Repetition of words in speech (speech stereotypies): perseveration, verbigeration, standing turns

Types of speech stereotypies

Several types of speech stereotypies are known: persistent repetition of one conclusion or word (perseveration), repetition of the same expression, figure of speech (standing turns), repetition of words or syllables in a certain rhythm or in rhymed form (verbigeration).

Perseveration - we sing odes to the persistence of the stubborn

The term perseveration comes from the Latin word perseveratio, which means “perseverance”, “persistence”. In speech, perseveration manifests itself as repeated reproduction of the same syllables, words or sentences.

A word or thought seems to be “stuck” in the patient’s mind, and he repeats it repeatedly and monotonously when communicating with his interlocutor. In this case, the repeated word or phrase is not related to the topic of the conversation. The patient's speech is monotonous. Perseveration can be expressed both orally and in writing.

Perseveration is the result of associative activity, part of consciousness and does not occur by chance. It should not be confused with obsessive phenomena, since the latter have an element of obsession, and the patient is aware of the absurdity of his actions.

Verbigeration is a common fate of schizophrenics

A mental disorder in which the patient repeats and shouts in a monotonous voice the same interjections, words, and phrases. These repetitions are automatic and meaningless and can last several hours or even days.

The patient rhythmically, often in rhyme, repeats words and combinations of sounds that do not make sense. Verbigeration should be distinguished from perseveration, since with the latter, repetitions depend on neuropsychic states, and disappear with the elimination of these states.

Standing speed

Standing phrases are fragments of phrases, expressions, words, and similar ideas that the patient repeatedly reproduces during a conversation.

At first, the patient pronounces them with the same intonation, and subsequently simplifies, reduces, and the process comes down to a stereotypical repetition of words.

Often the pronounced standing phrases are greatly distorted and it becomes impossible to understand their original meaning and sound.

Palilalia

Palilalia means the patient repeating a phrase, or part of it, a single word or syllable, from a fragment of speech he himself uttered, two or more times in a row.
Repetition occurs at normal voice volume; the volume may gradually decrease and the rate of speech become faster. For example, having given an answer to a question, the patient repeatedly and continuously repeats the answer.

Manifestations of palilalia relate not only to intellectual forms of speech, but also to emotional ones (exclamations, shouts). However, it usually does not refer to mechanically pronounced turns of automated speech. The number of repetitions can reach two dozen or more.

Echolalia

With echolalia, the patient repeats phrases and words that were said by people around him. Echolalia is often characteristic of young children, and in them it is not a pathology.

This is considered a pathology when echolalia causes mental retardation, or its development is observed in an adult.

Causes

Perseveration is based on the inability to switch from one action or process to another, more relevant one. The disorder may be caused by functional changes in brain activity associated with fatigue, stress, the stage of development of nervous activity, or a neurotic disorder. More persistent and severe perseverative disorders are observed with organic damage to the brain, in particular with local damage to the prefrontal and premotor areas of the cortex, subcortical structures, and tertiary zones of the cortex. The causes of perseverations are divided into physiological, psychopathological and neurological.

Physiological factors

Most people at certain periods of their lives become prone to perseverations. The most common reasons are a decrease in the control function of activity, the lack of a clear program of action due to fatigue, emotional exhaustion, and prolonged stress. Physiologically determined perseverations are unstable, manifest themselves to a mild degree, and are more often associated with thought processes, emotions, and less often with the motor sphere. Possible reasons for development:

• Inertia of nervous processes.
  In some people, slow switching is due to the physiological inertia of the nervous system. Usually they find it difficult to complete one task and start another, to quickly adapt to changing circumstances, and to consider a problem from different points of view. Perseverations are presented in mild forms, most often in the form of getting stuck on the topic of conversation.
• Overwork.
  When a person gets tired physically, mentally or emotionally, the process of cyclic excitation and inhibition of neural structures is disrupted, and the signal to stop the action is delayed. Therefore, when people are very tired, it can be easier for them to continue performing monotonous operations and thinking the same thoughts than to switch to rest or just stop.
• Childhood.
  The peculiarity of the nervous processes of children is that arousal can persist for a long time after the cessation of exposure to the stimulus. In combination with the unformed voluntariness of mental functions, this contributes to the emergence of perseverative movements and phrases.

Neurological factors

The most common cause of perseveration is gross organic pathology of the brain. Motor type disorders are determined when the anterior parts of the cerebral hemispheres are affected. The development of the pathological process in the premotor zones and underlying subcortical structures provokes elementary motor perseveration; when the prefrontal zones are damaged, systemic motor perseveration is formed, manifested by repeated repetition of the action program. Damage to the lower parts of the premotor cortex of the left hemisphere leads to perseverative speech disorders.

Perseverative thinking develops with pathology of the frontal lobes of the cerebral cortex and reflects a decrease in control over intellectual functions and programming of activities. Sensory perseverative changes are based on organic damage to the cortical sections of the analyzers - areas of processing information coming from the senses. The occurrence of perseverations is most likely in the following diseases:

• Cerebral atherosclerosis.
  With this disease, the inner walls of arterial vessels are covered with cholesterol plaques. Focal deposits narrow the lumen of the artery, blood flow is disrupted, and the nutrition of brain cells deteriorates. Perseverative symptoms most often concern the speech of patients and appear in aphasia.
• Dementia.
  This group includes Alzheimer's disease, Pick's disease, Parkinson's disease and some others. The pathological substrate is atrophic changes in the cortex in the frontotemporal and frontal parts of the brain, subcortical structures. Severe disturbances of intelligence, memory, and systemic perseverations in speech and praxis (purposeful movements) develop.
• Traumatic brain injuries.
  Perseverative disorders are found in brain injuries with predominant damage to the lateral orbitofrontal zones and the prefrontal convexity of the cortex. Involuntary repetitions of words, phrases, and complex actions are diagnosed in the intermediate and long-term period of injury.
• Strokes.
  Local damage to the brain matter as a result of hemorrhage or ischemia leads to a variety of neurological disorders: loss of sensitivity and motor function, disturbances in speech, breathing, and swallowing. Aphasic syndrome is prone to reverse development. Perseverations are found in expressive phrasal speech and are explained by difficulties in choosing words and insufficient control functions.
• Brain tumors.
  A decrease in goal-directed behavior is characteristic of tumor processes localized in the frontal lobes of the brain, in their basal parts, near the subcortical motor nodes. Meaningful activity loses its selective character and is replaced by an inert stereotype that arose at the previous stage. Motor and speech motor perseverations are most often diagnosed.

Speech stereotypies and psychoneurological diseases

The causes of speech stereotypies often lie in the development of neurological and psychological diseases.

Causes of perseverations

Experts believe that the cause of perseveration is damage to the lower parts of the premotor nuclei of the cortex of the left hemisphere in right-handers, and the right hemisphere in left-handers.

The most common cause of perseveration is considered to be neurological diseases resulting from physical damage to the brain. In this case, it becomes impossible to switch between different activities, changing the train of thought and the order of actions when performing various tasks.

With the neurological nature of the disease, the causes of perseveration are:

1. Traumatic brain injuries , in which the lateral orbitofrontal areas of the cortex and its prefrontal convexities are affected.
2. Aphasia is the appearance of disturbances in speech formed at a previous stage of life. These disorders arise due to physical damage to the speech centers, as a result of traumatic brain injury, encephalitis, and brain tumors.
3. Pathologies related to the area of ​​the frontal lobes of the cerebral cortex.

Psychiatry and psychology classify perseveration as a symptom of various phobias and anxiety syndromes. The course of this speech stereotypy in the psychological and psychiatric direction can be caused by:

• obsessiveness and selectivity of individual interests, which is most often found in people with autistic disorders;
• lack of attention with hyperactivity, while stereotypy arises as a defense mechanism to attract attention to oneself;
• a steady desire to learn and experience new things can lead to fixation on one conclusion or activity;
• Perseveration is often a symptom of obsessive-compulsive disorder.

Perseveration should not be confused with obsessive-compulsive disorder, human habits, and sclerotic changes in memory.

Perseverations are more often observed in patients with dementia (dementia), which is caused by vascular damage to the brain, as well as with age-related atrophic processes in the brain. The patient’s intellect is impaired, and he cannot understand the question being asked and, instead of a logical answer, repeats previously used phrases.

What provokes the development of verbigeration?

With verbigeration there is no connection with certain neuropsychic conditions. One of the features of verbigeration is that the patient pronounces words without showing emotion. As a rule, verbal repetitions are accompanied by active facial expressions and motor disturbances.

Most often, these verbal iterations occur in patients with dementia and catatonic schizophrenia.

Causes of standing revolutions, palilalia and echolalia

The appearance of standing phrases in speech signals a decrease in intelligence and empty thinking.
They often appear with a disease such as epileptic dementia. Also, one of the diseases characterized by standing movements is Pick's disease, as well as other atrophic diseases of the brain. Palilalia is a typical manifestation of Pick's disease. It is also often accompanied by diseases such as striatal pathology, striopallidal pathology (atrophic, inflammatory, vascular), postencephalic parkinsonism, pseudobulbar syndrome, catatonia, Tourette's syndrome, schizophrenia.

The occurrence of echolalia is often associated with damage to the frontal lobes of the brain. If the patient has symptoms such as hallucinations, lack of coordination, and forgetfulness, it is necessary to seek advice from a specialist. If brain damage is not diagnosed, then the causes of echolalia may be imbecility, schizophrenia, autism, Asperger's syndrome, Tourette's syndrome.

Treatment

The main treatment of perseverative deviations is aimed at eliminating the cause - a mental or neurological disease. Medical and psychological assistance is provided comprehensively, including medication support, psychotherapy, and psychocorrection. The key objectives of these areas are to reduce tension caused by perseverative symptoms, increase the skill of controlling actions, and master ways of voluntarily switching attention.

Psychotherapy

Psychotherapeutic sessions are aimed at reducing anxiety, emotional stress, as well as replacing perseverative processes with adequate behavior and thinking. The ability to relax and manage your emotional state is achieved through auto-training and neuromuscular relaxation techniques. To eliminate perseverations, behavioral psychotherapy is used: a technique for redirecting thoughts by abruptly changing the topic of conversation, a limiting method that allows you to reduce perseverative manifestations by limiting the volume of repetitive actions.

Psychocorrection

Psychocorrectional work is aimed at increasing mental performance, developing self-regulation skills through improving cognitive processes, especially attention and thinking. To successfully overcome perseverations, you need the ability to purposefully switch attention. This function is trained during special exercises (for example, finding numbers in red-black tables), group psychotechnical games. Another line of work is to increase the flexibility of thinking. The main method of developing this quality is solving creative problems.

Establishing diagnosis

Diagnosis of speech stereotypies involves comprehensive testing. The patient is asked to undergo special testing or answer simple questions (implying “yes” or “no” answers), repeat similar-sounding sounds or sound combinations.

The patient is also asked to name the objects that are in the room, name the days of the week, explain the meaning of the words, and retell the text.

When examining a patient, it is very important to determine whether he understands speech addressed to him. If there is a suspicion of mild forms of speech disorders, the speech pathologist uses other more complex diagnostic methods.

To diagnose speech stereotypies, a technique is used that includes a series of separate tests. The patient is asked to write words in normal and reverse order, write words and phrases in upper and lower case letters, read text in forward and reverse order, write numbers in normal and reverse order, and perform multiplication. When making toasts, the doctor assesses the number of correct and incorrect answers per minute.

Diagnostics

In everyday situations, perseveration is manifested by repetition of the same phrase, despite changing the topic of conversation or question, cyclical reproduction of any actions (for example, flipping through a book without attempting to read), repeated voicing of a request that does not make sense or has already been fulfilled. Children have monotony, a narrow focus on games and hobbies, and a weak and unstable interest in learning new things.

Medical diagnostics are carried out by a psychiatrist and a neuropsychologist. The primary collection of information is carried out through conversation and observation. With pronounced perseverations, repetitions of phrases, words, syllables, movements and actions are detected already at the first medical consultation. To objectively determine perseverations, a number of neuropsychological tests are performed:

• Speech and mental tests.
  Perseverativity of speech and thinking is revealed when solving an association test, establishing analogies, memorizing and reproducing a series of words. In an associative experiment, patients tend to pronounce one word in response to different stimulus words from the psychologist. When performing a task on simple analogies, they do not look for a logical connection, but choose words “according to a pattern,” for example, all the first (or last) words in lists. While reproducing a series of words, they become fixated on one or two, repeating them.
• Motor tests.
  Perseveration is diagnosed using a rhythm copying test (tapping rhythms) and a dynamic praxis test, when the patient is asked to repeat the sequence of hand positions “fist-palm-rib”. Typical results: sluggish reproduction of the previous series of movements/rhythm, returning to the wrong option, doing the wrong structure and repeating it.
• Graphic samples.
  Perseverative movements are detected in patients when drawing, writing numbers and letters. In elementary perseveration, they draw a circle, and then circle it many times or draw several continuous circles - a spiral. Similar errors occur when trying to write the numbers “6”, “9”, letters “d”, “b”. With complex movement disorder, it is difficult to draw a series of geometric figures - instead of a given sequence, the patient draws one figure several times.

Therapy and correction

Treatment of patients with speech stereotypies involves the following techniques:

• pharmacotherapy;
• physiotherapy;
• psychotherapy;
• psychological correction;
• physiotherapy;
• logotherapy;
• working with defectologists.

It is necessary to begin therapy with treatment of the main provoking disease. The ability to restore speech function will depend on the main diagnosis.

If the patient has aphasia, the main emphasis is on automated speech, then the patient is gradually taught to comprehend and separate the main from the secondary. If the underlying disease is dementia, during therapy they focus on the semantic meaning of words. Patients with a mild form of schizophrenia are taught to correctly construct sentences that preserve semantic content.

In Western countries, when treating these disorders, the main emphasis is on drug therapy. Neuroleptics are the most widely used. They contribute to changes in the pathological processes of the brain.

Medicines for perseveration

As a symptom, perseveration cannot be treated, but thanks to drug therapy of the underlying disease, its intensity is reduced. Neuroleptics are often used for the above diseases. This is a group of drugs that have a calming effect.

With their constant use, a person does not react to external stimuli in the same way, that is, excessive experience of situations goes away, which can cause annoying repetition of actions or thoughts. Psychomotor agitation is reduced, aggressiveness is weakened, and the feeling of fear is suppressed. Some antipsychotics are used as sedatives, while others, on the contrary, are used when mental functions need to be activated. Each drug is selected individually by the doctor.

Along with the use of drugs, it is important to provide psychotherapeutic support to the person, especially if perseverations are caused by stress and other psychological factors.