qualities to be noted are the amount of verbalization, fluency, rate, rhythm, volume, and tone.
English may be their first language, but they may have word-finding difficulty due to an altered mental status or a neurocognitive disorder.
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.
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Volume can be quiet if a patient is depressed/withdrawn or loud if they are agitated
neurocognitive disorder or hearing difficulties that may make them unable to control the volume of their voice.
the tone may indicate a patient’s mood.
happy, sad, irritated, angry, agitated, restricted, blunted, flat, broad, bizarre, full, labile, anxious, bright, elated, and euphori
minimally irritated versus extremely agitated.
affect is appropriate to the situation.
patient who is smiling and laughing after being brought into the hospital for involuntary evaluation is considered to have an inappropriately elated affect.
whether the affect is congruent or incongruent with what the patient says their mood is
f a patient says their mood is “great” and they are smiling, then their affect is happy and therefore congruent.
However, if that patient said “great” while they are crying, then their affect would be tearful and incongruent.
organization of the thoughts expressed by a patient
Common descriptions of irregular thought processes are circumstantial, tangential, the flight of ideas, loose, perseveration, and thought blocking
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