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Circumstantiality

Speech characterized by indirection and delay in reaching the point because of unnecessary detail, although the components of the description have a meaningful connection. Many people without mental disorders speak circumstantially.

Observed in obsessional persons

Derailment (Loosening of Associations)

Speech in which a person shifts from one subject to others that are unrelated or only obliquely related without realizing that the subjects are not meaningfully connected. Ideas slip off the track between clauses, not within them.

Observed in schizophrenia, manic episodes, and other psychotic disorders

Flight of Ideas

An almost continuous flow of accelerated speech in which a person changes abruptly from topic to topic. Changes are usually based on understandable associations, plays on words, or distracting stimuli, but the ideas do not progress to sensible conversation.

Most frequently noted in manic episodes

Neologisms

Invented or distorted words, or words with new and highly idiosyncratic meanings

Observed in schizophrenia, other psychotic disorders, and aphasia

Incoherence

Speech that is largely incomprehensible because of illogic, lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Shifts in meaning occur within clauses. Flight of ideas, when severe, may produce incoherence.

Observed in severely disturbed psychotic persons (usually schizophrenic)

Blocking

Sudden interruption of speech in midsentence or before completion of an idea. The person attributes this to losing the thought. Blocking occurs in normal people.

Blocking may be striking in schizophrenia.

Confabulation

Fabrication of facts or events in response to questions, to fill in the gaps in an impaired memory

Common with amnesia

Perseveration

Persistent repetition of words or ideas

Occurs in schizophrenia and other psychotic disorders

Echolalia

Repetition of the words and phrases of others

Occurs in manic episodes and schizophrenia

Clanging

Speech in which a person chooses a word on the basis of sound rather than meaning, as in rhyming and punning speech. For example, "Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!"

Occurs in schizophrenia and manic episodes

CHAPTER 16 ■

Anxiety and Depression 101

Anxiety and Depression 101

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