——————————————– Signs and Symptoms in Psychiatry

Assist.Prof. Hafidh M. Farhan
Head of Department of Psychiatry Kufa College of Medicine University of Kufa ——————————————–

Signs and Symptoms in Psychiatry

Disorders of perception. Illusions.

Misperception or misinterpretation of a real external sensory stimulus. Hallucinations.

A false perception without an objective stimulus. a)Hypnogogic Hallucinations.
b)Hypnopompic Hallucinations.
c)Auditory Hallucinations.

d)Visual Hallucinations. e)Olfactory Hallucinations. f)Gustatory Hallucinations. g)Tactile Hallucinations. h)Somatic Hallucinations. j)Lilliputian Hallucinations.

Hallucinosis.
Hallucinations usually auditory that are associated with chronic alcohol abuse and occur

with a clear consciousness.
Disturbances of consciousness (Awareness). 1.Disorientation.

Disturbance of orientation in time place and person.

2.Clouding of consciousness.

Incomplete clear orientation with disturbances in perception and attitudes.

3.Stupor.

Complete loss of motor activity and of speech.

4.Delirium.

Clouding of consciousness with disorientation, fearful mood state, restlessness and hallucinations.

5.Coma.

Profound degree of unconsciousness.

6.Twilight state.

Narrowing of consciousness with hallucinations.

7.Confusion.

Disturbances of consciousness with disorientation and inappropriate reaction to environmental stimuli.Lucid intervals do occur in confusion.
8.Trance.

Focused attention and altered consciousness usually seen in hypnosis.

9.Hypnosis.

Artificially induced modification of consciousness characterized by heightened suggestibility.

             

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Assist.Prof. Hafidh M. Farhan
Head of Department of Psychiatry Kufa College of Medicine University of Kufa ——————————————–

Disorders of affect and mood.

1.Inappropriate affect.

Disharmony between the emotional feeling tone and the thought or the speech accompanying it.

2.Blunted affect.

Disturbances in affect manifested by a severe reduction of the intensity of externalized feeling tone.

3.Flattening of affect.

Absence or near absence of any signs of affective expression.Voice is monotonous and face is immobile.
4.Labile affect.

Rapid and abrupt changes in emotional feeling tone unrelated to external tone.

5.Dysphoric mood.

An unpleasant mood.

6.Expansive mood.

A person’s expression of feeling without restraint frequently with over stimulation of their significance or importance.
7.Mood swings.

Oscillation between elation and depression in mood.

8.Elevated mood/Elation of mood.

A mood more cheerful than the usual with air of confidence and enjoyment.

9.Euphoria.

Intense elation with feeling of grandeur.

10.Anhedonia.

Loss of interest in and withdrawal from all regular and pleasurable activities. Often associated with depression.
11.Anxiety.

Feeling of apprehension caused by anticipation of danger which may be external or internal.

12.Agitation.

Severe anxiety associated with motor restlessness.

13.Panic.

Acute,episodic,intense attack of anxiety with overwhelming feelings of dread.

14.Apathy.

Dulled emotional tone associated detachment or indifference.

15.Ambivalence.

Coexistence of two opposing impulses toward the same thing.

16.Melancholia.

Severe depressive state.Used in the term Involutional Melancholia both descriptively and also in reference to distinct diagnostic entity

                

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Assist.Prof. Hafidh M. Farhan
Head of Department of Psychiatry Kufa College of Medicine University of Kufa ——————————————–

Physiological disturbances associated with mood.

1.Insomnia.Lack of or diminished ability to sleep.
a)Initial:Difficulty in falling asleep.
b)Middle:Difficulty in sleeping throughout night without waking up. c)Terminal:Early morning awakening.

2.Diurnal variation.Mood is worst in the morning and improves as the day progress. 3.Pica.Craving and eating of nonfood substances.
4.Bulimia.Insatiable hunger and voracious eating.

Motor behaviour (Conation).
1.Echopraxia.
Pathological imitation of movements of one person by another. 2.Catatonia.

a)Catalepsy:An immobile position that is constantly maintained.
b)Catatonic excitement:
Agitated, purposeless motor activity, uninfluenced by external stimuli. c)Catatonic stupor:Markedly slowed motor activity,to a point of immobility and

seemingly unawareness of surroundings.
d)Catatonic rigidity:Voluntary assumption of rigid posture.
e)Catatonic posturing:
Voluntary assumption of an inappropriate or bizarre posture,generally maintained for long periods.
f)Cerea flexibilitas (Waxy flexibility):Condition of a person who can be molded

into a position that is than maintained. g)Akinesia:Lack of physical movement.

3.Negativism.Motiveless resistance to all attempts to be moved or to all instructions. 4.Cataplexy.Temporary loss of muscle tone and weakness precipitated by a variety of emotional states.
5.Stereotypy.Repetitive fixed pattern of physical action or speech. 6.Mannerism.Ingrained, habitual involuntary movement.

7.Automatism.Automatic performance of an act or acts generally representative of unconscious symbolic activity.
8.Command automatism. Automatic following of suggestion. 9.Mutism.Voicelessness without structural abnormalities.

10.Overactivity.
a)Psychomotor agitation:
Excessive motor and cognitive overactivity. b)Hyperactivity(Hyperkinesis): Restless,aggressive,destructive activity. c)Tic:Involuntary,spasmodic motor movement.
d)Sleep walking (Somnambulism): Motor activity during sleep. e)Akathisia.Subjective feeling of muscular tension secondary to antipsychotic or

other medication.
f)Compulsion:Uncontrollable impulse to perform an act repetitively.

*Dipsomania:Compulsion to drink alcohol. 3-7

                                

Assist.Prof. Hafidh M. Farhan
Head of Department of Psychiatry Kufa College of Medicine University of Kufa ——————————————–

*Kleptomania: Compulsion to steal.
*Nymphomania: Excessive and compulsive need for coitus in a woman. *Satyriasis: Excessive and compulsive need for coitus in a man *Trichotillomania: Compulsion to pull out hair.
*Ritual: Automatic activity, compulsive in nature, anxiety reducing in origin.

g)Ataxia: Failure of muscle coordination, irregularity of muscle action. h)Polyphagia:Pathological overeating.
i)Tremor:Rhythmical alteration in movement,which is usually faster than one

beat a second.
11.Hypoactivity (Hypokinesis). Decreased motor or cognitive activity. 12.Mimicry.Simple,imitative motor activity of childhood.
13.Aggression.Forceful goal directed action that may be verbal or physical.
14.Acting out.Direct expression of an unconscious wish or impulse in action. 15.Astasia abasia.The inability to stand or walk in a normal manner. 16.Dyskinesia.Difficulty in performing voluntary movements.
17.Twirling.A sign present in autistic children who continually rotate in the direction in which their head is turned.
18.Bradykinesia.Slowness of motor activity.
19.Chorea.Random and involuntary quick,jerky,purposeless movements. 20.Convulsions.An involuntary, violent muscular contraction or spasm.

a)Clonic convulsion:

Convulsion in which the muscle alternatively contract and relax.

b)Tonic convulsion.

Convulsion in which the muscle contraction is sustained. 21.Dystonias.Slow,sustained contraction of the trunk or limbs.

THINKING.

A.General disturbances in form or process of thinking.
1.Mental disorder.Clinically significant behaviour or Psychological syndrome associated with distress or disability.
2.Reality testing.Objective evaluation and judgment of the world outside the self. 3.Formal thought disorder.
Disturbance in the form of the thought rather than the content of thought.
4.Illogical thinking.Thinking containing erroneous conclusions or internal on tradictions. 5.Dereism.Mental activity not concordant with logic or experience.
6.Autistic thinking.Preoccupation with inner,private world.
7.Emotional insight.Deep level of understanding or awareness that is likely to lead to positive changes in personality and behaviour.
B.Specific disturbances in form of thought.
1.Neologism.
New word created by the patient.
2.Word salad.Incoherent mixture of words and phrases.
3.Circumsntiality.Indirect speech that is delayed in reaching the point but eventually gets from original point to desired goal.

                                  

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Assist.Prof. Hafidh M. Farhan
Head of Department of Psychiatry
Kufa College of Medicine
University of Kufa
——————————————–
4.Tangentiality.Inability to have goal directed associations of thought. 5.Incoherence.Thought that generally is not understandable.
6.Perseveration.Persisting response to a previous stimulus after a new stimulus has been presented.
7.Verbigeration.Meaningless repetition of specific words or phrases. 8.Echolalia.Psychopathological repeating of words or phrases of one person by another. 9.Condensation.Fusion of various concepts into one.
10.Loosening of association.Flow of thought in which ideas shift from one subject to another in a completely unrelated way.
11.Derailment.Gradual or sudden deviation in train of thought without blocking. 12.Flight of ideas.Rapid,continuous verbalizations or plays on words produce constant shifting from one idea to another;ideas tend to be connected.
13.Clang association.Association of words similar in sounds but not in meaning. 14.Blocking.Abrupt interruption in train of thinking before a thought or idea is finished. C.Specific disturbances in content of thought.
1.Poverty of content.
Thought that gives little information because of vagueness,empty repetitions,or obscure phrases.
2.Overvalued idea.Unreasonable,
sustained false belief maintained less firmly than a delusion.
3.Delusion.False belief,based on incorrect inference about external reality,not consistent with patient’s intelligence and cultural background.

a)Bizarre delusion.

An absurd,totally implausible,
strange false belief.
b)Systematized delusion.
False belief or beliefs united by a single event or theme. c)Mood congruent delusion.

Delusion with mood-appropriate content.

d)Mood in congruent delusion.

Delusion with contents that has no association with mood or mood is neutral.

e)Nihilistic delusion.

False feeling that self,others,or the world is nonexistent or coming to an end.

f)Delusion of poverty.

A person’s false belief that he or she is bereft or will be deprived of all material possessions.
g)Somatic delusion.
False belief involving function of the body.

                      

h)Paranoid delusions.

Includes Persecutory delusions and delusions of reference,

*Delusion of Persecution.

control and grandeur.

 

A person’s false belief that he or she is being harassed, cheated or persecuted.

*Delusion of grandeur.

A person’s exaggerated conception of his or her importance,power or identity.

*Delusion of reference.

 

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Assist.Prof. Hafidh M. Farhan
Head of Department of Psychiatry Kufa College of Medicine University of Kufa ——————————————–

A person’s false belief that the behaviour of the others refers to himself or herself;that events,objects,or other people have a particular unusual

significance,usually of a negative nature.

i)Delusion of self accusation.

False feeling of remorse or guilt.
j)Delusion of control.False feeling that a person’s will,thoughts,or feelings are being controlled by external forces.

*Thought withdrawal.

Delusion that thoughts are being removed from a person’s mind by other people or forces.

*Thought insertion. Delusion that thoughts are being implanted from a person’s mind by other people or forces.

*Thought broadcasting.

Delusion that a person’s thought can be heard by others.
*Thought control.Delusion that a person’s thought are being controlled by other

people or forces.

k)Delusion of infidelity (Delusional jealousy).

False belief derived from pathological jealousy about a person’s lover being unfaithful.

l)Erotomania.Delusional belief,more commonly in woman than in men,that someone is deeply in love with them.
m)Pseudologia phantastica.
A type of lying in which person appears to believe in the reality of his or her

fantasies and acts on them.
4.Egomania.Pathological self-preoccupation.
5.Monomania.Preoccupation with a single object.
6.Hypochondria.Exaggerated concern about health that is based on unrealistic interpretations of physical signs or sensations as abnormal.
7.Obsession.Pathological persistence of an irresistible thought or feeling that cannot be eliminated from consciousness by logical efforts.
8.Compulsion. Pathological need to act on an impulse that,if resisted,produces anxiety. 9.Coprolalia.Compulsive utterance of obscene words.
10.Noesis.A revelation in which immense illumination occurs in association with a sense that a person has been chosen to lead and command.
11.Unio mystica.An oceanic feeling of mystic unity with an infinite power. 12.Phobia.Persistent,exaggerated,irrational,and invariably pathological dread of a specific stimulus or situation.

a)Specific phobia.

Circumscribed dread of a discrete object or situation.

b)Social phobia. Dread of public humiliation, as in fear of public speaking, performing or eating in public.

c)Acrophobia. Dread of high places. d)Agoraphobia. Dread of open places. e)Algophobia. Dread of pain

                      

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Assist.Prof. Hafidh M. Farhan
Head of Department of Psychiatry Kufa College of Medicine University of Kufa ——————————————–

f)Ailurophobia. Dread of cats g)Erythrophobia. Dread of red h)Panphobia. Dread of every thing. i)Claustrophobia. Dread of closed places. j)Xenophobia. Dread of strangers. k)Zoophobia. Dread of animals.

l)Needle phobia.The persistent,intense,pathological fear of receiving an injection.

Speech.
A.Disturbances in speech.
1.Pressure of speech.
Rapid speech that is increased in amount and difficult to interrupt. 2.Poverty of speech.Restriction in the amount of speech used;replies may be monosyllabic.
3.Poverty of content of speech.
Speech that is adequate in amount but conveys little information because of vagueness,emptiness,or stereotyped phrases.
4.Dysarthria.Difficulty in articulation,not in word finding or in grammar. 5.Stuttering.Frequent repetition or prolongation of a sound or syllable,leading to markedly impaired speech fluency.
6.Cluttering.Erratic and dysrhythmic speech,consisting of rapid and jerky spurts. 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 impaired.
2.Sensory aphasia.Organic loss of ability to comprehend the meaning of words. 3.Nominal aphasia.Difficulty in finding correct name for an object. 4.Alogia.Inability to speak because of a mental deficiency or an episode of dementia. 5.Copropregia.Involuntary use of vulgar or obscene language.

MEMORY. Disturbances of memory.

1.Amnesia.Partial or total inability to recall past experiences. A)Anterograde:Amnesia for events occurring after a point in time. B)Retrograde:Amnesia for events occurring before a point in time.

2.Confabulation.Unconscious filling of gaps in memory by imagined or untrue experiences that a person believes but they have no basis in fact.
3.Déjà vu.Illusion of visual recognition in which a new situation is incorrectly regarded as a repetition of a previous memory.

4.Jamais vu.Feeling of unfamiliarity with a real situation that a person has experienced. 5.Repression.A defense mechanism characterized by unconscious forgetting of unacceptable ideas or impulses.
6.Blackout.Amnesia experienced by alcoholics about behaviour during drinking bouts.

                           

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