DOCSLIB.ORG

A General Overview

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A General Overview The psychopathology of language disorders A general overview J. Cutting Honorary Senior Lecturer, Institute of Psychiatry, London, UK Summary ject is in urgent need of a new approach, and the phenomeno- I provide an overview of the subject within which the other con- logical studies in this special issue are thus very timely. tributions to this special issue can be placed. The approach is descriptive rather than phenomenological, and my own view is Key words that the descriptive psychopathology in this area is a muddle. Linguists have made most progress so far, which is why I have Formal thought disorder • Aphasia • Non-aphasic misnaming • emphasised their contribution. My further view is that the sub- Schizophrenia Introduction age could cause a language disorder was subsequently widened to include Wernicke’s area, and the area in be- If spoken language is a species of signs, we can first di- tween this and Broca’s area), it was still a very small part vide the psychopathological material into disordered of the overall brain. sign systems of all sorts, including disordered spoken When language disorders were subsequently encoun- language. The other sign systems for which there is a psy- tered in patients with damage outside this classic region, chopathological literature are written language, music, it was considered that some other name should be given numbers and sign language for the deaf, each with their to these – hence non-aphasic misnaming – even though it corresponding expressive and receptive disorders (not was acknowledged that some aphasic patients with a le- considered further here). sion within the classic zone could have purely misnaming Within the confines of spoken language disorder, we can problems, a condition which was called nominal aphasia. 1 follow Saussure and distinguish la langue (the structure The paradoxical use of the term formal thought disorder of language) from la parole (speech). This gives two major to refer to a disorder of language arose because Bleuler 4 classes of language disorder – disordered language struc- considered thought disorder to be the primary and funda- ture and speech disorder. Within each of these there are mental deficit in schizophrenia, a view with which Schil- various subclasses. der concurred. But whereas Bleuler believed that delu- The subclassification of speech disorder adopted is arbi- sions as well as peculiarities of speech stemmed from trary, but it should be uncontroversial because there are thought disorder, Schilder considered that some distinc- no serious problematical issues to consider. However, tion should be made in the two cases. He thought that a the subclassification of disordered language needs some disorder of the form of thought was to blame in the latter discussion, because the three major traditional varieties case – hence formal thought disorder – but that a disorder – aphasia, non-aphasic misnaming and formal thought of content of thought was evident in the former. disorder – overlap with respect to the pattern of linguistic Two further issues can be briefly mentioned. One is breakdown, and the third of these was called such be- the duplication of terms for the same psychopathologi- cause the person who named it 2 did not believe that it cal entity. This is due to the independent description of was a language disorder at all. a suggested entity by neurologists and psychiatrists. We The reasons for all this muddle are as follows. Each of the encounter this problem throughout the whole realm of varieties was described and named by virtue of their link psychopathology. with some purported cause. A second is a further multiplication of terms for the same Aphasia was the first specific mental disorder of any sort psychopathological entity owing to disputes about what to be attributed, by Broca 3, to a lesion of a specific area modality of the human state is involved. There are a mul- of the brain. Although the area of the brain where dam- titude of psychological terms for what is essential the same Correspondence Mill Wood, Wall Hill, Forest Row, East Sussex, England RH18 5EG • E-mail: [email protected] 48 Journal of Psychopathology 2016;22:48-54 A general overview sort of thing: schizophasia (neurological orientation), formal not an exact replica of what is heard, in that the pronouns thought disorder (cognitive orientation), ‘crazy talk’ (behav- are reversed, and it is delayed. The acquired variety 12 has iourist orientation), communication disorder (social orienta- been reported in Gilles de Ia Tourette syndrome 13. tion) and pragmatic language disorder (linguistic analysis). Speech automatisms may take the form of either stereo- There is also plethora of clinical terms for the same manner typed utterances during an epileptic discharge 14 or ‘in- of speaking: knight’s move thinking, derailment, tangential- trusive inner speech vocalizations… natterings’ 15 in the ity, loosening of associations and loss of goal. context of focal brain damage. Despite all these problems, the tripartite division into aphasia, non-aphasic misnaming and formal thought dis- Altered prosody order will be adhered to here because, as I shall show, Aprosody and dysprosody are synonymous terms for a there are linguistic distinctions to be found to support the disorder of what Monrad-Krohn 16, who first described it, otherwise dubious nosological considerations. referred to as the ‘melody of language’. Prosody is now regarded as separable into two components: the stress Varieties of speech disorder and rhythm with which a subject pronounces each pho- neme, which make up his or her regional and individual Altered amount of speech accent – usually referred to as stress prosody (sometimes Pressure of speech is a morbid speeding up of the rate as linguistic or propositional prosody); and the emotional of otherwise normal speech. It is characteristic of mania. valence in the subject’s speech – usually referred to as af- Logorrhoea refers to the same entity, although in a neuro- fective or emotional prosody. Each of these components logical context – epilepsy, focal brain damage 5. Fisher 6 can be disordered in the expressive or receptive mode, coined another term for the same sort of thing, in a neu- giving rise to four types of aprosody: expressive stress rological context, except that the content was nonsensi- aprosody; receptive stress aprosody; expressive emotion- cal – nonsense speech amphigory. al aprosody; and receptive emotional aprosody. Monrad- Anarthria, literally ‘lack of speech’, is used for the mark- Krohn 17 also referred to hyperprosody – an exaggeration edly reduced output of speech accompanying the early of all prosodic components – which he believed could stages of a brain lesion inside the classical language area. occur in mania. This tends to move on to a severe expressive aphasia. Expressive stress aprosody is the cause of the ‘foreign ac- Mutism is the equivalent psychiatric term. cent syndrome’ 18, where the patient speaks with an ac- Poverty of speech is inappropriately laconic speech, and, cent resembling that of a native of another country. Mon- although no different from anarthria, is the term used in rad-Krohn’s 16 first patient was a Norwegian who began the context of schizophrenia. speaking like a German, which was acutely embarrassing for her because this happened during the German oc- Altered fluency of speech cupation of Norway and she was branded a collabora- Stuttering (stammering) can be defined as ‘silent or audi- tor. Both expressive stress aprosody and receptive stress ble involuntary repetition or prolongation of an utterance aprosody are associated with left hemisphere damage 19. of a sound’ or ‘a sound improperly patterned in time and Expressive and receptive varieties of emotional aproso- the speaker’s reaction to it’ 7. It can be developmental or dy are associated with right- hemisphere damage 20 or acquired. The acquired form is usually a consequence of schizophrenia 21. Subjects cannot express emotion in multiple bilateral cerebrovascular lesions or, if unilateral, their voice such that normal raters can determine which left-sided lesions 8. Joseph 9 observed it in two cases of of a number of standard emotions they are supposed depressive illness. to be expressing, nor distinguish a designated standard Palilalia is the ‘compulsive repetition of a phrase or word emotion in someone else’s voice. which the patient reiterates with increasing rapidity and 11 with a decrescendo of voice volume’ . It is involuntary Varieties of Language Disorder and could be classified in the next section, but the ‘in- creasing speed and decreasing distinctiveness’ of the ut- Aphasia terance is its most striking characteristic 10. General considerations. Broca’s aphasia (expressive aphasia, motor aphasia) is a severe breakdown in the Involuntary speech structure of the language required for expression. At the Echolalia is the involuntary repetition of someone else’s outset there may be no speech at all (anarthria). Later, speech. It may be developmental or acquired. The devel- the pattern is predominantly one of phonemic and syn- opmental variety is usually part of infantile autism; it is tactical errors. 49 J. Cutting Conduction aphasia is a condition where the repetition Rosselli 31 define a neologism as a word which cannot be of speech is disproportionately affected relative to other traced back to any extant dictionary word, whereas they speech performance 22. The other structural components regard a word like ‘summerly’ as a paraphasia because it are usually abnormal, but the problem with repetition is appears to derive from summer. In my view, the solution an over-riding defining feature. Transcortical motor apha- to all this is to retain the single term paraphasia for all sia and transcortical sensory aphasia are conditions in inaccurate word selections, regardless of purported cause which the repetition of speech is relatively well preserved and regardless of whether the result sounds like a genu- compared with spontaneous expression in the former and ine word in the subject’s lexicon or not.
Load more

Recommended publications
  • Neurocase: the Neural Basis of Cognition Transient Paligraphia
    This article was downloaded by: [Florida International University] On: 16 June 2015, At: 04:31 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Neurocase: The Neural Basis of Cognition Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/nncs20 Transient paligraphia associated with severe palilalia and stuttering: A single case report Alfredo Ardila a , Monica Rosselli b , Cheri Surloff c & Jennifer Buttermore b a Instituto Colombiano de Neuropsicologia , Bogota, Colombia b Florida Atlantic University , Davie, Florida c Miami Institute of Psychology , Miami, FL, USA Published online: 17 Jan 2008. To cite this article: Alfredo Ardila , Monica Rosselli , Cheri Surloff & Jennifer Buttermore (1999) Transient paligraphia associated with severe palilalia and stuttering: A single case report, Neurocase: The Neural Basis of Cognition, 5:5, 435-440, DOI: 10.1080/13554799908402737 To link to this article: http://dx.doi.org/10.1080/13554799908402737 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information.
    [Show full text]
  • Formal Thought Disorder in First-Episode Psychosis
    Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 70 (2016) 209–215 www.elsevier.com/locate/comppsych Formal thought disorder in first-episode psychosis Ahmet Ayera, Berna Yalınçetinb, Esra Aydınlıb, Şilay Sevilmişb, Halis Ulaşc, Tolga Binbayc, ⁎ Berna Binnur Akdedeb,c, Köksal Alptekinb,c, aManisa Psychiatric Hospital, Manisa, Turkey bDepartment of Neuroscience, Dokuz Eylul University, Izmir, Turkey cDepartment of Psychiatry, Medical School of Dokuz Eylul University, Izmir, Turkey Abstract Formal thought disorder (FTD) is one of the fundamental symptom clusters of schizophrenia and it was found to be the strongest predictor determining conversion from first-episode acute transient psychotic disorder to schizophrenia. Our goal in the present study was to compare a first-episode psychosis (FEP) sample to a healthy control group in relation to subtypes of FTD. Fifty six patients aged between 15 and 45 years with FEP and forty five control subjects were included in the study. All the patients were under medication for less than six weeks or drug-naive. FTD was assessed using the Thought and Language Index (TLI), which is composed of impoverishment of thought and disorganization of thought subscales. FEP patients showed significantly higher scores on the items of poverty of speech, weakening of goal, perseveration, looseness, peculiar word use, peculiar sentence construction and peculiar logic compared to controls. Poverty of speech, perseveration and peculiar word use were the significant factors differentiating FEP patients from controls when controlling for years of education, family history of psychosis and drug abuse. © 2016 Elsevier Inc. All rights reserved. 1. Introduction Negative FTD, identified with poverty of speech and poverty in content of speech, remains stable over the course of Formal thought disorder (FTD) is one of the fundamental schizophrenia [7].
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research
    The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research World Health Organization Geneva The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of human resources for health, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; coordinating the global strategy for the prevention and control of AIDS; having achieved the eradication of smallpox, promoting mass immunization against a number of other
    [Show full text]
  • Chapter 4, and 2) the “Form” of Thought
    Pridmore S. Download of Psychiatry, Chapter 6. Last modified: February, 2020. 1 CHAPTER 6 FORM OF THOUGHT Introduction In the psychiatric examination, two aspects of thought are considered: 1) “content” - abnormal the content of thought (delusions) is described in Chapter 4, and 2) the “form” of thought. Form means the “arrangement of parts”. When the “arrangement of the parts” of thought are out of order, the logical connections between the ideas are lost – the thought is difficult to follow. Disorder in the form of thought (or formal thought disorder – FTD) is frequently, for the sake of brevity, referred to as ‘thought disorder’. Theoretically, ‘thought disorder’ could refer to disordered content (delusions), but in practice it is generally used to refer to FTD. [For the sake of convenience, “flight of ideas” and “poverty of thought”, which strictly speaking are not disorders of connection, but disorders of speed or amount of thought, will also be described in the paragraphs of this chapter.] FTD is diagnostically significant, and detection is important. While many health and social services workers can give a good account of some aspects of the mental state of a patient, the assessment of FTD requires special training and experience. The general public may comment that the patient’s speech is “odd”, he/she is ‘difficult to follow’, or ‘gets off the track’. The form of thought is mainly assessed by examining the speech of the patient. It is necessary to take the conventions of conversation into account when examining ‘form’. In everyday conversation we tend to ignore changes of subject and direction; we pay more attention to content and ‘the bottom line’.
    [Show full text]
  • Bipolar Disorder
    Unpacking Bipolar Disorder David C. Hall, MD Child Adolescent & Family Psychiatry Samaritan Center of Puget Sound February 8, 2011 Bipolar Disorders: Scope of the Problem ■ Bipolar I and II disorders occur in up to 4% of the population 1,2 ■ frequently begin in the mid to late-teens 3,4 ■ cause chronic disability 5-7 ■ characterized by recurrent and chronic symptoms with associated multiple psychiatric and medical comorbid conditions 1,2 ■ also excess and premature mortality and suicide 8-10 ■ Bipolar disorder has been listed among the top 10 causes of disability worldwide 7 ■ estimated to cost about $70 billion/year in 2008 dollars 11,12,15 Bipolar Disorders: Part I Understanding Diagnosis Whatever goes up must come down unless it goes into orbit Understanding the DSM Diagnostic and Statistical Manual, 4th Edition, Revised Published by the American Psychiatric Association ■ Committee determined symptom criteria ■ Based on peer reviewed literature and/or ■ Expert consensus ■ Disability or clear change from baseline lasting a week or more ■ Not accounted for by a broader category of illness or substance use ■ Designed to promote inter-rater consistency and credible research comparisons Bipolar Disorder: What is it? ■ A spectrum disorder of mood and cognition that has been described for centuries ■ Classification and treatments have developed mostly since the 1970’s ■ Psychotic levels of mania were often described as schizophrenia before then Diagnostic requirements ■ Symptoms meet full criteria for either ■ a major depressive episode in
    [Show full text]
  • Scale for the Assessment of Thought, Language, and Communication (TLC)
    VOL 12, NO. 3, 1986 Scale for the Assessment of Thought, Language, and Communication (TLC) by Nancy C. Andreasen The following set of definitions was or perceptual disorders) as manifesta- developed to improve the reliability tions of their schizophrenia. of assessments of "formal thought Because the term "formal thought disorder." In the past such assess- disorder" has been so misunderstood ments have been unreliable at least in and misused, it is recommended that part because clinicians and it no longer be used. The various researchers have not agreed upon the disorders which comprised the meaning of the terms which they concept of "formal thought disorder" have used. It is hoped that the can be better conceptualized as following definitions will provide a "disorders of thought, language, and common and reliable stock of terms communication." If viewed from an to describe the language and empirical perspective, most of them cognitive behaviors which can be are in fact disorders of commu- observed in psychiatric patients. nication, and the notion of thought This set of definitions began with a need only be invoked to explain a clinical recognition that the concept few of them. of "formal thought disorder" has That is, the following set of defini- often been misused and misunder- tions began with the idea that the stood. First, it has often been treated reliability of assessments could be as if it were unitary, but in fact it is improved if "thought disorder" were composed of a number of different defined in terms of language language behaviors which are behavior, and only behavior which conceptually divergent and not could be directly observed would be always correlated in the same evaluated.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders
    The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines World Health Organization -1- Preface In the early 1960s, the Mental Health Programme of the World Health Organization (WHO) became actively engaged in a programme aiming to improve the diagnosis and classification of mental disorders. At that time, WHO convened a series of meetings to review knowledge, actively involving representatives of different disciplines, various schools of thought in psychiatry, and all parts of the world in the programme. It stimulated and conducted research on criteria for classification and for reliability of diagnosis, and produced and promulgated procedures for joint rating of videotaped interviews and other useful research methods. Numerous proposals to improve the classification of mental disorders resulted from the extensive consultation process, and these were used in drafting the Eighth Revision of the International Classification of Diseases (ICD-8). A glossary defining each category of mental disorder in ICD-8 was also developed. The programme activities also resulted in the establishment of a network of individuals and centres who continued to work on issues related to the improvement of psychiatric classification (1, 2). The 1970s saw further growth of interest in improving psychiatric classification worldwide. Expansion of international contacts, the undertaking of several international collaborative studies, and the availability of new treatments all contributed to this trend. Several national psychiatric bodies encouraged the development of specific criteria for classification in order to improve diagnostic reliability. In particular, the American Psychiatric Association developed and promulgated its Third Revision of the Diagnostic and Statistical Manual, which incorporated operational criteria into its classification system.
    [Show full text]
  • The Mental State Examination 2
    2 The mental state examination Mental state examination Example Appearance and behaviour Appearance and behaviour: Mr Smith was a thin gentleman, appropriately dressed in casual clothes, with no evidence of poor personal hygiene or abnormal movements; he was not objectively hallucinating. He was polite, appropriate in behaviour, maintained good eye contact, and although it was initially difficult to establish a rapport, this improved throughout the interview. Speech and thought form Speech: normal in tone, rate and volume. Relevant and coherent, with no evidence Tone Flight of ideas of formal thought disorder. Rate Loosening of associations Volume Mood (subjective and objective) Mood: subjectively “fine”, objectively euthymic. Affect (observed) Affect: suspicious at times, particularly when discussing treatment; reactive. Thought content Thoughts: persecutory delusions and delusions of reference elicited. Could not Depressive/anxious Overvalued ideas “rule out” retaliating against neighbour, but no current thoughts, plans or intent to cognitions Ideas of reference harm neighbour, self or anyone else. No evidence of depressive cognitions or Preoccupations Delusions anxiety symptoms. No suicidal ideation. Obsessions Suicidal/homicidal Perception Perception: no abnormality detected Hallucinations Pseudo-hallucinations Illusions Cognition Cognition: alert, orientated to time, place and person. No impairment of concentration Consciousness Orientation or memory noted during interview. Attention/concentration Intelligence Memory Executive function Insight Insight: Patient believes he is stressed; he is aware that others think he has a psychotic illness but he disagrees with this. He does not want to receive any treatment and does not think he needs to be in hospital. He would be willing to see a counsellor for stress. Physical examination This chapter describes the information that should be reported in the spasm causing abnormal face and body movement or posture).
    [Show full text]
  • FLUENCY DISORDERS Definition
    Language and speech disorders available in this book are classified based on the diagnosis used in the Guidance Research Centers aliated with the Ministry of National Education. The disorders in the book are as below: Fluency Disorders, Language Disorders, Acquired Language Disorders, Speech Voice Disorders, Motor Speech Disorders, Voice Disorders, and Resonance Disorders. This book contains information on the definition, causes, characteristics, medical and educational diagnosis processes, education, training and treatment processes of each language and speech disorder. In addition, recommendations were made to the families and themselves of children with language and speech disorders. INDIVIDUALS WITH LANGUAGE AND SPEECH DIFFICULTIES “GUIDEBOOK FOR FAMILIES” EXECUTIVE DIRECTOR MEHMET NEZIR GÜL EDITORIAL DIRECTOR AHMET KAYA EDITOR PROF. DR. IBRAHIM H. DIKEN DR. MURAT AĞAR WRITERS DR. SEMA UZ HASIRCI M. ÖMER ARVAS REVISED BY M. ÖMER ARVAS ERDOĞAN MURATOĞLU PROJECT TEAM MURAT TANRIKOLOĞLU SERAP ERDEĞER GRAPHIC DESIGN / TRANSLATION AFS MEDYA PRINTING AND BINDING AFŞAR OFSET GENERAL ORDER PUBLICATION NO 7308 INTRODUCTORY PUBLICATIONS ORDER NO 174 ISBN 978-975-11-5496-5 “This publication was produced by the Ministry of National Education with the financial support of UNICEF. The opinions expressed in the publication are the individual’s own responsibility and in no way reflect the views and policies of the Ministry of National Education and UNICEF. “ CONTENTS 1. Introduction 2. Fluency Disorders 3. Language Disorders 4. Acquired Language Disorders 5. Speech Voice Disorders 6. Motor Speech Disorders 7. Voice Disorders 8. Resonance Disorders 9. Legal Rights 2 INTRODUCTION Hello dear parents - dear students, Life becomes even more meaningful for us as we get to know virtuous, talented and conscious students like you and their parents.
    [Show full text]
  • Psychiatric Terminology: Are Mental Health Practitioners Speaking the Same Language?
    PSYCHIATRIC TERMINOLOGY: ARE MENTAL HEALTH PRACTITIONERS SPEAKING THE SAME LANGUAGE? by NATALIA ANNE MCCARTHY BSW, The University of British Columbia, 1992 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK In THE FACULTY OF GRADUATE STUDIES (Social Work) THE UNIVERSITY OF BRITISH COLUMBIA August 2005 © Natalia Anne McCarthy, 2005 Abstract Mental health practitioners working in an interdisciplinary environment use psychopathology descriptors to formulate diagnoses, evaluate treatment response and communicate about patient care. Few studies have examined the specific meanings that practitioners ascribe to psychopathology descriptors. It is not clear whether practitioners attribute similar meanings to technical terms or if they effectively communicate these meanings to one another. Transcripts of 14 interviews with mental health practitioners in a provincial psychiatric hospital are analysed to determine whether variations exist in understood meanings of the terms manipulates and bizarre delusion. A rating scale is used to measure the degree of disagreement caused by 15 commonly used psychopathology descriptors. The findings suggest that interpretive variations and disagreements occur among interdisciplinary team members. This may result in negative outcomes for interdisciplinary teamwork and patient care. Further research and education are indicated. Table of Contents Abstract i» Table of Contents iii List of Figures v Introduction vi Acknowledgements viii Chapter 1: Literature Review 1 Language in Psychiatry 1 The Medical Model 2 Psychiatric Diagnosis 3 Are We Speaking the Same Language? _ _ 7 Chapter 2: Theoretical Foundations 9 Structuralism/Post-Structuralism: The Importance of Language 9 Social Constructionism 13 Chapter 3: Methodology ^ Sample 16 Data Collection 18 TheRAPP 19 20 Analysis Validity 21 Chapter 4: Findings 22 Experience and Training Related to Terminology 22 Perception of Role 22 Terms That Cause Interdisciplinary Disagreement 23 Ambiguous Terms.
    [Show full text]
  • The Clinical Examination of Children, Adolescents and Their Families
    IACAPAP Textbook of Child and Adolescent Mental Health Chapter INTRODUCTION A.5 THE CLINICAL EXAMINATION OF CHILDREN, ADOLESCENTS AND THEIR FAMILIES Thomas Lempp, Daleen de Lange, Daniel Radeloff & Christian Bachmann Thomas Lempp MD Department of Child and Adolescent Psychiatry, Goethe-University of Frankfurt, Germany Conflict of interest: none reported Daleen de Lange MD Okonguarri Psychotherapeutic Centre, Namibia Conflict of interest: none reported Daniel Radeloff MD Department of Child and Adolescent Psychiatry, Goethe-University of Frankfurt, Germany Conflict of interest: none reported Christian Bachmann MD Sherlock Holmes statue at Department of Child and Meiringen, Switzerland Adolescent Psychiatry, Charité (Wikipedia commons) - Universitätsmedizin Berlin, Germany This publication is intended for professionals training or practicing in mental health and not for the general public. The opinions expressed are those of the authors and do not necessarily represent the views of the Editor or IACAPAP. This publication seeks to describe the best treatments and practices based on the scientific evidence available at the time of writing as evaluated by the authors and may change as a result of new research. Readers need to apply this knowledge to patients in accordance with the guidelines and laws of their country of practice. Some medications may not be available in some countries and readers should consult the specific drug information since not all dosages and unwanted effects are mentioned. Organizations, publications and websites are cited or linked to illustrate issues or as a source of further information. This does not mean that authors, the Editor or IACAPAP endorse their content or recommendations, which should be critically assessed by the reader.
    [Show full text]
  • A Clinical Approach to Disorders of Speech Apoorva Pauranik Indore, India, [email protected]
    Pakistan Journal of Neurological Sciences (PJNS) Volume 9 | Issue 4 Article 13 12-2014 A clinical approach to disorders of speech Apoorva Pauranik Indore, India, [email protected] Follow this and additional works at: http://ecommons.aku.edu/pjns Part of the Neurology Commons Recommended Citation Pauranik, Apoorva (2014) "A clinical approach to disorders of speech," Pakistan Journal of Neurological Sciences (PJNS): Vol. 9 : Iss. 4 , Article 13. Available at: http://ecommons.aku.edu/pjns/vol9/iss4/13 REVIEW ARTICLE A CLINICAL APPROACH TO DISORDERS OF SPEECH Apoorva Pauranik Indore, India Correspondence to: Dr Apoorva Pauranik, House number 4, Ahilya Puri, Zoo Road. Near Residency Club. Indore. MP, India. Phone: + 91 9926634520. Email. [email protected] Date of submission: June 10, 2014, Date of revision: August 19, 2014, Date of acceptance: August 25, 2014 ABSTRACT Disorders of speech and communication, including Aphasia (mainly post stroke) are a major community health burden in terms of DALY (Disability Adjusted Life Years). Unfortunately they are relatively neglected with huge treatment gap. Traditionally aphasia related lesion sites have been grouped with reference to Rolandic & Sylvian fissures. However the theoretical models of language and speech organization in brain have undergone major conceptual shifts due to advances in cognitive neuropsychology, linguistics and functional neuro-imaging. Much more widely distributed overlap- ping neural networks are understood to be actively involved in various communication activities. The notion of speech centers or areas is somewhat outdated. Traditional aphasia syndromes may however be somewhat useful as a shorthand summary of the clinical profile, but are being considered now as of limited utility for planning an intensive, long-term speech therapy.
    [Show full text]