psych 9 (signs and symptoms)

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S2 L2: SIGNS and SYMPTOMS in PSYCHIATRY February 10,2011

SIGNS AND SYMPTOMS IN PSYCHIATRY

Signs- observations & objective findings elicited by the clinician.

Symptoms- subjective experiences described by the patient.Syndrome- group of s/s that together make up the recognizablecondition.

Phenomenology-a school of philosophy & psychiatry that focuses on s/s as an event thatcan be described & experienced.-developed by Edmund Husserl & Karl Jaspers-understand it through intuition & experience it through empathy."Personal World"- the way a person thinks or feels. It is abnormal when:

springs from a condition that is recognized universally asabnormal.

separates the person from others emotionally does not improve the person w/ sense of "spiritual & material"

security

DESCRIPTIVE TERMS

Neurosis-chronic or recurrent nonpsychotic disorder characterized mainly byanxiety.-it appears as a symptom such as obsession, compulsion, phobia, orsexual dysfunction.-the predominant disturbance is a symptom or group of symptoms that isdistressing to the individual& is recognized by him/her as an unacceptable& alien; reality testing is intact.

Psychosis-loss of reality testing & impairment of mental functioning

-manifested by delusions, hallucinations, confusion, & impaired memory.-psychotic became synonymous with severe impairment of social andpersonal functioning characterized by social withdrawal and inability toperform the usual household and occupational roles

Psychotic (American Psychiatric Glossary) grossly impaired realitytesting

CLASSIFICATION

CONCIOUSNESS state of awareness

A. Disturbances of consciousnessAppreciationperception modified by persons own emotions &thought.Sensorium cognitive functioning of special senses.

1. Disorientation disturbance of orientation in time, place, or person.2. Clouding of consciousness incomplete clear-mindedness w/

disturbances in perception & attitudes3. Stupor lack of reaction to, & awareness of surroundings4. Delirium bewildered, restless, confused, disoriented reaction assoc

w/ fear & hallucinations5. Coma profound unconsciousness6. Coma vigil coma w/c the pt appears to be awake w/ eyes open but

cannot be aroused7. Twilight state disturbed consciousness w/ hallucinations8. Dreamlike state complex partial seizure/ psychomotor epilepsy9. Somnolence abnormal drowsiness10. Confusion disturbance of consciousness in w/c reactions to

environmental stimuli are inappropriate; manifested by disorderedorientation in relation to time, place or person.

11. Drowsiness a state of impaired awareness assoc w/ a desire tosleep

12. Sundowning syndrome in older persons that usually occurs at night& characterized by drowsiness, confusion, ataxia & falling as a result ofbeing overly sedated w/ medications

B. Disturbances of AttentionAttention amt of effort exerted in focusing on certain portions of anexperience; ability to sustain a focus on 1 activity; ability to concentrate

1. Distractibility inability to concentrate attention2. Selective inattention blocking out only those things that generate

anxiety.3. Hypervigilance excessive attention & focus on all internal & external

stimuli4. Hyperpagia excessive thinking & mental activity5. Trance focused attention & altered consciousnessDisinhibition removal of an inhibitory effect that permits persons to losecontrol of impulses

C. Disturbance in Suggestibility1. Folie a deux/ Folie a trios communicated emotional illness between

2 or 3 persons2. Hypnosis artficially induced modifications of conscousnsess

charaterzed by heightened suggestibility

EMOTIONcomplex felling state w/ psychic, somatic, & behaviouralcomponents that is related to affect & mood.

A. Affect observed expression of emotion1. Appropriate effect emotional tone is in harmony. Classified furtheras broad or full effect

2. Inappropriate affect disharmony between emotional feeling tone &idea, thought or speech accompanying it

3. Blunted affect severe reduction in intensity of externalized feelingtone

4. Restricted or constricted affect reduction in intensity of feelingtone.

5. Flat affect absence/ near absence of any signs of affectiveexpression

6. Labile affect rapid & abrupt changes in emotional feeling toneB. Mood pervasive & sustained emotion subjectivelyI

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experienced reported by the pt & observed by others1. Dysphoric mood unpleasant mood2. Euthymic mood normal range of mood3. Expansive mood expression of feelings w/o restraint4. Irritable mood person is easily annoyed & provoked to anger5. Mood swings oscillations bet euphoria & depression/ anxiety6. Elevated mood mood more cheerful than usual7. Euphoria intesne elation w/ feelings of grandeur8. Ecstasy feeling of intense rupture9. Depression psychopathological feeling of sadness10. Anhedonia loss of interest in pleasurable activities11. Grief/ Mourning sadness appropriate to a real loss; aka

bereavement12. Alexithymia inability in describing or being awar of emotions/mood13. Suicidal ideationthoughts/ act of taking ones own life 14. Elation feelings of joy, euphoria, triumph, intense self-satisfaction, or

optimism.15. Hypomania mood abnormality w/ the qualitative characteristics of

mania but less intense16. Mania characterized by elation, agitation, hyperactivity,

hypersexuality & accelerated thinking & speaking17. Melancholia severe depressive state18. La belle indifferenece inappropriate attitude of calm or lack of

concern about ones disability

C. Other Emotions1. Anxiety feeling of apprehension2. Free-floating anxiety pervasive, unfocused fear not attached to any

idea3. Fear anxiety caused by consciously recognized & realistic danger.4. Agitation severe anxiety associated w/ motor restlesness; similar to

excitability w/ easily triggered anger/ annoyance5. Tension increased & unpleasant motor & psychological activity.6. Panic acute, episodic, intense attack of anxiety associated w/

overwhelming feelings of dread & autonomic discharge7. Apathy dulled emotional tone8. Ambivalence coexistence of 2 opposing impulses toward the same

thing in the same person at the same time9. Abreaction emotional release or discharge after recalling a painful

experience10. Shame failure to live up to self-expecations11. Guilt emotion secondary to doing what perceived as wrong12. Impulse control ability to resist an impulse drive or temptation to

perform an action13. Ineffability escstatic state in w/c person states it is indescribable

inexpressible & impossible to convey to another person14. Acathexis lack of feeling of assoc w/ an ordinarily emotionally

charged subject; in cathexis, the feeling is connected15. Decathexis detaching emotions from thoughts, ideas, or persons.D. Physiological Disturbances associated w/ Mood signs ofsomatic dysfunction most associated w/ depression (aka Vegetativesigns)1. Anorexia loss/ decrease appetite2. Hyperphagia increase take of food3. Insomnia lack /diminished ability of sleep

a. Initial difficult falling asleepb. Middle difficulty sleeping through the night w/o waking up &difficulty going back to sleepc. Terminal early morning awakening

4. Hypersomnia excessive sleeping5. Diurnal variation mood is regularly worst in the morning,

immediately after awakening, & improves as the day progresses.6. Diminished libido - sexual interest, drive & performance ( = manic) 7. Constipation inability/difficulty to defecate8. Fatigue feeling of weariness, sleepiness, or irritability following a

period of mental/bodily activity9. Pica craving/eating/non-food substances10. Pseudocyesis pt has s/s of pregnancy11. Bulimia insatiable hunger & voracious eating

12. Adynamia weakness & fatigabilityMOTOR BEHAVIOR (conation) includes impulses, motivations, wishes,drives, instincts, & cravings as expressed by a persons behaviour/ mentalactivity

1. Echopraxia pathological imitation of movement or 1 person byanother

2. Catatonia & Postural Abno seen in catatonic schizophrenia & somept with brain dse

a. Catalepsy immobile position that is constantly maintainedb. Catatonic excitement agitated, purposeless, motor activity,

uninfluenced by external stimulic. Catatonic stupor slowed motor activity, often to the point of

immobility & seeming unawareness of surroundingsd. Catatonic rigidity voluntary assumption of a rigid posture, held

against all efforts to be movede. Catatonic posturing voluntary assumption of an inappropriate or

bizarre posture, generally maintained for long periodsf. Cerea flexibilitas (Waxy flexibility) person can be modeled into a

position that is maintainedg. Akinesia lack of physical movement3. Negativism motiveless resistance to all attempts to be moved or to

all instructions4. Cataplexy temporary loss of muscle tone & weakness precipitated by

a variety of emotional states

5.

Stereotypy repetitive fixed pattern of physical action or speech6. Mannerism ingrained, habitual involuntary movement7. Automatism automatic performance of an act or acts generally

representing unconscious symbolic activity8. Command automatism automatic following of suggestions9. Mutism voicelessness w/o structural abnormalities10. Overactivity

a. Psychomotor agitation excessive motor & cognitive activity,usually non-productive & in response to inner tension

b. (Hyperkinensis) restless, aggresive, destructive activityc. Tic involuntary, spasmodic motor movementd. Sleepwalking (Somnambulism) motor activity during sleepe. Akathisa subjective feeling of muscular tension secondary to

antipsychotic or other meds, w/c can cause restlessness, pacing,repeated sitting and standing

f. Compulsion uncontrollable impuls to perform an act repetitively Dipsomania compulsion to drink alcohol Kleptomanina compulsion to steal Nymphomania compulsion for coitus in woman Satyriasis compulsion for coitus in man Trichotillomania compulstion to pull out hair Ritual automatic compulsive activity

g. Ataxia failure of muscle coordination ; irregularity of muscleaction

h. Polyphagia pahthological overeatingi. Tremor rhythmical alteration in movement (usually faster than 1

beat a second)j. Floccilation aimless picking usually at clothes, common ly seen

in delirium11. Hypoactivity (hypokinesis) - motor & cognitive activity12. Mimicry simple, imitative motor activity of childhood13. Aggression forceful, goal-directed action that may be verbal or

physical; motor counterpart of rage, anger & hostility14. Acting out direct expression of an unconscious wish/ impulse in

action living out unconscious fantasy impulsively in behaviour15. Abulia reduced impulse to act & think16. Anergia lack of energy (anergy)17. Astasia abasia inability to stand or walk in a normal manner, even

though normal leg movements can be performed ina sitting or lyingdown position

18. Coprophagia eating of filth of feces19. Dyskinesia difficulty performing voluntary movements


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20. Muscle rigidity - muscles remain immovable, seen in schizophrenia21. Twirling present in autistic children who continually rotate in the

direction in w/c their head is turned22. Bradykinesiaslow motor activity w/ normal, spontaneous

movement23. Chorea random & involuntary quick, jerky purposeless movement24. Convulsion involuntary, violent muscular contraction/ spasm

Clonic convulsion muscles alternately contract & relax Tonic convulsion muscle contraction is sustained

25. Seizure sudden onset of symptoms such as convulsions, LOC, &psychic or sensory disturbances

Generalized Tonic-Clonic Seizure generalized onset oftonic-clonic movements of the limbs, tongue biting, &incontinence followed by slow, gradual recovery ofconsciousness & cognition. (aka grand mal seizure &psychomotor seizure)

Simple partial seizure localized ictal onset of seizure w/oaltered consciousness

Complex partial seizure localized ictal onset w/ alteredconsciousness

26. Dystonia slow, sustained contractions of the trunk or limbs27. Amimia inability to make gestures or to comprehend those made by

others

THINKING goal-directed flow of ideas, symbols & associations initiated by

a problem or task & leading toward a reality-oriented conclusionPARAPRAXIS/FREUDIAN SLIP - unconscious motivated lapse from logic,part of normal thinkingABSTRACT THINKING is the ability to grasp the essentials of a whole, tobreak the whole into parts & to discern common properties

A. General distrubances in Form or Process of Thinking1. Mental disorder clinically significant behavior/ psychological

syndrome associated w/ distress/disability2. Psychosis inability to distinguish reality from fantasy

Neurosis mental disorder in w/c reality testing is intact3. Reality testing objective evaluation & judgment of the world outside

the self4. Formal though disorder disturbance in the form of thought rather

than the content of thought, thinking characterized by associations,neologisms, & illogical constructs. Person is defined as psychotic

5. Illogical thinking thinking containing erroneous conclusions/ internalcontradictions

6. Dereism mental activit not concordant w/ logic/ experience7. Autistic thinking preoccupation w/ inner private world8. Magical thinking a form of dereistic thought; thoughts, word, actions

assume power9. Primary process thinking general term for thinking that is dereistic,

illogical, magial; normally found in dreams, abnormally in psychosis10. Emotional insight deep level of understanding/awareness that is

likely to lead to positive changes in personality & behavior

B. Specific disturbances in Form of Thought1. Neologisms new word created by pt2. Word salad incoherent mixture of words & phrases3. Circumstantiality indirect speech that is delayed in reaching the

point but eventually gests from original point to desired goal4. Tangentiablitiy inability to have goal-directes associations of thought5. Incoherence thought that is not generally understandable6. Perseveration response to ap revious stimulus after a new stimulus

has been presented7. Verbigeration meaningless repetition of specific words or phrases8. Echolalia psychopathological repeating of words or phrases of 1

person by another9. Condenstaion fusion of various concepts into 110. Irrelevant answer answer that is not in harmony w/ question asked11. Loosening of associations flow of thought in w/c ideas shift from 1

subject to another in a completely unrelated way12. Derailment gradual or sudden deviation in train of thought w/o

blocking13. Flight of ideas rapid, continuous verbalizations or plays on words

produce constant shifting form 1 idea to another, but thend to beconnected

14. Clang association association of words similar in sound but not inmeaning

15. Blocking abrupt interruption in train of thought or idea is finished;after a brief pause, person indicates no recall of what was said

16. Glossolalia/ Speaking in Tongue expression of a revelatorymessage through unintelligiblie words. (aka cryptolalia a privatespoken language)

C. Specific disturbances in Content of Thought1. Poverty of Content thought taht gives little information because of

vagueness, empty repetitions, or obscure phrases2. Overvalued idea - unreasonable, sustained false belief maintained

less firmly than a delusion3. Delusion false belief, based on incorrect interference about external

reality, not consistent w/ pts intelligence & cultural background

Bizarre Delusion absurd, totally implausible, strange falsebelief

Systematized delusion false beliefs/ beliefs united by asingle event or theme

Mood-congruent delusion delusion w/ mood-appropriatecontent

Mood-incongruent delusion delusion w/ content that hasno association to mood/mood neutral

Nihilistic delusion false feeling that self, others, or theworld is nonexistent or coming to an end

Delusion of povertya persons false belief that he/she isbereft or will be deprived of all material possessions

Somatic delusion false belief involving functioning of thebody

Paranoid delusions include persecutory delusions &delusions of reference, control & grandeur. Delusion of persecutionpersons false belief that

he/she is being harassed, cheated or persecuted Delusion of grandeura persons exaggerated

conception of his/her importance, power or identity Delusion of Referencea persons false belief that

the behavior of others refers to him/herself

Delusion of Self-Accusation false feeling of remorse &guilt

Delusion of Controlfalse feeling that a persons willthoughts, or feelings are being controlled by external forces Thought Withdrawal delusion that thoughts are

being removed from a persons mind by other personsor forces

Thought Insertion delusion that thoughts are beingimplanted in a persons mind

Thought Broadcastingdelusion that a personsthought can be heard by others

Thought Controldelusion that a persons thoughtsare being controlled by other persons/forces

Delusion of Infidelity (delusional jealousy) false beliefderived from pathological jealousy about a persons loverbeing unfaithful

Erotomania/ Clerambault-Kandinsky Complexdelusional belief, more common in women, that someone isdeeply inlove with them

Pseudologia phantastica a type of lying in w/c a personappears to believe in the reality of his/her fantasies & actson them; associated w/ Munchaused syndrome, repeatedfeeling of illness

4. Trend/ Preoccupation of Thought centering of thought content on aparticular idea

5. Egomania pathological self-preoccupation6. Monomania preoccupation w/ single object


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7. Hypochondria exaggerated concern about health that is based noton real organic pathology but, rather, on unrealistic interpretation ofphysical signs or sensations as abnormal

8. Obsession pathological persistence of an irresistable thought orfeeling w/c cant be eliminated from consciousness by logical effort

9. Compulsion pathological need to act on an impulse that, if restricted,produces anxiety; repetitive behavior in response to an obsession

10. Coprolalia compulsive utterance of obscene words11. Phobia persistent irrational, exaggerated & invariably pathological

dread of a specific stimulus or situationa. Specific phobia circumscribed dread of a discrete obj or

situationb. Social phobia dread of public humiliation, as a fear in public

speaking, performing or eating in publicc. Acrophobia high placesd. Agoraphobia open placese. Algophobia painf. Ailurophobia catsg. Erythrophobia blushing/redh. Panphobia everythingi. Claustrophobia closed spacesj. Xenophobia strangersk. Zoophobia animalsl. Needle phobia/ Blood Injection Phobia receiving injection

12. Noesis a revelation in w/c immense illumination occurs in associationw/ a sense that a person has been chosen to lead & command

13. Unio mystica an oceanic feeling of mystic unity w/ an infinite power;not considered a disturbance in thought content if congruent w/persons religious/ cultural milieu.

SPEECHideas, thoughts, feelings as expressed thorough language;communication through the use of words & language

A. Disturbance in Speech1. Pressure of Speechrapid speech that is in amt & difficult to

interrupt2. Volubility (Logorrhea) copious, coherent, logical speech3. Poverty of Speech restriction in the amt of speech used4. Nonspontaneous Speech verbal responses given only when asked

or spoken to directly; no self initiation of speech5. Poverty of Content of Speech speech that is adequate in amt but

conveys little info because of vagueness, emptiness/ stereotypedphrases.

6. Dysprosody loss of normal speech melody (prosody)7. Dysarthria difficulty in articulation, not in word finding or in grammar8. Excessively Loud or Soft Speech loss of modulation of normal

speech volume9. Stuttering frequent repetition or prolongation of a sound or syllable,

leading to markedly impaired speech fluency10. Cluttering erratic & dysrrhythmic speech11. Acalculia nonsense speech associated w/ markedly impaired

comprehension12. Bradylalia abnormally slow speech13. Dysphonia difficulty/ pain in speakingB. Aphasic Disturbances disturbances in language output1. Motor Aphasis disturbance of speech caused by a cognitive disorder

in w/c understanding remains but ability to speak is gross impaired.AKA Brocas, nonfluent & expressive aphasia

2. Sensory Aphasia organic loss of ability to comprehend the meaningof words.AKA Wernickes, fluent & receptive aphasia

3. Nominal aphasia/Anomia/Amnestic Aphasia difficulty findingcorrect name for an object

4. Syntactial Aphasia inability to arrange words in proper sequence5. Jargon Aphasia words produced are totally neologistic; nonsense

word repeated w/ various intonations & inflections6. Global Aphasia combination of a grossly non-fluent aphasia & a

severe fluent aphasia7. Alogia inability to speak because of mental deficiency or an episode

of dementia8. Coprophasia involuntary use of vulgar or obscene language.

PERCEPTION - process of transferring physical stimulation intopsychological informatio; mental process by w/c sensory stimuli are brought

to awarenessA. Disturbances in Perception1. Hallucination false sensory perception not associated w/ real

external stimulia. Hypnagogic Hallucination false sensory perception occuring

while falling asleepb. Hypnopompic Hallucination false perception occuring while

awakening from sleepc. Auditory Hallucination false perception of soundd. Visual Hallucination false perception involving sightconsisting

of both formed images & non-formed imagese. Olfactory Hallucination smellf. Gustatory Hallucination tasteg. Tactile/Haptic Hallucination touch; Phantom Limb sensation

from amputated limb

h. Formication crawling sensation on/under the skini. Somatic/ Cenesthesic Hallucination things occuring in thebody

j. Lilliputan Hallucination/ Micropsia objects are seen asreduced in size

k. Mood-congruent Hallucination the content is consistent w/either a depressed/manic mood

l. Mood-incongruent hallucination content is not consistentm. Hallucinosis associated w/ chronic alcohol abuse & that occur

w/in a clear sensoriumn. Delirium Tremens clouded sensoriumo. Synesthesia caused by another sensationp. Trailing Phenomenon perceptual abnormality associated w/

hallucinogenic drugs in w/c moving obj are seen as a series ofdiscrete & discontinous images

q. Command Hallucination false perception of orders that aperson may feel obliged to obey or unable to resist

2. Illusion mis perception or misinterpretation of real externalsensory stimuli

B. Disturbances Associated w/ Cognitive Disorder & MedicalConditions1. Agnosia inability to recognize & interpret the significance of sensory

impressions2. Anosognosia (Ignorance of Illness)a persons inability to

recognize a neurological deficit as occuring to him/herself3. Somatopagnosia (Ignorance of the Body)/ Autopagnosia inability

to recognize a body part as his or her own4. Visual Agnosia inability to recognize objects or persons5. Astereognosis inability to recognize objects by touch6. Prosopagnosia inability to recognize faces7. Apraxia inability to carry out specific tasks8. Simultagnosia inability to comprehend more than 1 element of a

visual scene at a time or to integrate the parts into a whole9. Adiadochokinesia inability to perform rapid alternating movements10. Aura warning sensations such as automatisms, fullness in the

stomah, blushing & changes in respiration, cognitive sensations &affective states

C. Disturbances associated w/ Conversion & DissociativePhenomena somatisation of repressed material1. Hysterical Anesthesia loss of sensory modalities resulting from

emotional conflicts2. Macropsia objects seem larger than what they are


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3. Micropsia smaller4. Depersonalizationpersons subjective sense of being unreal,

strange or unfamiliar5. Derealization subjective sense that the environment is

strange/unreal6. Fugue- taking on a new identity w/ amnesia for the old identity7. Multiple Personality 1 person who appears at different times to be 2

or more entirely different personalities8. Dissociation unconsicious defense mechanism involving the

segregation of any group of mental or behavioural processess form therest of the persons psychic activity

MEMORYinformation stored in the brain is latter related tounconsciousness.ORIENTATION normal state of oneself & ones surrounding in terms ofTPP.

A. Disturbances of Memory1. Amnesia partial/total inability to recall past experiencesa. Anterograde after a point in timeb. Retrograde before a point in time2. Paramnesia falsification of memory by distortion of recalla. Fausse reconnaissance false recognitionb. Retrospective Falsification memory becomes unintentionally

distortedc. Confabulation unconscious filling of gaps in memoryd.

Deja vu illusion of visual recognition in w/c a new situation isincorrectly regarded as are petition of a previous memory

e. Deja entendu illusion of auditory recognitionf. Deja pense illusion that a new thought is recognized as a

thought previously felt or expressedg. Jamais vu false feeling of unfamiliarity w/ a real situation that a

person has experiencedh. False Memorya pts recollection of & belief in, an event that did

not actually occur3. Hypermnesia exaggerated degree of retention & recall4. Eidetic Image visual memory of almost hallucinatory vividness5. Screen memory consciously tolearbly memory covering for a

painful memory6. Repression characterized by unconscious forgetting of

unacceptable ideas/ impulses

7. Lethologica temporary inability to remember a name/a propernoun8. Blackout amnesia experienced by alcoholics about behavior during

drinking bouts

B. Levels of Memory1. Immediate reproduction or recall of perceived material w/in seconds

to minutes2. Recent recall of events over past few days3. Recent past recall of events over past few months4. Remote recall of events in distant pastINTELLIGENCE ability to understand, recall, mobilize, & constructivelyintegrate previous learning in meeting new situations

A. Mental Retardation sufficient lack of intelligenceB. Dementia organic/ global deterioration of intellectual functioningw/o clouding of consciousnessC. Pseudodementia clinical features resembling a dementia notcaused by organic conditionD. Concrete Thinking literal thinking; limited use of metaphor w/ounderstanding nuances of meaningE. Abstract Thinking ability to appreciate nuances of meaning;multidimensional thinking

INSIGHT ability to understand the true cause & meaning of situation

A. Intellectual Insight understanding of the objective reality of aset of circumstances w/o the ability to apply the understanding ina any usefulway to master the situation

B. True Insight understanding of the objective reality of asituation, coupled w/ the motivation & the emotional impetus to master thesituationC. Impaired Insight diminished ability to understand the objectivereality of a situation

JUDGMENTability to assess situation correctly & act appropriately in thesituation

A. Critical Judgment ability to assess, discern & choose amongvarious options in a situationB. Automatic Judgment reflex performance of an actionC. Impaired Judgment diminished ability to understand a situationcorrectly & to act appropriately

psych 9 (signs and symptoms)

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