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Mental Status Exam
 
 

Assessing Speech

 
 
 
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Overview

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

Slow speechPsychomotor retardation
Normal speech rate
Rapid speech - fast speech but able to be redirectedNormal, psychomotor agitation
Pressured speech - fast and without taking breaks, talking over other people and unable to be redirectedMania, anxiety

Volume of Speech

Loud - may be associated with psychomotor agitation
Normal speech volume
Weak - may represent shyness (normal), low self-esteem (depression), dysarthria

Quantity of Speech

Expansive - speaking at length and apparently without endMania, anxiety
Talkative - actively takes part in conversation.Normal
Poverty of speech - very little speech, even with persuasion.Shyness or psychomotor depression

Fluency

  • Listen For

  • Speed, intonation, phrasing and expression of speech.
  • Significance

  • Normal people comfortably speak at a rate of 100 words per minute - less than 50 per minute is indicative of dysfluency.
  • Causes of Impaired Speech Fluency

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

Tonality

Resonant - rich, deep tone.
Monotone - the patient uses a single tone for vocal expression.Boredom, psychomotor retardation
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