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Racing and Crowded Thoughts in Mood Disorders: a Data-Oriented Theoretical Reappraisal Gilles Bertschy, Sebastien Weibel, Anne Giersch, Luisa Weiner

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Racing and Crowded Thoughts in Mood Disorders: a Data-Oriented Theoretical Reappraisal Gilles Bertschy, Sebastien Weibel, Anne Giersch, Luisa Weiner Racing and crowded thoughts in mood disorders: A data-oriented theoretical reappraisal Gilles Bertschy, Sebastien Weibel, Anne Giersch, Luisa Weiner To cite this version: Gilles Bertschy, Sebastien Weibel, Anne Giersch, Luisa Weiner. Racing and crowded thoughts in mood disorders: A data-oriented theoretical reappraisal. L’Encéphale, Elsevier Masson, 2020, 46 (3), pp.202-208. 10.1016/j.encep.2020.01.007. hal-02935003 HAL Id: hal-02935003 https://hal.archives-ouvertes.fr/hal-02935003 Submitted on 15 Sep 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Review of the literature Racing and crowded thoughts in mood disorders: A data-oriented theoretical reappraisal Tachypsychie dans les troubles de l’humeur : une réévaluation théorique basée sur les données de la littérature a,b,c, a,b b a,d,e G. Bertschy ∗ , S. Weibel , A. Giersch , L. Weiner a Pôle de psychiatrie, santé mentale & addictologie des hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France b Inserm U1114, 67000 Strasbourg, France c Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France d Laboratoire de psychologie des cognitions, 67000 Strasbourg, France e Faculté de psychologie, université de Strasbourg, 67000 Strasbourg, France a r t i c l e i n f o a b s t r a c t Article history: Objectives. – Speed of thought is a central phenomenon in mood disorders. We aimed to provide an update Received 5 October 2019 on the topic ten years after a first narrative review published on racing and crowded thoughts in mood Accepted 23 January 2020 disorders. This update is based on recent publications, including recent works of our group. Available online 6 March 2020 Methods. – Narrative review based on publications from the last ten years including publications of our group and a systematic research of references on PubMed. Keywords: Racing Results. – The traditional dichotomist view of racing versus crowded thoughts is not refuted but appears to thoughts Crowded be more complex, as revealed by validation studies of the Racing and Crowded Thoughts Questionnaire. thoughts Bipolar Moreover, this dualistic view can no longer be conceptualized in a simple bijective concordance with Depression Mood disorders the distinction of hypomania versus mixed depression. We also show that racing/crowded thoughts are strongly associated with mixed depression and not with non-mixed depression, that they tend to be more associated in hypomania to irritability than to the typical symptoms of energy and activity increase and that they are clearly distinguishable from ruminations. Yet, although tightly linked to mood disorders, racing/crowded thoughts appear to be associated to anxiety as well as attention deficit/hyperactivity disorder and insomnia. Conclusions. – Racing and crowded thoughts should be studied in a dimensional perspective as an impor- tant facet of mind activity within and beyond the field of mood disorders. r é s u m é Mots clés : Objectifs. – Dix ans plus tôt a été publiée, sous la direction du premier auteur de cet article, une réévaluation Pensées accélérées théorique sur les pensées accélérées (« racing ») et grouillantes (« crowded ») dans les troubles de l’humeur, Pensées grouillantes que la tradition franc¸ aise rassemble volontiers sous le concept de tachypsychie, mais que les auteurs Tachypsychie anglo-saxons utilisent peu. Cette revue incluait des considérations théoriques sur le concept. Après une Bipolaire décade, qui a été marquée par l’émergence du concept de dépression mixte, nous proposons une mise à Dépression jour, basée sur les publications récentes incluant des travaux récents de notre groupe. Troubles de l’humeur Méthode. – Cette revue narrative s’appuie sur la réévaluation théorique initiale publiée en 2010 et reprend les publications de ces dix dernières années. Les études pertinentes ont été collectées au fil des travaux de notre groupe, incluent des publications de notre groupe et ont été complétées par une recherche systématique sur PubMed. ∗ Corresponding author at: Hôpital civil, clinique de psychiatrie, 1, place de l’Hôpital, BP 426, 67091 Strasbourg, France. E-mail address: [email protected] (G. Bertschy). Résultats. – Nous confirmons les éléments connus sur la tachypsychie en les étendant et en apportant cer- taines clarifications. La conception dichotomique des pensées accélérées versus les pensées grouillantes n’est pas réfutée mais elle apparaît plus complexe, comme l’a révélé les études de validation du Racing and Crowded Thoughts Questionnaire (le questionnaire de pensées accélérées et grouillantes), réalisées chez des sujets de la population générale et chez des patients bipolaires. Ces études montrent, à travers l’analyse factorielle des items composant cet auto-questionnaire, l’existence non pas de deux mais de trois facteurs. Un premier facteur décrit la suractivité des pensées, est associé à l’hypomanie et renvoie assez bien au concept de pensées accélérées linéaires, alors qu’un second facteur décrit le caractère pénible de la suractivité des pensées, est associé à l’humeur dépressive et renvoie, lui, assez bien au concept de pensées grouillantes. Il existe, cependant, un troisième facteur décrivant la surexcitabilité des pensées qui est à la fois associée à l’hypomanie et la dépression et qui vient donc brouiller les cartes du schéma dichotomique. De plus, cette vision dichotomique ne peut plus être conc¸ ue comme dans une simple concordance bijective avec la distinction hypomanie versus dépression mixte telle qu’elle était décrite dans le modèle proposé il y a dix ans. Il semble raisonnable de considérer que, dans la manie sévère, la tachypsychie n’est plus linéaire mais devient grouillante parce qu’à un certain stade, l’accélération excessive des pensées submerge les capacités de traitement de ces pensées par l’esprit. Par ailleurs, les études de la tachypsychie chez des patients déprimés, montrent que celle-ci est fortement associée à la dépression mixte et non à la dépression non mixte. Des études, sur sa présence au cours d’épisodes hypomanes, montrent que la tachypsychie tend à être plus associée à l’irritabilité qu’aux symptômes maniaques classiques d’augmentation de l’énergie et de l’activité. Ces résultats confortent l’intuition de Kraepelin et Weygandt d’un modèle à trois volets des symptômes cliniques des troubles de l’humeur dans lequel pensée associative et activité psychomotrice constituent deux volets distincts (en plus du troisième volet qui concerne les affects). Les travaux récents ont permis aussi d’apporter des éléments empiriques pour étayer la distinction entre tachypsychie et ruminations. Enfin, bien qu’étroitement liée aux troubles de l’humeur, la tachypsychie semble être associée à l’anxiété aussi bien dans la population générale que chez les sujets bipolaires. Elle est également très présente chez les sujets présentant un trouble déficit de l’attention/hyperactivité ou souffrant d’insomnie. Conclusion. – La tachypsychie, telle qu’elle s’exprime par des pensées accélérées et grouillantes, représente un concept clinique qui permet d’étudier une importante facette de l’activité de l’esprit dans une perspec- tive dimensionnelle dans et au-delà du domaine des troubles de l’humeur. 1. Introduction can be articulated”, “This experience resembles watching two or three television programs simultaneously.” The flight of ideas is Racing thoughts refer to a subjective acceleration and overpro- described by a logorrhea (which is also considered by itself in the duction of thoughts, which have been essentially associated with criterion B3), with abrupt changing of topics, such that the speech manic episodes in bipolar disorder. Indeed, racing thoughts, and can be disorganized and incoherent. The ICD-10, the WHO classi- their verbal equivalent, flight of ideas, are extremely characteristic, fication published in1994 [9], considers only the flight of ideas in if not pathognomonic, of manic thinking [1]. As Jamison so vividly the manic episode with psychotic symptoms. described it [2], manic thought is characterized by “[. .] a torrent of Although racing thoughts have been abundantly described by near unstoppable speech; thoughts bracchiate from topic to topic, psychiatrists, it is still unknown whether they belong to a sin- held only by a thin thread of discernible association. Ideas fly out, gle entity, or are rather a multi-faceted phenomenon. The clinical and as they do, they rhyme, pun, and assemble in unexampled ways. boundaries and characteristics of racing thoughts have not been The mind is alive, electric.” In his groundwork textbook on bipolar thoroughly evaluated in patients with mood disorders. There are disorder, Kraepelin [3] was the first to use the term “flight of ideas”, reasons to believe that racing thoughts might be associated not only to refer interchangeably to both the experience of speeded thought with full-blown manic, but also with depressive episodes in bipolar pressure, and its expression in the patient’s speech. Kraepelin con- disorder. As mentioned
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