Psychiatric Nursing Reviewer 1

PSYCHIATRIC NURSING TYPICAL SIGNS AND SYMPTOMS OF PSYCHIATRIC ILLNESS DEFINED I. CONSCIOUSNESS: State of awareness A. DISTURBANCES OF Apperception: Perception modified by one’s own emotions & thoughts o CONSCIOUSNESS

1. Disorientation 2. Clou Cloudi ding ng of con consc scio ious usne ness ss 3. Stupor 4. Delirium 5. Coma 6. Coma Vigil 7. Twilight state 8. Dreamlike st state 9. Somnolence 10. Confusion 11. Drowsiness 12. Sundowning

B. Disturbances of Attention

1. Distractibility 2. Selective inattention 3. Hypervigilance 4. Trance C. Disturbances in suggestibility 1. Foli Folie e a deux deux ( fol folie ie a tro trois is)) 2. Hypnosis II. Emotion: A. Affect 1. Appropriate affect

2. In Inappropriate af affect 3. Blunted affect 4. Rest Restri rict cted ed or Cons Constr tric icte ted d 5. Flat affect 6. Labile affect B. MOOD

1. Dysphoric mood 2. Eu Eu t h y m i c mo mood 3. Expansive mood 4. Mood swings (labile mood) 5. Elevated mood 6. Euphoria 7. Ecstasy 8. Depression 9. Irritable 10. Anhedonia 11. Grief or mourning 12. A le lex it ith ym ymi a 13. Suicidal ideation 14. Elation

Sensorium: State of cognitive functioning of the special senses o Disturbance of orientation in time, place, or person. Inco Incomp mple lete te clea clearm rmin inde dedn dnes ess s w/ dist distur urba banc nces es in per perce cept ptio ion n & att attit itud udes es Lack of reaction to & unawareness of surroundings. Bewildered, restless, confused, disoriented reaction associated with fear & hallucinations. Profound degree of unconsciousness. Coma in w/c a px appears to be asleep but ready to be aroused (akinetic mutism) Disturbed consciousness w/ hallucinations Often us used as as a synonym fo for complex pa partial se seizure or or psychomotor ep epilepsy Abnormal drowsiness Disturbance of consciousness in w/c reactions to environmental stimuli are inappropriate: manifested by a disordered orientation in relation to TPP A state of impaired awareness associated with a desire or inclination to sleep Syndrome in older people that usually occurs at night & is characterized by drowsiness, confusion, ataxia & falling as the result of being overly sedated w/ medications (Sundowner’s Syndrome) Is the amount of effort exerted in focusing on certain portions of an experience; Ability to sustain a focus on one activity ; Ability to concentrate Inability to concentrate attention; state in w/c attention is drawn to unimportant or irrelevant external stimuli Blocking out only those things that generate anxiety Excessive attention & focus on all in internal & external st stimuli, usually 2ndary to delusional or paranoid states Focused attention & altered consciousness, usually seen in hypnosis, dissociative d/o’s, & ecstatic religious experiences Compliant & uncritical response to an idea or influence Comm Commun unic ica ated ted emo emoti tion ona al ill illne nes ss bet bet 2 (3) (3) per perso sons ns Artificially induced modification of consciousness characterized by a heightened suggestibility Complex feeling state w/ psychic, somatic, & behavioral components that is r/t affect & mood Observed expression of emotion Condition in w/c the emotional tone is in harmony w/ the accompanying idea, thought, or speech Disharmony be bet th the em emotional fe feeling to tone & the id idea, th thought, or or sp speech accompanying it Disturbance in affect manifested by a severe reduction in the intensity of   externalized feeling tone Redu Reduct ctio ion n in in inte intens nsit ity y of of feel feelin ing g ton tone e les les seve severe re than than blun blunte ted d aff affec ectt but but clearly reduced Absence or near absence of any signs of affective expression; voice monotonous, face immobile Rapid & abrupt changes in emotional feeling tone, unrelated to external stimuli A pervasive & sustained emotion, subjectively experienced & reported by a px & observed by others an u n p l e a sa n t mood normal range of mood, i mp mp ly ly in in g ab absence of depressed or elevated mood a pers person on's 's expression of feel feelin ings gs witho without ut rest restra rain int, t, frequ frequen entl tly y with with an overestimatio overestimation n of th ei r significance significance or importance importance.. oscillations between euphoria & depression or anxiety Air of confidence & enjoyment; a mood more cheerful than usual in tense e l a ti on w i th feelings of grandeur Feeling of intense rapture psychopathological feeling of sadness A state in w/c a person is easily annoyed & provoked to anger loss of interest in and withdrawal from all regular and pleasurable activities, of often associated with depression sadness appropriate to a real loss a person's in abi l ity to to or difficulty in in d escrib ing be being aware of emotions or mood. thoughts or act of taking one's own l ife. Feelings of joy, .euphoria, triumph, intense self-satisfaction, or or optimism.

C. OTHER EMOTIONS 1

1. Anxiety 2. Free-floating anxiety 3. Fear 4. A g i t a t i o n 5. Tension 6. P a n ic 7. A p ath y 8. A m b iv a le n ce 9. Abreaction 10. Shame 11. Guilt 12. Impulse control 13. Melancholia D.

PHYSIOLOGICAL

DISTURBANCES ASSOCIATED WITH MOOD:

1. Anorexia 2. Hypcrphagia 3. Insomnia a. I n i t i a l b. M iddle

c. Terminal 4. Hypersomnia 5. Diurnal variation 6. Diminished libido 7. Constipation 8. Fatigue 9. Pica 10. Pseudocyesis

11. B u l i m i a 12. Adynamia III. MOTOR BEHAVIOR BEHAVIOR (CONATION): 1. Echopraxia 2. Catatonia and postural abnormalities a. Catalepsy b. Ca Catatonic excite itement c . C a t a to n i c s t u p o r

d . C ataton ic ic rigid it ity e. C at ataton ic ic po posturing f. Cerea flexibilitas (waxy flexibility) g . Akin e sia 3. Negativism 4. Cataplexy 5. Stereoty py 6. Mannerism 7 . A u to m a t is m 8. Command automatism 9. M utism 10. Overactivity a. Psyc sychomo homoto torr agit agita ation tion b. Hype Hypera ract ctive ive (hyp (hyper erkin kines esis is)) c. Tic d. Sleepw Sleepwal alkin king g (somnambu (somnambuli lism) sm)

Feeling of apprehension caused by anticipation of danger, which may ibe n t e r n a lo r external. P e r v a s i v e ,unfocused u nfocusedfear notat notat ta ch edlo edlo any idea. idea. A n xi e tycaused tycaused by consciousl consciously y recognized recogniazed nd re al ist icdanger icdanger.. severe a n x i e t y ass ociatedw it h moto moto r restlessness. restlessness. increased and unpleasant motor and psychological activity. acu te , e pis odic,int i nt en se a tt ac k of an x ie ty associated associated with overwhelming feelings feelings of dread and autonomic discharge. d u l l e d e m oti on a l to n e a s s oc i a t ew d it h detachment detachment or indifferenc indifference e c oe x is te n ce of tw o op p o sin g ipulses m toward the same th t h in g in the same thing thing in the same personat the same same tim e. emotional release or discharge after r ecal lin g a painf painful ul expe experie rience nce.. failure to live up to self-expectations. emotion secondary to doing what is perceived as wrong. ability to resist an impulse, drive, or temptation to perform an action. severe depressive state; used in the term involutional melancholia both descriptively and also in reference to adistinct adistinct diagnostic entity

signs of o f somatic som atic (usually (us ually autonomic) aut onomic) dysfunction, function, most often associatedwith associatedwith depression(Also called vegetative signs). loss of or decrease in appetite. increase in appetite and in ta ke of food. lack of or diminished a b i l i t y to sleep. difficulty in falling asleep difficulty in sleeping through theni gh t without without waking waking up anddi ff ic ul ty in going going back to sleep. early morning awakening excessive sleeping mood is regularly worst in themorning, themorning, immediately after awakening, and improves as the day progresses. decreased sexual interest, drive, and performance (increasedlibido (increasedlibido is is o ften associated with manic states). inab ility to defe defecat cate e or di ff ic ul ty in defecati defecating. ng. a feeling of weariness, sleepiness, orir orir rit ab ili ty followi following ng a period period ofm en ta l or bodi bodily ly activity activ ity.. cr av ing in g and eati ng of nonfood nonfood sub substances, such as paint and clay (usually girls) rare condition in which a patienthas patienthas the th e s ign s and symptoms symptoms of pregnanc pregnancy, y,such such as abdom abdomin inal al dis te ntio n, breast breast enl arg ement, pigmentation, ces sation of  menses, mens es, and morning morning sickness. in s a t ia b le hunger and voracious e a ting; seen in b u l i m ia nervosa and a typical depression aspect of the psyche that includes impulses, motivations, wishes, drives, instincts, and cravings, as-expressed by a person's behavior or motor activity. pathological imitation of movements of one person by another. seen in catatonic schizophrenia and some cases of brain diseases, such as encephalitis. general term for an immobile position that is constantly maintained agitated, pu purposeless mo motor acti activity vity uninfluenced by external stimuli m arked ly slowed m otor activity , o ftenID a point of immobility and seeming unawareness of surroundings Vo lu lu nt ntary assu mp mption of a rigid p os ostu re re ,,-held ag ai ainst all efforts to b moved. e volun ta tary as assu mp mp ti tion of an in ina pp ppropria te te or or bizarre p os ostu re re, gerally en en maintained for long periods condition of a person who can be molded into a position that is then maintained; when an exam iner moves the person's limb, the limb feels as if it were made of  wax. lack of p hysical m o vem en t, a s inthe extreme immobility of catatonic schizo phrenia; may also occur as an extrapyramidal side effect of antipsychotic medication. m otiveless resista nce to all atempts t to be moved or to all instructions temporary loss of muscle tone and weakness precipitated by a variety of emo tio na l states states.. repetitiv e fixe d pattern o f phy sicaaction l or speech. ingrained, habitual involuntarymovement. au tom atic p erform an ce of an act or acts g enerally rep resen tative of u nconscious symbolic activity. automatic following of suggestions (also automatic obedience). voicelessn ess without structural anormalities. b Exc Excessiv ssive e & mo motor tor & cog cogni niti tive ve ove overa rac ctivi tivity ty,, usua usuall lly y non nonpr pro oduc ductive tive & in response to inner tension. Rest Restle less ss,, aggre aggress ssiv ive, e, dest destru ruct ctive ive act activ ivit ity, y, often often asso associ ciat ated ed with with some some underlying brain pathology Involuntary, spasmodic motor movement motor motor activ activity during during sleep sleep.. 2

e. Akathisia f. Compulsion i. Dipsomania ii. Kleptomania i i i. Nymphomania i v . Satyriasis v. Trichotillomania vi. Ritual g . At a x i a H. Polyphagia i. Tre m or

1 1 . Hypoactivity Hypoactivity (Hypokinesis) (Hypokinesis) 12. Mimicry 13. Aggression 14. Acting Out 15. Abulia

16. Anergia 1 7 . A s t a s i a a b a s ia

18. Coprophagia 19. Dyskinesia 20. Muscl Muscle e rigi dit y 21. Twirling

22. Bradykinesia 23. Chorea 24. Convulsion a. Clonic convulsion b. Tonic convulsion 25. Seizure a. Generalized Generalized tonic-clon tonic-clonic ic seizure seizure b. Simp Simplle pa partia rtiall sei seiz zure c. Complex partial seizure 26. Dystonia

IV. THINKING

subjective feeling of musculartension muscular tension secondary to antipsychotic or other medication, which which can cause restlessness, restlessness,pacing, pacing, repeated sit ti ng and standing; can be mistaken for psychotic agitation uncontrolla uncon trolla ble impulse impu lse to perform an act repetitively compulsion to drink alcohol compulsion to steal excessive and compulsive need for coitus in a w om an excessive and com pulsive need for coitus in a man compulsion to pull out hair automatic activity, compulsivein compulsivein nature, anxiety reducing in origin failure of m uscle coordination; ir egularity of muscle action pathological overeating rhythm ical alteration in movem ent,which is v i s u a l l y faster than one beat a second; typically, typically, tremors decrease during periods of relaxation and sleep and increase during periods of of anger and increased increased tension. | decreased motor and and cognitive cognitive activity, activity, as in psychomotor retar dation; visible slowing of thought, speech, and movements. simple, im it at iv e motor activity activity of childhood. childhood. forceful, goal-directed action thatmay thatmay be verbal or physical; the motor counterpart of the affect of rage, anger, or hostility direct direct expressi expression on of an uncon unconscious scious wish wish or impul impulse se in actio action; n; living out unconscious fantasy impulsively in behavior reduced impulse to act and think, associated with indifference about consequences of action; a result of neurological deficit lack of energy (anergy) the i n a bi bi l i t y to stand or walk in a no rm al manner, even though norm al leg movements can be performed in asi asi tt in g or ly in g down position. The gait is bizarre and is not suggestive of a specific organic lesion;seen lesion;seen in conversion disorder. e a t i n g of filth or feces difficulty in performing voluntarymovements, as in extrapyramidal disorders. disorders. st at e in which the the muscles remain immovable; imm ovable; seen se en in schizophre nia. a sign present in autistic childrenwho cont inu al ly rotate rotate in in the dire ctio n in which their head is is turned. turned. slowness slowness of motor ac ti vi ty w it h n decrease in normal spontaneous spontaneous movement. random and involuntary invol untary quick, jerky, purposeless movements. movements. An involuntary, violent muscular co contraction or spasm convulsion in which the muscles alternately alternately contract contract and relax relax convulsion convulsi on in which the muscle contraction is sustained an attack or sudden onset of certain sy s ymptoms, such as convulsions, lo loss of   consciousness, consciousness, and psychic psychic or sensory sensory distur bances; seen in epilepsy and can be substance-induced generalized generalized onset onset of tonic-clonic tonic-clonic movements movements of the limbs, tongue tongue biting, biting, and incontinence incontinence followe fol lowed d by slow, gradual recovery recovery of con sciousness sciousness and cognition c ognition;; also called grand mal seizure and psychomotor seizure loca locali liz zed ict ictal on onset set of se seizure wi without alteration:; in co consci scious ness. Localized Localized ictal onset ons et of seizure with alterations alterations in conscious ness ness slow, sustained sustained contracti contractions ons of the trunk trunk or limbs; limbs; seen seen in medicat medication ion-induced dystonia Goal-directed flow of ideas, symbols, and associations initiated initiated by a problem or task and leading toward a reality-oriented conclusion; when a logical sequence occurs, thinking thinking is normal; normal; parapra parapraxis xis (un consciously motivated lapse from logic l ogic is also called a freudian slip) considered considered part of nor normal mal thinking.

A. GENERAL DISTURBANCES IN FORM OR OR PROCESS OF THINKING THINKING

1. Mental disorder

2. Psychosis

3. Real Realit ity y te testing 4. Forma Formall though thoughtt diso disorde rderr 5. Illo Illogi gic cal thin thinki king ng

6. Dereism 7. Autistic thinking 8. Magical thinking

Clinically Clinically significant behavior behavior or psychological psychological syndrome syndrome associated associated with with dist ress or or disabili disa bility, ty, not not just just an expe expecte cted d re sponse sponse to a particular particular event event or limited limited to rela tions tions between a person and society. ina inabilit ility y to to distinguish reality from fantasy; impaired reality testing, with the creat ion of  a new reality (as opposed opposed to neurosis: mental disorder disorder in which which reality testing is in tact; behavior may not violate gross gross social norms, norms, but but is relative relatively ly endu en duri ri ng or recur recurrent rent without treatment) Obje Object ctiv ive e ev evaluation ion an and judgment of the world outside the the se self. distur disturba banc nce e in in the form of thought thought rather rather than than the the conten contentt of of tho thoug ught ht;; thinki ng characterized by loosened associations, neologisms, and illogical constructs; thought process process is dis d isor orde dere red d and the person person is defined defined as psychotic psychotic Thin Thinki king ng conta ontain inin ing g erro errone neou ous s conc conclu lus sions ions or int intern ern al cont ontradi radic ctio tions; ns; psychopathological only when it is marked & when not caused by cultural values or intellectual deficit. m ental a c t i v i t y not concordant w i t h lo logic or experience Preo Preocc ccup upat atio ion n wi th in ne r, private private world; term used somewhat synony mousl m ously y wit h dereism. A form of dereistic thought; thinking similar to that of the preoperational phase in children(jean piaget), in which thoughts, words, or actions assume power (e.g. to cause or prevent events) 3

9. Primary processthinking process thinking General te rm for thi nk in g that that is is derei dereist stic ic,, illog ica l;-m agic al; normally fou nd in dreams, abnormally abnor mally in psy ps ychosis. 10. E m otional insigh t Deep leve l of unde rstandingor awareness that is likely to lead topos topos itiv e changes changes in in personality personality and be havior. B. SPECIFIC DISTURBANCES IN FORM OF THOUGHT 1. Neologism New word created by a p at at ie ie nt nt , oft en en by by combining syllables of other words, for idiosyncratic psychological reasons. 2. Word salad incoherent mixture of words and phrases. 3. Circumstantiality indirect speech that is d el ayed ay ed in reach reaching ing the point point but eventu eve ntu ally all y gets from from original original point to desired goal; characterized characterized by an over inclusion i nclusion of details and parenthetical remarks. 4. Ta Tangetiality I na na bi bi li li ty ty to to ha have go goal-directed as associations of of th thought; sp speaker ne never ge gets fr from desired point to desired goal. 5. Incoherence  Thought  Thought that that gen era ll y is not un derstand derstandable; able; runn ru nn in g together together of of thought thoughts s or words; words; w i th no logical logical or grammatica grammaticall connect connection, resultin gin disorgan ization. 6 . P e r s e v e ra ti o n P er s i s ti ng r e s p o n se to par e v i o u sst s st im ul usaft usafter er a new newst im ul u shas been presen presented; ted; often often associatedw associatedw it h cog nitivedisor nitivedisorders. 7. Verbigeration Verbigeration meaningless repetition of specific words or phrases 8. Echolalia psychopathological repeating of words or phrases of one person by another; tends to be repetitive and persistent; may be spoken spoken with wi th mock mocking ing or stac stacca cato to into in tona na ti on 9. condensation Fusion of various concepts into one 10. 10. irr irrel elev evan antt ans answe werr Answ Answer er that that is not not in in har harmo mony ny with with ques questi tion on aske asked d (pe (pers rson on appe appear ars s to to ign ignor ore e or or not not attend to question). 11. Loosen Loosening ing of association association Flow of of thought thought in which ideas ideas shift from one one subject subject to another another in a complet completely ely unrelated way: when sever speech may be incoherent. 12. derailment 13. fl fligh ight of of id ideas Rap Rapid, id, co continuous ve verbaliza izations or or pl plays on on wo words rds pr produce co constant sh shift ifting ing fr from one idea to another; ideas tend to be connected, & in the less severe from a li stener may be able to follow them. 14. Clan Clang g asso associ ciat atio ion n Asso Associ ciat atiion of wo word rds s simi simila larr in in sou sound nd but but not not in me mean anin ing; g; wo word rds s have have no logi logica call connection; nay include rhyming and punning. punning. Abruption eruption in tr a in of of t hi hi n nk k in in g be before a though or idea is finished; after a 15. Blocking brief pause, person person indicates no recall of what was bei b ei ng said or was going going to be said said (also known as thought deprivation). 16. Glossolalia expression o off a revelatory message th through uni unint ntel elli ligi gible ble words (also known as speaking in tongues); tongues); not considered considered a disturbance in thought if associated with practices of specific Pentecostal religions 1. Poverty of content

C. SPECIFIC DISTURBANCES IN CONTENT OF THOUGHT  Thought that gives little in formation because because of vagueness, empty repetitions, or obscure phrases.

2. Overvalued idea 3. Delusion

a. Bizarre delusion b. Systematized delusion c. Mood-congruent delusion d. Mood-incongruent delusion

e. N ih ih il ili st st ic ic de delusion

f. delusion of of po poverty g. somatic delusion h. paranoid delusion i. delusion of persecution ii. delusion of grandeur iii iii. de delusion of of re reference

i. Delusion of self accusation j. delusion of control i. th thought wi withdrawal

Unreasonable, sustained false belief maintained less firmly than a delusion false belief, based on incorrect inference about external reality, not consistent with patient's intelligence, and cultural background; cannot be corrected by reasoning an absurd, totally implausible, strange false belief (for example, invaders from space have implanted implanted electrodes in a person's brain). False belief of belief eliefs s united united by by a single event or theme (for ex example, a person is being being persecuted persecuted by t h e CIA, the FBI, or the Mafia). Delusion with mood-appropriate content (for (for example, example, a depressed dep ressed patient pati ent believes that he or she is responsible for the destruction of the world). Delusion Delusion with content content t ha t has no associa association tion to mood or is mood neutra neutrall (for (for examp example, le, a depr depress essed ed patie nt has has delusions of thoug thought ht contr control ol or thought broadcasting). Fa ls ls e feeling that self, others, or t he he wo world is nonexistent or, comin g to to an end. A person’s false belief th that he he or she is bereft or will be be deprived of of all material possessions. False belief involving functioning of the body

A pe perso rson’s fa false lse be belief ief th that th the be behavior ior of of ot others re refer fers to to him hims self or or herself; that events, objects, or other people have a particular & unusual significance, usually of a negative nature; derived from idea of of reference, in which a person falsely f eels that others are talking about him or her ( for example, belief that people on TV or radio are talking to or about the person) False feeling of remorse or guilt False feeling that a person’s will, thoughts, or feelings are being controlled by external forces. Delusion th that thoughts are being removed from a person’s mind by ot other people or forces 4

ii. thought insertion iii. iii. tho thought ught broa broadc dcas asti ting ng iv. thought control K . delusion of infidelity (delusional  jealousy) l. erotomania m. pseu pseudo dolo logi gia a phan phanta tast stic ica a 4. Trend Trend or preoc preoccup cupati ation on of thoug thought ht 5. Egomania 6. monomania 7. hypochondria 8. obsession 9. compulsion

10. coprolalia 11. phobia a. specific phobia b. social phobia c. acrophobia d. agoraphobia e. algophobia f. ailurophobia g. erythrophobia h. panphobia i. claustrophobia j. xenophobia k. zoophobia l. needle phobia 12. Noesis 13. Unio Mystica

Delusion th that thoughts are being implanted in a person’s mind by by other people or forces Delus elusio ion n tha thatt a pers perso on’s n’s tho thought ughts s ca can be be hea heard by oth others, ers, as thou though gh they they were being broadcast over the air. Delusion that a person’s thoughts are being controlled by other people or forces. False belief derived from pathological j ealousy about a person’s lover being unfaithful. Delusional belief, more common in women than in men, that someone is deeply in love with them (also known as Clerambault-Kandinsky complex) A type type of lyin lying g in whic which h a pers person on appe appear ars s to beli belie eve in the the real realit ity y of his his or her fantasies and acts on them, associated with Munchausen’s syndrome, repeated feigning of illness. Center Centering ing of thoug thought ht conte content nt on a partic particula ularr idea, idea, associa associated ted with with a strong strong affective tone, such as a paranoid trend or a suicidal or homicidal preoccupation Pathological self-preoccupation Preoccupation with a single object Exaggerated concern about health that is based not on real organic pathology but, rather, on unrealistic interpretations of physical signs or sensations as abnormal. Pathological persistence of an irresistible thought or feeling that cannot be eliminated from consciousness by logical effort; associated with anxiety Pathological need to act on an impulse that, if rested, produces anxiety; repetitive behavior in response to an obsession or perf ormed according to certain rules, with no true end in itself other than to prevent something from occurring in the future Compulsive utterance of obscene words Persistent, irrational, exaggerated, & invariably pathological dread of a specific stimulus or situation; results in a compelling desire to avoid the feared stimulus. Circumscribed dread of a discrete object or situation ( dread of spiders or snakes) Dread of public humiliation, as in fear of public speaking, performing, or eating in public. Dread in open places Dread of pain Dread of cats Dread of red (refers to a fear of blushing) Dread of Everything Dread of closed places Dread of strangers Dread of animals The persistent, intense, pathological fear of receiving an injection. A revelation in which immense illumination occurs in association with a sense that a person has been chosen to lead & command An oceanic feeling of mystic with an infinite power; not considered a disturbance in thought content if congruent with person’s religious or cultural milieu.

V. Speech A. DISTURBANCES IN SPEECH 1. Pressure of speech 2. Volubility(logorrhea) 3. poverty of speech 4. nonspontaneous sp speech

Rapid speech that is increased in amount & difficult to interrupt Copious, coherent, logical speech Restriction in the amount of speech used; replies may be monosyllabic Verbal res responses give iven on only wh when asked ked or spoken to to directly; no no selflfinitiation of speech amountt that that convey conveys s li tt le inform informati ation on 5. Poverty of content of speech speech that is ade qu ate in amoun because because of vagueness vagueness,, emptiness, emptiness, or or st er e otyped phrases. 6. Dysprosody loss of normal speech melody (called prosody). 7. dysarthria Difficulty in articulation, not in word finding or in grammar 8. excessive loud or soft speech loss of modu lation of normal speech volume; may reflect a variety of pathologi pathological cal condit con dit ions io ns ranging ranging from psychosis to depression to deafness. 9. Stuttering fr e que n t repetition or p r o l o n g a t i o n of a sound or syllable, leading to markedly impaired speech fluency Erratic & dysrhytmic speech, consisting of rapid & jerky spurts 10. cluttering B. APHASIC DISTURBANCES: DISTURBANCES IN LANGUAGE OUTPUT 1. Motor aphasia Disturbance of speech caused by a cognitive disorder in which understanding remains but ability to speak is grossly im paired; halting, laborious, and inaccurate speech (also known as Broca's, nonfluent, and expressive aphasia). 2. Sensory aphasia Organi Organic c loss loss of abil ity to comprehend the meaning of words; fluid 5

and spontaneous but incoherent and nonsensical speech (also known as Wernicke's, fluent, and rec ept ive aphasia) aphasia).. Difficulty in finding correct name for an object (also termed anomia and amnestic aphasia). Ina bil ity to arra arrange nge word words s in proper sequence. Words produced are totally neologistic; nonsense words repeated with vari ous into natio ns and infle ction s. Combination of a gr g r oss l y non- fluent aphasia and a severe fluent aphasia. Inability to speak because of a mental deficiency or an episode of   dementia Involuntary use of vulgar or obscene language; seen in Tourette’s disorder and some cases schizophrenia

3. Nominal aphasia 4. Syntactical aphasia 5. Jargon aphasia 6. Global aphasia 7. Alogia 8. copropregia VI. Perception : A.

process of transferring physical stimulation into psychological i nformation; mental process by w/c sensory stimuli are brought to awareness. False sensory perception not as sociated with real external stimuli; there may or may no! be adelus a delus ional-in terpr etationof  etationof the hallucinatory experience Fals False e sens sensor ory y perc percep epti tion on not not asso associ ciat ated ed with with real real exte extern rnal al stim stimul uli; i; ther there e may or may not be delusional interpretation of the hallucinatory experience. Fals False e perc percep epti tion on occu occurr rrin ing g whil while e awak awaken enin ing g from from slee sleep p False perception of   sound, usually voices but also other noises, such as music; most common hallucination in psychiatric disorders. ages False perception in volving sight consisting of both formed im (for example, people) and unformed images images (for (f or example, example, flashes flashes of  Light); most common in medically determined disorders. False perce rception of smell; most common in medica ical disorders. F a l s e pe perception of  ta st e, such as unpleas unpleasant anttaste, taste, caused by an uncinate seizure; seizure; most common in medical disorders. False perception of touch or surface sensation, as from an amputated limb (phantom limb); crawling sensation on or under the skin (formication) False sensation of things occurring in or to the body, most often visceral in origin (also known as cenesthesic hallucination) False perception in which objects are seen as reduced in size (also termed micropsia) Hallucination in which the content is consistent with either a depressed or a manic mood (for ex ample, a depressed patient hears voices say ing that the patient is a bad person; a manic patient hears voices saying saying that the pat ient ie nt is of inflated inflated worth, power, power, and knowledge). Halluc Hallucina inatio tion n in which which the the conten contentt is not not consi consiste stent nt with with either either depr depress essed ed or manic mood (in depression, hallucinations not involving such themes as guilt, deserved punishment or inadequacy; in mania, hallucinations not involving such themes as inflated worth or power. Hallucinations, most often auditory, that are associated with chronic alcohol abuse and that occur within a clear sensorium, as opposed to delirium tremens, hallucinations that occur in the text of a clouded sensorium. Perceptual abnorma rmality ity associat iated with ith hallu llucino inogenic drugs in whi which moving objects are seen as series of discrete and discontinuous images.

DISTURBANCES OF PERCEPTION

1. Hallucination a. Hypn Hypnag agog ogic ic hall halluc ucin inat atio ion n b. Hypn Hypnop opom ompi pic c hall halluc ucin inat atio ion n c. Auditory hallucination d. Visual hallucination e. Olfactory Olfactory hallucination f. G u s t a t o r y ha hallucination g. Tactile (haptic) hallucination hallucination h. Somatic hallucination i. Lilliputian hallucination j. Mood-congruent hallucination

k. MoodMood-inc incong ongrue ruent nt halluc hallucina inatio tion n

l. Hallucinosis

m. Trailin iling g phenomenon n. command hallucination 2. Illusion B. DISTURBANCES ASSOCIATED WITH COGNITIVE DISORDER & MEDICAL CONDITIONS 1. Anosognosia (ignorance of  illness) 2. Somatognosia (ignorance of the body) 3. Visual agnosia 4. Astereognosis 5. Prosopagnosia 6. apraxia 7. Simultagnosia

Misperception or misinterpretation of real external sensory stimuli : agnosia – an inability to recognize recognize & interpret the significance of sensory sensory impressions.

8. Adiadochokinesia 9. Aura

C. DISTURBANCES DISTURBANCES ASSOCIATED WITH CONVERSION AND DISSOCIATIVE PHENOMENA 1'. Hysterical anesthesia anesthesia

:

A person's inability to recognize a neurological deficit as occurring to himself or herself. A person’s inability to recognize a body part as his or her own (autotopagnosia) or persons. Inability to recognize objects inability to recognize objects by touch. inability to recognize faces Inability to carry out specific tasks than one element of a visual scene at a inability to comprehend more time or to integrate the parts into a whole alternating movements. movements. inability to perform rapid warning sensations such as automatisms, fullness in the stomach, blushing, and changes in respiration; cognitive sensations, and affec tive st ate s usually experien experienced ced before before a seiz ure; a sensory prodrome prodrome tha t precede precedes s a clas sic migra migraine ine head headach ache. e. somatization of repressed material or the development of physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control an{! not explained by any physical disorder. loss of sensory modal ities resulting from emotional conflicts 6

2. Macropsia 3. Micropsia

4. Depersonalization 5. Derealization 6. Fugue 7. Multiple personality 8. Dissociation

VII. Memory: A. DISTURBANCES OF MEMORY  1. Am Amnesia

a. Anterograde b. Retrograde 2. Paramnesia a. Fausse reconnaissance b. Re Retro trospec specttive ive fa falsif lsific ica atio tion

c. Confabulation d. Déjà vu

e. Déjà entendu f. Déjà pense g. Jamais vu h. False memory 3. Hy Hypermnesia 4. Eidetic image 5. Screen memory 6. Repression 7. Lethologica 8. Blackout

1. 2. 3. 4.

B. LEVELS OF MEMORY  Immediate Recent Recent past Remote VIII. INTELLIGENCE :

a. Mental retardation

b. Dementia

I. Dyscalculia (acalculia) (acalculia) 2. Dysgraphia (agraphia) 3. Alexia

c. Pseudodementia

d. Concrete thinking e. Abstract thinking IX. INSIGHT

stat st ate e in which objects objects seem larger than they are St at e in which objects objects seem smaller smaller than they they are (both macropsia macropsia and micropsia can also be associated associated with clear clear organic con ditions, such as complex partial seizures). A person's subjective subjectiv e sense of being unreal, strange, or unfamiliar. A subjec subjectiv tive e sense sense that that the environm environmen entt is strang strange e or unrea unreal; l; a feeling of  changed reality.  Taking on a new identity with amnesia for the old identity; often involves travel or wandering to new envir onments. One person who appears at different times to be tow or or mo more entirely different personalities and characters(called DID in the 4th edition DSM-IV) Unconscious defense mechanism involving the segregation of any group of   mental or behavioral processes from the rest of the person’s psychic activity; may entail the separation of an idea from its accompanying emotional tone, as seen in dissociative & conversion disorders. function by which information stored in the brain is later recalled to consciousness Partial or t ot a l i n a b i l i t y to to recall past ex experiences; may be organic or emotional in o rigin. Amnesia for events occurring after a point in time Amnesia for -vents occurring b efore a point in time. Falsification of memory by distort ion of recall. false recognition torted by being Mem emo ory be comes un uninte inten ntio tionally lly (u (unco nconscio sciou usly) ly) dis dis filtered through a person's present emotional, cognitive, and experi experient ent ial state. state. Unconscious filling of gaps in me memo mory ry by ima imagin gined ed (r untr untrue ue exper experii ences that a person believes but that have no basis in fact; most often associated with | organic pathology. Illusion of of visual recognition in which a new situation is incorrectly re garded as a repetition of a previous mem ory.

Illusion of auditory recognit ion. Illusion Illusion that th at a new thought thought is recognized as a thought previously fell or expressed. false feeling of unfamiliarity unfamiliarity with a real real s situation ituation that th at a person has expe rienced A person's recollection and belief belief by the pa ti en t of an ev en t that did did not actually occur. Exaggerated degree of retention and recall. Visual memory of almost hallucinatory vividness a consciously tolerable mem ory covering for a painful memory A defense mechanism characterized by unconscious forgetting of  unacceptable ideas or impulses. Temporary inability to remember a name or a proper noun. Amnesia experienced by alcoholics about behavior during drinking bouts; usually indicates that reversible brain damage has oc curred. Reproduction or recall of perceived material within seconds to minutes Recall of events over past few days Recall of events over past few months Recall of events in distant past and constructively integrate ability to understand, recall, mobilize, previo previous us learnin learning g in meet meet ing new new situat situations ions.. gree in which there is interference with lack of intelligence to a de social and vocational performance: mild (IQ of 50 or 55 to approximately 70), moderate (IQ of 35 or 40 to 5O or 55), severe (IQ found (IQ below 20 or 25); obsolete of 20 or 25 to 35 or 40), or proterms are id iot (mental age less less than 3 years), imbecile imbecile (mental (mental age of  3 to 7 years), and moron (mental age of  about 8). tellectual functioning without Organic and global deterioration of in clouding of con sciousness. Loss of ability to do calculations; not caused by anxiety or impair ment in concentration. concentration. Loss of ability to write in cursive style; loss of word structure. Loss of a previously possessed reading facility; not explained by defective visual activ ity. Clinical features resembling a dementia not caused by an organic condition; most often caused by depression (dementia syndrome of  depression). metaphor without understanding of  literal thinking; limited use of  nuances of  meaning; one-dimensional thought. Ability to appreciate nuances of meaning; multidimensional multidimensional thinking with ability to use metaphors and hypotheses appropriately. appropriately. A person's ability to understand the true cause and meaning of a situation 7

a. Intellectual insight

B. True insight C. Impaired insight X. JUDGMENT

A. Critical judgment judgment b. Automatic judgment c. Impaired judgment

(such as a set of symptoms). Understanding of the objective reality of a set of circumstances without the ability to apply the understanding in any useful way to master the situation understanding understanding of the objective objective real ity of a situation, coupled coupled with the motivation and the emotional impetus to master the situation. diminished ability to understand the objective reality of a situation Ability to assess a situation correctly and to act appropriately in the situation. Ability to assess, discern, and choose among various options in a situation Reflex performance of an action. Diminished ability to Under stand a situation correctly and to act appropriately.

DEFENSE MECHANISMS

Means and ways of avoiding emotional stress, destructive impul ses, or threat to self-esteem

Denial

Avoidance of the awareness of some painful aspects of reality by negating the sensory data

Distortion

External reality is grossly reshaped to suit inner need s including the unrealistic beliefs, hallucinations, wis thinking, delusions External objects are divided into extreme category to the other "all good" and "all bad" accompanied by ab rupt shifting of an object from one Unconscious blaming of unacceptable inclinations or thoughts on an external object

NARCISSISTIC DEFENSES

Splitting

Projection

IMMATURE DEFENSES

 The person expresses an unconscious wish or impulse through a ction to avoid being conscious of an accompanying effect. Blocking A temporary or transient inhibition of thinking which resembles repression but differs in that tension arise when the impulse, affect or thoughts are inhibited Hypochondriasi Reproach arising from bereavement, loneliness, or unacceptable aggressive impulses toward others is transformed into self-reproach and complaints of pain, somatic illness, and neurasthenia. s Introjection Accepting another person's attitudes, beliefs, and values as one's own Aggression towards others is expressed indirectly through passivity, masochism, and turning against the s PassiveAggressive Behavior Regression Person moves back to the previous developme ntal stage in order to feel feel safe or have needs met.  The immobilization immobilizati on of a portion of a personality resulting from unsuccessful completion of tasks in a Fixation development stage. Converting psychic derivatives into bodily symptoms & tending to react with somatic manifestations, rath Somatization than psychic manifestations  Through fantasy, the person indulges autistic retreat to resolve conflicts and obtain gratification. Schizoid Fantasy

Acting Out

NEUROTIC DEFENSES

Controlling

Displacement

Dissociation Compensation Externalization Identification Inhibition Intellectualizati on Isolation Rationalization Reaction Formation Repression Substitution Sexualization

An excessive attempt to m anage or regulate events or objects in the environment to minim ize anxiety an resolve inner con flicts flicts Involves the ventilation of intense feelings towards persons less threatening than the one whom aroused t feelings A temporary but drastic modification of a person's character or of one's sense of personal identity takes pl to avoid emotional distress Presence of overachievement in one area to offset real or perceived deficiencies in another area  The tendency to perceive elements o f one's own personality, including including instinctual instinctual impulses, conflicts, moo attitudes attitudes and styles of thinking in the external environment Modeling actions and opinions o f influential influential others, while searching for identity, or aspiring to reach a personal, social, or occupational goal Limitation or renunciation of ego functions that occur consciously Excessive use of intellectual processes to avoid affective expressions or experiences by paying attention t external reality Separation of the idea from the repressed affect that accompanies it Excusing own behavior to avoid guilt, responsibility, responsibility, conflict, anxiety, or loss of self-respect Acting the opposite of wha t one feels Excluding emotionally painful or anxiety provoking thoughts and feelings from conscious awareness Replacing the de sired gratification gratification with one that is more read ily available An object or function is endowed with sexual significance that did not previously have or that it possessed similar degree in order to wa rd off anxieties associated with prohibited imp ulses or their derivatives. MATURE DEFENSES

Anticipation

Humor Asceticism

Sublimation Suppression

Planning for future inner discomfort that is goal-directed and implies careful planning or worrying and premature but realistic affective expectation of dire and potentially dreadful outcomes Permits the overt expression of unpleasant effect on others; Eliminating the pleasurable effects of experiences. There is moral element in assigning values to specific pleasures. Substituting a socially acceptable activity for an impulse that is unacc eptable A conscious or semiconscious decision to postpone attention to a conscious impulse or conflict

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