Perseveration is a stable reproduction of any statement, activity, emotional reaction, sensation. Hence, motor, sensory, intellectual and emotional perseverations are distinguished. The concept of perseveration, in other words, is a “stuck” in the human consciousness of a certain thought, a simple idea, or their repeated and monotonous reproduction as an answer to the previous last interrogative statement (intellectual perseveration). There are spontaneous and repeated repetitions of what has already been said or accomplished, often referred to as iterations, and reproductions of experiences, referred to as echonesia.
Features of treatment
There is no universally recommended treatment algorithm for perseveration.
Therapy is carried out based on the use of a whole range of different approaches. One method should not be used as the only method of treatment. It is necessary to take new methods if the previous ones did not produce results. Roughly speaking, treatment is based on constant trial and error, which ultimately makes it possible to find the optimal method of influencing a person suffering from perseveration. The presented methods of psychological influence can be applied alternately or sequentially:
- Expectation.
It is the basis in psychotherapy for people suffering from perseveration. The point is to wait for changes in the nature of the deviations that have arisen against the background of the use of various methods of influence. That is, the waiting strategy is used in conjunction with any other method, which we will discuss below. If no changes occur, switch to other psychological methods of influence, expect results and act according to the circumstances. - Prevention.
It is not uncommon for two types of perseveration (motor and intellectual) to occur together. This makes it possible to prevent such changes in time. The essence of the technique is based on the exclusion of physical manifestations that people most often talk about. - Redirection.
This is a psychological technique based on a sharp change in ongoing actions or current thoughts. That is, when communicating with a patient, you can suddenly change the topic of conversation or move from one physical exercise or movement to another. - Limitation.
The method is aimed at consistently reducing a person’s attachment. This is achieved by limiting repetitive actions. A simple but clear example is to limit the amount of time a person is allowed to sit at a computer. - Abrupt cessation.
This is a method of actively getting rid of perseverative attachment. This method is based on the effect of introducing the patient into a state of shock. This can be achieved through harsh and loud phrases, or by visualizing how harmful the patient’s obsessive thoughts or movements or actions can be. - Ignoring.
The method involves completely ignoring the manifestations of the disorder in a person. This approach works best if the disorders were caused by attention deficit. If a person does not see the point in what he is doing, since there is no effect, he will soon stop repeating obsessive actions or phrases. - Understanding.
Another relevant strategy with which the psychologist recognizes the patient’s train of thought in case of deviations or in the absence of them. This approach often allows a person to independently understand his thoughts and actions.
Perseveration is a fairly common disorder that can be caused by various reasons.
When perseveration occurs, it is important to choose a competent treatment strategy. Medication is not used in this case.
Speech stereotypies, also known as speech iterations, verbal tics, are reflexive, meaningless and emotionally indifferent repetitions of sounds, syllables, words and entire phrases in the patient’s speech.
The patient’s speech can be either on his own initiative or provoked by questions from people around him.
What is perseveration
Perseveration is considered a very unpleasant manifestation of obsessive behavior. A characteristic feature is the reproduction of a certain physical action, phoneme, representation, phrase.
A typical example is a song that gets stuck in your head for a long time. Many subjects noticed that they wanted to repeat certain word forms or melody out loud for a certain period. Such a phenomenon, naturally, is a weak analogy of the deviation in question, but this is precisely the meaning of perseverative manifestations.
Individuals suffering from this disorder have absolutely no control over their own person at such moments. Intrusive repetition appears absolutely spontaneously and also suddenly stops.
The deviation in question is found in the persistent reproduction of an idea, manipulation, experience, phrase or concept. Such repetition often develops into an obsessive, uncontrollable form; the individual himself may not even detect what is happening to him. Thus, the concept of perseveration is a phenomenon caused by a psychological disorder, mental deviation or neuropathological disorder of an individual's behavioral patterns and speech.
Such behavior is also possible in cases of severe fatigue or distraction, not only in cases of mental illness or neurological disorders. It is believed that the basis of perseveration is the processes of repeated excitation of neural elements caused by the delay of the signal about the end of the action.
The violation in question is often mistaken for stereotypy, however, despite the general desire for obsessive repetition, perseveration is distinguished by the fact that it is the result of associative activity and a structural component of consciousness. Subjects suffering from perseveration undergo therapy with doctors who first help identify the root cause, after which they carry out a set of measures aimed at eliminating the reproducible thought, phrase, or repeated action from the daily life of the subject.
In order to prevent the formation of the described syndrome in adults, parents should carefully monitor the baby’s behavioral response for signs of perseveration. We can distinguish the following “attributes” of the violation in question: regular repetition of one tiny phrase that does not correspond to the topic of the conversation, characteristic actions (a baby, for example, can constantly touch a certain area on the body in the absence of physiological prerequisites), constant drawing of identical objects.
In childhood, there are specific manifestations of perseveration due to the peculiarities of the psychology of children, their physiology, and the active change of life guidelines and values of the little ones at different stages of growing up. This gives rise to certain difficulties in differentiating the symptoms of perseveration from the conscious actions of the baby. In addition, manifestations of perseveration can camouflage more serious mental disorders.
For the sake of earlier identification of possible mental disorders in children, one should carefully monitor the manifestations of perseverative symptoms, namely:
– systematic reproduction of one statement, regardless of the circumstances and the question asked;
– the presence of certain operations that are repeated invariably: touching a certain area of the body, scratching, narrowly focused activity;
– repeated drawing of one object, writing a word;
– invariably repeated requests, the need for fulfillment of which is highly doubtful within the boundaries of specific situational conditions.
Speech stereotypies and psychoneurological diseases
The causes of speech stereotypies often lie in the development of neurological and psychological diseases.
Causes of perseverations
Experts believe that the cause of perseveration is damage to the lower parts of the premotor nuclei of the cortex of the left hemisphere in right-handers, and the right hemisphere in left-handers.
The most common cause of perseveration is considered to be neurological diseases resulting from physical damage to the brain. In this case, it becomes impossible to switch between different activities, changing the train of thought and the order of actions when performing various tasks.
With the neurological nature of the disease, the causes of perseveration are:
- , in which the lateral orbitofrontal areas of the cortex and its prefrontal convexities are affected.
- - the appearance of disturbances in speech formed at the previous stage of life. These disorders arise due to physical damage to the speech centers, as a result of traumatic brain injury.
- Pathologies related to the area of the frontal lobes of the cerebral cortex
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Psychiatry and psychology classify perseveration as a symptom of various phobias and anxiety syndromes. The course of this speech stereotypy in the psychological and psychiatric direction can be caused by:
- obsessiveness and selectivity of individual interests, which is most often found in people with autistic disorders;
- lack of attention with hyperactivity, while stereotypy arises as a defense mechanism to attract attention to oneself;
- a steady desire to learn and experience new things can lead to fixation on one conclusion or activity;
- perseveration is often one of the symptoms.
Perseveration should not be confused with obsessive-compulsive disorder, human habits, and sclerotic changes in memory.
Perseverations are more often observed in patients with dementia (), which is caused by, as well as with age-related atrophic processes in the brain. The patient’s intellect is impaired, and he cannot understand the question being asked and, instead of a logical answer, repeats previously used phrases.
What provokes the development of verbigeration?
With verbigeration there is no connection with certain neuropsychic conditions. One of the features of verbigeration is that the patient pronounces words without showing emotion. As a rule, verbal repetitions are accompanied by active facial expressions and motor disturbances.
Most often, these verbal iterations occur in patients with catatonic schizophrenia.
Causes of standing revolutions, palilalia and echolalia
The appearance of standing phrases in speech signals a decrease in intelligence and empty thinking. They often appear with a disease such as epileptic dementia. Also, one of the diseases in which standing turns are characteristic is, as well as other atrophic diseases of the brain.
Palilalia is a typical manifestation of Pick's disease. It also often accompanies diseases such as striatal pathology, striopallidal pathology (atrophic, inflammatory, vascular), postencephalic, and schizophrenia.
The occurrence of echolalia is often associated with damage to the frontal lobes of the brain. If the patient has symptoms such as hallucinations, lack of coordination, and forgetfulness, it is necessary to seek advice from a specialist. If brain damage is not diagnosed, then the causes of echolalia may be schizophrenia, autism, or Tourette's syndrome.
Causes of perseveration
This disorder often arises as a result of physical effects on the brain. In addition, the individual has difficulty switching attention.
The main reasons for the neurological nature of the described syndrome are:
– suffered localized brain lesions, reminiscent of aphasia (an illness in which the individual cannot pronounce verbal structures correctly);
– obsessive reproduction of actions and phrases appears as a result of already existing aphasia;
– traumatic brain injury with lesions of the lateral segments of the cortex or the anterior zone, where the prefrontal convexity is located.
In addition to neurological causes associated with brain damage, there are psychological factors that contribute to the development of perseveration.
The persistence of reproducing phrases and manipulations arises as a result of stressors that affect subjects for a long time. This phenomenon is often accompanied by phobias, when a defense mechanism is activated by reproducing operations of the same type, which give the individual a feeling of non-danger and calm.
If autism is suspected, excessively scrupulous selectivity in certain actions or interests is also noted.
The described phenomenon is often detected with hyperactivity, if the child believes that he is not receiving enough attention, in his opinion. In this case, perseveration also acts as a component of defense, which in the child’s subconscious compensates for the lack of outside attention. With such behavior, the baby seeks to attract attention to his own actions or attention.
The phenomenon in question often appears among scientists. An individual is constantly learning something new, striving to learn something important, which is why he becomes fixated on a certain little thing, statement or action. Often the behavior described characterizes such an individual as a stubborn and persistent person, but sometimes such actions are interpreted as a deviation.
Intrusive repetition can often be a symptom of obsessive-compulsive disorder, which is expressed in following a certain idea that forces the individual to constantly perform specific actions (compulsions), or in the persistence of some thought (obsession). Such persistent repetition can be seen when the subject washes his hands, often unnecessarily.
Perseveration must be distinguished from other illnesses or stereotypes. Phrases or actions of a repetitive nature are often a manifestation of an established habit, sclerosis, subjective annoying phenomena in which patients understand the strangeness, absurdity and meaninglessness of their own behavioral patterns. In turn, with perseveration, individuals do not realize the abnormality of their own actions.
If an individual develops signs of perseveration, but there is no history of stress or trauma to the skull, this often indicates the occurrence of both psychological and mental variations of the disorder.
Manifestations
Based on the nature of perseveration, the following types of its manifestation are distinguished:
- Perseveration of thinking or intellectual manifestations. It is distinguished by the “settling” in the human creation of certain thoughts or its ideas, manifested in the process of verbal communication. A perseverative phrase can often be used by a person when answering questions to which it has absolutely nothing to do. Also, a person with perseveration can pronounce such phrases out loud to himself. A characteristic manifestation of this type of perseveration is constant attempts to return to the topic of conversation, which has long been stopped talking about or the issue in it has been resolved.
- Motor type of perseveration. Such a manifestation as motor perseveration is directly related to a physical disorder in the premotor nucleus of the brain or subcortical motor layers. This is a type of perseveration that manifests itself in the form of repeating physical actions repeatedly. This can be either the simplest movement or a whole complex of different body movements. Moreover, they are always repeated equally and clearly, as if according to a given algorithm.
- Speech perseveration. It is classified as a separate subtype of the motor type perseveration described above. These motor perseverations are characterized by constant repetition of the same words or entire phrases. Repetition can manifest itself in oral and written form. This deviation is associated with lesions of the lower part of the premotor nucleus of the human cortex in the left or right hemisphere. Moreover, if a person is left-handed, then we are talking about damage to the right hemisphere, and if a person is right-handed, then, accordingly, to the left hemisphere of the brain.
general characteristics
Perseverative phenomena were first described by the ancient Greek scientist Aristotle, although the term “perseveration” itself was introduced only in 1894 by the German physician A. Neisser.
Currently, several types of perseverations are distinguished: intellectual, sensory, emotional, motor. Intellectual ones are manifested by the repetition of stereotypical mental operations that do not lead to the goal and do not solve the task. For example, in a conversation a person returns again and again to a question that has already been answered. Sensory perseverations are repeated repetitions of visual, auditory and tactile images after the direct stimulus has ceased to affect the analyzer. A common option is the sound of a recently listened melody “in your head”. Perseverative emotions are characteristic of impressionable people who experience resentment, fear or joy for a long time, while the situation that provoked them has already ended and has lost its relevance.
Motor perseverations are realized by repeated repetition of individual movements or entire motor programs. Example: inability to write the letter “b” due to fixation on drawing an oval, inability to move to the image of the top element of the letter. A special type of motor disorder is speech perseveration. Its sign is the repetition of a syllable, word or part of a phrase in the process of speaking or writing.
Types of speech stereotypies
Several types of speech stereotypies are known: persistent repetition of one conclusion or word (perseveration), repetition of the same expression, figure of speech (standing turns), repetition of words or syllables in a certain rhythm or in rhymed form (verbigeration).
Perseveration - we sing odes to the persistence of the stubborn
The term perseveration comes from the Latin word perseveratio, which means “perseverance”, “persistence”. In speech, perseveration manifests itself as repeated reproduction of the same syllables, words or sentences.
A word or thought seems to be “stuck” in the patient’s mind, and he repeats it repeatedly and monotonously when communicating with his interlocutor. In this case, the repeated word or phrase is not related to the topic of the conversation. The patient's speech is monotonous. Perseveration can be expressed both orally and in writing.
Perseveration is the result of associative activity, part of consciousness and does not occur by chance. It should not be confused with obsessive phenomena, since the latter have an element of obsession, and the patient is aware of the absurdity of his actions.
Verbigeration is a common fate of schizophrenics
A mental disorder in which the patient repeats and shouts in a monotonous voice the same interjections, words, and phrases. These repetitions are automatic and meaningless and can last several hours or even days.
The patient rhythmically, often in rhyme, repeats words and combinations of sounds that do not make sense. Verbigeration should be distinguished from perseveration, since with the latter, repetitions depend on neuropsychic states, and disappear with the elimination of these states.
Standing speed
Standing phrases are fragments of phrases, expressions, words, and similar ideas that the patient repeatedly reproduces during a conversation.
At first, the patient pronounces them with the same intonation, and subsequently simplifies, reduces, and the process comes down to a stereotypical repetition of words.
Often the pronounced standing phrases are greatly distorted and it becomes impossible to understand their original meaning and sound.
Palilalia
Palilalia means the patient repeating a phrase, or part of it, a single word or syllable, from a fragment of speech he himself uttered, two or more times in a row.
Repetition occurs at normal voice volume; the volume may gradually decrease and the rate of speech become faster. For example, having given an answer to a question, the patient repeatedly and continuously repeats the answer.
Manifestations of palilalia relate not only to intellectual forms of speech, but also to emotional ones (exclamations, shouts). However, it usually does not refer to mechanically pronounced turns of automated speech. The number of repetitions can reach two dozen or more.
Echolalia
When the patient repeats phrases and words that were said by people around him. Often echolalia is characteristic of young children, and in them it is not a pathology.
This is considered a pathology when echolalia causes mental retardation, or its development is observed in an adult.
Establishing diagnosis
Diagnosis of speech stereotypies involves comprehensive testing. The patient is asked to undergo special testing or answer simple questions (implying “yes” or “no” answers), repeat similar-sounding sounds or sound combinations.
The patient is also asked to name the objects that are in the room, name the days of the week, explain the meaning of the words, and retell the text.
When examining a patient, it is very important to determine whether he understands speech addressed to him. If there is a suspicion of mild forms of speech disorders, the speech pathologist uses other more complex diagnostic methods
To diagnose speech stereotypies, a technique is used that includes a series of separate tests. The patient is asked to write words in normal and reverse order, write words and phrases in upper and lower case letters, read text in forward and reverse order, write numbers in normal and reverse order, and perform multiplication. When making toasts, the doctor assesses the number of correct and incorrect answers per minute.
