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Pressured speech example


Signs, Causes, Related Conditions, and Treatment

Pressured speech is when you talk in a fast, frantic, or urgent way. This symptom is common in bipolar disorder manic episodes.

Many people with bipolar disorder experience manic episodes, which are periods of at least one week where you feel euphoric, full of energy, and need less sleep. Pressured speech is a common characteristic of mania.

During a manic episode, you may feel a compulsive urge to talk rapidly without interruption. Understanding pressured speech can help you learn to manage its symptoms.

Pressured speech is when you speak rapidly and with a sense of urgency. Others may be unable to understand what you’re saying. You might talk about several ideas at once and be unable to think clearly while you’re speaking.

This is common during manic episodes and hypomanic episodes.

“Pressured speech occurs on a continuum and may range from extremely fast talking to completely incoherent, garbled speech,” says psychotherapist Melissa Bennett-Heinz, LCSW, LICSW.

“It is talking done too fast, erratic, irrelevant, or too tangential for the listener to understand — unrelenting and loud,” Bennett-Heinz says. “It can convey an urgency that is not relevant to the situation, and can be very difficult for a listener to interrupt.”

In many cases, the person with pressured speech is unaware they are speaking in this way.

“Often, people with pressured speech are minimally aware of any of their own urgent feelings underlying it, or they feel a sense of urgency from outside themselves without identifying with that feeling as their own,” says Dr. Thomas Adams, a board certified psychiatrist.

“They are also often not aware (or have an inaccurate understanding) of the effect their pressured speech has on others around them,” says Adams.

Some signs and symptoms of pressured speech include:

  • a compulsive need to speak
  • rapid speech
  • speaking without pauses
  • talking even when interrupted
  • talking in a nonsensical manner that’s difficult for others to understand
  • speaking about inappropriate topics
  • being unable to talk quickly enough to keep up with your thoughts

Pressured speech is a common symptom of bipolar disorder manic episodes.

According to Adams, there’s a connection between the speech regions of the brain and the behavioral systems involved in aggression, fear, reward-seeking, and motivation. More research on these connections is needed.

People with bipolar disorder who experience pressured speech may have difficulty prioritizing thoughts, which can become pressing as soon as they appear in their minds.

The concept of “flight of ideas” is often mentioned alongside pressured speech. While pressured speech and flight of ideas are both hallmarks of mania, there are some differences.

“Flight of ideas is a bit more abstract since it refers less to the concrete characteristics of speech (e.g., specific sounds, tone, volume) and more to the content and flow of the ideas the speaker is presenting with their speech,” Adams says.

Compared with pressured speech, a person with a flight of ideas tends to make larger jumps from topic to topic, covering a large area of meaning in a short period.

The experience of anxiety and fear is common to various mental health conditions, Adams says. The brain systems that have evolved to sustain anxious behaviors probably play a large role in “causing” pressured speech, Adams adds.

Conditions related to pressured speech

Pressured speech in itself is not a disorder but is associated with underlying conditions, such as:

  • bipolar disorder
  • mania
  • hypomania
  • schizophrenia
  • anxiety disorders
  • attention deficit hyperactivity disorder (ADHD)

“For mania, the most effective treatments tend to be antipsychotic medications, especially those that strongly block dopamine receptors,” Adams says.

Medications that can treat acute mania and pressured speech include:

  • antipsychotics
  • mood stabilizers
  • anticonvulsants

Psychotherapy can help treat conditions with pressured speech-like symptoms, but medications are much more important for people who experience a manic episode, Adams adds.

Additionally, a thorough medical evaluation is necessary to determine the underlying cause of the symptom.

“If it is determined that [pressured speech] is a result of bipolar disorder, there are a range of treatment options depending upon the severity,”Bennett-Heinz states.

“Most acute manic episodes may require hospitalization to stabilize the mood with medication, especially if there are other symptoms present that can be life threatening.”

When it comes to outpatient treatment, several treatment methods can help people with pressured speech manage their symptoms, Bennett-Heinz explains. They include:

  • medication management
  • therapy
  • psychoeducation, which can help identify causes and risk factors
  • good sleep hygiene
  • deep breathing
  • grounding exercises
  • a balanced diet

It’s especially important for anyone who has a diagnosis of bipolar disorder to get enough sleep and rest, to eat a balanced diet, and exercise regularly.

During bipolar disorder manic episodes, a person may experience pressured speech, which is needing to speak at a fast pace. This speech is uninterrupted and can be nonsensical.

Treatment options include medication, getting enough sleep, eating a balanced diet, and exercising regularly to regulate mood.

To learn more about bipolar disorder, its symptoms, and treatment options, check out Psych Central’s bipolar disorder hub.

Pressured Speech: Definition, Symptoms, and Causes

Pressured Speech: Definition, Symptoms, and Causes
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Medically reviewed by Timothy J. Legg, PhD, PsyD — By Diana Wells — Updated on December 6, 2019

Overview

Pressured speech is commonly seen as a symptom of bipolar disorder. When you have pressured speech, you have an extreme need to share your thoughts, ideas, or comments.

It’s often a part of experiencing a manic episode. The speech will come out rapidly, and it doesn’t stop at appropriate intervals. It’s difficult to understand what’s being said during pressured speech.

It’s also not possible to carry on a conversation because the person with pressured speech will not stop long enough for another person to speak.

There are several symptoms to watch for in pressured speech, which include:

  • rapid speech that’s difficult to understand
  • speech that’s louder than appropriate
  • inability to stop speaking to allow others to interject their thoughts
  • speech that occurs at inappropriate times at work, home, or school
  • an urgency to say what you’re thinking
  • unclear thought process when speaking
  • speaking numerous ideas at once that don’t connect
  • including rhymes or jokes in the speech
  • difficulty articulating thoughts because they’re coming too fast

When talking to someone with pressured speech, you may not be able to stop them from talking or get them to speak at a slower rate. A pressured speech episode may continue for more than an hour.

Pressured speech can be part of a manic episode. It’s most commonly seen in people with bipolar disorder. Although scientists don’t know the actual cause of bipolar disorder, it’s believed to be caused by changes in brain biochemistry and may have a genetic link.

You may be more likely to have it if a close relative has bipolar disorder, usually a parent, brother, or sister.

Because pressured speech is a symptom of experiencing a manic episode, usually associated with bipolar disorder, the focus is on treating the bipolar disorder. Pressured speech and bipolar disorder are psychiatric disorders and should be treated by a psychiatrist.

A psychiatrist is a medical doctor who specializes in mental health conditions.

Some primary care physicians will treat bipolar disorder.

In almost 50 percent of states in the United States, and the District of Columbia, a psychiatric mental health nurse practitioner (PMHNP) can also treat people with this mental health condition, independent of physician involvement.

This means the nurse practitioner has full practice authority (FPA).

There are several treatment options for bipolar disorder. These treatments may be used in combination depending on your symptoms and healthcare needs.

Medications

Taking prescribed medications regularly is the main way to manage bipolar disorder and its symptoms, including pressured speech.

The types of medications your healthcare provider may prescribe include:

  • antidepressants
  • mood enhancers
  • antipsychotic medications
  • anti-anxiety medications

Depending on your symptoms, your healthcare provider may prescribe one medication or a combination of medications.

Psychotherapy

Psychotherapy will help you make lifestyle and behavioral changes in your daily life that’ll help reduce and better manage the symptoms of bipolar disorder, including pressured speech.

Your psychotherapy may include:

  • stabilizing your daily tasks and rhythms
  • cognitive behavioral therapy
  • family therapy

Alternative treatments

Some natural supplements and alternative treatments are used to complement medications and therapy in many mood disorders. However, conflicting research on their effectiveness limits widespread adoption of some of these treatments.

Be sure to talk to your healthcare provider first if you decide to try a natural or alternative treatment for your bipolar disorder symptoms. Many supplements can interfere with medications or increase their side effects.

Pressured speech can be a symptom of several conditions.

Some of these conditions include:

  • bipolar disorder, the condition most commonly associated with pressured speech
  • autism, when coupled with bipolar disorder
  • anxiety, when experiencing manic episodes from bipolar disorder
  • schizophrenia
  • other mental health conditions
  • stroke

Pressured speech can be one of the more difficult symptoms of bipolar disorder because it’s difficult to manage or stop when it happens. It can also have wide-ranging negative effects or complications in all areas of your life.

At school

Pressured speech can present problems for students and teachers. It may make it difficult for teachers to direct a class.

For the student, it could result in being removed from class, and in some cases, the inability to continue in a normal school atmosphere.

At home

Pressured speech can be challenging to relationships with loved ones. It can make regular communication difficult and sometimes impossible.

The person with pressured speech may feel that they’re not being heard or understood. Those they live with may feel stress and frustration. When communication breaks down, sometimes the relationship can break down as well.

At work

Pressured speech may start during meetings, interactions with clients or customers, or interactions with coworkers. In the workplace, when pressured speech happens at inappropriate times, it can be disruptive. That may lead to disciplinary actions or even loss of a job.

Pressured speech is manageable with a bipolar disorder treatment plan created by a healthcare provider and psychotherapist.

If you think your treatment needs to be adjusted, you should talk to your healthcare provider. Only change your treatment if it’s approved by the medical professionals overseeing your care.

Last medically reviewed on December 6, 2019

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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    aanp.org/advocacy/state/state-practice-environment
  • DelBello MP. (2018). A risk calculator for bipolar disorder in youth: Improving the odds for personalized prevention and early intervention. DOI:
    10.1016/j.jaac.2018.07.871
  • Docherty NM. (2012). On identifying the processes underlying schizophrenic speech disorder. DOI:
    10.1093/schbul/sbr048
  • Hawken ER, et al. (2016). The manic phase of bipolar disorder significantly impairs theory of mind decoding. DOI:
    10.1016/j.psychres.2016.03.043
  • Hilty DM, et al. (2006). A review of bipolar disorder in adults.
    ncbi.nlm.nih.gov/pmc/articles/PMC2963467/
  • Mnif L, et al. (2016). Post-stroke emotional incontinence or bipolar disorder? DOI:
    10.2147/NDT.S102273
  • Psychiatric nurse practitioner. (2019).
    nursing.jnj.com/specialty/psychiatric-nurse-practitioner
  • Raja M, et al. (2008). Comorbidity of Asperger’s syndrome and bipolar disorder. DOI:
    10.1186/1745-0179-4-26
  • Ryles F, et al. (2017). A systematic review of the frequency and severity of manic symptoms reported in studies that compare phenomenology across children, adolescents and adults with bipolar disorders. DOI:
    10.1186/s40345-017-0071-y

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Medically reviewed by Timothy J. Legg, PhD, PsyD — By Diana Wells — Updated on December 6, 2019

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Reading blood pressure readings

The only way to know if you have high or low blood pressure is to measure your blood pressure. Understanding your results is the key to controlling your blood pressure.

  • Systolic blood pressure (First or top number) is the maximum pressure in the arteries when the heart contracts and pushes blood into the arteries.
  • Diastolic blood pressure (Second or lower number) - shows the pressure in the arteries at the time of relaxation of the heart muscle, it reflects the resistance of the peripheral vessels.

Which number is more important?

Systolic blood pressure (first number) is generally given more attention as a major risk factor for cardiovascular disease in people over 50 years of age. In most people, systolic blood pressure rises steadily with age due to the loss of elasticity of large arteries, an increase in heart rate, and the development of vascular disease.

However, elevated systolic or elevated diastolic blood pressure can be used to make a diagnosis of high blood pressure. The risk of death from coronary heart disease and stroke doubles with an increase in systolic pressure of 20 mm Hg. Art. or diastolic at 10 mm Hg. Art. among people aged 40 to 89 years.

Blood pressure ranges

In our country, the standards of the European Society for the Study of Hypertension are followed, there are also recommendations of the Ministry of Health of the Russian Federation from 2020, which established the following ranges of numbers:

  • Normal - systolic blood pressure less than 120-129 mmHg, diastolic blood pressure less than 80-85 mmHg.
  • Highly normal - systolic BP 130-139 mmHg, diastolic BP 85-89 mmHg.
  • 1 degree - 140-159 / 90-99 mm Hg.
  • 2 degree - 160-179 / 100-109 mm Hg.
  • 3 degree - more than 180/110 mm Hg.

Note: Diagnosis must be confirmed by a doctor. Hypertension is a disease or diagnosis, and hypertension is the fact of increased pressure. The doctor may also evaluate any unusually low blood pressure readings and associated symptoms.

Normal pressure

  • Optimal blood pressure - SBP less than 120 mm Hg. Art. and/or DBP less than 80 mm Hg. Art.
  • Normal blood pressure - pressure in the SBP range of 120-129 mmHg. Art. and/or DBP 80–84 mm Hg. Art.

If your results fall into this category, stick to heart-healthy habits such as a balanced diet and regular exercise.

High blood pressure

High blood pressure is when readings are consistently above 140 mmHg for systolic and for diastolic more than 90 mmHg Art. Measures must be taken to control this condition.

Grade 1 hypertension

Grade 1 hypertension is when blood pressure constantly fluctuates systolic within 140–159 and/or diastolic above 90–99 mmHg. Art. At this stage of high blood pressure, doctors may recommend lifestyle changes and may consider taking blood pressure medication. What you do next depends on your risk for atherosclerotic cardiovascular disease (CVD), such as heart attack or stroke, and your risk factors.

Hypertension 2nd and 3rd degree

2nd degree hypertension is when the blood pressure is constantly at the level of 160/100 mm Hg. or higher. During these stages of high blood pressure, doctors may prescribe a combination of blood pressure medications and recommend immediate lifestyle changes.

Hypertensive crisis

This stage of high blood pressure requires medical attention. If your blood pressure reading suddenly goes over 180/120 mmHg. Art., wait five minutes, and then check your blood pressure again. If your readings are still unusually high, contact your doctor immediately. Perhaps you have a hypertensive crisis.

If your blood pressure is over 180/120 mm Hg. Art. and you are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, vision changes or difficulty speaking, do not expect pressure relief. Call 103

Symptoms of low blood pressure

Most doctors consider chronic low blood pressure to be dangerous only if it causes noticeable signs and symptoms, such as:

  • Dizziness
  • Nausea
  • Fainting
  • Dehydration and unusual thirst
  • Lack of concentration
  • Blurred vision
  • Cold, clammy, pale skin
  • Fast breathing
  • Fatigue
  • Depression

A single abnormal blood pressure reading is not a cause for concern unless you are experiencing any other symptoms.

Why blood pressure is measured in mmHg. Art.

Abbreviation mmHg Art. means millimeters of mercury. Mercury was used in the first accurate pressure gauges, and the unit is still used in medicine today as the standard unit for measuring pressure.

Hypertension

Hypertension
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    • Hypertension

    WHO/Yoshi Shimizu

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    Basic facts
    • Hypertension - or high blood pressure - a serious pathological condition that significantly increases the risk of developing diseases of the cardiovascular system, brain, kidneys and other diseases.
    • An estimated 1.28 billion adults aged 30-79 worldwide have hypertension, the majority (two thirds) of whom live in low- and middle-income countries.
    • An estimated 46% of adults with hypertension are unaware they have the condition.
    • Less than half (42%) of adult patients with hypertension are diagnosed and treated.
    • Approximately one in five (21%) hypertensive adults controls the disease.
    • Hypertension - is one of the leading causes of death worldwide.
    • A 33% reduction in the prevalence of hypertension between 2010 and 2030 is one of the global targets for combating noncommunicable diseases.

    What is hypertension?

    Blood pressure is the force exerted by circulating blood on the arteries, the most important blood vessels in the body. Hypertension is characterized by an excessive increase in blood pressure.

    Blood pressure is described by two indicators. The first indicator (systolic pressure) is the pressure in the blood vessels at the time of contraction, or contraction, of the heart muscle. The second indicator (diastolic pressure) is pressure in the vessels at the moment when the heart is at rest between two contractions.

    The diagnosis of hypertension is made when, according to pressure measurements taken on two different days, the systolic pressure on both days is equal to or greater than 140 mm Hg. Art. and/or diastolic value pressure on both days is equal to or exceeds 90 mm Hg. Art.

    What are the risk factors for hypertension?

    Manageable risk factors include an unhealthy diet (excessive salt intake, a high content of saturated fats and spenders in the diet, insufficient consumption of vegetables and fruits), insufficient physical activity, consumption tobacco and alcohol, as well as overweight and obesity.

    Uncontrollable risk factors include family history of hypertension, age over 65, and comorbidities such as diabetes or kidney disease.

    What are the typical symptoms of hypertension?

    Hypertension is called the "silent killer". Most patients with hypertension are not even aware of the problem, since hypertension often does not give alarms and is asymptomatic. This is why it is so important to measure your blood pressure regularly.

    If symptoms occur, they may include early morning headaches, nosebleeds, irregular heartbeat, blurred vision, and ringing in the ears. Severe hypertension can cause weakness, nausea, vomiting, confusion, internal tension, chest pain and muscle tremor.

    The only way to detect hypertension is to have your blood pressure taken by a healthcare professional. Measurement of blood pressure is carried out quickly and painlessly. Although you can measure blood pressure yourself using automatic devices, to assess risk and related disorders, the examination should be carried out by a medical specialist.

    What are the complications of uncontrolled hypertension?

    Among other complications, hypertension can cause serious damage to the heart. Excessive pressure can cause the walls of the arteries to lose their elasticity and reduce the flow of blood and oxygen to the heart muscle. This increased pressure and decrease blood flow can cause:

    • chest pain, also called angina;
    • an infarction that occurs when blood flow to the heart is blocked, causing the heart muscle cells to die from oxygen starvation; the longer blood flow is blocked, the more serious the damage to the heart;
    • heart failure, in which the pumping function of the heart muscle cannot fully supply other essential organs with blood and oxygen;
    • cardiac arrhythmia, which can lead to sudden death.

    Hypertension can also cause stroke by tearing or blocking the arteries that supply blood and oxygen to the brain. In addition, hypertension can be a cause of kidney failure caused by kidney damage.

    Why is hypertension important in low- and middle-income countries?

    The prevalence of hypertension varies across regions and countries across income groups. The prevalence of hypertension is highest in the WHO African Region (27%) and lowest in the Region of the Americas (18%).

    The number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, predominantly in low- and middle-income countries. This increase is mainly due to increased risk factors for hypertension among the populations of these countries.

    How can the burden of hypertension be reduced?

    Lowering high blood pressure prevents heart attacks, strokes and kidney damage and other health problems.

    Prevention
    • Reducing salt intake (to less than 5 g per day)
    • Increasing the proportion of fruits and vegetables in the diet
    • Regular physical activity
    • Quitting alcohol

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    • Limiting intake of foods high in saturated fats
    • Eliminating or reducing trans fats in foods

    Case management
    • Reducing and managing stress
    • Treating blood pressure regularly 9005
    • Treatment of other diseases

    How is WHO responding to the problem of hypertension?

    The World Health Organization (WHO) is supporting countries to reduce the prevalence of hypertension as a public health problem.

    In 2021, WHO released new guidelines for the pharmacological treatment of hypertension in adults. The publication presents scientific sound advice on when to start treatment for hypertension; and recommended follow-up intervals for the patient. The document also indicates the blood pressure targets that must be achieved to control hypertension, and provides information on health system actors who can initiate treatment.

    In September 2016, to help governments improve the prevention and treatment of cardiovascular disease, WHO and the United States Centers for Disease Control and Prevention (USCDC) launched an initiative Global Hearts, which developed the HEARTS technical intervention package. The six modules of the HEARTS technical package (healthy lifestyle counseling, evidence-based treatment protocols, access to essential medicines) tools and technologies, risk-based management, team care and monitoring systems) provide a strategic approach to promoting cardiovascular health around the world.

    Learn more