Disorder of Speech and Language

Outline
Speech Disturbances
• Aphonia and Dysphonia
• Dysarthria
• Stuttering and Stammering
• Logoclonia
• Echolalia
• Changes in the Volume and Intonation of Speech
• Unintelligible Speech

Organic Disorders of Language

• Sensory Dysphasia
• Motor Aphasia
• Mutism

Schizophrenic Language Disorder

• Clinical Description and Thought Disorder
• Psychogenic Abnormalities
• Statistical Model of Language
• Linguistic Approaches to Schizophrenia
 APHONIA AND DYSPHONIA

• Aphonia is the loss of the ability to vocalize; the patient talks only in a
whisper.
• Dysphonia denotes impairment with hoarseness but without complete
loss of function.

• Occurs with paralysis of the 9th cranial nerve/with disease of the vocal
cords.
• May also occur without organic disease in dissociative aphonia, not
uncommon as a presentation among ear, nose and throat outpatients.
• Such a patient may speak in a ‘stage whisper’; phonation may fluctuate
according to the response of those the person is addressing.
VIDEO APHONIA AND DYSPHONIA

SLP Sanjay Kumar: Before Functional Aphonia Therapy || Within 8 Days || Bangalore - YouTube
 DYSARTHRIA

• Disorders of articulation may be caused by lesions of the brainstem such

as bulbar and pseudobulbar palsy.
• It may also occur with structural or muscular disorders of the mouth,
pharynx, larynx and thorax.
• Idiosyncratic disorders of articulation are sometimes seen in
schizophrenia and, perhaps, with personality disorders consciously
produced.
 VIDEO
DYSARTHRIA

Dysarthria - YouTube
 STUTTERING AND STAMMERING

• These have in the past been enquired about in the psychiatric history
under neurotic disturbances of childhood along with behaviours
such as nail biting.

• However, psychogenic aetiology has certainly now been

disproved, and any association with neuroticism may well be
secondary to the barriers in communication that stuttering causes.
VIDEO STUTTERING

Kids Talk About Stutte

ring - YouTube
 LOGOCLONIA

The spastic repetition of syllables that occurs with parkinsonism.

The patient may get stuck using a particular word.

ECHOLALIA

The patient repeats words or parts of sentences that are spoken to them or
in their presence. There is usually no understanding of the meaning of the
words.
It is most often demonstrated in excited schizophrenic states with learning
disability and with organic states such as dementia, especially if dysphasia is
also present
 CHANGES IN THE VOLUME AND INTONATION OF
SPEECH

• Depressed patients : speak quietly with a monotonous voice

• Manic patients : speak loudly and excitably with much variation in pitch.
• Excited patients with schizophrenia : speak loudly; intonation and stresses
on words may be idiosyncratic and inappropriate.

None of these modes of behaviour has diagnostic significance.

 UNINTELLIGIBLE SPEECH

• Dysphasia may be so profound that, although syllables are produced, speech is

unintelligible.
• Paragrammatism (disorder of grammatical construction) and incoherence of syntax
may occur in several disorders. Recognizable words may be so deranged in their
sentences as to be meaningless
• word salad, as occurs in schizophrenia.
• In mania, the speed of association may be so rapid as to disrupt sentence
structure completely and render it meaningless
• depression retardation may so inhibit speech that only unintelligible
syllables, often of a moaning nature, are produced.
• Private meaning may occur in schizophrenia-personal meaning :
• Neologisms : new words with an idiosyncratic
• Stock words and phrases in which existing words are used with special
individual symbolic meaning
• Cryptolalia : a private language that may be spoken or cryptographia
(written)
Organic Disorders of Language
Sensory Dysphasia

• Pure Word Deafness (Subcortical Auditory Dysphasia)

• Pure Word Blindness (Subcortical Visual Aphasia)
• Primary Sensory Dysphasia (Receptive Dysphasia)
• Nominal Dysphasia
• Jargon Dysphasia

Motor Aphasia

• Pure Word Dumbness

• Pure Agraphia
• Primary Motor Dysphasia
• Alexia with Agraphia
• Isolated Speech Area

Mutism
Sensory Dysphasia
 Conduction dysphasia

Reel-Example: Conduction Aphasia 1 - YouTube

 Primary Sensory
Dysphasia

Fluent Aphasia (Wernicke's Aphasia) - YouTube

 Motor Dysphasia

Pure Word Dumbness

• understands spoken speech and writing and can respond to comments. Writing is preserved but speech is
indistinct and cannot be produced at will. There is no local disturbance of muscles required in speaking, and the
disability is an apraxia limited to movements required for speech.

Pure Agraphia
• an isolated inability to write that may also occur with unimpaired speech (agraphia without alexia); there is
normal understanding of written and spoken material. This is the equivalent for writing of pure word dumbness in
speech.

Primary Motor Dysphasia

• disturbance to the processes of selecting words, constructing sentences and expressing them. Speech and
writing are both affected, and there is difficulty in carrying out complex instructions, even though understanding
for both speech and writing may be preserved. The patient finds it difficult to choose and pronounce words, and
speech is hesitant and slow; they recognize their errors, try to correct them and are clearly upset. Gesture may be
used to replace verbal communication. Speech is attempted and recognized as spoken words, but words are omitted
and sentences shortened, and perseveration occurs.
 Motor Dysphasia

Alexia with Agraphia

• In alexia with agraphia, the patient is unable to read or write, but speaking and understanding speech are
preserved. Alexia in this condition is similar to that of pure word blindness: the patient cannot understand words
that are spelt out aloud, showing that they are effectively illiterate because of disturbance of the visual symbolism
of language.

Isolated Speech Area

• Two types, expressive and receptive, are described: transcortical motor dysphasia and transcortical sensory
dysphasia.
• Verbigeration describes the repetition of words or syllables that expressive aphasic patients may use while
desperately searching for the correct word.
 Broca’s
Aphasia

Broca's Aphasia (Non-Fluent Aphasia) - YouTube

 MUTISM
• All the major categories of psychiatric disorder may manifest mutism: learning disability, organic
brain disease (sometimes drug related), functional psychosis and neurosis and personality disorder.
Some more specific causes include depressive illness, catatonic schizophrenia and dissociative
disorder.

• Mutism occurs as an essential element of stupor, and it is necessary to assess the level of
consciousness as part of a full neurologic examination for all patients with this sign.
• no lowering of consciousness : psychoses and neuroses, it is likely that the mute patient
understands everything that is said around them.
Schizophrenic Language Disorder
Schizophrenic Language Disorder
• Misuse of Words and Phrases
These are called stock words or phrases, and their use will sometimes become obvious in a longer conversation in which an
unusual word or expression may be used several times.
neologism

• Destruction of Words and Grammar

• Alogia : negative thought disorder, or poverty of thoughts as expressed in words.
• Paralogia : positive thought disorder, or the intrusion of irrelevant or bizarre thought.
• Paraphasia : destruction of words with interpolation of more or less garbled sounds. Although the patient is only able
to produce this nonverbal sound, it clearly has significance or meaning to them.
• Literal paraphasia : gross misuse of the meaning of words to such an extent that statements no longer make any
sense.
• Verbal paraphasia describes the loss of the appropriate word but the statements are still meaningful, for example a
patient described a chair as ‘a four-legged sit-up’.
• Agrammatism : grammar is also sometimes altered; the loss of parts of speech
• Telegramese : Adverbs are occasionally lost, resulting in coarsening and poverty of sentences
• Paragrammatism : mass of complicated clauses that make no sense in achieving the goal of thought.
 PSYCHOGENIC ABNORMALITIES

• Hysterical mutism may occur as an abnormal reaction to stress.

• A man aged 35 had been unable to tolerate the continual nagging from
his wife and her two sisters who lived with them. One day, after heavy
drinking the previous evening, he smashed his wife’s furniture at
home and then became mute for 24 hours. He was eventually referred
from the accident and emergency department to the psychiatric ward,
and speech returned gradually over the next 2 to 3 days without other
treatment.
LINGUISTIC APPROACHES TO SCHIZOPHRENIA

Syntactical Analysis
• In studies of speech analysed for syntax, compared with manic and normal controls, patients with schizophrenia
showed less complex speech, fewer well-formed sentences, more semantic and syntactic errors and less
fluency. There were also marked use of paraphrasias, agrammatisms, anomia, pronoun word problems
circumlocutions, etc. These problems seemed to be associated with a general intellectual impairment.

Propositional Analysis
• Normal speech is considered to proceed as in a single tree diagram with all branches leading from a single key
proposition, but psychotic speech more often breaks the ‘rules’ of propositional relationships. Observers, listening
to the speech of patients with schizophrenia, are often struck with its oddity and deviance.
• Chaika (1995) : this is not purely a deficit of syntax but more a phenomenon like severe and repeated slips of the
tongue, in which the error is a lapse of executive control, a lapse of volition.
• Morice (1995) : with increasing complexity of syntax there is an increase in the number of errors in the speech of
patients with schizophrenia; speakers expressing very simple sentences made relatively few errors. One of his
patients expressed this: ‘and communicating ordinarily I can get lost in the chaos of the language’.
Hatur Nuhun…