Assessment of Speech under Mental Status Examination (Disorders of Speech)

Assessment of Speech under Mental Status Examination (Disorders of Speech) - Speech is evaluated passively throughout the psychiatric interview. It is of key importance to do a speech assessment before you proceed to complete MSE. Speech assessment should be done in the patient's mother tongue or the language in which the patient is comfortable. If the patient speaks less than normal, they may be experiencing depression or anxiety. Conversely, an increased/hyperverbal amount of speech may also indicate some level of anxiety or that a patient is currently manic. Fluency refers to the patient’s language skills. The rate of speech may be slow in depressed patients or those with a neurocognitive disorder. The pressured rate may indicate acute substance intoxication or that the patient is experiencing a manic episode. A delayed speech response time may also indicate a neurocognitive disorder or that the patient is experiencing a thought process disorder such as thought blocking seen in psychosis. The rhythm of speech can provide clues to a number of diagnoses. Slurred speech may indicate intoxication. Dysarthria may indicate a possible motor dysfunction when speaking. Volume can be quiet if a patient is depressed/withdrawn or loud if they are agitated. Lastly, the tone may indicate a patient’s mood.
To summarise-
Coherence or not
Relevance or not
Tone (loudness) of speech - normal/increased/decreased
Tempo (rate or speed) of talking - normal/increased/pressure of speech/decreased
Volume (amount) of speech. Estimate words per minute - verbose/pressure of speech/decreased
Prosody - emotional intonations of speech
Reaction time - increased/decreased
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