Descriptive Psychopathology: The Signs and Symptoms of ...

230 Section 3: Examination domainsDyslexia, problems with reading, is associated with neurologic disease and is afeature of developmental deviation. Patients with lesions in the dominant angulargyrus of the parietal lobe, for example, may have a disconnection of visualperceptions from language systems. They can write spontaneously, but not readwhat they have written (alexia without agraphia). When both reading and writingare affected, the patient is said to have visual asymbolia. 7Patients with frontal lobe disease may have difficulty reading and understandingcomplex sentences.Disturbances of speech articulationDysarthriaDysarthria is abnormal speech articulation. Speech sounds are distorted and speech istypically slow and labored. Dysarthria is characteristic of Broca’s aphasia and isolatedlesions in the dominant precentral gyrus of the insula, a cortical area between thefrontal and temporal lobes. This area is involved in motor speech planning.Acute dysarthria is associated with oral–buccal dystonia, often from antipsychoticdrugs but also from some SSRI agents. When laryngeal muscles are dystonic,speech becomes husky, gravelly, or strained, disrupting the flow of speech andmaking any utterance difficult. Primary dysarthria is associated with impairedhearing. The slurred speech of alcohol intoxication is a form of dysarthria thatrepresents ataxia of the muscles of speech. Slurring also occurs with basal gangliadisease and pseudobulbar palsy. Increased muscle tone is associated with theformer and dysphagia, drooling, and emotional incontinence are associated withthe latter. Brainstem lesions cause dysarthric speech that appears “breathless” andnasal. Scanning speech is characterized by the over-emphasis of all syllables, stretchingout their sounds, and is a sign of cerebellar–pontine disease.Manneristic speechManneristic speech is characteristic of catatonia and basal ganglia disease. Speechmannerisms include using foreign accents inconsistent with one’s language orbackground, 8 robotic and stilted speech, speaking as if a child learning how to read(slow and halting, not using combined verb forms [e.g. “can not” rather than“can’t”]), speaking in odd rhythms, falsetto, staccato or nasally, with unexpectedstress on some words or syllables, and as if engaged in great oratory (seen in mania).Stammering and stutteringIn stammering the normal flow of speech is interrupted by pauses and theinterjection of repeated words or parts of words. Stammering is associated with