Thought, Language And Communication Disorders: A Case Study

and
Communication Disorders

Thought, Language,
I. Clinical

Assessment, Definition of Terms, and Evaluation of Their Reliability

Nancy C. Andreasen,

MD

psychiatry has considered thought disorder to be pathognomonic symptom of schizophrenia. Evaluation of the
\s=b\ Bleulerian

a

Bleulerian perspective has been severely handicapped by the lack of any standard and widely agreed-on definition of thought disorder. Consequently, the conceptualization of thought disorder has tended to be quite diverse, and evaluation of thought disorder has tended to be quite unreliable. This report presents a set of definitions of linguistic and cognitive behaviors frequently observed in patients. These definitions derive from clinical
And I am I think becoming more aware that perhaps on an analogy the matter of some who understand or enjoy loud rages of anger, the same thing can be true for other people, and I have to kind of try to learn to see when that 's true and what I can do about it."
Pressure of Speech.-An increase in the amount of spon¬ taneous speech as compared with what is considered ordinary or socially customary. The patient talks rapidly and is difficult to interrupt. Some sentences may be left uncompleted because of eagerness to get on to a new idea.
Simple questions that could be answered in only a few words or sentences will be answered at great length, so that the answer takes minutes rather than seconds and indeed may not stop at all if the speaker is not interrupted.
Even when interrupted, the speaker often continues to talk. Speech tends to be loud and emphatic. Sometimes speakers with severe pressure will talk without any social stimulation and talk even though no one is listening. When patients are receiving phenothiazines or lithium carbonate, their speech is slowed down by medication, and then it can be judged only on the basis of amount, volume, and
Although less severe derailments (ie, those in which the relationship between juxtaposed ideas is oblique) have sometimes been referred to in the past as tangentiality or as flight of ideas when in the context of mania, such distinctions are not recommended because they tend to be unreliable. Flight of ideas is a derailment that occurs rapidly in the context of pressured speech. Tangentiality has been defined herein as a different phenomenon in that it occurs as the immediate response to a question.
Exclusions.—Derailment differs from circumstantiality in that each new subject is only obliquely related or even unrelated to the previous one and is not a further illustra¬ tion or amplification of the same idea or subject. It may lead to loss of goal, but the speaker may also realize that he has gotten off the track and return to his original subject, and this should also be considered derailment.
Example.—Interviewer: "What did you think of the whole Watergate affair?" Patient: "You know I didn 't tune in on that, I felt so bad about it. I said, boy, I 'm not going to know what 's going on in this. But it seemed to get so murky, and everybody 's reports were so negative. Huh,