Monday, October 19, 2009

Once, I gathered all my courage to pick up a Medicine Multiple Choice Questions book. Strangely, I did not fare all that badly in the Psychiatry section; at least I could understand the questions. Detailed answers for these questions was quite interesting. Reading which suddenly I was awestruck by a phrase: flight of ideas. Ha! That’s what I do. Yaix! It’s a disorder. I didn’t feel all that morose. You can see its definition embedded on the top panel of this blog. Clinical details are below:

Thinking is accelerated in flight of ideas, which may reach such a pitch that goal direction is lost and the connection between ideas is governed not by sense but by sound or idiosyncratic verbal or conceptual associations. [In my case, sense does stay but sometime I do search for the sound. For instance, a two-word rhyming phrase such as mental malaise and perennial prevalence is my favorite]

Alliteration, assonance, rhyme (clang associations), and punning may determine the torrent of ideas that is distracted readily by internal or environmental stimuli. Flight of ideas is usually associated with pressured speech and may be experienced by the patient as racing thoughts. Flight of ideas is characteristic of mania, but it may occur also in excited schizophrenic patients, especially those in acute catatonia. In hypomania the flight of ideas is less marked, the tempo being accelerated but the associations less disorganized.

The tempo of thinking may be slowed in retardation of thought, especially in major depression. The patient often complains of fuzziness, woolliness, and poor concentration. [Reverse is the case with me: my concentration becomes acute, fuzziness is there but not all that marked] Response time to questions is increased. [Not really] There are long silences during which the patient may lose the thread of the conversation. [Silence is the staircase to self-understanding! See my rhyming instinct] In the extreme, retardation of thought becomes mutism or even stupor. [I haven’t yet reached there]

So in all I’ve a benign disorder.


Something else I found on language; pretty useful and worth remembering:

Language is a system of communication that is also used as a tool of thought. Language facilitates thinking by the way semantics hierarchically organizes ideas and concepts and by the way in which syntax indicates the relationship between those ideas and concepts.

Language competence is assessed from the patient's speech during the psychiatric interview. Any history of spoken or written language difficulty, or any observation of clumsy articulation, disordered rhythm, and difficulty in the understanding or choice of words, should be noted and investigated further. Language comprehension is tested by asking the patient to point to single objects, and then to point to a number of objects in a particular sequence. The interviewer may also ask the patient to perform a series of actions in an arbitrary sequence (e.g., "Touch your nose with your right index finger, then point that finger at me, then put it behind your back."). Language expression is evaluated by asking the patient to repeat words, phrases, and sentences and to name correctly a number of objects. Expression and comprehension are evaluated by asking the patient to read a passage aloud and to answer questions about it. Asking the patient to take dictation tests graphic language. Any errors and slowness in performance should be noted. The following sections describe some common disorders of language.

Aphasia is a dysfunction in the patient's ability to express himself or herself. The three most common forms of aphasia are all manifest as difficulty in repeating words or phrases. In Broca aphasia, comprehension is relatively intact but expression dysfluent, sparse, telegraphic, and full of circumlocution. In Wernicke aphasia, comprehension is affected. Expression, though fluent, rambles, lacks meaning, and is full of errors to which the patient seems oblivious. In conduction aphasia, comprehension is intact, expression is fluent but full of errors and pauses, and repetition is difficult; however, reading is relatively intact.

Muteness is seldom found in neurologic disease, except in the acute phase, in seizure disorder, or in advanced cerebral degeneration. The aphasic patient is never mute. Muteness is much more commonly a sign of melancholia, stupor, catatonia, somatoform disorder, dissociation or negativism in children (i.e., elective mutism).

Schizophrenic Language: The psychiatrist's main diagnostic problem is to differentiate schizophrenic language from the "jargon" of Wernicke aphasia. Schizophrenic patients tend to be heedlessly bizarre in thought content; aphasic patients are more aware of their errors and are more likely to use substitutions to overcome their language defects. The confused speech of schizophrenic patients is known as word salad. It may be so chaotic as to be barely comprehensible.

Paralogia, or talking past the point, occurs when the patient gives answers that are erroneous but reveal knowledge of what should be the correct answer. For example, the interviewer may ask, "How many legs has a cow?" and the patient responds, "Five." Talking past the point occurs in Ganser syndrome (also called the syndrome of approximate answers). It is most likely to be observed in individuals who regard hospitalization for insanity as preferable to incarceration for crime.

Neologisms are new words coined by the patient. They are often condensations of ideas that attempt to capture the ineffable. Neologisms are most common in schizophrenia; they must be distinguished from aphasic paraphasia, and circumlocution, to which the patient resorts in order to overcome expressive difficulty. Sometimes a neologism reveals that the patient has been "derailed" by the sound or sense of an associated word or idea. At other times, neologisms are a response to hallucinations or a defense (in a private code) against the intrusion by the interviewer upon the patient's privacy.

Source for both citations is

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