Disorganized speech is a symptom of mental health diagnoses like schizophrenia. It is evidence of thought disorder which researchers define as a kind of psychosis.
Treatment for a mental health diagnosis can reduce symptoms of disorganized speech, although they may not go away completely.
What is disorganized speech?
Disorganized speech is a sign of a thought disorder that shows differences in language and communication patterns. Thought disorder is one possible symptom of schizophrenia, although symptoms can display differently depending on the person.
Psychiatrists used to define schizophrenia in terms of subtypes, but this is no longer the case. But researchers still say that thought disorder is more common among people with disorganized schizophrenia than those with paranoid schizophrenia.
When psychosis worsens, you may experience more disorganized speech, which can occur even when psychosis is well managed, but medication is there to help reduce symptom severity.
Disorganized speech may also occur in nonpsychotic illnesses, drug intoxication, and organic brain disorders. Organic brain disorders are conditions causing symptoms that include:
- difficulties with memory
- hallucinations
- delusions
- personality changes
Examples of disorganized speech
The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) are scales rating thought disorders that have disorganized speech.
Types of disorganized speech include:
- Derailment: This describes a loose association between words. Research gives the example of a person using the word “marathon,” to describe feeling out of breath, as if they have run a marathon, then jumping to the Greek town of Marathon and discussing Greece’s association with democracy.
- Tangentiality: This describes going off track. An example could be trying to answer a question about an injury, but going on to talk about the weather — “I was riding my horse. It was sunny, but I prefer the sunshine. This time of the year is very sunny.”
- Incoherence: Also called “word salad,” the person says a group of words that together make no sense to the listener.
- Illogicality: This describes coming to conclusions that don’t follow basic logic.
- Circumstantiality: Long-windedness in reaching the answer to a question.
- Pressure-of-speech: This means increasing the speed at which you speak.
- Distractibility of speech: This describes changing the topic of conversation abruptly because of an external stimulus.
- Clanging: This means choosing words based on their sounds, such as talking in rhymes.
Some negative speech symptoms can also indicate thought disorder. An example is loss of goal, which is an inability to complete a sentence or an idea through speech.
Related mental health conditions
Thought disorder is a psychotic symptom. The psychiatric community defines psychosis by its association with mental health diagnoses, specifically:
- Schizophrenia spectrum disorders
- Bipolar disorders
- Major depressive disorders with psychotic features
Still, psychosis varies greatly between people, and researchers use different methods to define and diagnose it, with an overlap in diagnostic standards between conditions.
To receive a schizophrenia diagnosis, you must experience symptoms for 6 months. For acute psychotic disorder, this changes to 1 month.
2016 research indicates Behavioral Variant Frontotemporal Dementia (bvFTD) also has symptoms of disorganized speech that have sometimes led to schizophrenia or mania misdiagnosis.
Signs of disorganized speech
Some signs of disorganized speech are:
- using very few words (laconic speech)
- empty speech or sounding like there is little meaning, also known as pseudo-philosophical
- becoming distracted and changing topics during conversation
- using words together in an illogical way (word salad)
- incomplete thoughts or sentences
- incorrect word choice
People with disorganized speech may also have extremely vague or extremely abstract speech.
Disorganized speech vs. disorganized thinking
The National Institute of Mental Health (NIMH) defines thought disorder in part as having ways of thinking that are unusual or illogical and may include trouble with speech and thought organization.
Research from 2017 notes that for practical reasons, thought disorder is classified as disorganized speech, but that this may be an oversimplification. It may not take into account how thought disorder may differ from person to person in terms of severity and effects.
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Doctors treat disorganized speech by treating the condition causing it. In the case of schizophrenia, treatment typically includes a combination of talk therapy and prescription medications.
Medications for schizophrenia include typical and atypical antipsychotics, such as:
First-generation (typical) antipsychotics:
- chlorpromazine (Thorazine)
- fluphenazine (Prolixin)
- haloperidol (Haldol)
- perphenazine (Trilafon)
- thiothixene (Navane)
- trifluoperazine (Stelazine)
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Second-generation (atypical) antipsychotics:
- aripiprazole (Abilify)
- aripiprazole lauroxil (Aristada)
- asenapine (Saphris)
- brexpiprazole (Rexulti)
- cariprazine (Vraylar)
- clozapine (Clozaril)
- iloperidone (Fanapt)
- lumateperonee (Caplyta)
- lurasidone (Latuda)
- olanzapine (Zyprexa)
- samidorphan (Lybalvi)
- paliperidone (Invega)
- quetiapine (Seroquel)
- risperidone (Risperdal)
- ziprasidone (Geodon)
Summary
A person with disorganized speech may have thought disorder, which can be a symptom of psychosis. Experiencing disorganized speech can also contribute to a schizophrenia diagnosis.
The phenomenon is also associated with bipolar disorders and major depression with psychotic features.
Medication and talk therapy can help treat the symptoms of the condition causing disorganized speech.
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