Language and speech disorder

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'Speech disorder' refers to defects in the ability to generate and pronounce verbal statements, whereas 'language disorder' designates deficits in the use of language.(.51> In view of frequent difficulties in making this distinction, the two terms are often used interchangeably.

In medical nomenclature the prefix 'a' denotes the complete loss of an ability, and the prefix 'dys' denotes a less pronounced impairment. However, this principle is not always followed strictly. Thus the terms 'aphasia' and 'dysphasia' are often used synonymously.

Disturbed generation and pronounciation of words

Aphonia designates the inability to vocalize. Thus whispering occurs in somatic illnesses (paralysis of cranial nerve IX or diseases of the vocal cords) and hysteria. Dysphonia is a somatic impairment with hoarseness.

Dysarthria refers to disorders of articulation occurring in various malformations or diseases which impair the mechanisms of phonation, in lesions of the brain stem, in schizophrenia, and in psychogenic disorders.

The causes of stuttering and stammering are still unclear, but they are often considered to be of neurotic origin. Logoclonia (the spastic repetition of syllables) occurs in parkinsonism (paralysis agitans).

Disturbances in talking

'Disturbances in talking' was proposed by Scharfetter (41> as a generic term for disorders of speech or language not belonging to the preceding group of disturbances. Changes in volume of sound and in intonation occur in affective and schizophrenic states, and refer to loud excited and quiet monotonous speech.

Bradyphasia (decelerated talking) and tachyphasia (accelerated talking) occur in mood disorders, schizophrenia, and organic dysphasias. Logorrhea (verbosity) is observed in various disorders, especially in manic states.

Alogia (poverty of speech) is a decrease in spontaneous talking; it occurs in depression and schizophrenia.

In poverty of content of speech the amount of speech is adequate but conveys little information. This is often related to schizophrenic disorganization of thinking.

Verbigeration is the monotonous repetition of syllables and words observed in organic language disorders, schizophrenia, and agitated depression.

Echolalia is the repetition of words or parts of sentences that are spoken by others. It can be observed in schizophrenia, organic states, and subnormality.

Sometimes patients give approximate answers, i.e. they avoid giving correct answers to questions that they have obviously understood. This occurs in organic disorders, schizophrenia, and hysteria.

Paraphasia is often used as a synonym for approximate answers. More strictly defined, it denotes the enunciation of an inappropriate sound instead of a word or phrase. This happens in organic speech disorders but may also have psychogenic causes.

Speech may be unintelligible for various reasons. Paragrammatism and parasyntax(loss of grammatical and syntactical coherence) occur in organic mental disorders and excited manic states, and in schizophrenics whose severe thought derailments become manifest as 'word salad'. Private symbolism can be observed in schizophrenics in three forms: use of existing words with a particular symbolic meaning, creation of 'neologisms' (new words with an idiosyncratic meaning), and production of a private incomprehensible language, which may be spoken (cryptolalia) or written (cryptographia).

Mutism (refraining from speech) may be found in various kinds of psychiatric disorder. It is a cardinal feature of stupor and also occurs as a 'hysterical' reaction to stress.

Pseudologia fantastica is characterized by excessive fluent lying which is developed into a fantastic construct. This 'mythomania' occurs in hysterical and asocial personality disorders.

Organic language disorders

This term embraces impairments of spontaneous language, naming, writing, and reading, occurring as a result of differently localized brain dysfunctions, which are sometimes combined. These disorders can be divided into 'sensory' (receptive) and 'motor' (expressive) defects containing the following principal subcategories. Dysphasic patients often present with a mixture of receptive and expressive disturbances.

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