L2: Psychiatric Symptoms & Signs Flashcards
Definition of perception
- The process by which sensory stimuli are given a meaning (i.e. transferring physical stimulation into psychological information).
Disorders of perception
- Illusions
- Hallucinations
- Depersonalization & Derealisation
Characters of Illusions
- May affect any sensory modality (auditory, visual, …).
- May occur in normal or pathological condition (e.g delirium).
Def of Illusions
- Misinterpretation of a real external sensory stimuli e.g.: mistaking a robe for a snake and mirage phenomenon.
Def of Hallucinations
False perception in absence of any external stimuli.
classification of hallucinations, according to complexity
Elementary:
- Hallucination are ill formed stimuli e.g. noises, flashes of light
Complex:
- Hallucination are more sophisticated and relatively meaningful stimuli e.g. voices, music, faces, scenes
what are Hallucinations classified according to?
- complexity
- Sensory modality
what is the most common type of hallucinations?
Auditory hallucination
Classification of hallucinations, according to sensory modality
- Auditory Hallucinations
- Visual hallucinations
- Tactile hallucinations
- Olfactory and Gustatory hallucinations
- Somatic hallucinations
where do Auditory hallucination mainly occur?
- They mainly occur in psychotic disorders especially schizophrenia.
Varieties of Auditory hallucination
where is visual hallucination most common?
- Most common in organic mental disorders (e.g delirium, substance intoxication or withdrawal).
- May occur in schizophrenia, severe mood disorder or dissociative disorder.
what are Tactile hallucination?
- False perception of touch e.g phantom limb (from amputated limb)
- Crawling sensation on or under the skin in cocaine intoxication or withdrawal.
where is Olfactory (smell) or gustatory (taste) hallucination most common?
- Most common in organic disorders e.g temporal lobe epilepsy.
- May occur also in: schizophrenia or severe mood disorders.
what are Somatic hallucinations?
- False sensation of things occurring in the body (mostly visceral).
Examples of Somatic hallucinations
- complaint that a snake is wondering in the abdomen and complaint of buming pain in the brain.
where do Somatic hallucinations occur?
- They usually occur in psychotic disorders especially schizophrenia.
Hallucination can occur in normal conditions such as ……
- While getting into sleep (hypnagogic).
- During awakening (hypnopompic).
- After physical stimulation of a sense organ (flashes of light after pressing the eye ball).
what is Depersonalization & Derealisation?
Disturbed perception of oneself or the surrounding environment.
Def of Depersonalization
- The person perceive himself, his body or parts of his body as different, unreal or unfamiliar.
Def of Derealization
- The person perceive the external world, objects or people as different, strange or unreal.
where do Depersonalization and derealization occur?
- Depersonalization and derealization can occur in normal person during stress, in anxiety disorders, mood disorder, schizophrenia and in organic disorders e.g. temporal lobe epilepsy.
what are disorders of thinking classified into?
- Disorders of the form of thinking
- Disorders of the stream of thinking
- Disorders of the content of thinking
Characters of Disorders of
The form of thinking
- They are also called formal thought disorders.
- They are abnormalities in the logical structure and association of thoughts.
- They lead to failure in producing coherent and logically connected meanings.
- Formal thought disorders usually occur in psychotic disorders and in organic mental disorders.
what are types of Disorders of
The form of thinking?
- Loosening of associations
- Incoherence
- Word Salad
- neologism
- Verbigration
- Perservation
- Clang Associations
- Irrelevance
- Circumstatiality
- Tangentiality
- Derailment
Def of Loosening of associations
Mild degree of loosening between ideas rather than words or group of words.
Def of Incoherence
- Severe degree of loosening of association to the extent that thoughts and words seem to run together without logical or grammatical rules or connection.
Def of Word Salad
- Extreme loosening of association in which the speech become haphazard mixing of words and phrases.
Def of Neologism
- Fragmentation of words into sounds or syllables that results in a complete jargon of insensible sounds
although the patient may look like speaking a foreign language.
Def of Verbigration
- Spontaneous repetition of specific words or phrases without any apparent meaning or motivation.
Def of Perservation
- Occur when the patient repeats the same response despite changing the stimulus.
Def of Clang association
- Association of words according to their tone, sound or rhyme, but not according to meaning.
Def of Irrelevance
- In which the patient responds to a specific stimulus by a response that is not related to the stimulus.
Def of Circumstatiality
- The patient gives unnecessary details but ultimately reaches the goal.
Def of Tangentiality
- Ideas are poorly connected to each other around a basic central theme.
- Ideas look as if going beside each other just touching part of the adjacent idea and only moving along periphery of the goal to be reached.
Def of Derailment
- Sudden deviation of the train of thought; the patient suddenly change the subject of speech
- If derailment is preceded by a period of silence, it is called thought block.
what are disorders of the stream of thinking?
what are disorders of the content of thinking?
- These are abnormalities in the ideas or beliefs contained in the thought.
- They include:
1. Delusions.
2. Obsessions.
Def of Delusions
- False fixed belief based on incorrect inferences about reality
Characters of Delusions
- It is not consistent with the patient cultural background.
- It cannot be corrected by logic or reasoning.
Types of Delusions
Types of delusions according to the theme
- Delusion of persecution
- Delusion of grandeur or grandiosity
- Delusion of reference
- Delusion of guilt or self accusation
- Nihilistic delusion
- Hypochondriacal delusion
- Delusion of infidelity (delusional jealousy)
- Erotomania (delusion of love)
- Delusion of influence and control (passivity phenomena)
Delusion of persecution
- The patients believe that people are harassing them, chasing them, spying on them or trying to kill them.
Delusion of grandeur or grandiosity
- The patient believes that he has special power or high religious position.
Delusion of reference
- The patient believes that the usual events have a special (usually dangerous) significance in reference to him e.g. people are starring at him, talking about him
- Sometimes he believe that people in TV are talking about him or talking directly to him.
Delusion of guilt or self accusation
- False belief of remorse and gui
Nihilistic delusion
- The patient denies the existence of one organ or may deny the existence of the whole person.
Hypochondriacal delusion
- The patient believes that he has a serious illness despite the absence of medical evidence.
Delusion of infidelity (delusional jealousy)
- The belief that one’s spouse is unfaithful despite no supporting evidence.
Erotomania (delusion of love)
- The belief that someone usually inaccessible and in higher social class is in love with the patient.
Types of Delusion of influence and control (passivity phenomena)
Thought insertion: patient believes that thoughts are being implanted in his mind by external force.
Thought withdrawal: patient believes that thoughts are being taken out of his mind.
Thought broadcasting: patient believes that their thoughts are available to others through radio or TV.
Delusion of influence and control
(passivity phenomena)
- False belief that a person’s will, thoughts or feelings are being controlled by external forces.
Compare between obsessions & Compulsions
what are disorders of Speaking?
- Volubility
- Poverty of Speech
- Poverty of Content of Speech
- Stuttering & Stammering
- Hurried Speech
- Monotounus Speech
- Dysarthria
- Mutism
- Aphasia
Def of Volubility
- Increase in the amount of speech.
Def of Poverty of speech
- Sppech is scanty
Def of Poverty of content of speech
- speech that is adequate in amount but conveys little information because of vagueness, emptiness or stereotyped phrases.
Def of Stuttering and stammering
Def of Monotonous speech
- A speech lacking resonance and emotional inflections, It can be a trait or may be due to flattening of emotion.
Def of Hurried speech
- Rapid utterance of coherent goal directed speech.
Def of Dysarthria
It is a disorder of articulation that may be organic as in post stroke patient and slurred speech in drug. intoxication.
Def of Mutism
- The patient can’t speak any words, occur in conversion disorder, catatonia and in some neurological diseases.
Def of Aphasia
what are disorders of Emotions?
The clinical study and evaluation of emotion is concerned with two main aspects: Mood & Affect
Compare between mood & affect
what are emotions?
Emotion is a complex feeling state with psychic, somatic and behavioral components.
what are disorders of mood?
- Pleasant & Unpleasant moods
Types of Pleasant mood
Types of unpleasant mode
what are disorders of Affect?
- Constricted or restricted affect
- Blunted affect
- Apathy
- Indifference
- Inappropriate affect (incongruity)
- Ambivalence
- Lability of affect (emotional incontinence)
what is Apathy?
- loss of emotion or lack of feeling (there is loss of both emotional expression and experience).
what is Indifference?
lack of objective emotional response. (there is loss of emotional expression but emotional experience is preserved).
Incidence of Indifference
More in females
where does Lability of affect (emotional incontinence) occur?
- It occurs in gross organic lesions of the brain e.g. the pseudobulbar syndrome.
what is la belle indifference?
occurs in hysteria when the patient feels happy in spite of his disability.
Def of Inappropriate affect (incongruity)
- Disharmony between the emotional experience, expression or feeling tone with the coexisting idea or situation.
Def of Ambivalence
- The presence of two opposing emotions towards the same person at the same time (e.g love and hate).
Def of Lability of affect (emotional incontinence)
The emotional Change from one extreme to the other with no obvious cause (laughing & Weepig & Crying)
what are examples of disorders of Motor Behaviour?
- Psychomotor retardation
- Agitation
- Excitment
- Stereotypy
- Mannerism
- Perservation
- lack of violation
- Catatonic Symptoms
Def of Psychomotor retardation
- Diminished motor activity, occur in depression.
def of Agitation
- The patient is moving around, moving his limbs and head, wrinkling his fingers and cannot stay for some time in one place.
Def of Excitment
- occurs in primary psychiatric disorders e.g mania and schizophrenia and in organic mental disorders e.g drug addiction and temporal lobe epilepsy.
Def of Stereotypy
Means monotonous repetition e.g touching the nose.
Def of Mannerism
- Repeated movements, which may continue for hours or days without cessation.
- And Keeping with the thought (eg a patient with paranoia salutes repeatedly in a grandiose manner.)
Def of Perservation
- Repetition of the same movement inspite of the patient’s effort or desire to do a new one (eg during a meal the patient continues to put the spoon in the plate and up to his mouth, even after the plate gets empty) (may happen in dementia).
Def of Lack of Violation
- Lack of initiation and reduction of spontaneous movements (e.g. shaking hands).
- The patient has no desire or well to perform acts.
what are catatonic symptoms?
- Catalepsy
- Catatonic posturing
- Catatonic rigidity
- Waxy flexibility
- Catatonic Stupor
- Catatonic excitement
- Negativism
- Automatic obedience
- Echolalia
- Echopraxia
Def of Catalepsy
- the term refers to immobile relatively lasting position.
Def of Catatonic posturing
- acquiring an inappropriate bizarre posture.
Def of Catatonic rigidity
- assuming a rigid (but normal) posture and holding it against all effort to change it.
def of Waxy flexibility
- the patient can be modeled in any position induced by the examiner maintaining such posture beyond the physiological fatigue.
Def of Catatonic stupor
marked retardation of motor activity to the point of immobility.
Def of Negativism
- the patient does exactly the opposite of what he is asked to do.
Def of Catatonic excitement
- extreme degree of motor hyperactivity, intense, not related to a provo stimulus in the surrounding environment.
Def of Automatic obedience
- the patient exactly and readily responds to the orders performing them in full details regardless their odd content.
Def of Echolalia
- the patient repeat the same words of the question or the last word.
Def of Echopraxia
- the patient imitates the movement of another person e.g. the examiner.
What is Memory?
Memory is the psychological function by which information stored in the brain is later recalled in consciousness.
what are levels of memory?
- Immediate memory: Capacity to retain information for about 0.5 second
- Recent (short term) memory: 15-20 seconds.
- Recent past memory: 5 minutes.
- Remote (long term): Long lasting storage.
what are disorders of memory?
- Amnesia
- Hypermnesia
- Paramnesia
Def of Amnesia
memory loss
Types of Amnesia
Def of Hyperamnesia
- Abnormally pronounced memory when life events can be registered and recalled in details.
(Occur in hypomania)
Def of Paramnesia
falsification or distortion of recalled memories.
Types of Paramnesia
- Confabulation
- Retrospective falsification
- Déjà vu
- Jamais vu
Def of Confabulation
- filling the amnestic gaps by fabricated events and untrue experiences, this occur beyond the conscious awareness. (Occur in alcoholics)
Def of Retrospective falsification
unintended distortion of memory that includes selective omission, additions and biased reorganization of memory to fit the present goal
Def of deja vu
feeling that the present situation, person or information has been seen before while it is actually new. (may occur normally)
def of Jamais Vu
definitely familiar person or situation is perceived as seen for the first time. (may occur normally)
Compare between attention & Concentration
what are disorders of Attention?
Distractibility: failure to sustain attention to one object. Occur mainly in mania and in hypomania.
Selective inattention: while heightened attention is directed toward some specific target and neglecting almost all others.
Hypervigilance (hyperprosexia): a state of heightened attention, can occur in paranoid states and occasionally
what is Orientation?
Awareness of time, place and persons.
What is Disorientation?
- Disturbed orientation to time, place and persons.
- It is usually related to disturbed consciousness.
most common symptoms indicating disturbances in consciousness, orientation, memory and attention highly suggest an ……
organic mental disorder e.g. delirium.
Def of consciousness
the general state of awareness of the self and the environment.
what are disorders of consciousness?
- Lethargy
- Confusion
- Somnolence
- Stupor
- Coma
Def of lethargy
- The patient is drowsy and less aware or less interested in the surrounding.
Def of Confusion
The patient is easily distracted and may be slow to respond and may be disoriented to time, place and persons.
Def of Somnolence
- The patient is sleeping and can’t stay awake unless someone or something wakes him up.
- He can usually talk and follow directions.
Def of Stupor
- He is in deep sleep unless something loud or painful wakes him up.
- He may not be able to talk or follow directions.
Def of Coma
The patient can’t be awakened at all.
NB: disorders of consciousness are usually due to …… etiology.
Organic
Disorders of Judgement
- Judgment is the ability to assess a situation rationally and to act appropriately within that situation.
- It has several aspects (cultural, social, moral, etc…) that should be considered in order to be assessed by the clinician.
Disorders of Insight
- In psychiatry, insight refers to the patient’s conscious recognition of his condition, i.e. awareness that:
a) He is disturbed or ill.
b) His illness is psychiatric in nature.
c) He should seek professional help.
d) He should cooperate with the offered treatment. - Full or partial awareness of these aspects indicates the degree of his insight.
