Linking words together based on similar sounds rather than coherent meaning is a symptom of psychosis in people with bipolar disorder. Such bipolar symptoms occur during psychotic episodes in the manic phase, but can also occur with depressive psychosis.
“This speech pattern is characteristic of disorganized thinking in psychotic disorders,” explains psychiatrist Michael Peterson, MD, PhD, an assistant professor in the department of psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison. Dr. Peterson offers these examples of clang associations: “that boat hope floats” or “the train brain rained on me.” The words involved often have a rhyming, near-rhyming, or punning (choosing words based on double meanings) quality to them.
There are other types of language changes that may be present with bipolar symptoms in addition to clang associations, including:
- Word salad. A jumble of words that are not apparently linked and may be hard to understand.
- Disorganization. Jumping from one idea to another without transition.
- Neologism. Making up words that have no meaning to anyone but the speaker.
- Echolalia. Repeating others’ words or phrases.
Typically, if you spend time with a person who is becoming psychotic, you will notice that his language gets less sensible and understandable as his psychosis gets worse. He may not be aware that he is not making sense as he strings together clang associations or other unusual language associations. Eventually he may become totally incoherent or appear to be “speaking in tongues.” Rationalizing with him or trying to talk to him about what he is saying is not going to get you any clear answers. Instead, start seeking treatment for his bipolar symptoms as soon as you notice that his language is starting to fall apart.
Other Signs of Bipolar Psychosis
Clang associations and other language changes may be accompanied by other symptoms of psychosis, which include:
- Disordered thinking or speaking
- Being excessively responsive to stimulation in the environment
- Difficulty determining what is real and what is not
- Problems completing ordinary tasks (problems may be related to memory, concentration, clear thinking, etc)
Bipolar psychosis looks a lot like symptoms of schizophrenia, which can result in a misdiagnosis for some patients with manic depression or other psychiatric illnesses. About half of people with bipolar disorder will have a psychotic episode at some point in their lives. Psychosis is usually temporary, but it is important to get treatment immediately.
Management of Clang Associations
Because clang associations are a symptom of psychosis, managing them requires treatment of the psychosis.
“They are managed primarily using antipsychotic medications. The goal in treating bipolar episodes with psychosis is to resolve the acute symptoms and to stabilize mood. Antipsychotic medication for bipolar disorder may be used either during the psychotic episode only, or as longer-term mood-stabilizing medications,” says Peterson.
As worrying as clang associations and other language problems may be, effective treatments exist that can get your loved one back on track.
Last Updated: 7/13/2010