Stuttering and depression

  Author: Dr. KAZAKOV   А.V.- the representation in Southern Federal District: Taganrog (RC for biocybernetics) 

Stuttering, or logoneurosis, being a multicomponent and simultaneously multilevel psychophysiologic  phenomenon, assumes the  important part  of the mental factor in its  genesis  and  further development. It was even specified  by the first researchers of the stuttering problem. Thus, Liebmann (1901) " found a number of  mental phenomena ". Netkachev G.D. (1909) insisted, that " stuttering is  a  merely mental suffering, expressed by convulsive movements in the organs of speech ", and Freschels  (1931) mentioned, that " quite developed stuttering is almost always accompanied by more or less severe mental disorders ". Describing symptomatology, Netkachev G.D. (1909,1913) paid attention to the fact,  that " this psychoneurosis  generates anxious-hypochondriac character with such features as suspiciousness, hypochondria, diffidence, perpetual distress or irritability " and determined  as " illness of a timid person ",  which is characterized by   fear, compulsive thoughts,  depression of spirit after failures and cases of stuttering, a state of  melancholy and hypohondria". Tartakovsky I.I. (1934) specified, that " at stuttering  mental depression, disturbed expectation, fear and anxiety for one’s  speech, doubt and obsession " prevail. 

In these characteristics of psychopathological changes at stuttering the semiology of depression of the neurotic level is actually described. 

According to Sartorius N. (2003), depression is one of the most complicated medical problems. This is a widespread disease, quite often resulting in the loss of working capacity, negatively influencing family relations and having serious social and economic consequences. According to the existing estimations, in the world there are about 100 million patients who have one of the forms of depressive disorder. At  the same time there is an increase of frequency of  atypical, latent (low-grade) forms at which typical affects of depression (melancholy, anxiety, apathy) are in the middle distance or disguised by the other symptoms. According to Vein A.M., Vorobjeva O.V. (2000), now the share of typical cases makes up only 10 %, and the  bulk of depressions proceeds atypically and have a bent for  chronicity. The prevalence of not serious  variant of depression - endoreactive [dysthymic] depression - according to the international researches, makes up  3,1 - 3,9 %. 

 Pathophysiological  aspect of the depression progress  is developed insufficiently by now. The  inadequate functioning of serotonergic, dopaminergic and noradrenergic mediator systems plays the main part. The  attention is paid to the raised level of cortisol in blood and the change of a ratio “cortisol/dihydroepi androsterone” (DHEA-S).

 As stuttering in overwhelming majority of cases arises at children's age, it is necessary to speak in   detail of the  features of this disorder of affective sphere in this age category. As Dmitrieva T.B. and co-authors, 2001 observe, the difference of opinions and approaches to the problem research  of depressions of children's age means the absence of the researchers’ conceptual unity. (So, Sukhareva G.E. (1955, 1959) notes, that in the clinical picture of depression the vegetative-somatic disorders prevail. Patients’ frequent complaints are unpleasant somatic sensations, pains in the region of heart, and children of preschool age feel the pains in a stomach.  The  author emphasizes, that  these age features of depressions make to assume originally the presence of somatic, instead of  mental child’s pathology, that is the child’s latent [masked] depression is determined. Majluf E. (1960), Sperling M. (1959), Stutte H. (1969) approve, that in the childhood the semiology of depression is shown mainly by  somatic equivalents, disorders  of progress, school phobias and criminal behavior. In opinion of  Kuhn R. (1963), Spiel W. (1969), Ajuriagerra J. de. (1970), affective disorders at children's age arise essentially more often, than they are diagnosed. In the work  of Sperling M. (1959) as the attributes of children’s depression the disorders  of digestion,  sleeplessness,  itch,  headaches, the slowed down motility, grizzle, absence of interests, sad face are described. Sandler J., Joffe W.G. (1965) during the research of " latent and disguised " forms of depressions   especially emphasized   a child’s affective reaction. In opinion of de Negri M., Moreti G. (1971), at preschool age depression is shown by the delay of intellectual opportunities (sometimes  to pseudo-moronity), absence of the initiative, limitation of contacts, the tendency to isolation, attacks of crying, negative reaction to frustration, phobias and anxiety.    It is approved as conclusions, that children's depression is connected with factors of the environment, that is it always reactive, the long anxiety can result in occurrence of paroxysmal phenomena (nightmares, attacks of  asthma, etc.), less often to a persistent condition of an  emotional tension, children's depression  changes easily under the influence of an environment, children's suicides have sharp emotional pathogeny (as a  "short circuit"). Dmitrieva T.B. (1980, 1981), examining the teenagers’ psychogenic depressions, observed the originality of affective manifestations in puberty: significant expressiveness of vegeto-vascular and neurotic disorders, neurotic level of disorganization of mental activity, abnormality  of  depressive semiology, inclusion in the clinical picture of specific adolescent  behavioural responses. Posokhova V.I. (1982), Natalevich E.S. and co-authors (1982) single out from the existing multiformity of clinical variants of teenagers’ reactive depressions:  asthenic, anxious, dysphoric, hypochondriac. 

 Now the pharmacotherapy with application of various classes of antidepressants, possessing a lot of undesirable by-effects and lacks,  is considered to be the basic method of depressions treatment. 

Within the logoneurosis it is expedient to consider two variants of the depression development: like reactive depression,  having fast  dynamics of clinical symptoms development, and like primary dysthymia, when the gradual beginning and chronicity is usually observed. In both variants exacerbations in the form of depressive attacks are possible. The presence of a depressive component in the structure of logoneurosis  essentially complicates the problem of its adequate and fast correction, reducing the effect of any therapeutic influence, as affective manifestations reflect changes in mediator systems of  brain, which possess the certain degree of functional stability.

 The  direct influence with the physiologic irritant is represented as optimal. For functional system of speech the irritant  is one’s own speech, which is necessary to transform and change into the therapeutic factor in appropriate way. Such approach is realized in the developed by REC of biocybernetics the multimedia complex BreathMaker, working on the principle of resonant speech production and double, auditory and visual,  control according to  the mechanism of a biological feedback. For a strict individualization of medical influence the testing module of the complex analyzes individual acoustic characteristics of the patient, on the basis of which the individual parameters of correction are calculated. The duplex mode of the biological feedback promotes the increase of correctional effect due to increase of reliability of the applied way of  control. Steady improvement of the psycho-emotional status in the form of regression of depressive semiology allows to assume the normalization of neuromediators exchange  under influence of effect, correcting logoneurosis. 

Conclusions: Cited data allow to consider a method of  resonant speech production physiologically adequate and highly effective both for correction logonuerosis, and for elimination of the depressive syndrome, accompanying it.