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What is clanging speech?

Clanging speech is a disorganized pattern of speech characterized by rhyming, alliteration, and discourse that lacks coherence or logic. It is most commonly associated with schizophrenia and other psychotic disorders.

What are the main features of clanging speech?

The main features of clanging speech include:

  • Rhyming – Words that have similar sounds are strung together, often in nonsensical ways. For example, “I got lots of thoughts in my head, some happy, some filled with dread.”
  • Alliteration – Repetition of the same first consonant sound. For example, “Mad men move in manic manners.”
  • Loose associations – Ideas are connected through sounds rather than logical meaning. For example, “The red roses filled the room, I swept them with a broom.”
  • Neologisms – Made up words are incorporated. For example, “I feel fraggled after waking from a dazzling dream.”
  • Perseveration – Persistent repetition of words or ideas even when they no longer make sense.
  • Tangentiality – Responses digress and never return to the original topic.

Overall, the speech lacks coherence and appears disorganized, even though each individual phrase may utilize creative language techniques.

What causes clanging speech?

Clanging speech is most commonly associated with formal thought disorder, which refers to disorganized thinking and speech. The main conditions linked to clanged speech include:

  • Schizophrenia – Clanging is present in the disorganized speech of schizophrenia. It reflects the loose associations seen in schizophrenic thought disorder.
  • Bipolar disorder – Some individuals exhibit clanging during manic episodes associated with bipolar disorder.
  • Psychotic depression – Clanging may emerge when severe depression includes psychotic features.
  • Drug-induced psychosis – Intoxication with stimulants like cocaine or amphetamines can trigger clanging speech.
  • Neurodegenerative disorders – Conditions like Alzheimer’s disease progressively impair thought and language abilities.

In most cases, clanging reflects an underlying disruption in logical, meaningful thought processes. When cognition is impaired, speech loses coherence.

How is clanging speech assessed?

Mental health professionals assess clanging speech through clinical interviews and verbal tests. Some important aspects in the assessment include:

  • Evaluating spontaneous speech – Listening to how the individual speaks in conversation.
  • Using prompts – Providing prompts to elicit speech allows assessment of clanging in response.
  • Rating severity – Determining how frequent and severe clanging patterns are.
  • Testing cognition – Administering tests of thinking abilities and executive function.
  • Ruling out other causes – Considering medical conditions, medications, drugs, or neurological issues.
  • Assessing functionality – Determining how speech impacts communication and daily living.

Rating scales like the Scale for the Assessment of Thought, Language, and Communication may quantify features like poverty of speech, perseveration, and tangentiality.

What are the treatment options for clanging speech?

Clanging speech itself is not treated directly. Rather, treatment targets the underlying condition contributing to disordered thinking and language. Possible treatment approaches include:

  • Antipsychotic medication – Used to reduce psychotic symptoms in conditions like schizophrenia.
  • Mood stabilizing medication – Helps stabilize mood swings in bipolar disorder.
  • Cognitive rehabilitation – Therapies help rebuild cognition and communication skills.
  • Counseling – Talk therapy aids with coping with psychiatric symptoms.
  • Substance abuse treatment – Needed when drug use precipitates clanging speech.

With proper treatment of the underlying disorder, clanging speech often improves. Supportive communication strategies can also help. However, residual language dysfunction may persist in some cases.

What are the complications associated with clanging speech?

Clanging speech can lead to several complications, including:

  • Impaired communication – The disordered speech makes it very difficult to effectively communicate needs and interact with others.
  • Social isolation – The inability to hold meaningful conversations may lead to withdrawal and loneliness.
  • Self-care deficits – In severe cases, disordered thoughts and speech prevent self-care.
  • Risk of harm – Bizarre behavior and speech raise risks of self-harm or aggression.
  • Limited functionality – Jobs, relationships, and independent living are jeopardized without communication skills.

Clanging speech on its own is not dangerous. But the underlying psychiatric or neurological causes require prompt treatment to avoid further deterioration and associated risks.

What is the prognosis for clanging speech?

The prognosis for clanging speech depends on the underlying cause and promptness of treatment. In general:

  • Clanging from psychotic disorders like schizophrenia may persist chronically, with some fluctuation in severity.
  • Clanging during mood episodes of bipolar disorder tends to resolve when the mood episode ends.
  • Drug-induced clanging is short-lived and resolves when intoxication ends.
  • Clanging from neurocognitive disorders worsens progressively as the condition advances.

With medication and rehabilitation, the prognosis for managing clanging speech associated with psychiatric disorders is fair. However, persistent deficits in communication and cognition often remain.


In summary, clanging speech is a disorganized pattern of rhyming, alliteration, and nonsensical associations. It arises from psychiatric conditions like schizophrenia, as well as from drug effects and neurodegenerative disorders. Though not inherently dangerous, clanging can impair communication and functioning. Addressing the root cause and providing cognitive rehabilitation give the best chance of improving severe clanging speech. Ongoing support is often needed even with treatment. The prognosis depends on the individual situation.