Appearance and behaviour Flashcards
Distractibility
inability to screen out irrelevant stimuli, such as noises outside the room
Think - ADHD, mania, organic mental disorders “ delerium”
Internal preoccupation
episodic inattentiveness to the interviewer whenever the patient becomes distracted by intrusive thoughts or hallucinations
- severe depression
- psychosis
Resistance
conscious or unconscious attempt to withhold information or affect from the examiner
Splitting
the inability of a person to recognise good and bad features simultaneously in another individual ( or institution)
- BPD
Akathisia
Feeling of motoric restlessness -
particularly the legs, - usually a side effect of neuroleptic medication (ie. antipsychotics)
It is a subjective experience and its diagnosis is therefore based on patients reports. However may appear to tremble nervously, shake their legs ( even when sitting) or keep getting up to walk around
Attempts to remain still are likely to increase discomfort. It should be differentiated from anxiety, psychomotor agitation , agitated depression, and restless legs syndrome
Abulia
Decreased activity due to a lack of ability or power to execute action despite a desire to do so.
It is often associated with slowing or increased latency of mentation. described as inert, uncaring, and undriven- may resemble depression but abulic patiens wont cry or report feeling sad.
Most often seen in Schizophrenic or ABI (frontal/basal ganglia)
- slow in performing simple cognitive tasks
Agitation
emotionally distressed, cannot sit still or attend and gives evidence of heightened tension
acute grief, generalised anxiety, heart or thyroid disease, medical crisis, drug intoxication or withdrawal, cognitive dysfunction, mania or psychosis
Aggression
Behaviour that reflect rage, hostility and the potential for physical or verbal destructiveness.
It is the expression of negative affect meant to assault, harm or manipulate another person in some way
May be planned and/or due to poor impulse control
Frontal lobe impaired persons in part related to an inability to empathise with others,
Demented/delirious/psychotic patients - erroneously perceive other persons as intending to harm them
Conduct disorder /BPD/Antisocial - always volitional and planned
Assertiveness
socially appropriate limit setting and self definition
Akinesia
A marked reduction in accessory motor activity (eg. arms swinging while walking) and in normal automatic movements (eg. blinking, swallowing, periodic postural adjustment).
There may be associated slowing of mentation (abulia)
Associated with psychotic states, extreme depression, catatonia, epilepsy and movement disorders such as parkinsonism ( including that induced by antipsychotic drugs). Lesions of the supplementary motor cortex and hydrocephalus can produce akinesia and mutism.
- differentiate it from paralysis
Apathy
a lack of emotions or desire, a feeling of uninvolvement, or not caring.
The outward manifestation of apathy may be confused with abulia
Apathy occurs most often in depression and schizophrenia
Athetoid movements
Abnormal movements that are slow, writhing, involuntary and involving the extremeties (eg. fingers, hands and sometimes toes and tongue)
often described as “snakelike”
https://www.youtube.com/watch?v=J_wIDm1_ax4
Automatic movements (automatisms)
Involuntary movements that occur in the setting of altered consciousness also termed automatisms.
May occur in psychotic states including catatonia and in hysterical fugue states, but are most suggestive of complex partial or absence seizures. These movements vary widely in character and complexity from bizarre, purposeless movements to complex behaviours
Common epileptic automatisms - lip smacking and swallowing ( complex partial seizures) and rhythmic rapid eye blinking ( absence seizures)
Bradykinesia
slowing of motor activity as thought one is in slow motion
Common in EPSE - parkinsonism, schizophrenia, major depression
Catalepsy
maintenance of certain bodily positions or postures for prolonged periods of time
often associated with catatonic states such as schizophrenia
Cataplexy
A temporary state of sudden involuntary muscle relaxation causing loss of postural muscle tone, in the setting of intact consciousness.
Causes: falling down to only one eyelid closure
Occurs with narcolepsy and is related to REM sleep that abnormally intrude s into wakefullness. It is often precipitated by laughter, fright, or emotional stress.
It is not in itself evidence of a major psychiatric disorder
Catatonia
Severe psychotic disturbance of motor function. It is usually manifested by markedly decreased activity but may entail hyperactivity ( catatonic excitement)
The limbs are either rigid or flexible when moved passibely by the examiner. patients may be echopraxic and are mute or echolalic. Automatisms and extreme braykinea can occur as well as grimacing and staring. Catatonic patients may be excessively excited underneath the emotionally unresponsive and motorically statuesque exterior, the may become combative.
Relatively rare, seen in SCZ, BPD, depression and other psychosis
Ddx: partial complex seizures, viral encephalitis, severe parkinsonism, NMS, delirium, lesions of mesial frontal regions, and neurosyphilis
Cogwheel rigidity
involuntary resistance to passive flexion/extension and pronation/supination or rotational movements around a joint
Found as EPSE/parkinsons
Not lead pipe rigidity - extreme stiffness but no ratcheting
Choreiform movements
irregular, involuntary movements of face, limb or trunk muscles which are faster, jerkier and more discrete than athetoid movements
They reflect basal ganglia dysfunction and can be a manifestation of basal ganglia infarction, tumours or calcifcation. They can occur concurrently with athetoid movements. Hemiballismus is related but more extreme
They are seen in Tardive dyskinesia, Parkinsons disease, Huntingtons disease sydnehams chorea , advanced age and toxicity ( lithium, amphetamines, phenytoin, estrogens, dopamine agonists)
Coma
profound unconsciousness with loss of voluntary activity and communication
appears to be asleep, although they cannot be aroused
- due to severe bihemispheric or brainstem reticular formation dysfunction
Must be differentiated from an hysterical condition, locked in syndrome - pontine tegmental lesions ( patient is awake and aware but unable to activate muscles other than those controlling vertical eye movements and/or eye closure
Compulsion
Unwanted, ego-dystonic impulse to perform certain motor behaviours. The patient usually realises that the behaviour is unreasonable, but can suppress it only temporarily and at the expense of increasing anxiety
Common: washing/checking
- associated with obsessions
Disinhibited behaviour
poor self control or loss of the capacity to resist unacceptable impulses
Refers to characteristic and socially inappropriate speech and behaviour - severe dysfunction of frontal lobes
- SCZ, ethanol intoxication, exaggerated inappropriate rudeness, candor, lewdness, profanity, jocularity, sexual behaviour, preoccupation, public undressing - childish joking ( witzelsucht)
Dystonia
involuntary INCREASED tone in a muscle or group of muscles that occurs rarely in parkinsonism and more frequently as an EPSE of antipsychotics
Potential dangerous form is dystonia - laryngospasm as it threatens airways or unilateral spasm of the Sternocleidomastoid (torticollis),
Eyeballs rolling upward, accompanied by extension of the neck ( oculogyric crisis)
bending over backward such that the back of the head approaches the legs ( opisthotonus)
Echopraxia
Involuntary repetition and imitation of another persons movements inappropriate to the situation.
Seen in catatonia, tic disorders and partial complex seizures, frontal lobe damage, dementias
Extrapyramidal side effects (EPSE)
The pyramidal tracts of the LOWER brainstem ( medulla oblongata) contain fibers of the corticospinal tract - axon of the upper motor neurons of the voluntary motor pathway.
EPSE = all other (involuntary) central neural structures and pathways subserving movement, tone and posture
- Extrapyramidal system = movements of BRAINSTEM, CEREBELLUM and BASAL GANGLIA
- SE of antipsychotics - parkinsons disease , tremor, bradykinesia, cogwheeling, paratonia ( diffuse muscle stiffness), dystonia, akathisia
Eye contact
normal - look at each other without staring
Depressed, socially awkward , paranoid, SCZ - avoid eye contact
Manic, aggressive - stare excessively, making the other person feel uncomfortable
Catatonic patients - stare
Lead pipe rigidity
Markedly increased muscle tone and resistance to passive movment independent of the direction of movement
Patient is almost as stiff as a board. Muscle tone is SMOOTH and CONSISTENT rather than ratcheting as in cogwheel rigidity
- may indicate brain damage, NMS , acute withdrawal of dopamine agonists in Parkinsons
Manipulative
Attitude of behaviour in which one exploits, outsmarts or subtly coerces another person in order to gain advantage, maintain control or get ones own way
- may be subtle or more overt
- Cluster B personality disorders + normal children
Mannerisms
A peculiar and repetitive body movement or action that appears bizarre to the observer because it is exaggerated or out of context and does not resemble known types of involuntary movements
- need to know history
- may have a meaning to the patient
Motor perserveration
deficient capacity to shift from one motor behaviour to another
- ie. difficulty changing tasks from finger to nose
Parkinsonian movements
involuntary movements due to dysfunction of the basal ganglia
TRAP
- resting tremor
cogwheeling
rigidity masked facies, bradykinesia, festinating gait
Seen in EPSES, progressive supranuclear palsy, encephalitis, neurosyphilis
Psychomotor retardation
slowing of body movements secondary to psychic dysfunction
accompanied by : hypokinesia or akinesia
seen in: delirium, major depression, drug intoxication or withdrawal, hypothyroidism dementia, schizoaffective disorder
Resistance
unconscious or subconscious opposition to attempts by others to help the patient or to bring into the patients awareness information or ideas that are uncomfortable or conflictual
Splitting
A psychological defense mechanism in which other persons and things are viewed in extremes , without the ability to consider compromise or to integrate seemingly conflicting information into a whole
Things are “ black or white” , “ good or bad”
The patient idealises or denigrates the same person , or splits groups of others into good guys and bad guys
Stereotypy
A repetitive, purposeless movement
- rocking, head banging of autistic children
- more complex than simple tics and unlike automatisms occur without concomitant alteration of consciousness
Tics
Abnormal sudden, repetitive, stereotyped jerky movments of eyes, vocal organs, face, extremeties, or trunk
