Sign & Symptoms in Psychiatry.pdf. The severity of these side effects is often dose-dependent to the

Sign & Symptoms in Psychiatry.pdf

1. SIGN & SYMPTOMS IN
PSYCHIATRY
LECTURER: MALYSHEVA VALERIA

2. CHARACTERISTICS OF PSYCHIATRIC SIGNS AND
SYMPTOMS:
THE DIFERENCEBETWEEN THE TWO IS CLEAR.
SYMPTOM:ARE SUBJECTIVELY FELT ABNORMALITIES THAT
MAY OR MAY NOT BE VISIBLE TO OTHERS
SIGNS:ARE ABNORMALITIES THAT CAN BE SEEN BY A
DOCTOR. IN PSYCHIATRY, THE DIFFERENCE BETWEEN
SYMPTOMS AND SIGNS IS FREQUENTLY BLURRED, AND
SYMPTOMS OF PSYCHIATRIC DISORDERS MAY NOT BE
RECOGNIZED AS SUCH BY PATIENTS.

3. SIGNS AND SYMPTOMS CATEGORIES:
PHYSIOLOGICAL MANIFESTATIONS OF PSYCHIATRIC
DISORDERS:
1-INSOMNIA: LACK OF OR DIMINISHED ABILITY TO SLEEP.
2-HYPERSOMINA: EXCESSIVE NIGHTTIME SLEEP OR
EXCESSIVE SLEEPING DURING THE DAY WITH LOSS OF
MUSCLE TONE.
3. ANOREXIA:LOSS OF OR DECREASE IN APPETITE.
4. HYPERPHAGIA: INCREASED IN APPETITE AND INTAKE
OF FOOD.
5. DIMINISHED LIBIDO: DECREASED SEXUAL INTEREST,
DRIVE, AND PERFORMANCE
6. CONSTIPATION

4. I. THINKING:
GOAL –DIRECTED FLOW OF IDEAS, SYMBOLS, AND
AID ASSOCIATIONS INITIATED BY A PROBLEM OR A
TASK AND LEADING TOWARD A REALITY –
ORIENTED CONCLUSION
DISORDERS OF THINKING CAN BE DIVIDED INTO
THE FOLLOWING CATEGORIES:
1-DISORDER OF THE STREAM OF THOUGHT -(SPEECH
AND PRESSURE).
2-DISORDER OF CONTENT OF THOUGHT.
3-DISORDER OF FORM OF THOUGHT.

5. I. Disorders of the stream of thought:
In this category there is an alteration in either the
amount or speedof speech:
1. Pressure of thought: when ideas arise in unusual
variety and pass through the mind rapidly.
2. Poverty of thought: where only a few thoughts;
which lack variety and richness.
3. Thought blocking: stream of thought can be
interrupted suddenly.

6. 2.Specificdisturbancesincontentofthought:
1.PovertyofContent:thoughtthatgiveslittleinformation
becauseofvagueness,emptyrepetitionorobscure
phrases.
2.Delusion:falsefixedbelief,basedonincorrectinference
aboutexternalreality,notconsistentwithcultural
backgroundthatcannotbecorrectedbyreasoningor
logic
3.Preoccupation of thought: centering of thought content
on a particular idea, associated with a strong affective
tone, such as a paranoid trend or a suicidal or homicidal
preoccupation

7. 4. Hypochondria:Exaggerated concern about one's health
that is based not on real organic pathology but, rather, on
unrealistic interpretations of physical signs or sensations as
abnormal
5. Obsession:Pathological persistence of an irresistible
thought or feeling that cannot be eliminated from
consciousness by logical effort which is associated with
anxiety.
6.Compulsion:Pathological need to act on an impulse that,
if resisted, produces anxiety; repetitive behavior in response
to an obsession.
7. Suicidal ideation:Thoughts, ideas, or ruminations about
the possibility of ending one's life

8. TYPES OF DELUSIONS:
1. Bizarre delusion:An absurd, totally implausible, strange false belief
(for example, invaders from space have implanted electrodes in a parson's brain). 2. Systematized delusion:false belief or beliefs united by a single event
or theme (for example, a person is being persecuted by the CIA, FBI, or the mafia or the boss).
3. Mood–congruent delusion:delusion with mood-appropriate
content (for example, a depressed patient believes that he or she is
responsible for the destruction of the world).
4. Mood –incongruent delusion: delusion with content that has no
association to mood (for example, a depressed patient has delusion of
thought control or thought broadcasting).

9. 5. Nihilistic delusion: False feeling that self,others, or the world is
nonexistent or ending.
6. Delusion of poverty:False belief that one is bereft or will bedeprived of
all material possessions.
7. Somatic delusion: False belief involving functioning of one's body (for
example, belief that the brain is rotting or melting).
8.Paranoid delusions: Includes persecutory delusions and delusions of
reference, control, and grandeur.
*Delusion of persecution:False belief that one is being harassed, cheated,
or persecuted; often found in litigious patients who have a pathological
tendency to take legal action because of imagined mistreatment.
**Delusion of reference:False belief that the behavior of others refers to
himself or herself.
9. Delusion of grandeur: Exaggerated conception of one's importance
power, or identity.

10. 10. Delusion of self-accusation: false feeling of remorse and guilt.
11. Delusion of control: false feeling that a person's will, thoughts,
or feelings are being controlled by external forces.
*Thought withdrawal: delusion that one's thoughts are being
removed from a person's mind by other people or forces.
**Thought insertion: delusion that one's thoughts are being
implanted in person’s mind by other people or forces.
***Thought broadcasting: delusion that a person's thoughts can be
heard by others as though they were being broadcast into the air
12. Delusion of infidelity (Delusional jealousy): a false belief derived
from pathological jealousy that a person's lover is unfaithful.
13. Erotomania: delusional belief, more common in women than in
men, that someone is deeply in love with them

11. 1. Neologism: new word created by the patient, and only
understands by patient's, often by combining syllables of other
words.
2. Word salad: incoherent mixture of words and phrases.
3. Circumstantiality:indirect speech that is delayed in reaching
the point but eventually gets from original point to desired goal.
4. Tangentiality: inability to have goal– directed associations of
thought, speaker never gets from desired point to desired goal.
Specific disturbances in form of thoughts

12. 5. Incoherence: thought that generally is not
understandable; running together of thoughts or words
with no logical or grammatical resulting in
disorganization connection
6. Perseveration: persisting repetition or continuous
expression of an idea to a previous stimulus after a new
stimulus has been presented.
7. Echolalia: psychopathological repeating of words or
phrases of one person by another.
8. Irrelevant answer: answer that is not in harmony
with asked question (person appears to ignore or not
attend to question).

13. 9. Loosening of associations: flow of thought in which
ideas shift from one subject to another in a completely
unrelated way.
10. Flight of ideas: rapid continuous verbalization or
plays on words produce constant shifting from one
idea to another. The ideas tend to be connected.
11. Clang association: association of words similar in
sound but not in meaning; words have no logical
connection.
12. Blocking: abrupt interruption in train of thinking
before a thought or idea is finished

14. II. Judgment: ability to assess a situation correctly and to act
appropriately in the situation.
III. Consciousness:state of awareness.
A) Disturbances of consciousness are most often associated with
brain pathology.
*Clouding of consciousness: incomplete clear mindedness with
disturbance in perception and attitude
*Stupor: lack of reaction to and unawareness of surroundings.
*Confusion: disturbance of consciousness in which reaction to
environmental stimuli are inappropriate, manifested by a disordered
orientation in relation to time, place or person.
*Drowsiness: a state of impaired awareness associated with a desire or
inclination to sleep.
*Coma: profound degree of unconsciousness

15. B) Disturbances of attention: attention is the amount of effort
exerted in focusing on certain portion of an experience,
ability to sustain a focus on one activity; ability to
concentrate.
*Distractibility: inability to concentrate attention, state in
which attention is drawn to unimportant or irrelevant
external stimuli
**selective inattention: blocking out only those things that
generate anxiety
***hyper vigilance: excessive attention and focus on internal
and external stimuli, usually secondary to delusional or
paranoid states.

16. IV. Disturbances of orientation: orientation refers
to one's awareness of time, place and person .
*Disorientation to time: pathological time
disorientation can be mild or severe.
**Disorientation to place: often signifies a
greater degrees of cognitive impairment than
disorientation to time
***Disorientation to person: alack of awareness
of one's own identity or others

17. IV. Memory: function by which information stored in the brain
is later recalled to consciousness.
Disturbances of memory:
1. Amnesia:partial or total inability to recall past experiences;
may by organic or emotionally in origin.
A. Anterograde:
amnesia for events occurring after appoint in time. (Inability
to recall recent events)
B. Retrograde: amnesia for events occurring before a point in
time. (Inability to recall remote events)
C. Total amnesia: loss of memory for recent events and for
remote events
D. Circumscribed amnesia: loss of memory for limited time.

18. II. Paramenesia: falsification of memory by distortion of
recall
Retrospective falsification: memory becomes
unintentionally (unconsciously) distorted by being filtered
thought a person's present emotional, cognitive and
experiential state.
Confabulation: conscious filling of gaps in memory by
imagined or untrue experience
De ja vu: illusion of visual recognition in which a new
situation is in correctly regarded as a repetition of pervious
memory
Jamais vu: false feeling of unfamiliarity with a real situation
that person has experienced.

19. 3. Hypermnesia: exaggerated degree of
retention and recall
B. Levels of memory:
1. Immediate: reproduction or recall of
perceived material within seconds to minutes
2. Recent: recall of events over past few days
3. Recent past: recall of events over past few
months
4. Remote: recall of events in distant past

20. V. Perception: process of transferring physical stimulation into
psychological information; mental process by which sensory stimuli are
brought to awareness.
A. Disturbances of perception:
I. Hallucination: It is false sensory perception not associated with real
external stimuli.
Types of hallucinations:
1. Hypnagogic hallucination: false sensory perception occurring while
falling asleep2. Hypnopompic Hallucination: false perception occurring while
awakening from sleep
3. Auditory hallucination: false perception of sound, usually voices but
also other noises such as music.

21. 4. Visual hallucination: false perception involving sight
consisting of both formed images (for example, people) and
unformed images ( for example, flashes of light)
5. Olfactory hallucination: false perception of smell
6. Gustatory hallucination: false perception of taste, such as
unpleasant taste
7. Tactile hallucination: false perception of touch or surface
sensation or under the skin.
8. Command hallucination: false perception of orders that a
person may feel obliged to obey or unable to resist.
9. Somatic hallucination: false sensation of things occurring
in or to the body.

22. 10. Mood – congruent hallucination:
hallucination in which the content is consistent with either a
depressed or a manic mood (for example, a depressed
patient hears voices saying that the patient is a bad person; a
manic patient hears voices saying that the patient is of
inflated worth, power and knowledge)
11. Mood – incongruent hallucination:
hallucination in which the content is not consistent with
either a depressed or a manic mood (for example, in
depression hallucination not involving such themes as guilt,
deserved punishment or inadequacy; in mania, hallucinations
not involving such themes as inflated worth or power)

23. 2. Illusion: misperception or misinterpretation of real
external sensory stimuli.
B. Disturbances associated with conversion and
dissociative phenomena:
1-macropsia: state in which objects seem lager than
they are
2-micropsia: state in which objects seem smaller than
they are
3-depersonalization: a person's subjective sense of
being unreal, strange, or unfamiliar to oneself.
4-derealization:
a subjective sense that the environment
is strange or unreal; a feeling of changed reality

24. VI.Emotion(Mood):Complexfeelingstatewithpsychic,
somatic,andbehavioralcomponentsthatisrelatedto
affect&mood.
Mood:
emotional subjective experienced and reported by the
patient.
Affect:
observed expression of emotion, may be consistent with
patient’s description of emotion

25. A. Affect:
Appropriateaffect: condition in which the emotional tone is in
harmony with the accompanying idea, thought, or speech; also
described as broad full affect
Inappropriate affect: disharmony between the emotional feeling tone
and the idea, thought, or speech accompanying it
Blunted affect: disturbance in affect manifested by a sever reduction in
the intensity of externalized feeling tone
Restricted or constricted affect: reduction in intensity of feeling tone
less severe than blunted affect by clearly reduced.
Flat affect: absence or near absence of any signs of affective expression,
voice monotonous, face immobile
Labile affect: rapid and abrupt changes in emotional feeling tone,
unrelated to external stimuli

26. B. Mood: a pervasive and sustained emotion subjectively
experienced and reported by a patient and observed by
others, examples include depression, elation and anger.
1. Dysphoric mood: an unpleasant mood
2. Euthymic mood: normal range of mood, implying absence
of depressed or elevated mood
3. Irritable mood: a state in which a person is easily annoyed
and provoked to anger
4. Labile mood ( mood swings): oscillation between euphoria
and depression or anxiety
5. Elevated mood: air of confidence and enjoyment; a mood
more cheerful than usual

27. 6. Elation: feeling of joy, euphoria, intense self – satisfaction,
or optimism
7. Euphoria: intense elation with feeling of grandeur
8. Ecstasy: feeling of intense rapture
9. Depression: psychopathological feeling of sadness
10. Anhedonia: loss of interest in and withdrawal from all
regular and pleasurable activities, often associated with
depression.
11. Grief or mourning: feeling of sadness appropriate to real
loss
12. Alexithymia: inability or difficulty in describing or being
aware of one's emotions or moods.

28. Other emotions:
1. Phobia: persistent, irrational, exaggerated and invariably
pathological dread of a specific stimulus or situation; results
in a compelling desire to avoid the feared stimulus.
2. Anxiety: feeling of apprehension caused by anticipation
of danger, which may be internal or external.
3. Fear: anxiety caused by consciously recognized and
realistic danger
4. Agitation: severe anxiety associated with motor
restlessness
5. Tension: increased motor and psychological activity that
is unpleasant.

29. 6. Panic: sudden episodic, intense attack of anxiety
associated with over whelming feelings of dread and
autonomic discharge
7. Apathy: dulled emotional tone associated with
detachment or indifference
8. Ambivalence: coexistence of two opposing
impulses toward the same thing in the same person
at the same time
9. Guilt: emotion secondary to doing what is
perceived as wrong.

30. VII. Motor behavior: aspect of the psyche that
includes impulses, motivation, wishes, drives,
instincts, and cravings, as expressed by a
person’ s behavior or motor activity
1. Echopraxia:
pathological imitation of movements of one
person by another.
2. Catatonia and postural abnormalities:seen
in catatonic schizophrenia and some cases of
brain diseases, such as encephalitis

31. A. Catalepsy (posturing): sustained immobile
position the patient initiate positions by him self.
B. Waxy flexibility: condition of a person who can
be molded in to a position that is the maintained,
when examiner moves the person’s limb, the limb
feels as if it were made of wax
C. Akinesia: lack of physical movement, an in the
extreme immobility of catatonic schizophrenia. It
may also occur an extrapyamidalside effect of
antipsychotic medication

32. 3. Negativism: motiveless resistance to all attempts to
be moved or to all instruction
4. Stereotype: it's a monotonous repetition of certain
movement without purpose& it involves the head or
arms. E.G. Foot tapping body rocking ( these seen in
schizophrenia mental sub normality)
5. Mannerism: its repetitive movement which isn't
monotonous & is keeping with the personality
character.
6. Automatic obedience: the performance of all simple
commands in a robot–like fashion.

33. 7. Over activity:
1. Psychomotor agitation: excessive motor and
cognitive over activity, usually nonproductive and in
response to inner tension characterized by pacing
and restlessness.
2. Hyperactivity (hyper kinesis): restless, aggressive,
destructive activity, often associated with some
underlying brain pathology
3. Tics: sudden involuntary, spasmodic motor
movement of small groups of muscle.
4. Sleepwalking: motor activity during sleep

34. 5. Akathisia: subjective feeling of muscular tension
secondary to antipsychotic or other medication, which can
cause restlessness, pacing, repeated sitting and standing
6. Compulsion: uncontrollable impulse to perform an act
repetitively
7. Ataxia: failure of muscle coordination, irregularity of
muscle action
8. Static tremor: rhythmical alteration in movement,
which is usually faster than one beat a second; typically,
tremors decrease during periods of relaxation and sleep
and increase during periods of anger and increased
tension, involve hand occur in anxiety.

35. 9. Hypoactivity: decreased motor and cognitive
activity, as in psychomotor –retardation, visible
slowing of thought, speech and movements
10. Aggression: forceful – goal –directed action
that may be in verbal or physical; the motor
counterpart of the affect of rage, anger or hostility
11. Dyskinesia: difficulty in per forming voluntary
movements, as in extra pyramidal disorders
12. Convulsion (seizure) an involuntary, violent
muscular contraction or spasm

36. VIII. Insight: ability of the patient to
understand the true cause and meaning of a
situation (such as a set of symptoms)
another definition: ability of the patient to
understand the objective condition of his
illness.
Types:
A. Complete insight
B. Loss of insight