Graphorrhea

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In psychology, graphorrhea, or graphorrhoea, is a communication disorder expressed by excessive wordiness with minor or sometimes incoherent rambling, specifically in written work. [1] Graphorrhea is most commonly associated with schizophrenia [2] [3] [4] [5] but can also result from several psychiatric and neurological disorders such as aphasia, thalamic lesions, temporal lobe epilepsy [6] and mania. Some ramblings may follow some or all grammatical rules but still leave the reader confused and unsure about what the piece is about.

Contents

Characteristics

Graphorrhea can be distinguished in several ways. The patients’ writing has a tendency to look ‘scrawled’ and it does not abide usual grammar regulations. The content produced is, for the most part, meaningless and hard to understand.

In recent years, there have been developments in determining the presence of graphorrhoea. For example, digital phenotyping uses computerized measurement tools to apprehend the characteristics of a psychiatric disorder. In the case of schizophrenia, behavioural symptoms, such as graphorrhea, are being objectified and quantified under ‘e-semiotics’ (the study of electronic signs and their interpreted meanings). The anticipated result of the new computerized system is that patients with manic episodes will have an easier way to ‘write’ their thoughts using SMS (short message service). The aim of using these computerised tools to diagnose graphorrhoea is to evaluate the cognitive functions of schizophrenia patients in a more precise manner. The patients’ thoughts will appear more ordered and easier to follow as a result, to determine how ‘disorganised’ they really are and the degree to which the patient is able to communicate through writing. [7]

Associations with schizophrenia

Graphorrhea is a communication disorder that particularly targets the individual’s ability to communicate through writing, which is considered a by-product of disorganized speech experienced with schizophrenia. [8]

Common symptoms of schizophrenia include thought disorder, which is related to the presence of graphorrhoea. The inability to structure thoughts renders methods of communication: speech and writing. An example of a disease, where troubles with speech negatively affect writing skill is speech articulation disorder. Its symptoms include incomprehensive speech that impacts the ability of  transcription (spelling skills). Transcription is crucial for transforming ideas into language. [9] Language and communication dysfunctions in schizophrenia are usually referred to as a jumbled speech, which  affects patients’ writing ability making writing unclear and poorly organized. [10]

The pathophysiology of schizophrenia links the disorder with a dysregulation of multiple neural pathways, neurotransmitters damaged by the disease result in failed interactions between different receptors; [11] damage to the dopamine neurotransmitter is commonly observed in schizophrenic patients. [12] This failed interaction between dopamine receptors is associated with poor cognitive task performance affecting the measures of goal maintenance (GM) and the working memory (WM), [13] necessary to produce understandable writing. GM and WM are critical for cognitive control. Goal maintenance is to find which specific actions are needed to enforce a certain outcome. [14] The working memory is crucial for administering these goal-directed behaviours. The information is stored and used in the working memory temporarily, to perform the given task. [15] Damage to either drastically limits cognitive capabilities or produces symptoms of graphorrhea.

Treatment of 'graphorrheic' symptoms

The issue with negative symptoms of schizophrenia, such as graphorrhoea, is that available schizophrenia treatments tend to ignore them and focus on treating the positive symptoms of the disease. Negative symptoms play a critical role in the cognitive decline seen in schizophrenic individuals. Identifying early signs of schizophrenia will help eradicate further progression of the disease, thus, the recognition of these symptoms becomes more significant. [16]

In terms of current treatment for schizophrenic symptoms related to graphorrhoea, at first instance antipsychotics are offered to the patient and then a course of maintenance therapy. The initial goal of the treatment is to restore patient’s ‘normal’ routine e.g., eating and sleeping. Once a point of stability is reached, maintenance therapy addresses self-care and mood dysfunctions in order to avoid relapse of an acute psychotic episode. [17] Such treatments aim to improve mental well- being of an individual and increase the chances of finding a structure to their thoughts. Organized thoughts will mitigate symptoms of graphorrhea.

Associations with aphasia

Aphasia is a disorder diminishing the ability to understanding and formulating language, [18] which includes a difficulty in communicating through writing (graphorrhea). It is caused by serious brain damage to the left hemisphere, which is responsible for speech and language comprehension. [19]

The specific type of aphasia with similar symptoms to Graphorrhea is called jargon aphasia. It is a disorder resulting in produced speech beings incoherent to listeners; is inability to communicate through speech is the result of violating grammatical rules or the overuse of invented words. [20] Apparent symptoms of jargon aphasia directly translate into writing and are then classified as graphorrhoea.

A notable early example of graphorrhoea is given below: a 71-year-old ex-physician suffering with aphasia, who, although had adequate speech fluency, his produced speech was incomprehensive, which then translated into jumbled writing. The nature of his speech is clearly demonstrated in the following conversation:

Question: What is this, Doctor G……? (A pen is shown)

Answer: Kind of ateuna is emessage, card.

Question: What do you use it for?

Answer: This is a tape of brouse to make buke deproed in the auria. [21]

On average throughout the conversation only a limited few words were used correctly, whereas the remainder were jargon and lengthy unintelligible sentences. Much like his writing, fluent and abrupt yet appeared to be ‘meaningless scribbles’, again, with a limited correct use of words. [21]

Likewise, patients of crossed aphasia have displayed severe written language deficits. The difference with crossed aphasia is that it is caused by a right-hemisphere lesion, nonetheless victims still suffer from similar writing complications.

Unlike schizophrenia, the individual’s writing ability is most seriously impaired in aphasia. Individuals experience that there is a widely recognised discrepancy between oral and written ability; this discrepancy occurred in around 35% of the individuals and 64% of them demonstrated that their written language ability was worse. [22]

Treatment of 'graphorrheic' symptoms

To improve aphasic individual’s ‘graphorrheic’ symptoms, the orthographic retraining method using a mobile phone keyboard has appeared effective. The treatment tackled the use mobile phone typing to re-educate single word spelling to patients suffering with severe aphasia. However, the results of the study demonstrated that in fact handwriting better maintained progress made by the patients. Typing simply utilises motor movements and spatial memory of the keys, unlike handwriting which makes use of individual allographs needed to differentiate between each letter. These peripheral skills necessary for handwriting impacted the corrective process of written communication more efficiently, in individuals suffering with aphasia. [23]

See also

Related Research Articles

<span class="mw-page-title-main">Aphasia</span> Inability to comprehend or formulate language

In aphasia, a person may be unable to comprehend or unable to formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in the Global North. Aphasia can also be the result of brain tumors, epilepsy, brain damage and brain infections, or neurodegenerative diseases.

<span class="mw-page-title-main">Expressive aphasia</span> Language disorder involving inability to produce language

Expressive aphasia, also known as Broca's aphasia, is a type of aphasia characterized by partial loss of the ability to produce language, although comprehension generally remains intact. A person with expressive aphasia will exhibit effortful speech. Speech generally includes important content words but leaves out function words that have more grammatical significance than physical meaning, such as prepositions and articles. This is known as "telegraphic speech". The person's intended message may still be understood, but their sentence will not be grammatically correct. In very severe forms of expressive aphasia, a person may only speak using single word utterances. Typically, comprehension is mildly to moderately impaired in expressive aphasia due to difficulty understanding complex grammar.

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Receptive aphasia</span> Language disorder involving inability to understand language

Wernicke's aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent speech, which is characterized by typical speech rate, intact syntactic abilities and effortless speech output. Writing often reflects speech in that it tends to lack content or meaning. In most cases, motor deficits do not occur in individuals with Wernicke's aphasia. Therefore, they may produce a large amount of speech without much meaning. Individuals with Wernicke's aphasia are typically unaware of their errors in speech and do not realize their speech may lack meaning. They typically remain unaware of even their most profound language deficits.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations, delusions, and disorganized thinking. Other symptoms include social withdrawal, and flat affect. Symptoms typically develop gradually, begin during young adulthood, and in many cases never become resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. To be diagnosed with schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially substance use disorders, depressive disorders, anxiety disorders, and obsessive–compulsive disorder.

Clanging is a symptom of mental disorders, primarily found in patients with schizophrenia and bipolar disorder. This symptom is also referred to as association chaining, and sometimes, glossomania.

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions - all disturbances of thought content and form. Two specific terms have been suggested — content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: a disruption of the form of thought. Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses. Disorganized speech leads to an inference of disorganized thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. One of the first known cases of thought disorders, or specifically OCD as we know it today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."

In psychology, alogia is poor thinking inferred from speech and language usage. There may be a general lack of additional, unprompted content seen in normal speech, so replies to questions may be brief and concrete, with less spontaneous speech. This is termed poverty of speech or laconic speech. The amount of speech may be normal but conveys little information because it is vague, empty, stereotyped, overconcrete, overabstract, or repetitive. This is termed poverty of content or poverty of content of speech. Under Scale for the Assessment of Negative Symptoms used in clinical research, thought blocking is considered a part of alogia, and so is increased latency in response.

Schizotypal personality disorder, also known as schizotypal disorder, is a cluster A personality disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classification describes the disorder specifically as a personality disorder characterized by thought disorder, paranoia, a characteristic form of social anxiety, derealization, transient psychosis, and unconventional beliefs. People with this disorder feel pronounced discomfort in forming and maintaining social connections with other people, primarily due to the belief that other people harbor negative thoughts and views about them. Peculiar speech mannerisms and socially unexpected modes of dress are also characteristic. Schizotypal people may react oddly in conversations, not respond, or talk to themselves. They frequently interpret situations as being strange or having unusual meanings for them; paranormal and superstitious beliefs are common. Schizotypal people usually disagree with the suggestion that their thoughts and behaviors are a 'disorder' and seek medical attention for depression or anxiety instead. Schizotypal personality disorder occurs in approximately 3% of the general population and is more commonly diagnosed in males.

Anosognosia is a condition in which a person with a disability is cognitively unaware of having it due to an underlying physical or psychological condition. Anosognosia can result from physiological damage to brain structures, typically to the parietal lobe or a diffuse lesion on the fronto-temporal-parietal area in the right hemisphere, and is thus a neuropsychiatric disorder. A deficit of self-awareness, it was first named by the neurologist Joseph Babinski in 1914. Phenomenologically, anosognosia has similarities to denial, which is a psychological defense mechanism; attempts have been made at a unified explanation. Anosognosia is sometimes accompanied by asomatognosia, a form of neglect in which patients deny ownership of body parts such as their limbs. The term is from Ancient Greek ἀ- a-, 'without', νόσος nosos, 'disease' and γνῶσις gnōsis, 'knowledge'. It is also considered a disorder that makes the treatment of the patient more difficult, since it may affect negatively the therapeutic relationship.

The dopamine hypothesis of schizophrenia or the dopamine hypothesis of psychosis is a model that attributes the positive symptoms of schizophrenia to a disturbed and hyperactive dopaminergic signal transduction. The model draws evidence from the observation that a large number of antipsychotics have dopamine-receptor antagonistic effects. The theory, however, does not posit dopamine overabundance as a complete explanation for schizophrenia. Rather, the overactivation of D2 receptors, specifically, is one effect of the global chemical synaptic dysregulation observed in this disorder.

<span class="mw-page-title-main">Thought broadcasting</span> Delusion that others can hear oneselfs thoughts

Thought broadcasting is a form of delusional condition wherein the individual believes that others can hear their inner thoughts. The person may hold the belief that either those nearby can perceive their thoughts or that their thoughts are being transmitted via mediums, such as television, radio or the internet.

An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person would hear a sound or sounds which did not come from the natural environment.

Muteness or mutism is defined as an absence of speech while conserving or maintaining the ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, caregivers, teachers, doctors or speech and language pathologists. It may not be a permanent condition, as muteness can be caused or manifest due to several different phenomena, such as physiological injury, illness, medical side effects, psychological trauma, developmental disorders, or neurological disorders. A specific physical disability or communication disorder can be more easily diagnosed. Loss of previously normal speech (aphasia) can be due to accidents, disease, or surgical complication; it is rarely for psychological reasons.

In psychology, logorrhea or logorrhoea is a communication disorder that causes excessive wordiness and repetitiveness, which can cause incoherency. Logorrhea is sometimes classified as a mental illness, though it is more commonly classified as a symptom of mental illness or brain injury. This ailment is often reported as a symptom of Wernicke's aphasia, where damage to the language processing center of the brain creates difficulty in self-centered speech.

Thought blocking is a neuropsychological symptom expressing a sudden and involuntary silence within a speech, and eventually an abrupt switch to another topic. Persons undergoing thought blocking may utter incomprehensible speech; they may also repeat words involuntarily or make up new words. The main causes of thought blocking are schizophrenia, anxiety disorders, petit mal seizures, post-traumatic stress disorder, bradyphrenia, aphasia, dementia and delirium.

Jargon aphasia is a type of fluent aphasia in which an individual's speech is incomprehensible, but appears to make sense to the individual. Persons experiencing this condition will either replace a desired word with another that sounds or looks like the original one, or has some other connection to it, or they will replace it with random sounds. Accordingly, persons with jargon aphasia often use neologisms, and may perseverate if they try to replace the words they can not find with sounds.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

In psychiatry, stilted speech or pedantic speech is communication characterized by situationally inappropriate formality. This formality can be expressed both through abnormal prosody as well as speech content that is "inappropriately pompous, legalistic, philosophical, or quaint". Often, such speech can act as evidence for autism spectrum disorder (ASD) or a thought disorder, a common symptom in schizophrenia or schizoid personality disorder.

Metacognitive training (MCT) is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive–compulsive disorder and borderline over the years. It was developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of cognitive behavioral therapy, but focuses in particular on problematic thinking styles that are associated with the development and maintenance of positive symptoms, e.g. overconfidence in errors and jumping to conclusions. Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).

References

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  22. ↑ Coppens, Patrick; Hungerford, Suzanne (2001-09-01). "Crossed aphasia: Two new cases". Aphasiology. 15 (9): 827–854. doi:10.1080/02687040143000249. ISSN   0268-7038. S2CID   145322710.
  23. ↑ Beeson, Pélagie M.; Higginson, Kristina; Rising, Kindle (2013). "Writing Treatment for Aphasia: A Texting Approach". Journal of Speech, Language, and Hearing Research. 56 (3): 945–955. doi:10.1044/1092-4388(2012/11-0360). ISSN   1092-4388. PMC   3929384 . PMID   23811474.
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