negative symptoms of schizotypy reported lower levels of cognitive slippage than those who endorsed both positive and negative schizotypy symptoms. Due to the wide variety of individuals on the schizotypal spectrum, McCarthy (2015) suggests further research should be conducted on individuals at different points on the spectrum in order to enhance understanding of symptom severity and the appropriate use of measures such as the Cognitive Slippage Scale.

Among individuals with schizoid personality disorder, cognitive slippage manifests as an inability to control associations made within the context of things such as dreams, creative thoughts and free association. The slippage results in an inability to override subordinate associations between topics in order to purposefully acknowledge clearer, surface level associations. Such individuals have no difficulty making links between topics, but rather are unable to prioritize which links are more salient and thus suppress less applicable links.

In addition to inclusion as diagnostic criteria, the presence of cognitive slippage as a form of formal thought disorder is considered to be associated with psychosis proneness. Martin and Chapman (1982) determined that college students at risk for psychosis displayed signs of cognitive slippage on a referential communication task. Allen, Chapman, and Chapman (1987) identified college students who scored high on the Per Mag Scale, a measure designed to identify thought processes indicative of psychosis. They found that most of these high scoring students also exhibited signs of cognitive slippage on two measures of it. Of the students who scored very high on the Per Mag, those who also scored above the mean on a depression scale were the most likely to demonstrate cognitive slippage. Additionally, Edell (1987) reinforced the idea that although individuals with sub clinical psychopathology exhibit more severe thought disorder on unstructured tests, they perform relatively normally on more structured measures of cognition.

Dykens, Volkman, and Glick (1991) considered the relationship between thought disorder and high functioning adult autism by utilizing both objective and projective measures. They collected objective data using the Thought, Language, and Communication Disorder Scale, and projective data through use of the Rorschach test. In their definition of "cognitive slippage," they broke the dysfunction down into processes such as "incongruous combinations," "fabulized combinations," "deviant responses," and "inappropriate logic." Their findings suggest that individuals with autism display more disordered thinking than typically developed individuals. To explain this, they suggest that cognitive slippage is rooted in difficulty with complex perceptual processing, a known feature of autism. Another study used Rorschach inkblots to compare individuals with Asperger syndrome to high functioning individuals with Autism. They found that individuals with Asperger syndrome tended to exhibit greater levels of disordered and disorganized thinking in their responses than the typically developed individuals.

In response to implications that cognitive dysfunctions were rooted in eating disorder etiology, researchers Strauss and Ryan (1988) conducted a study to compare the rates of logical errors, cognitive slippage, and conceptual complexity among individuals with eating disorders compared to their healthy counterparts. They evaluated 19 restrictive anorexic individuals, 14 purging anorexic individuals, 17 bulimic individuals, 15 individuals with sub clinical eating pathology, and 17 healthy control individuals. Though they found differences between the anorexic groups and the others in regards to logical errors, there were no significant differences between any group on rates of cognitive slippage.

Broadbent et al. (1982) developed the Cognitive Failures Questionnaire (CFQ), a self report measure designed to identify the presence of "cognitive slippage." For the purposes of the CFQ, however, they used this term to refer to lapses in attention, difficulty processing information, memory issues, perception problems, and complications in decision making.