Nice little article in the British Medical Journal last week (written by several clinicians from the OASIS service), about a difficulty that can arise in assessing young people who might have the early signs of psychosis: putting their unconventional speech in context. (The use of unusual words and phrases as part of a pattern of disorganised speech can be evidence of formal thought disorder, a symptom of psychosis).
The authors describe the case of a young man whose use of street slang in the assessment interview made him appear more thought disordered than he actually was. Thankfully the clinician had the foresight to check the urbandictionary.com and discover that many of the words the man used were “legit”, rather than neologisms (there is a quiz in the article to test yourself on how you would classify the words, as slang or neologism). The authors describe the detailed assessment procedures the team used to further ascertain the presence of an at risk mental state (pdf).
The article made me think about what happens in routine mental health assessments in less specialised settings: how often do clinicians misclassify heavy use of slang as evidence of thought disorder?