Clinical types of psychopathy according to ICD-10 (F60 – F60.7) – general characteristics.

Description

 Neurotic stuttering.

A functional disorder of the fluency and rhythm of speech associated with dysfunctional psycho-emotional factors. The distinctive features of this form of stuttering are changes in the intensity of manifestations depending on the situation surrounding the patient and his psychological state, an undulating or recurrent course, and the presence of concomitant vegetosomatic or neurotic disorders. Diagnosis is based on a history of indications of psychotrauma, exclusion of organic causes of stuttering, and examination of speech function. Neurotic stuttering is treated using speech therapy, neurology, medical psychology and psychotherapy.

Additional facts

 Neurotic stuttering.

A psychologically determined form of speech impairment, expressed in a change in its rhythm, the appearance of hesitations and repetitions. Like other types of stuttering, it is associated with tonic and tonic-clonic spasms in the respiratory-vocal and articulatory muscles. The functional nature of neurotic stuttering and its close connection with a traumatic situation make it possible to classify it as a group of neuroses, or neurotic conditions. In this regard, neurotic stuttering in neurology and speech therapy received a second name - logoneurosis. Logoneurosis most often manifests in childhood. According to some data, short-term stuttering is observed in 4 children out of 100. Children 4-5 years old are most susceptible to stuttering, since during this period the active development of speech function occurs. However, the appearance of neurotic stuttering is possible at almost any age: both during the period of speech formation (2-3 years) and in adults. Boys and men stutter more often than girls and women.

Neurotic stuttering

Symptoms in children

Speech neurosis is characterized by pauses during a conversation; in addition, signs of pathology may be as follows:

• the child repeats certain sounds, syllables or words several times;
• there are problems with the pronunciation of certain syllables or words;
• spasms of the larynx are observed;
• lack of air.

Along with the listed signs, the child has respiratory and articulatory convulsions, and also observes:

• feeling of fear;
• increased anxiety;
• low self-esteem;
• increased sweating;
• restless sleep.

In some cases, when pronouncing syllables or words, the child’s facial expression changes, and grimaces and tics may appear.

Pathogenesis

 The leading cause of logoneurosis is a psychotraumatic situation. This can be acute mental trauma (severe fright or other sudden shock, an attack of anger) or chronic stress (separation from loved ones, family conflict, troubles at work). In the first case, neurotic stuttering can be short-term, although often its symptoms reach significant severity, up to transient mutism (especially in children). In the chronic course of a psychotraumatic situation, speech pathology is consolidated, and other neurotic disorders may be added. In children, about 60% of cases of the disease are associated with an unfavorable speech climate in the family. These include attempts by relatives to speed up the child’s speech development, excessive demands on speech, information overload, bilingualism in the family, a sharp increase in demands on the child’s speech abilities. In some children, neurotic stuttering can develop when imitating the speech of a stuttering person, if one is in their close environment. In such cases, stuttering becomes fixed according to the type of neurotic fixation. Hereditary predisposition plays a certain role in the occurrence of the neurotic form of stuttering. It may consist of a genetically determined functional deficiency of the apparatus that provides speech motor skills. The pathogenesis of logoneuroses has not been sufficiently studied. In acute stressful situations, neurotic stuttering presumably develops due to the emergence of a stable pathological conditioned reflex connection, and its consolidation is facilitated by the formation of motor automatism. When stuttering develops at the age of 2-4 years, it can be assumed that it is based on a pathological fixation of natural hesitations in speech, typical for the period of formation of speech function.

Differential diagnosis

Symptoms

 A distinctive feature of the neurotic form of stuttering is the uneven intensity of speech disturbances. In the same patient, the severity of stuttering can vary from practically unimpeded speech to stuttering so severe that speech contact becomes unproductive. Usually, in a familiar environment for the patient, among people close to him (friends, relatives), neurotic stuttering is little manifested and may even be unnoticeable. The intensity of stuttering increases significantly with excitement and emotional stress, with awareness of one’s responsibility or the high significance of the ongoing conversation. All patients with logoneurosis note a sharp increase in stuttering symptoms when it is necessary to speak with strangers or speak in front of an audience. Over time, stuttering begins to leave its mark on the patient's behavior. He tries to avoid pronouncing difficult words, masks his stuttering by stretching out sounds, and so on with speech techniques. In most cases, logophobia develops. Due to a speech impediment, the patient becomes embarrassed to speak with strangers and refuses to speak at planning meetings and conferences. Young children suffering from logoneurosis do not want to participate in the morning performances held in kindergarten; schoolchildren, if necessary, orally answer the lesson, prefer to remain silent. Logophobia is most pronounced in adolescents; it can lead to disruption of learning the curriculum and complete school maladjustment. The appearance of neurotic stuttering can have a different character. In acute psychotrauma, stuttering occurs as an acute neurotic reaction that develops after recovery from an affective-shock state. A chronic psychotraumatic situation, including an unfavorable speech climate, as a rule, leads to the appearance of pre-neurotic changes with individual episodes of hesitation in speech. Then, either a gradual decrease and disappearance of stuttering can occur, or it can be consolidated as a pathological speech automatism. When fixed, neurotic stuttering is often accompanied by other neurotic conditions: asthenia, sleep disturbance, depressive neurosis, neurasthenia, phobias, hysteria, hypochondria, enuresis, etc. Autonomic disorders that fit into the clinic of vegetative-vascular dystonia are possible. Adolescents are especially susceptible to neurotic and somatovegetative disorders. The long course and unfavorable dynamics of stuttering in them can provoke neurotic personality development. Cramps. Euphoria.

Symptoms and clinical picture

In adults and children, stuttering manifests itself with the same symptoms. The development of these symptoms is associated with spasm of the muscles of the tongue, lips, larynx, and soft palate.

The main symptoms of logoneurosis:

• multiple repetitions of individual sounds, syllables, words;
• difficulty pronouncing words or syllables;
• articulatory spasms;
• involuntary pauses that occur during pronunciation;
• spasms of the speech apparatus;
• feeling of lack of air.

In addition, patients may present complaints indicating neurotic conditions :

• increased feeling of anxiety;
• the appearance of unmotivated fears;
• problems with self-esteem;
• increased sweating;
• sleep disturbances (insomnia or nightmares);
• state of mental stress;
• decreased appetite.

Logoneurosis will also be indicated by changes in facial expressions, tension in the facial muscles, tics, involuntary grimaces, twitching of the lips, and rapid blinking during speech.

The severity of the symptoms of the disease depends entirely on its stage:

1. In the first stage of logoneurosis, the child begins to stutter only in moments of strong excitement, and at rest the speech is clear, separate and understandable, the symptoms of logoneurosis are completely absent.
2. In the second stage , stuttering manifests itself constantly, the patient becomes withdrawn, complex, and taciturn.
3. In the third stage of appearance, stuttering appears in public, and disappears when the person returns to a comfortable environment.
4. The fourth stage of logoneurosis is characterized by obvious hesitations during the pronunciation of individual words.

Diagnostics

 Diagnosis of logoneurosis is carried out with the participation of a speech therapist and a neurologist. It is important to identify the patient’s history of acute or chronic stressful situations. A diagnostic examination of speech determines a violation of its tempo, rhythm and smoothness, the presence of hesitations, stretching of individual sounds, repetitions of syllables. A neurological examination does not reveal significant abnormalities in the neurological status. There may be some revival of reflexes and signs of autonomic dysfunction. It is necessary to differentiate neurotic stuttering from neurosis-like stuttering. The latter occurs as a result of TBI or various diseases of the central nervous system (ischemic stroke, intracerebral tumor, hydrocephalus, previous encephalitis), gradually progresses, and is not accompanied by logophobia and attempts by the patient to hide the speech defect. As a rule, with a neurosis-like form of stuttering, organic personality changes are observed: difficulty switching, predominantly euphoric mood, inertia. To completely exclude the organic nature of stuttering, additional studies should be performed: EEG, Echo-EG, REG, MRI or CT scan of the brain.

Treatment in adults

Treatment is aimed at restoring the proper functioning of the nervous system, so doctors use herbal medicine, reflexology, physiotherapy, and medications (Glycine, Novo-passit).

The treatment will be determined by a neurologist after a thorough examination of the patient. Complex treatment is often used - taking sedatives, traditional medicine, manual therapy, massage, acupuncture.

The listed methods significantly improve the patient’s emotional background, help normalize nerve impulses, reduce excitation of the autonomic nervous system, and improve mood and sleep.

Speech therapy treatment is also mandatory. With the help of a speech therapist, the patient learns proper breathing, which significantly reduces the symptoms of the disease.

In some cases, the problem is partially eliminated, or stuttering returns after a course of therapy. Then more serious treatment is needed. We need the help of a psychotherapist who will show the patient relaxation and auto-training techniques, help overcome fears and minimize the consequences of psychological trauma. Are used:

• group therapy;
• autogenic training;
• cognitive behavioral therapy;
• Gestalt therapy.

Medications that may be prescribed include:

• Pantogam;
• Piracetam;
• Phenibut;
• Phenotropil;
• Noofen;
• Anvifen;
• Gopantam and other nootropic drugs.

Differential diagnosis

 Logoneurosis and so-called stumbling should be differentiated. The latter is a consequence of early organic cerebral pathology and includes slurred speech due to articulation disorders, disturbances in the rhythm and speed of speech (choking speech, tachylalia), monotonous speech, rearrangement of semantic stress, difficulty selecting words, etc. Neurotic stuttering can be a concomitant disorder with some mental illnesses (schizophrenia, oligophrenia, psychopathy). In such cases, the patient is prescribed a consultation with a psychiatrist.

Treatment

 Therapy for logoneurosis is usually complex and is carried out jointly by a speech therapist, neurologist, psychologist and psychotherapist. Regular speech therapy sessions are provided to correct stuttering. However, they may not be effective with continued exposure to a traumatic situation. In order to change the patient’s attitude towards such a situation and thereby eliminate its traumatic influence, the following are carried out: psychocorrection, psychotherapy sessions, psychoanalysis, psychological training, art therapy. If logoneurosis is based on problems in the family, then family counseling and family psychotherapy are recommended. For children, a favorable speech atmosphere is of particular importance: a calm pace of speech, understandable and friendly statements from people around them. Neurological assistance is necessary for the selection and correction of drug therapy aimed at relieving the symptoms of logoneurosis and accompanying neurotic disorders. Depending on the leading symptoms of the disease, it may include sedatives, antidepressants, tranquilizers, and antipsychotics. It is possible to use electrosleep and various reflexology methods. Along with generally accepted approaches to the treatment of logoneurosis, there are a large number of proprietary methods. These include the method of social rehabilitation created by Yu. B. Nekrasova, the method of sustainable speech normalization developed by L. Z. Arutyunyan, a technique based on breathing exercises by A. N. Strelnikova, etc. Biofeedback therapy is also used, and in difficult cases they resort to hypnotherapy.

Source

Correction and treatment of logoneurosis

The diagnosis of Logoneurosis is usually made in childhood or adolescence. If your child develops logoneurosis, treatment must be started immediately. Having discovered speech defects in a child, parents should show him to competent specialists. When stuttering, doctors mainly prescribe the use of medications. The use of medications alone without psychotherapy does not lead to the expected result, because full speech correction is possible only with classes with a speech therapist and psychologist. Also, you should not self-medicate, but rather consult a specialist, as the problem can worsen.

Specialists at the Ember Center correct logoneurosis in children without prescribing medications. Specially developed techniques are used to help children and adults get rid of stuttering forever. Activities carried out by specialists before the start of classes:

1. Examination of the client and finding out the cause of the speech defect.
2. Determination of the necessary correction program.
3. Assignment of regular classes with gradual complication.

Parents play an important role in the correction of logoneurosis in children. Their task:

• Organize the child’s daily routine with daytime and full night sleep.
• Limit viewing of cartoons and access to the computer. Restriction reduces overexertion of brain activity.
• Organize correct, slow and calm communication, clearly pronounce words when talking with a child. Say difficult words repeatedly with him.
• Protect your child's speech. Read familiar books, do not memorize poems, do not ask to retell fairy tales until the stuttering has completely passed.
• Choose quiet games: modeling, construction, drawing. During the game, the child needs to pronounce the actions being performed.

It is more difficult to treat an adult than a child, since the child’s psyche and speech are more plastic, children have a higher potential for compensating for defects. With adults, correction of logoneurosis is more difficult and takes longer. But if the client wishes and exercises regularly, logoneurosis in adults is also eliminated. To correct logoneurosis, the client must strictly follow the recommendations prescribed by the specialist. In some cases, you will need to remain silent for several days and perform special exercises.