19 - 2. Altered amount of speech

2. Altered amount of speech:

© SPMM Course 5. Psychopathology of speech Aspects of conversational speech:

1. Spontaneity: Comments that are not just responses to questions is present in normal speech
2. Turn-taking: Responses and comments are made only when the other speaker completes his sentences, or when natural pauses occur during conversations.
3. Mutual topic: Content is focussed and related to the comments made by the other speaker
4. Animation: Accompanying non-verbal behaviours are almost always present in normal speech Disorders of phonation/articulation: Aphonia refers to the inability to vocalize. It refers to sound production (phonation) rather than sound manipulation (articulation) – disturbance of the latter being dysarthria. In aphonia, whispering occurs; it may be due to paralysed vocal cords or due to hysteria. Dysarthria refers to disorders of articulation; it may be due to lesions in the brain stem (bulbar), cortex (pseudo bulbar), cerebellum or extrapyramidal system. Dysarthria can also be drug induced in schizophrenia. Stammering: In stammering the normal flow of speech is interrupted by pauses or by the repetition of fragments of words or parts of words. Tics often accompany stammers. Boys stammer more often than girls; usually reduced in adulthood. Stuttering is difficulty in uttering speech sounds at the beginning of words. Utterances are repetitive, prolonged and pauses are common. Primary stuttering is seen in children, in adults new onset stutter may be related to stroke or extrapyramidal symptoms. Disturbed speech production:
5. Altered speed of speech: Quiet speech in low volume with poor intonation, reduced spontaneity and prolonged reaction time is seen in depression. The terms used here are bradyphasia (decelerated talking) while tachyphasia refers to accelerated talking seen in manic states.
6. Altered amount of speech: 2.1. Logorrhoea refers to increased quantity of speech, generally without the pressure of speech or formal thought disturbances (see below) and seen especially in early manic states. 2.2. Alogia is a term used to denote poverty of speech and a decrease in spontaneous talking; it occurs in depression and schizophrenia. This must be differentiated from the poverty of content of speech where the amount of speech is adequate but conveys little information. This is often related to schizophrenic formal thought disorder (see below). 2.3. Mutism: This denotes a complete lack of speech. Severe depression with psychomotor retardation may be associated with mutism though this is relatively rare in the absence of catatonia. Mutism is almost always present in a catatonic stupor. a. Elective mutism: Mostly seen in children who refuse to speak to certain people; for example, the child may not speak at school but speak at home.