Tangential speech

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Tangential speech or tangentiality is a communication disorder in which the train of thought of the speaker wanders and shows a lack of focus, never returning to the initial topic of the conversation. [1] It tends to occur in situations where a person is experiencing high anxiety, as a manifestation of the psychosis known as schizophrenia , in dementia or in states of delirium. [2] It is less severe than logorrhea and may be associated with the middle stage in dementia. [1] It is, however, more severe than circumstantial speech, in which the speaker wanders but eventually returns to the topic. [3]

Contents

Some adults with right hemisphere brain damage may exhibit behavior that includes tangential speech. [4] Those who exhibit these behaviors may also have related symptoms such as seemingly inappropriate or self-centered social responses, and a deterioration in pragmatic abilities (including appropriate eye contact as well as topic maintenance). [5]

Definition

The term refers simplistically to a thought disorder shown from speech with a lack of observance to the main subject of discourse, such that a person whilst speaking on a topic deviates from the topic. Further definition is of speech that deviates from an answer to a question that is relevant in the first instance but deviates from the relevancy to related subjects not involved in a direct answering of the question. [6] [7] [8] In the context of a conversation or discussion the communication is a response that is ineffective in that the form is inappropriate for adequate understanding. [9] The person's speech seems to indicate that their attention to their own speech has perhaps in some way been overcome during the occurrence of cognition whilst speaking, causing the vocalized content to follow thought that is apparently without reference to the original idea or question; or the person's speech is considered evasive in that the person has decided to provide an answer to a question that is an avoidance of a direct answer. [2]

History

The earlier phenomenological description (Schneider 1930;et al.) allowed for further definition on the basis of formal characteristic rather than content, producing later practice relying upon clinical assessment (Andreasen 1979). [10] The term has undergone a re-definition to refer only to a person's speech in response to a question, and to provide the definition separation from the similar symptoms loosening of association and derailment (Andreasen 1979). [6] [11]

Other

According to the St. Louis system for the diagnosis of schizophrenia, [12] tangentiality is significantly associated with a low IQ prior to diagnosis (AU Parnas et al 2007). [13]

See also

Related Research Articles

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">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.

A word salad, or schizophasia, is a "confused or unintelligible mixture of seemingly random words and phrases", most often used to describe a symptom of a neurological or mental disorder. The term schizophasia is used in particular to describe the confused language that may be evident in schizophrenia. The words may or may not be grammatically correct, but are semantically confused to the point that the listener cannot extract any meaning from them. The term is often used in psychiatry as well as in theoretical linguistics to describe a type of grammatical acceptability judgement by native speakers, and in computer programming to describe textual randomization.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Disorganized schizophrenia, or hebephrenia, was a subtype of schizophrenia prior to 2013. Subtypes of schizophrenia were no longer recognized as separate conditions in the DSM 5, published in 2013. The disorder is no longer listed in the 11th revision of the International Classification of Diseases (ICD-11).

Pressure of speech is a speech fast and frenetic, including some irregularities in loudness and rhythm or some degrees of circumstantiality; it is hard to interpret and expresses a feeling/affect of emergency. It is mainly a neuropsychological symptom of specific mental disorders, like bipolar disorders, thought disorders, stress-related disorders, etc. – see below.

This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry in Europe.

In psychiatry, derailment categorises any speech that sequences of unrelated or barely related ideas compose; the topic often changes from one sentence to another.

The word schizophrenia was coined by the Swiss psychiatrist Eugen Bleuler in 1908, and was intended to describe the separation of function between personality, thinking, memory, and perception. He introduced the term on 24 April 1908 in a lecture given at a psychiatric conference in Berlin and in a publication that same year. Bleuler later expanded his new disease concept into a monograph in 1911, which was finally translated into English in 1950.

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.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States

Circumstantial speech, also referred to as circumstantiality, is the result of a so-called "non-linear thought pattern" and occurs when the focus of a conversation drifts, but often comes back to the point. In circumstantiality, apparently unnecessary details and seemingly irrelevant remarks cause a delay in getting to the point.

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.

Simple-type schizophrenia is a sub-type of schizophrenia included in the International Classification of Diseases (ICD-10), in which it is classified as a mental and behaviour disorder. It is not included in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the upcoming ICD-11, effective 1 January 2022. Simple-type schizophrenia is characterized by negative ("deficit") symptoms, such as avolition, apathy, anhedonia, reduced affect display, lack of initiative, lack of motivation, low activity; with absence of hallucinations or delusions of any kind.

The Scale for the Assessment of Negative Symptoms (SANS) is a rating scale that mental health professionals use to measure negative symptoms in schizophrenia. Negative symptoms are those conspicuous by their absence—lack of concern for one's appearance, and lack of language and communication skills, for example. Nancy Andreasen developed the scale and first published it in 1984. SANS splits assessment into five domains. Within each domain it rates separate symptoms from 0 (absent) to 5 (severe). The scale is closely linked to the Scale for the Assessment of Positive Symptoms (SAPS), which was published a few years later. These tools are available for clinicians and for research.

Within psychological testing, the Scale for the Assessment of Positive Symptoms (SAPS) is a rating scale to measure positive symptoms in schizophrenia. The scale was developed by Nancy Andreasen and was first published in 1984. SAPS is split into 4 domains, and within each domain separate symptoms are rated from 0 (absent) to 5 (severe). The scale is closely linked to the Scale for the Assessment of Negative Symptoms (SANS) which was published a few years earlier.

A self-disorder, also called ipseity disturbance, is a psychological phenomenon of disruption or diminishing of a person's minimal self – the fundamental sense that one's experiences are truly one's own. People with self-disorder feel that their internal experiences are actually external; for example, they may experience their own thoughts as coming from outside themselves, whether in the form of true auditory hallucinations or merely as a vague sense that their thoughts do not belong to them.

References

  1. 1 2 Forensic Aspects of Communication Sciences and Disorders by Dennis C. Tanner 2003 ISBN   1-930056-31-1 page 289
  2. 1 2 G. David Elkin (1999). Introduction to clinical psychiatry. McGraw-Hill Professional - 1999. ISBN   9780838543337 . Retrieved 2012-01-17.
  3. ↑ Crash Course: Psychiatry by Julius Bourke, Matthew Castle, Alasdair D. Cameron 2008 ISBN   0-7234-3476-X page 255
  4. ↑ Introduction to Neurogenic Communication Disorders by Robert H. Brookshire 1997 ISBN   0-323-04531-6 page 393
  5. ↑ Perspectives on Treatment for Communication Deficits Associated With Right Hemisphere Brain Damage by Margaret Lehman Blake 2007 ISSN   1058-0360 page 333
  6. 1 2 P. J. McKenna, Tomasina M. Oh Schizophrenic speech: making sense of bathroots and ponds that fall in doorways - 210 pages. Cambridge University Press, 2005. 2005-02-17. ISBN   9780521810753 . Retrieved 2012-01-12. ISBN   0-521-81075-2
  7. ↑ Tali Ditman & Gina R. Kuperberg Building coherence : A framework for exploring the breakdown of links across clause boundaries in schizophrenia. Martinos Center for Biomedical Imaging. Retrieved 2012-01-17.
  8. ↑ Howard H. Goldman 2000 - Review of general psychiatry - 583 pages A Lange medical book McGraw-Hill Professional, Retrieved 2012-01-17 ISBN   0-8385-8434-9
  9. ↑ Jeffrey A. Lieberman, T. Scott Stroup, Diana O. Perkins 2011 Essentials of Schizophrenia - 268 pages American Psychiatric Pub, 2 Jun 2011 Retrieved 2012-01-12 ISBN   1-58562-401-2
  10. ↑ S.J.Wood, N.B.Allen & C.Pantelis (Editors) 2009 - The Neuropsychology of Mental Illness Cambridge University Press Archived 2016-03-04 at the Wayback Machine Retrieved 2012-01-17 ISBN   978-0-521-86289-9
  11. ↑ Branca Telles Ribeiro 23 Jun 1994 - Coherence in psychotic discourse - 320 pages Oxford studies in sociolinguistics Oxford University Press, Retrieved 2012-01-17 ISBN   0-19-506615-4
  12. ↑ Stephens, J. H.; Astrup, C.; Carpenter Jr, W. T.; Shaffer, J. W.; Goldberg, J. (1982). "A comparison of nine systems to diagnose schizophrenia". Psychiatry Research. 6 (2): 127–43. doi:10.1016/0165-1781(82)90001-4. PMID   6953455. S2CID   9781596.
  13. ↑ Urfer Parnas, A.; Jansson, L.; Handest, P.; Nielsen, J.; Sæbye, D.; Parnas, J. (2007). "Premorbid IQ varies across different definitions of schizophrenia". World Psychiatry. 6 (1): 38–41. PMC   1805734 . PMID   17342225.
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