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psychology Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries betwe ...
, alogia (; from Greek ἀ-, "without", and λόγος, "speech" + New Latin -ia) is poor
thinking In their most common sense, the terms thought and thinking refer to conscious cognitive processes that can happen independently of sensory stimulation. Their most paradigmatic forms are judging, reasoning, concept formation, problem solving, an ...
inferred from speech and language usage. "alogia An impoverishment in thinking that is inferred from observing speech and language behavior. There may be brief and concrete replies to questions and restriction in the amount of spontaneous speech (termed poverty of speech). Sometimes the speech is adequate in amount but conveys little information because it is overconcrete, overabstract, repetitive, or stereotyped (termed poverty of content)." There may be a general lack of additional, unprompted content seen in normal
speech Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...
, so replies to questions may be brief and concrete, with less spontaneous speech. This is termed poverty of speech or laconic speech. "laconic speech Condition characterized by a reduction in the quantity of spontaneous speech; replies to questions are brief and unelaborated, and little or no unprompted additional information is provided. Occurs in major depression, schizophrenia, and organic mental disorders. Also called poverty of speech." The amount of speech may be normal but conveys little information because it is vague, empty, stereotyped, overconcrete, overabstract, or repetitive. "poverty of content of speech Speech that is adequate in amount but conveys little information because of vagueness, emptiness, or stereotyped phrases." This is termed poverty of content or poverty of content of speech. Under Scale for the Assessment of Negative Symptoms used in
clinical research Clinical research is a branch of healthcare science that determines the safety and effectiveness ( efficacy) of medications, devices, diagnostic products and treatment regimens intended for human use. These may be used for prevention, treat ...
, thought blocking is considered a part of alogia, and so is increased latency in response. This condition is associated with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social wi ...
,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
, severe depression, and
autism The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
. "poverty of ideas a thought disturbance, often associated with schizophrenia, dementia, and severe depression. ...." As a
symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
, it is commonly seen in
patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health ...
s with schizophrenia and
schizotypal personality disorder Schizotypal personality disorder (STPD or SPD), also known as schizotypal disorder, is a mental and behavioral disorder. DSM classification describes the disorder specifically as a personality disorder characterized by thought disorder, paran ...
, and is traditionally considered a negative symptom. It can complicate psychotherapy severely because of the considerable difficulty in holding a fluent conversation. The alternative meaning of alogia is inability to speak because of dysfunction in the
central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain and spinal cord. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all p ...
, "alogia ''n.'' inability to speak because of dysfunction in the central nervous system. In a less severe form, it is sometimes referred to as dyslogia." found in mental deficiency and dementia. In this sense, the word is
synonymous A synonym is a word, morpheme, or phrase that means exactly or nearly the same as another word, morpheme, or phrase in a given language. For example, in the English language, the words ''begin'', ''start'', ''commence'', and ''initiate'' are all ...
with
aphasia Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in t ...
, and in less severe form, it is sometimes called dyslogia.


Characteristics

Alogia may be on a continuum with normal behaviors. People without mental illness may have it occasionally including when fatigued or disinhibited, when writers use language creatively, when people in certain disciplinessuch as politicians, administrators, philosophers, ministers, and scientistsuse language pedantically, or in people with little education. Hence, deciding if an individual has alogia depends on contextual clues. Is the person in control? Can the person moderate the effect if asked to be specific or concise? Is it better with another topic? Are there other significant symptoms? Alogia is characterized by a lack of speech, often caused by a disruption in the thought process. Usually, an injury to the left side of the brain may cause alogia to appear in an individual. While in conversation, alogic patients will reply very sparsely and their answers to questions will lack spontaneous content; sometimes, they will even fail to answer at all. Their responses will be brief, generally only appearing as a response to a question or prompt. Apart from the lack of content in a reply, the manner in which the person delivers the reply is affected as well. Patients affected by alogia will often slur their responses, and not pronounce the
consonants In articulatory phonetics, a consonant is a speech sound that is articulated with complete or partial closure of the vocal tract. Examples are and pronounced with the lips; and pronounced with the front of the tongue; and pronounced w ...
as clearly as usual. The few words spoken usually trail off into a whisper, or are just ended by the second syllable. Studies have shown a
correlation In statistics, correlation or dependence is any statistical relationship, whether causal or not, between two random variables or bivariate data. Although in the broadest sense, "correlation" may indicate any type of association, in statisti ...
between alogic ratings in individuals and the amount and duration of pauses in their speech when responding to a series of questions posed by the researcher. The inability to speak stems from a deeper mental inability that causes alogic patients to have difficulty grasping the right words mentally, as well as formulating their thoughts. A study investigating alogiacs and their results on the category fluency task showed that people with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social wi ...
who exhibit alogia display a more disorganized
semantic memory Semantic memory refers to general world knowledge that humans have accumulated throughout their lives. This general knowledge (word meanings, concepts, facts, and ideas) is intertwined in experience and dependent on culture. We can learn about ...
than controls. While both groups produced the same number of words, the words produced by people with schizophrenia were much more disorderly and the results of
cluster analysis Cluster analysis or clustering is the task of grouping a set of objects in such a way that objects in the same group (called a cluster) are more similar (in some sense) to each other than to those in other groups (clusters). It is a main task of ...
revealed bizarre coherence in the alogiac group. If the condition is assessed using a language other than the individual's primary language, the medical professional needs to make sure that the problem is not from language barriers. This condition is associated with schizophrenia,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
, and severe depression.


Example

The following table shows an example of "poverty of speech" which shows replies to questions that are brief and concrete, with a reduction in spontaneous speech: The following example of "poverty of content of speech" is a response from a patient when asked why he was in a hospital. Speech is vague, conveys little information, but is not grossly incoherent and the amount of speech is not reduced. "I often contemplate—it is a general stance of the world—it is a tendency which varies from time to time—it defines things more than others—it is in the nature of habit—this is what I would like to say to explain everything."


Causes

Alogia can be brought on by frontostriatal dysfunction which causes degradation of the semantic store, the center located in the
temporal lobe The temporal lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the mammalian brain. The temporal lobe is involved in proc ...
that processes meaning in language. A subgroup of chronic schizophrenia patients in a word generation experiment generated fewer words than the unaffected subjects and had limited lexicons, evidence of the weakening of the semantic store. Another study found that when given the task of naming items in a category, schizophrenia patients displayed a great struggle but improved significantly when experimenters employed a second stimulus to guide behavior unconsciously. This conclusion was similar to results produced from patients with
Huntington's Huntington's disease (HD), also known as Huntington's chorea, is a neurodegenerative disease that is mostly inherited. The earliest symptoms are often subtle problems with mood or mental abilities. A general lack of coordination and an unst ...
and
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
, ailments which also involve frontostriatal dysfunction.


Treatment

Medical studies conclude that certain adjunctive drugs effectively palliate the
negative symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...
of schizophrenia, mainly alogia. In one study,
Maprotiline Maprotiline, sold under the brand name Ludiomil among others, is a tetracyclic antidepressant (TeCA) that is used in the treatment of depression. It may alternatively be classified as a tricyclic antidepressant (TCA), specifically a secondary ...
produced the greatest reduction in alogia symptoms with severity reduction in 50% of patients (out of 10). Of the negative symptoms of schizophrenia, alogia had the second best responsiveness to the drugs, surpassed only by attention deficiency.
D-amphetamine Dextroamphetamine is a central nervous system (CNS) stimulant and an amphetamine enantiomer that is prescribed for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is also used as an athletic performance and c ...
is another drug that has been tested on people with schizophrenia and found success in alleviating negative symptoms. This treatment, however, has not been developed greatly as it seems to have adverse effects on other aspects of schizophrenia such as increasing the severity of
positive symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
.


Relation to schizophrenia

Although alogia is found as a symptom in a variety of health disorders, it is most commonly found as a negative symptom of schizophrenia. Previous studies and analyses conclude that at least three factors are needed to cover both the positive and negative symptoms of schizophrenia; the three are: psychotic, disorganization, and negative symptom factors. Studies suggest that an inappropriate affect is strongly associated with bizarre behavior and positive
formal thought disorder A thought disorder (TD) is any disturbance in cognition that adversely affects language and thought content, and thereby communication. A variety of thought disorders were said to be characteristic of people with schizophrenia. A content-thought ...
on a disorganization factor; attention impairment correlates significantly with psychotic, disorganization, and negative symptom factors. Alogia contains both positive and negative symptoms, with the poverty of content of speech as the disorganization factor, and poverty of speech, response latency, and thought blocking as the negative symptom factors. Alogia is a major
diagnostic sign Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
of schizophrenia, when organic mental disorders have been excluded. In schizophrenia,
negative symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...
including
flattening of affect Reduced affect display, sometimes referred to as emotional blunting or emotional numbing, is a condition of reduced emotional reactivity in an individual. It manifests as a failure to express feelings ( affect display) either verbally or nonverba ...
, avolition, and alogia are responsible for the considerable
morbidity A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ...
of the disease compared with other
psychotic disorders Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior t ...
. Negative symptoms are common in the prodromal and residual phases of the disease and can be severe. During the first year, negative symptoms can progress, especially alogia, which may start off from a relatively low rate. Within 2 years, up to 25% of patients will have significant negative symptoms. Psychotic symptoms tend to diminish as the individuals age, but negative symptoms tend to persist. Prominent negative symptoms at disease onset, including alogia, are good predictors of worse outcomes. Negative symptoms can arise in the presence of other psychiatric symptoms. Positive symptoms are a common cause of apathy, social withdrawal, and alogia. Secondary causes of negative symptoms, such as depression and demoralization, often remit within a year, which helps distinguishing them from primary negative symptoms. Symptoms that don't diminish over a year with medications should be reconsidered as possible primary negative symptoms.


See also

*
Aphasia Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in t ...
* Communication deviance * List of language disorders *
Mutism Muteness or mutism () is defined as an absence of speech while conserving or maintaining the ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, caregi ...


References


Other references

* * * * {{cite book , ref = {{harvid , Thought Disorder , 2016 , editor-last1 = Fatemi , editor-first1 = S Hossein , editor-last2 = Clayton , editor-first2 = Paula J , year = 2016 , title = The Medical Basis of Psychiatry , edition = 4th , location = New York , publisher = Springer Science+Business Media , isbn = 978-1-4939-2528-5 , doi = 10.1007/978-1-4939-2528-5 , last1 = Andreasen , first1 = Nancy C , chapter = 25 Thought Disorder , pages = 497–505 Medical signs Schizophrenia