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Assessment of the psychiatric patient
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
In mania, speech may be loud, rapid and difficult to interrupt (pressure of speech). Speech may be disordered in the form of flight of ideas, which is characterised by frequent shifts of topic connected by sounds, puns, rhymes or word associations, which can be difficult to follow. Other abnormalities of the form of speech include circumstantial speech (inability to stick to the point), neologisms (new words created by patient) and perseveration (repetition of the previous verbal response).
ISQ – Psyche-pathology
Published in Bhaskar Punukollu, Michael Phelan, Anish Unadkat, MRCPsych Part 1 In a Box, 2019
Bhaskar Punukollu, Michael Phelan, Anish Unadkat
Other types of thought disorder: — Metonym – An inappropriate or imprecise but related word is used in place of the correct word in a sentence.— Neologism – A new word that has no meaning is created,— Echolalia – Automatic and pointless repetition of another person’s words or phrases.— Verbigeration – Imitation of another person’s phrases in a stereotyped manner.— Palilalia – Repetition of a word from an individual’s own spoken words.— Logoclonia – Repetition of words or phrases, particularly the end syllables.— Logorrhoea: excessive flow of words or pressure of speech as occurs in mania.
The fundamentals of psychiatry
Published in Ben Green, Problem-based Psychiatry, 2018
In the section on thought we are concerned with two main headings: form and content. The form of thought may be reflected by speech. Thus if speech is thought disordered it may be reasonable to assume that thought (which occurs before speech) is similarly disordered. Thoughts may also be pressured, which may lead to pressure of speech; they may be dominated by intrusive thoughts (as in obsessive compulsive disorder); they may exhibit flights of ideas (as in mania) or sudden unpleasant gaps (as in thought blocking in schizophrenia). To assess the content of thought you might ask for the main thoughts that dominate a person’s recent thinking life: ‘What kind of things do you think about most?’, ‘What kind of things do you worry about nowadays?’ Record any worries, preoccupations, intrusive thoughts, overvalued ideas or delusions. Under thought content you may also record any abnormal experiences such as hallucinatory experiences or thought interference (withdrawal, insertion or broadcasting).
Roozbeh adult autism spectrum disorder clinic: lessons learned from first 34 cases
Published in International Journal of Developmental Disabilities, 2022
Javad Alaghband-rad, Samira Jamaloo, Mahtab Motamed
Twelve of our patients had been misdiagnosed prior to their referrals to ASD Clinic. Five of patients were previously diagnosed with obsessive compulsive disorder. Patients with ASD have some rituals and stereotyped which may be similar to or be mistaken with compulsions (Hollocks et al.2019). Three of patients were diagnosed with bipolar disorders due to their socially inappropriate relationships mistaken for being too outgoing or socially disinhibited and having higher sexual desire. Being too talkative or clingy and not appreciating the social situation may mimic pressure of speech in bipolar disorder. Being odd, eccentric, or socially isolated and having stereotyped behaviors or fixed and restricted beliefs make differentiating ASD symptoms from schizophrenia quite a challenge. Yet, adults with ASD use less reciprocal communication and have poorer rapport compared to adults with schizophrenia (Trammell et al.2013). Similarly, social detachment or reduced social motivation and sharing of emotions may be difficult to distinguish from psychomotor symptoms of depression and social phobia in individuals with ASD (Chandrasekhar and Sikich 2015, Hollocks et al.2019, Stewart et al.2006). Considering developmental history and the course of the disease across the life span would be therefore of great importance to differentiate ASD from other mental health disorders.
Orofacial function in children with Speech Sound Disorders persisting after the age of six years
Published in International Journal of Speech-Language Pathology, 2020
Åsa Mogren, Lotta Sjögreen, Monica Barr Agholme, Anita McAllister
In addition to difficulties with consonant and vowel production, many participants also exhibited deviant resonance. Some of the participants had low-pressure consonant production. The deviations in resonance could be related to lack of energy, low muscle tone and low subglottal and oral pressure during speech. In a study assessing adolescents with persistent SSD, around 25% had “abnormal resonance” (Lewis et al., 2015). The authors suggest “a motor-based articulatory deficit in addition to the phonological processing deficits” based on the co-occurrence of abnormal resonance and oral motor imitation difficulties in the participants. There was a significant difference between participants with and without parent reported motor difficulties regarding resonance, where participants with motor difficulties displayed deviant resonance to a higher degree.
Behavioural equivalents of schizophrenia in people with intellectual disability and autism spectrum disorder. A selective review
Published in International Journal of Developmental Disabilities, 2021
Disorganized speech included the features incoherence, derailment, (severely) impoverished speech, vanished speech, meaningless response/confused use of words (illogical speech), pressure of speech, and echolalia. Disorganized behaviour included the following features: derailment (in task solving), sequence failure, aimlessness, rocking, repetitive behaviour, unexpected violent behaviour, meaningless response (non-verbal/gestures), task interruption by changing focus (derailment), task derailment, using known objects wrongly (apraxia), impaired task solving in known activities like tooth brushing etc. The following case highlights the importance of observation of disorganized behaviour in patients with ASD, who are suspected of having a psychotic episode (Bakken 2010): ‘Claire’ has severe ID and ASD, usually using and understanding the meaning of approximately 20-30 words. In retrospect, it seems that she had experienced at least three episodes of schizophrenia before admission to a specialized inpatient unit for ID. She was referred for psychiatric assessment as she displayed sleeplessness and lost about 25% body weight. Her verbal language disappeared. She both attacked people without early signs of aggression and destroyed things in the environment. This challenging behaviour was for the most part associated with anxiety attacks. Delusions or hallucinations were not reported and difficult to assess. The staff observed behaviour suspected to be ‘auditory hallucinatory behaviour’ (constantly holding her ears, and she would complain about ‘hurt in the ear’ without otitis or other ear complaints). At the same time she was screaming. If the problems described above encompassed all information available about Claire’s condition, there would be insufficient clues for identifying the origin of her problems, and how to supply the right treatment and care. A closer look revealed important additional information: Disorganized speech and behaviour was observed and assessed as severe during the acute phase, but was still the most prominent sign of psychosis for about four to five months. Her verbal language vanished completely. Claire displayed distorted ability of sequencing during almost all activities through the day. She seemed to hesitate and frequently stop during all activities, also when walking. She stopped, turned around, went back a couple of steps, turned around again, and took some steps forward. After a few steps she stopped again. She seemed confused in most settings and was not able to keep her attention focused for more than a few seconds. She would eat paper napkins beside the main dish for supper.