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Communication Disorders in Psychiatric Conditions

VIEWS: 192 PAGES: 42

									    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
                                                                   1
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.


                                               2
Causes
 Neurotransmitters
 Brain damage
 Genetics
 Infections
 Prenatal damage
 Drug/ alcohol abuse
 Nutrition



                        3
 Psychological trauma – emotional,
  physical, sexual
 Early loss of parent/s
 Neglect


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




                                      4
  ªÀÄ£ÉÆÃgÉÆÃUÀUÀ¼   Psychiatric
  ÀÄ
                     conditions


                                     Adults &
Children             Adolescent
                                     Geriatrics
ªÀÄPÀ̼ÀÄ                          zÉÆqÀتÀgÀÄ ªÀÄvÀÄÛ
                                   ªÀAiÀĸÁVgÀªÀgÀÄ

                                                         5
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
                                                                        6
Today’s topic…

Communication disorders in

        Neurotic (ZÀAZÀ®vÉ) disorders

        Psychoses (ªÀÄw «PÀ®vÉ)

        Depression (T£ÀßvÉ, ªÀÄAPÀÄ,
         ªÀiÁAzÀå)

        Personality (ªÀåQÛvÀé gÉÆÃUÀUÀ¼ÀÄ)
         disorders                            7
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.


                                                                     8
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




                                                            9
   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..
                                                     10
             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.
                                             11
These include


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




                                       12
Organic Psychoses
Impairment of

        memory (£É£À¥ÀÅ),
        orientation,
        comprehension,
        calculation,
        learning capacity and judgment
        alteration of mood,
        disturbance of behavior and personality.
                                                    13
   Acute disorders – delirium, dementia
    (avÀÛ «PÀ®vÉ)

   Alcoholic psychoses – delirium tremens,
    Korsakov’s psychosis, alcoholic
    dementia, hallucinations.

   Drug psychoses.




                                              14
   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.




                                                          15
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..


                                                                   16
 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.
                                                      17
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.
                                                 18
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.
                                                         19
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…
                                                         20
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.
                                                    21
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.


                                                       22
   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.


                                                                23
   Speech is often punctuated by long pauses,



   voice disorders due to change in
    neuromuscular systems of larynx.



   Word finding difficulties



                                                 24
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.




                                                         25
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.
                                                       26
Psychiatric problems of Old age
Organic disorders            Functional disorders

Dementia                     Depressive illness

Alzheimer’s disease

Frontal lobe type dementia

Alcohol and dementia



                                                    27
   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)




                                                                28
   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)




                                                         29
   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.




                                                            30
              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.



                                                   31
   Counseling
   Speech Language Therapy
   Psychotherapy
   Drug management
   Behavior cognitive therapy
   Social work assistance



                                 32
SLP Management
   Assessment – observations and informal
    assessment, case history, checklists and formal
    assessments (both language and speech),
    functional communication skills, etc.


   Differential diagnosis


   Counseling
                                                      33
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).
                                                   34
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.
                                                      35
   Individual programme planning – strengths and needs,



   Individual and group therapy programmes



   Cognitive therapy



   Augmentative and Alternative communication therapy –
    computers, communication aids, etc.


                                                           36
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


                                                          37
Multidisciplinary team
Professionals             Non-professionals

 Psychiatrist             Patient
 Clinical Psychologist    Care givers
 SLP & Audiologists       Social workers
 PT/OT                    Teachers
 Neurologist              Volunteers and NGOs
 Dieticians                (along with
 Nursing staff
                            certificates, services
                            are also required)

                                                     38
   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.

                                                                  39
When to seek medical help?

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

                                            40
   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

                                                    41
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..




                                                    42

								
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