Tangential+Speech

 Patients suffering from mania often display pressure, tangential and delusional speech. Likewise, with bilateral or right frontal lobe damage, speech may become pressured and tangential such that the patient rapidly diverges to other and unrelated topics.

Patients with tangential speech lose the point altogether. Instead, words or statements trigger other words or statements which are related only in regard to sound (e.g. like a clang association) or some obscure and ever shifting semantic category. Speech may be rushed or pressured and the patient may seem to be free associating as they jump from topic to topic.

In contrast to the aphasia/speech arrest associated with left frontal injuries, right frontal lesions may result in speech release ("motor mouth"). Speech becomes -Disinhibited -Pressured -Contaminated with tangential associations -May seem to be free associating as they jump from topic to topic -In the extreme speech becomes filled with confabulatory ideas.

Example: When asked how a lion and a dog were alike, responding "They both like fruit--ha ha. No. That's not right. They like trees--fruit trees. Lions climb trees and dogs chase cats up trees, and they both have a bark."

Tangentiality is in some manner related to impulsiveness as well as circumlocution. In contrast, patients with circumlocutious speech often have disturbances involving the left cerebral hemisphere and frequently suffer from word finding difficulty and sometimes receptive or expressive dysphasia. They experience difficulty expressing a particular idea or describing some need as they have trouble finding the correct words. Thus talk around the central point and only through successive approximations are able to convey what they mean to say.