Descriptive Psychopathology: The Signs and Symptoms of ...

241 Chapter 9: Disturbances in speech and languagefrom it as in flight-of-ideas. The patient with elliptical speech appears to understandwhat has been asked, but does not directly answer the question. Ellipticalspeech is vague, contains few nouns and little information.Example:Q: “Where were you living when you came into the hospital?”A: “It was OK there.”Q: “And where is that?”A: “I lived there without him.”Q: “But where exactly is your place? What’s the address?”A: “I came here from there.”Non-sequitive speech refers to the patient uttering unrelated responses to theexaminer’s questions or comments. It is observed in schizophrenia and receptiveaphasia. Such patients are not aware of the disconnection of their responses.Patients who perseverate a theme may return to their subject rather than the topicat hand, and manic patients may make unrelated statements as part of theirflight-of-ideas, but such patients can sometimes recognize their non-sequitivespeech and can be briefly brought back to the topic.Example:Examiner: “You were telling me about your family ...”Patient: “The clock tower is near my house.”In- and out-of-class paraphasia (private word usage)Paraphasia is the imprecise use of words. A phonemic or literal paraphasia is amisuse of the sound of a word, sometimes creating a new word (neologism), as in“glob” for “glove”. A semantic or verbal paraphasia can be in- or out-of-class,depending on how close it is to the appropriate word or phrase. Semantic paraphasiais more common in cortical than in subcortical aphasia or in schizophrenia.In-class semantic paraphasias are close in general meaning to the correct wordand are often understandable substitutes for the correct word, such as “writer” for“pen” or “moving machine” for “automobile”. Out-of-class paraphasias are farremoved from the correct word or phrase and meaning is often lost. Another termfor an out-of-class paraphasia is private word usage. Kraepelin used the umbrellaterm “incoherence” to describe some of the speech problems of his patients withdementia praecox, and illustrates with examples of private word usage: 51“A patient said ‘Life is a dessert-spoon’ ...another ‘We are already standing inthe spiral under the hammer,’ ... and a third ‘Death will be awakened by thegolden hammer’...”. “Dessert-spoon”, “spiral under the hammer”, and “awakenedby the golden hammer” are real words, but used in such an idiosyncratic privateway that they lose meaning.