DISORDERS OF SPEECH

Presenter : Dr. Ayesha Zahiya

Moderator: Dr.Ravisha Thunga
 OBJECTIVES
1) SPEECH : • 3) SPEECH DISTURBANCES :
Phonemes • Stammering & Stuttering
Morphemes • Aphonia & Dysphonia
Syntax • Dysarthria
Semantics • Logoclonia
Prosody • Echolalia
Pragmatics • Mutism
2)APHASIA : • Talking past the point (VORBEIREDEN)
Receptive • Neologisms
Intermediate • Changes in the volume & intonation of
Expressive speech
 SPEECH
Definition (Sims) : Speech is the aspect of language that corresponds to the
mechanical and articulatory functions that allow language to be vocalized.
Phonemes (Sims) : are the most basic sounds that are available for use in language.
Morphemes (Sims) : These are smallest meaningful unit of a word, and combinations
of morphemes make up words. Produced from phonemes . Eg: ‘do’ or ‘un’
Syntax (Sims) : Is the allowable combination of words in phrases and sentences and
includes the rules that determine word order. (Grammar)
 SPEECH
Semantics(Sims) :are the meanings that
correspond to the words and include the
meaning of all possible sentences.
Prosody (Sims) : Refers to the modulation of
vocal intonation that influences accents, and
also the literal and emotional meanings of
words and sentences.
Pragmatics (Sims) : Refers to the multiple
potential meanings of any utterance , which
requires knowledge of context and of the
speakers for full interpretation. Eg: This
room is cold.
 SPEECH DISTURBANCES
STAMMERING AND STUTTERING:
According to Fish,
In STAMMERING, the normal flow of speech
is interrupted by pauses or by repetition of
fragments of the word.
● Associated with – Grimacing , Tic like
movements.
● Occurs during : adolescence & at the onset
of Schizophrenia.
Speech
disturbances
 SPEECH DISTURBANCES

In STUTTERING,
usually begins at the age of 4.
M/C in boys than girls.
Improves with time.
Noticed when the person is
Anxious.
Sometimes persists into adult life
and may become social disability.
 APHONIA AND DYSPHONIA
Aphonia is the loss of the ability to
vocalize(Sims).
The patient talks only in a whisper.
Dysphonia denotes impairment with
hoarseness but without complete loss of
function (Sims).
Seen In - Paralysis of the ninth cranial
nerve
- Disease of the vocal cords.
 Dissociative Aphonia
Patient suddenly lose their voice due
to emotional or psychological stress.
Such a patient may speak in a ‘stage
whisper’.
May occur without organic disease.
Phonation may fluctuate according to
the response of those, the person is
addressing.
 DYSARTHRIA
Disorders of articulation (Sims).
Cause - Bulbar and Pseudo
Bulbar Palsy
- Structural and Muscular
Disorders of mouth , pharynx ,
larynx and thorax.
Seen In - Schizophrenia -
Personality Disorders.
 LOGOCLONIA
This describes the spastic repetition
of syllables (Scharfetter, 1980).
It was first reported among
individuals with dementia
(Kraepelin 1910).
Seen In - Alzheimer's and
Parkinsonism.
The patient may get stuck using a
particular word.
 ECHOLALIA
The patient repeats words or parts of
sentences that are spoken to him or in his
presence (Sims).
There is usually no understanding of the
meaning of the words.
Seen In - Autism
- Tourette's Syndrome
- Schizophrenia
- Learning Disability
- Organic states.
 MUTISM
MUTISM- is complete loss of speech (Fish).
- refraining from speech during
consciousness (Sims).
Seen In -Catatonic schizophrenia
-Personality disorder
-Depression
-Dissociative disorder
-Learning disability
-Functional psychosis and neurosis
-Oragnic brain disorders.
 ELECTIVE MUTISM
Occur in children who refuse to
speak to certain people.
Eg: child might be mute at
school but speak at home.
Recognised technique for
dealing with family quarrels.
 HYSTERICAL MUTISM
Complete loss of speech
may occur as an
abnormal reaction to
stress (Sims).
● Rare and M/C
Hysterical Disorder of
speech is Aphonia.
 Hysterical mutism
● In DEPRESSION with
psychomotor retardation may
be associated with MUTISM.
● Most common element of
CATATONIC STUPOR.
● May occur in non stuperose
catatonic individuals
as mannerism.
Eg: In 1935 Catatonia patient
said,
‘My words are too valuable
to be given away’
● She was mute even after 20
years, she would use gestures
and at times she would write
the answers to questions
when given a pencil and
paper.
 AKINETIC MUTISM
There is mutism but patient is
aware of the environment despite a
lowering of the level of
consciousness and Anterograde
amnesia (Fish).
● Associated with lesion of Upper
Midbrain and Posterior
Diencephalon.
Talking Past The Point( VORBEIREDEN)

The content of the

patient’s replies to
questions shows that
they understand what
has been asked but
have responded by
talking about an
associated topic (Fish)
Seen in Ganser syndrome,
Dissociative Disorder,
Schizophrenia.
● Adolescent Patient may
find the phenomenon
amusing and assume a
facetious attitude towards
it.
● Seen in Herbephrenic
Schizophrenia.
 Ganser’s Syndrome
A rare dissociative disorder
characterized by nonsensical or
wrong answers to questions and
other dissociative symptoms.
● Also called as Nonsense
syndrome, Balderdash syndrome,
Prison psychosis, Syndrome of
approximate answers.
 GANSER’S SYNDROME
Symptoms - Approximate
answers
- clouding of
consciousness
- Hallucinations
- Amnesia
● 1st described in 1898,
occurred in 4 criminals.
 GANSER’S SYNDROME
● Seen in prisoners and army
personnel under
severe stress, going to war,
under trial.
● Associated with recent head
injury or severe
emotional stress.
● Personality disorder and
Major Depression is risk
factor
 NEOLOGISMS
Definition -
May be new words that are
constructed by the patient or
ordinary words that are used
in a new way (Fish)
 NEOLOGISM
● Seen in Schizophrenia.
● In Catatonia it maybe mannerism or
stereotypes.
The Patient may distort the
pronunciation of some words the same
way as they distort some body
movements.
● Some use Stock word instead of the
correct one.
Eg:Pt may use the word car & all
aeroplane as ‘air car’ & boat as ‘sea
car’.
 NEOLOGISM
● Sometimes result of a derailment.

● Technical Neologism
Patient is making up a technical term for a
private experience that cannot be expressed
in ordinary words (Fish).
● Malapropism
They are conspicuously misused words,
may be mistaken for neologisms in some
individuals (Fish).
 Changes in the Volume and Intonation of Speech

● Many depressed patients speak

quietly with a
monotonous voice.
● Manic patients often speak loudly
and excitably
with much variation in pitch.
● Seen in Schizophrenia Patients.
 Aphasia
Disorder of speech resulting from interference with
functioning of certain areas of the brain (Fish).
● Aphasia implies the loss of language altogether
and
dysphasia implies impairment or difficulty with
language
(Sims).
● M/C in organic states.
● 3 Types - 1. RECEPTIVE APHASIA
2. INTERMEDIATE APHASIA
3. EXPRESSIVE APHASIA.
 RECEPTIVE (Sensory) APHASIA
● Here Patients are unable to understand
spoken speech, with loss of
comprehension of the meaning of words
(Sims).
● Pure Word Deafness (Subcortical
Auditory Aphasia)
● Pure Word Blindness ( Subcortical
Visual Aphasia)
● Wernicke’s Aphasia (Fluent Aphasia).
 Pure Word Deafness
The patient can speak, read and
write fluently, correctly and with
comprehension (Sims).
● He cannot understand speech,
even though hearing is not
impaired for other sounds.
● Lack of Recognition (Agnosia)
for the spoken word.
 Pure Word Blindness
● The Patient can speak
normally and understand the
spoken word.
He can write spontaneously to
dictation but cannot read with
understanding (Sims).
● The condition is therefore
agnosic alexia without
dysgraphia.
● Risk factor - Right
homonymous hemianopia.
WERNICKE'S AREA

● A region in the posterior

section of the superior
temporal gyrus.
● In the dominant cerebral
hemisphere.
● Brodmann's area 22.
WERNICKE'S
APHASIA
(Jargon Aphasia)
Cause-
● Ischemic stroke
affecting the posterior
temporal lobe of the
dominant hemisphere.
● Seen in an embolic
stroke that afects the
inferior division of the
middle cerebral artery
supplying the temporal
cortex.
 INTERMEDIATE APHASIA
Nominal Aphasia ( Amnesic or
Anomic Aphasia) -
● Patient cannot name objects,
although they have plenty of
words at their disposal (Fish).
● M/C seen in left hemisphere
lesions.
 CONDUCTION APHASIA (Central Aphasia) -
In this the patient cannot
repeat the message although
he can speak and write
(Sims).
● Seen in lesions of Arcuate
fasciculus
 EXPRESSIVE (MOTOR) APHASIA
There is disturbance to the
processes of selecting words,
constructing sentences and
expressing them (Sims).
● Pure word Dumbness
● Pure Agraphia
● Alexia With Agraphia
● Broca's Apashia (Non fluent
Aphasia).
Pure Word
Dumbness
The Patient understands
spoken speech and
writing and can respond
to comments.
● Writing is preserved
but speech is indistinct
and cannot be produced
at will.
Pure Agraphia
It is an isolated inability to write
(Sims).
● It may also occur without
impairment of speech (agraphia
without alexia)
● There is normal understanding
of written and spoken material.
Alexia With Agraphia
● The patient is unable to read or
write, but speaking and
understanding speech are
preserved.
BROCA'S AREA
A region in the inferior
frontal lobe.
● In the dominant hemisphere
of the brain.
● Brodmann area 44 and 45.
Broca’s
aphasia
Cause-● Stroke
involving the dominant
inferior frontal lobe or
Broca’s area.
● A thrombus or emboli
in the middle cerebral
artery or internal carotid
artery
In this Aphasia,
NAMING, READING
AND WRITING are
IMPAIRED.
 Schizophrenic Language Disorder
● Defective communication in Language is
the defining characteristic of Schizophrenia
(Crow 1997).
● Speech confusion in Schizophrenia is
called as Schizophasia (Word salad).
● Schizophasia has a superficial
resemblance to Aphasia where the disorder
of speech is more greater than the deficit of
intelligence.
Kraepelin (1919) defined Akataphasia
as a disorder in the expression of
thought in speech.

● Loosening of associations, which

implied incompleteness in the
development of ideas. It was the 1st
fundamental symptoms of
Schizophrenia by Bleuler (1911).

● Cameron (1944) described

Asyndesis, It is an inability to preserve
conceptual boundaries and a marked
paucity of genuinely causal links.
THANK YOU
 REFERENCES
1) Fish’s Clinical Psychopathology: Signs and
Symptoms in Psychiatry

2) Sims’ Symptoms in the Mind