Racing and crowded thoughts in mood disorders: A data-oriented theoretical reappraisal

Abstract

Objectives. -Speed of thought is a central phenomenon in mood disorders. We aimed to provide an update on the topic ten years after a first narrative review published on racing and crowded thoughts in mood disorders. This update is based on recent publications, including recent works of our group. Methods. -Narrative review based on publications from the last ten years including publications of our group and a systematic research of references on PubMed.Results. -The traditional dichotomist view of racing versus crowded thoughts is not refuted but appears to be more complex, as revealed by validation studies of the Racing and Crowded Thoughts Questionnaire. Moreover, this dualistic view can no longer be conceptualized in a simple bijective concordance with 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 important facet of mind activity within and beyond the field of mood disorders..

Investigating racing thoughts via ocular temporal windows: deficits in the control of automatic perceptual processes

“…Racing thoughts also predict a greater likelihood of conversion to BD after a first depressive episode (Diler et al, 2017; Fiedorowicz et al, 2011; Zeschel et al, 2013). It is noteworthy that racing thoughts, although primarily related to mood disorders, are not specific to BD and can be found in other psychiatric conditions which share symptoms of mood alterations, such as anxiety disorder, attention deficit/hyperactivity disorder and sleep disorders (Bertschy, Weibel, Giersch, & Weiner, 2020). A study on a healthy population suggests that milder forms of racing thoughts can be associated to sub-clinical mood instability (Weiner et al, 2018).…”

“…However, the mechanisms underlying racing thoughts may generalize to perception. Racing thoughts were first studied phenomenologically based on qualitative analyses of BD patients' descriptions (Bertschy et al, 2020; Piguet et al, 2010). Since then, significant advances have been made to capture this complex phenomenon, notably via the development of the Racing and Crowded Thoughts Questionnaire (RCTQ) (Weiner et al, 2018).…”

Psychopathological Dissection of Bipolar Disorder and ADHD: Focussing on Racing Thoughts and Verbal Fluency

“… 45 In the same study, using a principal component analysis, we found that a single component explained 55.9% of the variance with major and exclusive contributions from 9 items. Therefore, as suggested by one of our recent studies, 32 This component did not support a dualistic view of racing thoughts versus crowded thoughts and suggested instead that subjective thought overactivation encompasses an overproduction of thoughts but also thoughts getting muddled, as well as the unrestrained/uncontrollable nature of thought flow. …”

“… 48 It has been shown that subsyndromal hypomanic symptoms appear to enhance psychosocial functioning in bipolar-II patients. 65 As we developed elsewhere, 32 in hypomanic states, it is possible that an inverse U-shaped relationship between racing thoughts and well-being/functioning. In mild hypomania, the cognitive ability to process new thoughts is well balanced with the speed of thinking: one is therefore not overwhelmed and the experience is that thinking is fluid and pleasant.…”

“…Racing thoughts refer to a subjective acceleration and overproduction of thoughts. 5 , 32 Initially, they were mainly associated with manic episodes in BD: racing thoughts and their verbal equivalent, flight of ideas, are extremely characteristic of manic thinking. 33 In his historical textbook on manic-depressive illness at the beginning of the twentieth century, Kraepelin was the first to use the term “flight of ideas”.…”