Disorders of Speech

By A dit Bh rdw j
a
a
a
a
 Types

• Stammering and stuttering

• Mutism
• Talking past the point (Vorbeireden)
• Neologism
• Speech confusion and Schizophasia
• Aphasia
•
Stammering and stuttering
• Normal ow of speech is interrupted by pauses or by the religion of fragments of
the word.
• Grimacing and tic like movements
• Begins by the age of four, more common in boys
• May be visible or noticeable when person is anxious
• Also occurs in - Severe Adolescent crisis or onset of acute schizophrenia
fl
Mutism
• Complete loss of speech and may occur in children with a range of emotional or
psychiatric disorders and in adults with hysteria, depression, schizophrenia or
organic brain disorders.
• Elective mutism in children who refuse to speak to certain people
• Hysterical mutism is rare, known as aphonia.
• Severe depression with psychomotor retardation may be associated with mutism.
• Always present in catatonic stupor
• Akinetic mutism associated with lesion of the upper midbrain or posterior
dicephalon.
Vorbeireden
• Patient reports the answer to the question by talking about an associated topic.
• ‘Approximate answers’ may be a feature of gander syndrome which is a dissociative
disorder.
• Talking past the point is found in schizophrenia especially among adolescents
• These patients nd this phenomenon amusing and assume a facetious attitude
towards it- seen in hebephrenic subtype of schizophrenia
• Also known as pseudo dementia
fi
Neologism
 • New words are constructed or old words are used in a new way
• Individuals with motor aphasia use the wrong word or invent new word or distort
the phonetic structure of the word - paraphasia
• Seen in schizophrenia and Catatonia
• Severe positive formal thought disorder leads to neologism
• technical neologism- patient tries to use a new word for an experience that is
completely outside the realms of normal
• Hallucinatory voices may also play a part in neologism
• Malapropisms- conspicuously misused words, of no particular known psychiatric
signi cance
fi
Speech confusion and
schizophasia
• Super cial resemblance to aphasia
• Schizophasia is regarded as a form of thought disorder
• Known as word salad or speech confusion
fi
Aphasia
 Receptive aphasia

• Three types- pure word deafness, agnostic alexia and visual asymbolia
• 1) pure word deafness- attributed to lesion in temporal lobe, patient hears words but cannot
understand them
• 2) Agnostic alexia- patient can see words but unable to read them, lesion of left visual cortex
and corpus callosum
• 3) Visual asymbolia- distortion of visual word schemas, words cannot be recognised and
therefore mootte word schemas cannot be activated. Lesions in supramarginal gyri.
• Visual agnosia- can see them but not recognise the object. They will however recognise the
object with kinaesthetic sense.
 Intermediate aphasia
• In nominal or amnesiac aphasia the patient cannot name objects although they
have plenty of words at their disposal. They nd it di cult to carry out written and
verbal commands.
• Di culty in writing spontaneously.
• Found in di use brain damage.
• Substantial disturbances in language function with impairments of speech and
writing,
• syntactical aphasia- both receptive and expressive parts of speech are a ected.
ffi
ff
fi
ffi
ff
 Expressive aphasia
• Cortical motor aphasia- also known as brocas aphasia, verbal aphasia, or expressive
aphasia
• Patient has di culty their thoughts into words and in severe cases speech may be
restricted to expletives and a few words.
• Presence of recurring utterances and these words are produced with di erent
intonations to produce di erent meanings.
• In less severe cases, Patients understand what is said to them but cannot reply with
right words, described as unable to nd the right words.
• In pure word dumbness the oatient is unable to speak spontaneously, to repeat words
and to read aloud but they can write spontaneously, copy and write to dictation.
ffi
ff
fi
ff
Thank you