Observation psychiatrique : quelle valeur accorder à l'analyse sémiologique de la diffluence du discours du patient ?

The fact that for a given patient, assessing the intensity of a clinical sign is changed according to the diagnostic hypothesis of the clinician, is likely to reduce the semiological value of this clinical sign. This study aims to evaluate the semiological value of the sign “diffluent speech”. Twenty-seven psychiatric residents have conducted a semiological analysis of a filmed clinical case. They were randomly and blindly distributed into three groups. The clinical case was presented either as a case of schizophrenia, either as a case of manic episode, or as a case of borderline personality disorder. The psychiatric residents to whom the case was presented as corresponding to a case of schizophrenia evaluated a higher intensity of the sign “diffluent speech” compared to the psychiatric residents to which the case was presented as corresponding to a borderline personality disorder. To increase the semiological value of the examination of diffluent speech, we propose to distinguish two aspects: abnormalities of the rhythm of the speech and abnormalities of the semantic-pragmatic organization of the discourse.