Descriptive Psychopathology: The Signs and Symptoms of ...

243 Chapter 9: Disturbances in speech and languageobserved in Wernicke’s and mixed aphasias and in subcortical aphasia involvingdominant basal ganglia and thalamic structures.Jargon agrammatism or driveling speechThe neurologic term “jargon speech” and the psychiatric term “driveling speech”refer to the same phenomenon. This speech is fluent and associations appeartightly linked and to follow grammatical rules, but the meaning of the speech islost, as if the patient were speaking a language unfamiliar to the examiner. Drivelingspeech is similar to the comedic “double-talk”, but it is not feigned. When associatedwith schizophrenia, subcortical aphasia, or chronic illicit-drug-induced psychoses,driveling speech is sporadic and interspersed with understandable utterances,the driveling increasing with the complexity of the conversation, the examiner’spersistent questioning, or the patient’s anxiety. When associated with Wernicke’s ormixed aphasia, driveling is fairly constant, and any understood speech that thepatient utters is often non-sequitive.Example:DerailmentQ: “Tell me about your family. What are they like?”A: “There are three substitutes, one beyond the two. The smaller fidget doesn’tget round about, if the peach instructucates.”In this example, the patient’s driveling speech includes paraphasias (“substitutes”for children, “beyond” for older, “smaller” for younger). “Fidget” is adescriptor for the youngest child, a boy with attention deficit disorder. “Peach”refers to the boy’s teacher (a phonemic paraphasia). “Doesn’t get round about” isan out-of-class paraphasic phrase and “instructucates” is a portmanteau wordcombining instruction and educates. Driveling speech can usually be parsed intoelements of aphasia.Derailment refers to the sudden disrupted switch from one line of thought to anew parallel line of thought. Mild derailment, or cognitive slippage, is describedin patients with schizotypal personality disorder. Severe derailment is observed inpatients with schizophrenia, some chronic illicit-drug-induced psychoses, subcorticalaphasia, and cerebellar neocortical lesions.Example:To the comment: “Your situation at work would be stressful for most people”, a patient replied:“The head person [store manager] is often rude and I may not go on vacation.” To thequestion: “How come you switched schools?” a patient replied: “I had a heavy course load.My sister was good at math, but not me.”Sometimes derailment follows blocking: “They were talking about me in a threatening way ...I was hospitalized before.”