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The fundamentals of psychiatry
Published in Ben Green, Problem-based Psychiatry, 2018
Other speech types include tangential speech which veers markedly away from the topic under discussion and may be a feature of thought disordered speech. In mania speech may be pressured – the speech is rapid and crammed with ideas that tumble over one another to be expressed. In schizophrenia and some organic disorders there may be perseverative features such as the rhythmic repetition of the last words you said, known as echolalia, or the last syllable, palilalia.
Acute Mental Status Change
Published in Lauren A. Plante, Expecting Trouble, 2018
Matthew K. Hoffman, Victoria Greenberg
A complete neurological examination must be conducted (Figure 11.3) (3), including the Glasgow Coma Scale, signs of head trauma, mental status exam, cranial nerves, reflexes, strength, and motor function. When talking with the patient, the provider should pay attention to pressured or tangential speech, quiet speech, or inability to answer. The provider should determine if the patient is responding to internal stimuli or having visual and auditory hallucinations.
Remediative approaches for cognitive disorders after TBI
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
Mark J. Ashley, Rose Leal, Zenobia Mehta, Jessica G. Ashley, Matthew J. Ashley
Development of categorization skills follows an acquisition sequence: 1) piling, 2) keychaining, 3) iconic categorization, and 4) symbolic categorization.89 Piling occurs when the individual places all items in a single group without regard for shared attributes. Keychaining (or edge matching89) involves a serial ordering of members of the category with which only a single feature is shared between adjacent members. Items 1 and 2 might share color while Items 2 and 3 share shape. Items 1 and 3 may not share any attributes. Difficulties with keychaining are often manifest in the communication patterns of people with TBI. Discourse analysis shows that people with TBI have impairment of productivity, content, and cohesion.90 A conversational topic is, in fact, a category. Language, on the other hand, is quite abstract and, consequently, tangential speech, or difficulties in maintaining topic cohesion, is most likely a manifestation of difficulty maintaining categorical boundaries.
Distance delivery of a spoken language intervention for school-aged and adolescent boys with fragile X syndrome
Published in Developmental Neurorehabilitation, 2018
Andrea McDuffie, Amy Banasik, Lauren Bullard, Sarah Nelson, Robyn Tempero Feigles, Randi Hagerman, Leonard Abbeduto
Boys with FXS are likely to speak in short phrases that are adequate for conveying their immediate needs and wants. Vocabulary and grammatical skills are, however, delayed relative to cognitive-level expectations and conversational interactions are negatively impacted by other co-occurring problems. Social anxiety and inattention may limit sustained engagement in conversational interactions, whereas repetitive, poorly articulated, and tangential speech may interrupt the sequential flow of information exchange between conversational partners. The goal of the current project was to improve the spoken language of boys with FXS by teaching their mothers to provide models of developmentally advanced vocabulary and grammar as well as to provide prompts to elicit child responses that continued the topic of the shared conversation. Interactions were situated within the context of shared story-telling using wordless picture books, which provided both a visual structure and a linear sequence for maintaining a sustained and on-topic conversation.
Surviving the “silent epidemic”: A qualitative exploration of the long-term journey after traumatic brain injury
Published in Neuropsychological Rehabilitation, 2021
Aviva Margaret Lefkovits, Amelia J. Hicks, Marina Downing, Jennie Ponsford
Some also reported experiencing current judgement from friends about their newfound tendencies post-injury (e.g., tangential speech) or fearing future judgment from employers (e.g., not being hired due to stigma surrounding brain injury or being deemed “incapable” when asking for assistance at work). I’m not sure if you actually told an employer that you had an acquired brain injury whether they’d actually want to employ you anyway, ‘cause it’s such an unknown for most people (P20, 11 years post-injury).
Development of a Bereavement Group in a Geriatric Mental Health Clinic for Veterans
Published in Clinical Gerontologist, 2018
Elizabeth A. Mulligan, Michele J. Karel
Each round of the group was co-facilitated by one of the co-authors and a geropsychology intern or fellow, who reflected on strategies for improving the referral process in the future. The inclusion of veterans of various ages was important for meeting the needs of a system in which there was not another bereavement group available. However, at times it was difficult for younger veterans with different types of losses (e.g., the loss of a parent in their 50s) to fully relate to the other group members. Referral sources were provided with details about the group structure, goals, and expectations via email. It may have been useful to have brief meetings with the most common referring teams to discuss how best to describe the group to patients. Additionally, it may have been helpful to incorporate a brief cognitive screen into the group screening process if there was no recent documentation of cognitive status. Several veterans with mild neurocognitive disorder participated actively in the group without any known difficulty. At least one veteran’s cognitive impairment seemed more consistent with dementia; although he had not been formally diagnosed, his memory impairment, tangential speech, and limited insight posed some challenges for his full and meaningful participation. Of note, data from this individual was not included in the analysis of group outcomes because he only attended two sessions and we encouraged the referring provider to complete further assessment of his cognition. Finally, this group was offered approximately twice per year due to clinic staffing and a rotation between it and other time-limited groups. Therefore, it was helpful to research and continually develop a list of bereavement groups in the community, such as those offered by local hospice agencies, hospitals, and councils on aging.