During a conversation with Nurse John with a client, he observes that client shifts from one topic to next on a regular basis. Which of following terms describes this disorder?

Correct Answer: D. Loose association

Loose associations are conversations that constantly shift in topic. Loose associations don’t necessarily start in a cogently, then become loose. A manifestation of a thought disorder whereby the patient’s responses do not relate to the interviewer’s questions, or one paragraph, sentence, or phrase is not logically connected to those that occur before or after.

• Option A: Flight of ideas is characterized by a conversation that’s disorganized from the onset. A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may be disorganized and incoherent. It is part of the DSM -5 criteria for Manic episodes.
• Option B: Concrete thinking implies highly definitive thought processes. Concrete thinking is reasoning that’s based on what you can see, hear, feel, and experience in the here and now. It’s sometimes called literal thinking, because it’s reasoning that focuses on physical objects, immediate experiences, and exact interpretations.
• Option C: Ideas of reference or delusions of reference involve a person having a belief or perception that irrelevant, unrelated or innocuous things in the world are referring to them directly or have special personal significance. The two are clearly distinguished in psychological literature.