Aphasia following a right thalamic hemorrhage

A left-handed patient with a right thalamic hemorrhage and disordered speech is described. Sequential examinations and aphasia testing were done during a 1-year follow-up period and the results are reported. This case supports those authors who have described characteristics they feel are helpful in diagnosing disordered speech associated with thalamic lesions. Paucity of speech, reduced voice volume, anomia, some paraphasia, and severe dysgraphia were present, but comprehension and repetition were relatively preserved. She showed modest improvement with time. This case also confirms that thalamic involvement in speech is a dominant, rather than a specifically left hemispheric function.     

Speech in mania: Syntactic aspects

In this study, we observed and linguistically analyzed the verbal behavior of six manic subjects, looking specifically for those linguistic capacities which were intact and for those which were disrupted. From interviews and tape-recordings of manic subjects in both analytic-protocol and discourse situations, we observed a preservation of basic speech capacities, including the ability to comprehend and generate grammatical sentences and to utilize highly complex linguistic transformations. We noted, however, a disruption in the ability to properly utilize ellipsis and semantic (discourse) anaphora such that manic subjects did not maintain a meaningful progression of thought in discourse.     

A different form of agraphia: Syntactic writing errors in patients with motor speech and movement disorders

Three patients are described who displayed syntactic writing errors in combination with a motor speech disturbance and impaired motor limb function. Two of the patients had bulbar amyotrophic lateral sclerosis (ALS). Agraphia appeared when verbal communication was no longer possible. Autopsy in one patient disclosed only lesions consistent with ALS. The third patient had palilalia and chorea and, although not aphasic, his written language showed persistent syntactic errors. We hypothesize that the agraphia in these patients occurred because of the combination of disordered feedback from the motor speech apparatus and limbs.     

Manic temporality

Time-consciousness has long been a focus of research in phenomenology and phenomenological psychology. We advance and extend this tradition of research by focusing on the character of temporal experience under conditions of mania. Symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight-of-ideas, hyperactivity. But what is the underlying structure of temporal experience in manic episodes? We tackle this question using a strategically hybrid approach. We recover and reconstruct three hypotheses regarding manic temporality that were advanced and modeled by two pioneers of clinical phenomenology: Eugène Minkowski (1885–1972) and Ludwig Binswanger (1881–1966). We then test, critique, and refine these hypotheses using heterophenomenological methods in an interview-based study of persons with a history of bipolar and a current diagnosis of acute mania. Our conclusions support a central hypothesis due to Minkowski and Binswanger, namely, that disturbance in the formal structure of temporal experience is a core feature of mania. We argue that a suitably refined variant of Binswanger’s model of disturbance in manic protention helps to explain a striking pattern of impaired insight and impaired reasoning in manic episodes.     

Speech discrimination and lip reading in patients with word deafness or auditory agnosia

The purpose of this study was to assess the ability of four patients with word deafness or auditory agnosia to discriminate speech by reading lips. The patients were studied using nonsense monosyllables to test for speech discrimination, a lip reading test, the Token Test for auditory comprehension, and the Aphasia test. Our results show that patients with word deafness or auditory agnosia without aphasia can improve speech comprehension by reading lips in combination with listening, as compared with lip reading or listening alone. In conclusion, lip reading was shown to be useful for speech comprehension among these patients.     

Psychiatry: The Importance of Understanding Persons While Treating Diagnoses

Modern psychiatry emphasizes chemical, genetic, psychosocial, and similar theoretical biological sciences. While these sciences can explain mental disorders they fail to generate a full understanding of the patient as a person. I argue that psychiatry, to not stereotype persons, must integrate both the important advances in molecular and social sciences needed to diagnose and treat mental illnesses and provide an encounter with the person who is the patient. Standardized forms of diagnostic interviewing now dominate in the psychiatrist–patient relationship. Individualizing forms of inquiry, by contrast, elicit a personal understanding of the patient and her problems and the information necessary to diagnose and treat the patient's mental disorders.

This understanding attitude towards individuals is essential so that psychiatrists avoid falling into over-simplified stereotyping explanations of the persons who are their patients. If psychiatry allows its diagnoses of disordered processes that occur within persons to function as labels for persons, then psychiatry appears scientifically to condone the uses of stereotypes. With an understanding attitude towards patients, psychiatry can better treat mental disorders, while also respecting human diversity.     

Psychoanalytic observations on the effect of lithium on manic attacks

This paper describes a predictable relation between our manic-depressive patients' blood lithium levels and particular changes in their conscious and unconscious mental processes (i.e., their thoughts, wishes, fantasies, inclinations, and feelings). These changes were, in turn, predictively related to specific changes in these patients' overt manic symptomatology. Because each of our patients' manic episodes was heralded by a marked increase in unconscious or conscious phallic sexual thoughts, feelings, and behaviors, and because this increase preceded any observed deterioration in ego or superego functioning, we hypothesize that a primary increase in our patients' phallic instinctual drives secondarily overwhelmed the capacity of their egos to defend against these drives, and that this, in turn, resulted in the development of our patients' overt manic symptoms. Psychoanalysis (or psychoanalytically oriented psychotherapy) made our patients consciously aware both of their previously unconscious phallic sexual thoughts and impulses, and of their defenses against them. This new awareness enabled our patients to recognize when their, now conscious, phallic sexual impulses and thoughts became inappropriately intensified; and this, in turn, permitted them to avoid overt manic episodes by counteracting these inappropriate inclinations with increased doses of lithium.     

Motor and cognitive interference effects on unimanual tapping rates

Experiments conducted on both normal and disordered populations have led to the hypothesis that the left hemisphere's specialization for language results from its control over motor activities. This control is reflected in the lateralized disruption of manual activity during cerebral time-sharing tasks. Recent studies have challenged this hypothesis, stating that the interference effects reflect both cognitive and motor mechanisms in the left hemisphere. This experiment investigates whether the left hemisphere's control over speech involves both of these components or is purely motor. The question was examined by measuring the effect of concurrent hemispheric activity on single-finger tapping rates. Forty subjects tapped under two conditions: speaking and listening. The data show there may be both motor and cognitive mechanisms involved in left-hemisphere control.     

Multidisciplinary assessment and diagnosis of conversion disorder in a patient with foreign accent syndrome

Multiple reports have described patients with disordered articulation and prosody, often following acute aphasia, dysarthria, or apraxia of speech, which results in the perception by listeners of a foreign-like accent. These features led to the term foreign accent syndrome (FAS), a speech disorder with perceptual features that suggest an indistinct, non-native speaking accent. Also correctly known as psuedoforeign accent, the speech does not typically match a specific foreign accent, but is rather a constellation of speech features that result in the perception of a foreign accent by listeners. The primary etiologies of FAS are cerebrovascular accidents or traumatic brain injuries which affect cortical and subcortical regions critical to expressive speech and language production. Far fewer cases of FAS associated with psychiatric conditions have been reported. We will present the clinical history, neurological examination, neuropsychological assessment, cognitive-behavioral and biofeedback assessments, and motor speech examination of a patient with FAS without a known vascular, traumatic, or infectious precipitant. Repeated multidisciplinary examinations of this patient provided convergent evidence in support of FAS secondary to conversion disorder. We discuss these findings and their implications for evaluation and treatment of rare neurological and psychiatric conditions.     

The Inner Eye and the Inner Scribe of Visuo-spatial Working Memory: Evidence from Developmental Fractionation

Abstract

Evidence for two major hypotheses that attempt to explain the development in memory span with age is reviewed: the identification time hypothesis and the rehearsal hypothesis. The rehearsal hypothesis is also strongly related to the recent application of the working memory model to memory development. In this model, rehearsal is assumed to occur from an extremely young age. This assumption is critically evaluated. It is concluded that there is no strong support for the identification time hypothesis, except as a facet of familiarity. Neither was there good evidence that very young children use verbal rehearsal, although it did appear to be a factor later on. A revised model is proposed, based on three factors. The first is a speech perception system and phonological store; the second is a speech output system which can be used for sublexical segmentation and later rehearsal. The third system is long-term memory with links to both the speech perception and speech output systems. These links enable active strategies to be developed.     

Gesture, speech, and computational stages: a reply to McNeill

McNeill (1985) claimed that speech and its accompanying gestures "share a common computational stage" that is located early in the speech production process. This position depends on two crucial arguments that we believe are unsound: first, that gestures "are synchronized with linguistic units in speech" and, second, that gestures "have semantic and pragmatic functions that parallel those of speech." Careful analysis of the relevant data indicated that although the processes underlying gestural production are globally autonomous, they are linked to speech production at more than just one computational stage. An account is offered that explicates these links.     

The contribution of apraxic speech to working memory deficits in Parkinson's disease

This article links two formerly separate areas of research associated with Parkinson's disease (PD): speech and memory. It is proposed that speech deficits occur in PD not merely at the level of muscular control, as is commonly termed dysarthria, but also at the level of speech planning and programming, more aptly described as a form of apraxia. It is further argued that PD patient groups exhibit small deficits in verbal span, and the link between apraxic speech and verbal span is elucidated via Baddeley's (1986) model of working memory. An experiment is described in which aspects of speech of 36 PD and 43 healthy control subjects were rated and classified, and measures of span and articulation rate for words of different syllable lengths were taken. Twenty-three PD subjects had dysarthric speech, while 14 of them had apraxic speech, which was associated with lower memory span scores for longer words. It is concluded that apraxic speech can be a source of reduced memory span in PD. In addition to implications for rehabilitation and therapeutic work with PD sufferers, these findings advance our theoretical understanding of the Parkinsonian syndrome.     

How to grow up or (nearly) die trying: developing trust in one’s own capacity for growth

This paper is a single case study describing intensive psychoanalytic psychotherapy with an adolescent girl, an apparently bright and capable girl who was struck down at 15 by a double blow of trauma and loss. She cracked along her fault lines which, it is argued, were created during the ordeal of her psychic birth in the first year of life. It is proposed that ordinary Oedipal humiliations precipitated anxiety about dependency. While any adolescent is likely to have to grapple with these difficulties, the terrible life events that befell this girl compounded her dependency just when she might have been moving towards independence. In addition, the ordinary task of mourning childhood and familiar family relationships was obscured by the new and devastating losses that needed to be mourned. Unable to face this task, she spurned the support of her loving family and any potential good object and instead became dependent on manic over-achievement and grievance. The paper traces how the intricacies of the patient’s internal world slowly unfurled through the transference and countertransference and through her story as she told it to her therapist. The therapist describes the slow and difficult process of making links between that story and their experiences together in the consulting room. The theoretical concepts that enabled these links to be made are outlined and the ways in which they guided the therapist’s technique are discussed.     

Interactional patterns of bipolar patients and their spouses

This study examined the interactional patterns of eight bipolar patients (when manic and in remission) and their spouses by videotaping the couples' interactions and then quantifying those interactions using the Marital Interaction Coding system. These couples' interactions were compared to the interactions of eight happily and eight unhappily married nonbipolar psychiatric control patients and their spouses. The purposes were to determine (a) whether the interactional pattern between bipolar patients and their spouses changes or remains the same when the patient is in a manic vs. a nonmanic state and (b) how the interaction patterns of bipolar patients when manic and nonmanic compare to happily and unhappily married nonbipolar psychiatriccontrol patients. Significant differences in interactions were found between manic and nonmanic states, in addition to significant differences between these patients and the control groups. There were also expected differences between happily and unhappily married psychiatric control groups. Implications are discussed for marital therapy for manies that involves problemsolving and communication training.     

Affective reactivity of language symptoms, startle responding, and inhibition in schizophrenia

The speech of some schizophrenia patients becomes markedly more disordered when negative affect is aroused. The authors tested associations between affective reactivity of speech and responsiveness and inhibition on an acoustic startle task in a sample of 27 outpatients. Patients whose language was reactive to negative affect showed significantly higher initial startle amplitudes than those whose language was not reactive. However, they also showed greater habituation to repeated startle stimuli over trials, even after differences in initial amplitudes were controlled statistically. These findings suggest that affective reactivity of speech is associated with higher initial startle responsiveness but also with greater habituation and, conversely, that patients who are relatively nonreactive to excitatory affective and sensory stimuli are also less reactive to inhibitory input.     

Anticipatory coarticulation in a patient with apraxia of speech

Articulatory anticipation of vowel gestures was assessed in an apraxic patient, a dysarthric patient, and three normal speakers. The technique of assessment included perceptual identification of gated speech stimuli. The speech material consisted of /getVte/ utterances with the target vowels /i/, /y/, and /u/. In the case of the apraxic patient the gated vowels were identified at a later instant relative to the preceding plosion burst than in the normal speakers. This result was interpreted as reflecting a delayed onset of coarticulatory gestures, in particular lip rounding. The identification rates for the dysarthric's vowels rather reflected the general reduction of this patient's vowel space.     

A MEDIATIONAL MODEL OF AUTONOMY, SELF-ESTEEM, AND EATING DISORDERED ATTITUDES AND BEHAVIORS

This study expands upon existing literature by examining how the relationship between autonomy deficits and low self-esteem may create a psychological environment conducive to the development of eating disordered behaviors. Findings supported a mediational model to account for eating disordered behaviors in 71 college women. In this model, lack of autonomy was related to decreased global self-esteem, which in turn was associated with bulimia, body dissatisfaction, and drive for thinness. Although only tentative and cross-sectional in nature, this study is of particular importance because it links autonomy and self-esteem in a coherent model predictive of eating disordered behaviors in college women. Developmental aspects of eating disorders and treatment implications are discussed.