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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).
Clinical Theory and Skills EMIs
Published in Michael Reilly, Bangaru Raju, Extended Matching Items for the MRCPsych Part 1, 2018
I. The most likely diagnosis is schizotypal disorder. Clearly there are a number of features of this disorder: circumstantial speech, aloofness, odd appearance and a transient psychotic-like period. It appears from collateral history that such disturbances are long-standing. [X. p95–6]
The fundamentals of psychiatry
Published in Ben Green, Problem-based Psychiatry, 2018
The speech of the patient may be totally spontaneous or may occur only when you ask questions. The answers to questions are usually relevant, but may be wildly off the point. Sometimes all the patient’s speech is spontaneous and irrelevant and any intervention by the doctor is unheeded. When answers to questions begin relevantly but drift from the point this may be termed circumstantial speech, e.g. in answer to a question about their mother’s age at death: ‘Well, she died young, not to say tragically, through an accident. I think there are too many accidents now They’re becoming more and more common. It’s a violent world. Look at the gang wars about drugs …’ There is a conversational logic to this kind of speech, but it is difficult to focus in history taking as the actual information that the patient’s mother died at 45 is never given.
Psychosis in Emerging Adulthood: Phenomenological, Diagnostic, and Clinical Considerations
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2019
Aubrey M. Moe, Nicholas J.K. Breitborde
Psychotic illness is also often marked by symptoms of disorganization impacting thinking and behavior. Disorganization of thinking often affects the speech of people with psychosis, and these symptoms vary in severity, ranging from mild manifestations such as tangential or circumstantial speech to derailment or world-salad, which render speech incomprehensible (Tandon et al., 2009). Symptoms of disorganized speech, which are often referred to as formal thought disorder (Andreasen, 1979), are thought to be reflective of underlying abnormalities of logical processes. Taken together, disorganization of speech impairs one’s ability to communicate effectively with others, namely, in terms of a failure to convey meaning (Docherty, 2012). Thus, emerging adults evidencing these symptoms may tend to drift in conversation, use words or phrases in unusual ways, or in extreme cases have speech that is unintelligible. Disorganization can also influence the behavior of individuals with psychosis, with manifestations including inappropriate or incongruent affect, wearing inappropriate attire for season or situation (e.g., sandals and shorts in a snowstorm), and even catatonic motoric immobility (Tandon et al., 2009). Disorganization can also manifest in other abnormal motor behavior, including odd or peculiar movements (e.g., posturing, mannerisms, and facial expressions) or excessive motor activity (Diagnostic and Statistical Manual of Mental Disorders [5th ed.]; American Psychiatric Association, 2013). The nature of the interrelatedness of disorganized symptoms and other symptoms of psychosis is unclear, as disorganization is at times conceptualized as a positive symptom process (Kay, Fiszbein, & Opfer, 1987) and at other times as most representative of negative symptoms (McGorry, Bell, Dudgeon, & Jackson, 1998). However, the current diagnostic nomenclature for psychotic disorders suggests that disorganized speech and behavior should be considered independently of other symptom clusters (Diagnostic and Statistical Manual of Mental Disorders [5th ed.]; American Psychiatric Association, 2013).