Thought content refers to the worries and preoccupations manifested by the patient and elicited at interview. Abnormal beliefs and experiences are, of course, part of the thought content, but are regarded as sufficient to be discussed separately (see below).

• An obsessional rumination is a recurrent, persistent thought, impulse, image or musical theme that enters the mind despite the individual’s effort to resist it. The
  individual recognizes that the obsessional thought is their own, but it is usually unpleasant and often ‘out of character’, such as the thought that the patient has accidentally killed someone while driving their car. Common obsessions concern dirt, contamination and orderliness.
• A compulsion is a repetitive and seemingly purposeful action performed in a stereotyped way, referred to as a compulsive ritual. Compulsions are accompanied by a subjective sense that they must be carried out (or the patient will be overwhelmed by either anxiety or a superstitious belief that something bad will occur) and by an urge to resist. Compulsive rituals are used to counteract ruminations, so patients repetitively wash their hands to diminish the fear of contamination with dirt.

Insight and illness beliefs

Insight is the degree to which a person recognizes that he or she is unwell, and is minimal in patients with a psychosis. Illness beliefs are the patient’s own explanations of their ill-health, including diagnosis and causes. These beliefs should be elicited because they can help to determine prognosis and compliance with treatment, with any disease.