COMMUNICATION DISORDERS

IN PSYCHIATRIC CONDITIONS

ªÀÄ£ÉÆÃgÉÆÃVUÀ¼À°è
PÀAqÀħgÀĪÀ ¸ÀAªÀºÀ£À
zÉÆõÉUÀ¼ÀÄ
Mr. SUNIL KUMAR. RAVI,
Junior Research Fellow (Ph.D-SLP)
Department of Speech Language Pathology
AIISH, Mysore.

Monthly Public Lecture Series,

AIISH, Mysore. 25.12.2010
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MENTAL ILLNESS
 Mental illness is a psychological or
behavioral pattern generally
associated with subjective distress, or
disability that occurs in individual and
which are not part of normal culture or
development.

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Causes
 Neurotransmitters
 Brain damage
 Genetics
 Infections
 Prenatal damage
 Drug/ alcohol abuse
 Nutrition

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 Psychological trauma – emotional,
physical, sexual
 Early loss of parent/s
 Neglect

 Death/divorce
 Dysfunctional family life
 Low self esteem
 Social/ cultural expectations.

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 Psychiatric conditions
ªÀÄ£ÉÆÃgÉÆÃU
ÀUÀ¼ÀÄ

Children Adolescent Adults & Geriatrics

ªÀÄPÀ̼ÀÄ zÉÆqÀتÀgÀÄ
ªÀÄvÀÄÛ
ªÀAiÀĸÁVgÀªÀgÀÄ
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Children Adolescents Adults & geriatrics

Psychoses Delayed development Organic disorders

(Schizophrenia, PDD)

Disruptive behaviors/ Neurotic disorders Schizophrenia

conduct disorders

Neurotic, anxiety & Psychotic disorders Delusional disorders

emotional disorders

Major affective Organic brain Psychotic disorders

disorders syndromes
Personality disorders Mood disorders

Anxiety and phobic

disorders
Personality disorders
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Today’s topic…

Communication disorders in
 Neurotic (ZÀAZÀ®vÉ) disorders
 Psychoses (ªÀÄw «PÀ®vÉ)
 Depression (T£ÀßvÉ, ªÀÄAPÀÄ, ªÀiÁAzÀå)
 Personality (ªÀåQÛvÀé gÉÆÃUÀUÀ¼ÀÄ)
disorders
 Geriatric psychiatry.
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NEUROTIC DISORDERS

 It’s a global term used to cover minor psychiatric conditions

such as
 Anxiety (PÀ¼ÀªÀ¼À ªÀÄ£ÉÆÃZÉ£É)
 Depression
 Obsessional and
 Phobic neuroses (¨sÀAiÀÄ).
 No organic basis and patient does not lose touch with reality.

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Communication and speech problems in Anxiety
patients

 Avoidance Strategies in relation to communication.

 Stuttering (vÉÆzÀ®Ä)
 Voice disorders (aphonia, etc..) - zÀé¤ vÉÆAzÀgÉUÀ¼ÀÄ
 Jerky and poor controlled gestures
 Fear that they are saying wrong thing,
 Develop phobias to specific social situations

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 Language use is affected by continuous
checking (results in repeating words and
phrases)  interrupt the flow of conversation.

 Articulation (GZÁÑgÀuÉ vÉÆAzÀgÉUÀ¼ÀÄ)

– may be affected by some of the medication
prescribed which result in dry mouth, etc..
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 PSYCHOSES
Major mental illness (ªÀÄ£ÀzÀ PÁ¬Ä¯É)
and

Features include
 Incoherent speech
 Idiosyncratic beliefs,
 Purposeless / unpredictable/ violent
behavior,
 No concern for one’s own safety and
comfort.
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These include

 Organic psychoses
 Major affective (mood) disorders
 Schizophrenia
 Paranoid states

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Organic Psychoses
Impairment of
 memory (£É£À¥ÀÅ),
 orientation,
 comprehension,
 calculation,
 learning capacity and judgment
 alteration of mood,
 disturbance of behavior and personality.
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 Acute disorders – delirium, dementia
(avÀÛ «PÀ®vÉ)
 Alcoholic psychoses – delirium tremens,
Korsakov’s psychosis, alcoholic
dementia, hallucinations.
 Drug psychoses.

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 Schizophrenic disorders are the most prevalent of
the psychoses,

 They have severe problems relating to their

environment and other people,

 contact with reality is poor and they lack insight.

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Description of psychotic symptoms
Disorders of

 Perception (UÀ滸ÀĪÀzÀ°è) – hallucinations (auditory,

visual, tactile, somatic), delusions
 Thinking (AiÉÆÃZÀ£É)
 Emotion (ªÀÄ£ÉÆÃzÉéÃUÀ) – depression and elation
 Motor symptoms – abnormalities of social behavior, facial
expression and posture, stereotypic, echopraxia, etc..

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 Disorders of body image – lack of awareness
about body parts, movements, etc.
 Memory – amnesia (impaired registration,
recognition, recall)
 Consciousness (JZÀÑgÀzÀ) – partial impairment
of consciousness, hallucinations, etc.
 Insight and the mechanisms of defence – denial,
lack of awareness of one’s own mental state.

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Childhood Psychosis
 Autism (vÀAvÀ£ÀvÉ)
 Childhood schizophrenia – disordered
language, impoverished speech, etc…
 Both verbal and non-verbal communication
skills are affected.
 Mutism at one extreme - over productive at
another extreme.
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Communication disorders
 Communication and speech disturbances – three
areas:
1. Communication and speech skills prior to the
onset of the illness and possibly maintained or
exacerbated by the psychosis.
2. Communication disorders caused by psychosis
3. Disorders caused by drug and physical treatments
and organic conditions.
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Schizophrenic Speech
 Speech is more difficult to understand (odd themes &
delusional ideas).
 Total quantity of speech is reduced.
 Reduced lexical density and dysfluency, etc..
 Repetition of syllables and words, ceases to speak in
the middle of the sentence, echolalia,
 Difficulty in generating a coherently organized stream
of speech, less speech content, etc…
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DEPRESSION

 3% of world population suffer from depressive

states (WHO).
 3 – 4% of men and 7 – 8% of women suffer
from depressive illness.
 It is characterized by depressed mood,
pessimistic thinking, lack of enjoyment, reduced
energy and slowness.
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Communication disorders
 Difficulty in communicating within their
social environment.
 Reluctance to talk of their distress, problems,
hopes, fears, and their denial of difficulties.
 Changes in facial expression, posture, gesture,
low eye contact, restlessness, nervousness, etc.

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 Asking the same question repeatedly (poor concentration),
talking in short staccato-like phases.

 Slow speech tempo with frequent pauses and hesitations,

dead voice with reduced volume, stress and rhythm.

 Language tends to be limited to convey the minimum of

information, and the responses are short or non-verbal,
nasalized speech, etc.

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 Speech is often punctuated by long pauses,

 voice disorders due to change in

neuromuscular systems of larynx.

 Word finding difficulties

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 PERSONALITY DISORDER
 Abnormality of personality causes problems to
both the patient and others due, in the severest
cases, to the unacceptable, anti-social behavior
resulting in dislike of person and the possibility
of rejection.

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 Communication skills and disorders
 Speech problems may be more to do with lack of
experience through restricted exposure to the
usual variety of speech situations.
 In some cases, severe stuttering,
 voice disorders, and
 continuing articulatory disorders inherited from
childhood.
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Psychiatric problems of Old age
Organic disorders Functional disorders

Dementia Depressive illness

Alzheimer’s disease

Frontal lobe type dementia

Alcohol and dementia

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 Awareness/ lack of mental deterioration, which may cause
frustration, depression, anxiety, stress, and tension.

 Difficulties with attention, concentration, judgment, and

behavior, Confusion, disorientation

 Aphasia (impaired language ability)

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 Communication skills become increasingly impaired,
and verbal output becomes less informative with
frequent word finding problems.

 Patients may be mute, perseverative, echolalic, or

palilalic (with excessive reiterative utterances)

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 Word finding difficulties, semantic paraphasias,
naming ability is severely impaired

 In later stages, speech becomes largely

unintelligible, with jargon, echolalia and palilalia,
mutism,

 Decline in cognitive functions.

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 Management
 Management needs to include measures to
reduce symptoms,
 Steps to help the patient solve the problems
of their life
 Treatment to help the patient to improve his
relationships.

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 Counseling
 Speech Language Therapy
 Psychotherapy
 Drug management
 Behavior cognitive therapy
 Social work assistance

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SLP Management
 Assessment – observations and informal assessment,
case history, checklists and formal assessments (both
language and speech), functional communication
skills, etc.

 Differential diagnosis

 Counseling
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Goals of SLP treatment
 Tx of basic conversation skills like,
 Greeting and addressing someone by name,
 Making a personal enquiry,
 Asking a conversational question.
 Wong & Woolsey (1989)found significant
improvement on the above skills but,
 The improvement was very slow (75 sessions).
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Clegg, et al, 2007
 Both traditional and non-traditional therapy
procedures like the following are used to treat
Schizophrenic Speech.
 Desensitizing the person on VERBAL
COMMUNICATION,
 Developing language productivity and increasing
awareness of Social Communication Skills.
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 Individual programme planning – strengths and needs,

 Individual and group therapy programmes

 Cognitive therapy

 Augmentative and Alternative communication therapy –

computers, communication aids, etc.

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Practical aspects in SLP treatment
 Fluctuations if Mental Health status of the patient
 Motivation of patient and family members
 Working with Multidisciplinary team
 Intervention to understand and manage
STRESS related issues of patient.
 Duration & flexibility of SLT

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Multidisciplinary team
Professionals
Non-professionals
 Psychiatrist
 Clinical Psychologist  Patient
 SLP & Audiologists  Care givers
 PT/OT  Social workers
 Neurologist  Teachers
 Dieticians  Volunteers and NGOs
 Nursing staff (along with
certificates, services
are also required)
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 The main challenge is to assess and then to meet the
needs of those whose communication skills are impaired
by mental disorder,

 to reject paths that prove inappropriate or ineffective,

and to refine and develop a quality service.

 It is not an easy challenge to meet, but if it can be done,

the quality of life of many people will immeasurably
improved.
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When to seek medical help?

 Confusion
 Hallucinations
 Headaches
 Depression
 Anxiety
 Fatigue
 Weight loss, long standing sleeping
disturbances, suicidal tendencies, etc…

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 Physical – aches, sleep disturbances

 Emotional – sad, scared or anxious

 Cognitive – thinking, beliefs, memory

 Behavioral - aggression, inability to perform

routine activities, drugs

 Perceptual – seeing/ hearing things

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Thanks to…
 Dr. Vijayalakshmi Basavaraj, Director, AIISH,
Mysore.
 Dr. G. Jayaram, Co-ordinator, Monthly Public
Lecture Series, AIISH, Mysore.
 Prof. S. Venkatesan & Prof. Shyamala. K.C.,
AIISH, Mysore.
 One and all present here..

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