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Mental Status Exam

Assessing Speech

April 1st, 2023


Listen to the patient speak on order to assess for a potential speech disorder. Listen to the rate of speech, volume, quantity, fluency and tonality.
  • Causes of Abnormal Speech

  • Psychiatric disorder - mood disorder, anxiety, schizophrenia
  • Confusion - delirium, dementia, intellectual disability
  • Dysphasia / aphasia
  • Dysarthria - stroke, brain injury, Parkinson's, MS
  • Dysphonia - laryngitis, neuropathology, trauma, mass, atrophy, systemic disease
  • Hearing impairment
  • English as a non-native language
  • Intoxication

Rate of Speech

The rate of speech refers to the speed at which the patient speaks.
  • Interpretation

  • Slow speech (bradylalia)Depression, Parkinson's disease, cognitive impairment
  • Normal speech rate
  • Rapid speech (tachylalia) - fast speech but able to be redirectedNormal, mania, anxiety, stimulants
  • Pressured speech - fast and without taking breaks, talking over other people and unable to be redirectedMania, anxiety

Volume of Speech

The loudness or softness of a person's speech can be indicative of emotional factors, cultural background, or hearing impairments.
  • Interpretation

  • Loud (hyperphonia)Personality trait, hearing impairment, mania
  • Normal speech volume
  • Weak (hypophonia) - low or soft speechShyness, anxiety, depression, Parkinson's disease

Quantity of Speech

Speech quantity is the amount of speech produced by an individual, helping to identify patterns of over-talkativeness or paucity of speech.
  • Interpretation

  • Excessive talking (logorrhoea) - speaking at length and apparently without endMania, ADHD, anxiety
  • Talkative - actively takes part in conversation.Normal
  • Poverty of speech - very little speech, even with persuasion.Shyness, depression, schizophrenia, cognitive impairment


Fluency refers to the ease and flow of speech, exploring potential disruptions such as stuttering or hesitations, which could be related to anxiety, neurological disorders, or language impairments.
  • Examples of Dysfluency

  • Stuttering - repetition, prolongation, or pauses in speechMay be developmental, neurogenic, or psychogenic
  • Cluttering - rapid, disorganized speech with excessive word and phrase repetitionsOften related to language or learning disabilities
  • Causes of Impaired Speech Fluency

  • Dysphasia / aphasia
  • Dysarthria
  • Confusion - delirium, dementia, intellectual disability
  • Hearing impairment
  • Foreign language
  • Intoxication


Tonality refers to the pitch, intonation, and expressiveness of an individual's speech.
  • Interpretation

  • Expressive - varied pitch and intonationNormal tonality
  • Monotone - the patient uses a single tone for vocal expression.Boredom, depression, schizophrenia, autism spectrum disorder
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