Alogia

In psychology, alogia (/ˌeɪˈloʊdʒɪə, əˈloʊdʒiə, əˈlɒdʒɪə, -dʒə/; from Greek ἀ-, "without", and λόγος, "speech" + New Latin -ia)[1][2][3] is poor thinking inferred from speech and language usage.[4] There may be a general lack of additional, unprompted content seen in normal speech, so replies to questions may be brief and concrete, with less spontaneous speech. This is termed poverty of speech[4] or laconic speech.[5] The amount of speech may be normal but conveys little information because it is vague, empty, stereotyped, overconcrete, overabstract, or repetitive.[4][6] This is termed poverty of content[4] or poverty of content of speech.[6] Under Scale for the Assessment of Negative Symptoms used in clinical research, thought blocking is considered a part of alogia, and so is increased latency in response.[7]

This article is about the psychological symptoms including poverty of speech and poverty of speech content. For inability to speak because of dysfunction in the central nervous system, see aphasia. For inability to speak often caused by a speech disorder or surgery, or by unwillingness to speak, see muteness. For the progressive metal band, see Alogia (band). For Alogian, see Alogi.

This condition is associated with schizophrenia, dementia, severe depression, and autism.[8][9] As a symptom, it is commonly seen in patients suffering from schizophrenia and schizotypal personality disorder, 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,[10][3] found in mental deficiency and dementia.[11][3] In this sense, the word is synonymous with aphasia,[3] and in less severe form, it is sometimes called dyslogia.[10]

The rest of the article focuses on the first meaning.

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 disciplines—such as politicians, administrators, philosophers, ministers, and scientists—use language pedantically, or in people with intelligence or 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?[12]

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.[13] Their responses will be brief, generally only appearing as a response to a question or prompt.[14]

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 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 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.[15] 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.[15] A study investigating alogiacs and their results on the category fluency task showed that people with schizophrenia who exhibit alogia display a more disorganized semantic memory 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 revealed bizarre coherence in the alogiac group.[16]

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.[17]

This condition is associated with schizophrenia, dementia, and severe depression.[18]

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:

Example of "poverty of speech"[19]
Poverty of speech Normal speech

Q: Do you have any children?
A: Yes.
Q: How many?
A: Two.
Q: How old are they?
A: Six and sixteen.
Q: Are they boys or girls?
A: One of each.
Q: Who is the sixteen-year-old?
A: The boy.
Q: What is his name?
A: Edmond.
Q: And the girl's?
A: Alice.

Q: Do you have any children?
A: Yes, a boy and a girl.
Q: How old are they?
A: Edmond is sixteen and Alice is six.

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."[20]

Causes

Alogia can be brought on by frontostriatal dysfunction which causes degradation of the semantic store, the center located in the temporal lobe 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 and Parkinson's disease, ailments which also involve frontostriatal dysfunction.[21]

Treatment

Medical studies conclude that certain adjunctive drugs effectively palliate the negative symptoms of schizophrenia, mainly alogia. In one study, Maprotiline produced the greatest reduction in alogia symptoms with severity reduction in 50% of patients (out of 10).[22] Of the negative symptoms of schizophrenia, alogia had the second best responsiveness to the drugs, surpassed only by attention deficiency.[22] D-amphetamine 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.[23]

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 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.[24]

Alogia is a major diagnostic sign of schizophrenia, when organic mental disorders have been excluded.[20]

In schizophrenia, negative symptoms including flattening of affect, avolition, and alogia are responsible for the considerable morbidity of the disease compared with other psychotic disorders.[25] Negative symptoms are common in the prodromal and residual phases of the disease and can be severe.[26] 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.[27] Psychotic symptoms tend to diminish as the individuals age, but negative symptoms tend to persist.[28] Prominent negative symptoms at disease onset, including alogia, are good predictors of worse outcomes.[27][29]

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.[27]

See also

References
  3. Shiel, William C. (Jr.). "Medical Definition of Alogia". MedicineNet. Archived from the original on 2019-08-06. Retrieved 2019-12-19. Alogia: 1. Complete lack of speech, as in profound mental retardation or advanced dementia. Alogia is synonymous in this sense with aphasia. 2. Poverty of speech, as commonly occurs in schizophrenia. From the Greek a-, without + logos, speech.
  4. DSM-5 (2013), "Glossary of Technical Terms", p. 817. "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)."
  5. Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "Chapter 4 Signs and Symptoms in Psychiatry", GLOSSARY OF SIGNS AND SYMPTOMS, p. 27 "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."
  6. Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "Chapter 4 Signs and Symptoms in Psychiatry", GLOSSARY OF SIGNS AND SYMPTOMS, p. 29 "poverty of content of speech Speech that is adequate in amount but conveys little information because of vagueness, emptiness, or stereotyped phrases."
  7. Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "6 Psychiatric Rating Scales", Table 6–5 Scale for the Assessment of Negative Symptoms (SANS), p. 44.
  8. APA dictionary of psychology (2015), p. 816 "poverty of ideas a thought disturbance, often associated with schizophrenia, dementia, and severe depression. ...."
  9. Hommer, Rebecca E.; Swedo, Susan E. (2015-03-01). "Schizophrenia and Autism—Related Disorders". Schizophrenia Bulletin. 41 (2): 313–314. doi:10.1093/schbul/sbu188. ISSN 0586-7614. PMC 4332956. PMID 25634913.
  10. APA dictionary of psychology (2015), p. 40 "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."
  11. Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "Chapter 4 Signs and Symptoms in Psychiatry", GLOSSARY OF SIGNS AND SYMPTOMS, p. 22 "alogia Inability to speak because of mental deficiency or an episode of dementia."
  12. Thought Disorder (2016), 25.3. What Are the Boundaries of Thought Disorder?., pp. 498-499.
  13. Purse, Marcia. "Alogia-Definition". reviewed by Medical Review Board. About.com. Archived from the original on 2012-04-02.
  14. Alpert, M; Kotsaftis, A; Pouget, ER (1997). "At Issue: Speech fluency and schizophrenic negative signs". Schizophrenia Bulletin. 23 (2): 171–177. doi:10.1093/schbul/23.2.171. PMID 9165627.
  15. Alpert, M; Clark, A; Pouget, ER (1994). "The syntactic role of pauses in the speech patients with schizophrenia and alogia". Journal of Abnormal Psychology. 103: 750–757. doi:10.1037/0021-843X.103.4.750.
  16. Sumiyoshi, C.; Sumiyoshi, T.; Nohara, S.; Yamashita, I.; Matsui, M.; Kurachi, M.; Niwa, S. (Apr 2005). "Disorganization of semantic memory underlies alogia in schizophrenia: an analysis of verbal fluency performance in Japanese subjects". Schizophr Res. 74 (1): 91–100. doi:10.1016/j.schres.2004.05.011. PMID 15694758. S2CID 44481783.
  17. DSM-5 (2013), Schizophrenia Spectrum and Other Psychotic Disorders, Schizophrenia, Culture-Related Diagnostic Issues, p. 103.
  18. APA dictionary of psychology (2015), p. 816 "poverty of ideas a thought disturbance, often associated with schizophrenia, dementia, and severe depression. ...."
  19. Thought Disorder (2016), 25.4.1.1. Poverty of Speech, pp. 499-500. "This is a restriction in the amount of spontaneous speech so that replies to questions tend to be brief, concrete, and unelaborated. Unprompted additional information is rarely provided. For example, in answer to the question, "How many children do you have?" the patient replies, "Two. A girl and a boy. The girl is thirteen and the boy ten." "Two" is all that is required to answer the question, and the rest of the reply is additional information. "
  20. Akiskal, Hagop S (2016). "1 The Mental Status Examination". In Fatemi, S Hossein; Clayton, Paula J (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. 1.5.5. Speech and Thought., pp. 8-10. doi:10.1007/978-1-4939-2528-5. ISBN 978-1-4939-2528-5. Associative slippage also may manifest in general vagueness of thinking, which is not grossly incoherent but conveys little information, even though many words may have been used. This disturbance, known as "poverty of thought" ( 24), is a major diagnostic sign of schizophrenia, when known organic mental disorders have been ruled out. Here is a sample from a letter a high school student wrote to the psychiatrist in response to the question why he was in the hospital: "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.".
  21. Chen, RY; Chen, EY; Chan, CK; Lam, LC; Lieh-Mak, E (2000). "Verbal fluency in schizophrenia: reduction in semantic store". Australian and New Zealand Journal of Psychiatry. 34 (1): 43–48. doi:10.1046/j.1440-1614.2000.00647.x. PMID 11185943. S2CID 23484802.
  22. Shafti, S.S.; Rey, S.; Abad, A. (2005). "Drug – Specific Responsiveness of Negative Symptoms". International Journal of Psychosocial Rehabilitation. pp. 10 (1), 43–51. Archived from the original on 2012-07-12. Retrieved 2012-04-29.
  23. Desai, N; Gangadhar, BN; Pradhan, N; Channabasavanna, SM (1984). "Treatment of negative schizophrenia with d-amphetamine". The American Journal of Psychiatry. 141 (5): 723–724. doi:10.1176/ajp.141.5.723. PMID 6711703.
  24. Miller, D; Arndt, S; Andreasen, N (2004). "Alogia, attentional impairment, and inappropriate affect: Their status in the dimensions of schizophrenia". Comprehensive Psychiatry. 34 (4): 221–226. doi:10.1016/0010-440X(93)90002-L. PMID 8348799.
  25. DSM-5 (2013), Schizophrenia Spectrum and Other Psychotic Disorders, Key Features That Define the Psychotic Disorders, Negative Symptoms, p.88.
  26. DSM-5 (2013), Schizophrenia Spectrum and Other Psychotic Disorders, Clinician-Rated Assessment of Symptoms and Related Clinical Phenomena in Psychosis, Schizophrenia, Diagnostic Features, p.101.
  27. Lewis, Stephen F; Escalona, Rodrigo; Keith, Samuel J (2017). "12.2 Phenomenology of Schizophrenia". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. THE SYMPTOMS OF SCHIZOPHRENIA, Course and Associated Features of Negative Symptoms. ISBN 978-1-4511-0047-1.
  28. DSM-5 (2013), Schizophrenia Spectrum and Other Psychotic Disorders, Clinician-Rated Assessment of Symptoms and Related Clinical Phenomena in Psychosis, Schizophrenia, Development and Course, p.102.
  29. Fatemi, S Hossein; Folsom, Timothy D (2016). "6 Schizophrenia". In Fatemi, S Hossein; Clayton, Paula J (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. 6.12. Prognosis and Course of Illness, TABLE 6.7 Predictors of course and outcome in schizophrenia, p. 111. doi:10.1007/978-1-4939-2528-5. ISBN 978-1-4939-2528-5.

Other references
  • VandenBos, Gary R, ed. (2015). APA dictionary of psychology (2nd ed.). Washington, DC: American Psychological Association. doi:10.1037/14646-000. ISBN 978-1-4338-1944-5.
  • American Psychiatry Association (2013). "Bipolar and Related Disorders". Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. ISBN 978-0-89042-555-8.
  • Sadock, B. J.; Sadock, VA (2008). Kaplan and Sadock's Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins. ISBN 9780781787468.
  • Andreasen, Nancy C (2016). "25 Thought Disorder". In Fatemi, S Hossein; Clayton, Paula J (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. pp. 497–505. doi:10.1007/978-1-4939-2528-5. ISBN 978-1-4939-2528-5.
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