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bizarre delusion

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one involving a belief that the patient's cultural group regards as totally implausible (e.g., radiation from the moon is changing him into a reptile)

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crystallized delusion

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one in which the details remain unchanged over time

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delusional jealousy

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that the patient's sexual partner is unfaithful

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delusion of being controlled (of passivity)

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that the patient's thoughts, feelings, impulses, or actions are somehow controlled externally rather than under his/her own control

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delusion of reference

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that events, objects, or actions of other persons have a special meaning for (i.e., refer to) the patient (e.g., that other persons are smiling because they want the patient to die). Distinguished from idea of reference, in which the belief is held with less than delusional conviction or persistence. Ideas of reference are far more common than delusions of reference.

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depressive delusions

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delusions involving themes of extreme personal inadequacy, guilt, disease, death, nihilism, or deserved punishment

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encapsulated delusion

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a delusional belief involving a relatively restricted and circumscribed topic (e.g., a single person or idea) in a person whose thought and behavior are otherwise normal

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erotomanic delusion

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that another person, usually someone of higher social status or prestige (e.g., an entertainer, athlete, or politician), or a person especially respected by the patient (e.g., a priest, doctor, or teacher), is in love with the patient

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grandiose delusion

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that the patient has extraordinary worth, power, or knowledge, or a special relationship to a deity or a famous person (e.g., that God has given him a divine mandate to establish a new government)

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nihilistic delusion

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that the patient, part of the patient's body, the universe, or an important part of the universe does not exist or has ceased to exist

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persecutory delusion

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that the patient is or has been attacked, harassed, cheated, injured, or conspired against by others (e.g., that his family is poisoning his food)

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somatic delusion

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that some feature of the appearance, structure, or function of one's body has changed (e.g., that parasites are destroying her internal organs)

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systematized delusions

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a group of delusional beliefs that are logically interconnected

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overvalued idea

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an unreasonable and sustained belief that is maintained with less than delusional conviction (i.e., the person is, at times, able to acknowledge the possibility that it might not be true)

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concrete thinking

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excessive literalness of expression and understanding; inability to think beyond the context of the immediate present, to generalize, to recognize any meaning but the most overt, and to appreciate symbolism and metaphor

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neologism

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a new word or phrase used by a patient that seems to have a private or special meaning and whose derivation is not readily apparent

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disturbances of thought associations

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abnormalities in the normal associative process by which goal-directed thinking progresses

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loose associations

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he general term for shifts in train of thought or speech that occur without adequate logical connection. Normal progression of goal-directed thinking may be described as tight associations. Looseness or tightness are variable in degree; loose associations are an occasional experience in normal mental life.

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clang associations

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shifts in thought related to sounds rather than meanings of words

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blocking

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sudden, involuntary, complete interruption in progress of speech or thought

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flight of ideas

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abnormally rapid progression of thoughts with many abrupt shifts in topic that are usually based on understandable (but loose) associations, distracting stimuli, or plays on words; often accompanied by intense, rapid speech that is difficult to interrupt, as if the person is unable to stop talking (pressured speech)

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word salad

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associations so loose that speech is incoherent

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verbigeration

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despite adequate quantity, speech conveys little or no information because of excessive vagueness, useless repetitions, meaningless or cliched phrases, etc.

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circumstantiality

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a tendency to digress and to insert irrelevant information and unnecessary explanations and qualifications before a thought is eventually completed

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tangentiality

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digression and irrelevancy so severe that the thought or communication is never completed

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overinclusive thinking

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inability to preserve conceptual boundaries, so that irrelevant or distantly associated elements become incorporated into concepts, making thought less precise and more abstract.

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perseveration

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the morbid, stereotyped, inappropriate repetition of the same response to a series of different stimuli; inability to suppress a response that is no longer appropriate. Usually refers to speech but may also describe other motor behavior.

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hallucination

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A perceptual experience that has a compelling sense of reality, like a true perception, but occurs without external stimulation of the sensory organ. A person may or may not be aware of the nonreality of a hallucination. Transient hallucinatory experiences are not always psychopathologic and may occur in persons without a mental disorder. The term is not applied to the perceptual experiences that occur during sleep (dreaming) or to neurologic symptoms such as tinnitus.

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auditory hallucination

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involving the perception of sound, often of human voices. This is the most frequent type of hallucination in primary psychiatric disorders. Hallucinations in other sensory modalities without any auditory hallucinations strongly suggest a secondary rather than primary mental disorder (i.e., that the hallucinations are caused by a general medical condition, substance use, or substance withdrawal).

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autoscopic hallucination

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visions of one's own body as if seen from an external position

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gustatory hallucination

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involving the perception of taste (usually unpleasant)

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hypnagogic hallucination

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while falling asleep (abnormally early dream activity)

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hypnopompic hallucination

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while awakening from sleep (persistence of dream activity)

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kinesthetic hallucination

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involving feelings of movement

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lilliputian hallucination

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involving visions of tiny persons or animals

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olfactory hallucination

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involving the perception of odor, usually foul (e.g., burnt rubber)

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somatic hallucination

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involving a sensation localized inside the body (such as a feeling of electricity in the head, or of snakes in the intestine). The sensation may be one that is physiologically impossible (because corresponding sensory receptors do not exist). Somatic hallucinations must be distinguished from true sensations (e.g., arising from an as-yet-undiagnosed general medical condition), from hypochondriacal preoccupation with normal internal sensations (e.g., one's heartbeat or peristalsis), and from tactile hallucinations. Note: pain is never considered a form of hallucination.

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tactile hallucination: (also called haptic hallucination)

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involving the sensation of touch on or immediately beneath the skin. The most common tactile hallucinations involve feelings of insects or other creatures crawling; this symptom is called formication (N.B. the fourth letter of this word).

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visual hallucination

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involving the sense of sight. Visual hallucinations may consist of unformed images (e.g., flashes of light), simple formed images (e.g., visions of people), or complex formed images (e.g., people acting in an environmental setting)

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hallucinosis

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persistent hallucinations in clear (unclouded) consciousness

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illusion

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abnormal misperception or misinterpretation of a genuine external stimulus (e.g., hearing rustling of leaves as the sound of whispering)

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synesthesia

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stimuli in one modality overflow to (cause hallucinations in) another modality (e.g.,"tasting" colors during LSD hallucinosis)

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Emotion

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is an internal feeling state that includes both objective physiologic changes and a subjective experience.

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Affect

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refers most precisely to the outward manifestations of emotion. Thus, emotion is the private interior state and affect is its visible expression; however, the terms are often used interchangeably.

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Mood

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refers to a relatively pervasive and prolonged internal emotional state that influences other internal experiences and external behaviors. Although some persons use all three of these terms interchangeably, it is more useful to restrict mood to the latter definition.

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autonomous mood

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persisting unchanged in quality, without response to ongoing events

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blunted affect

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reduced in amplitude; changes are visible but seem restrained or muted

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constricted affect

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restricted in range, so that certain emotions seem unavailable to the person

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dysphoric affect or mood

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unpleasant or painful, such as anxiety, sadness, depression, anger, or irritability

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elevated affect or mood

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an exaggerated feeling of well-being, euphoria, or elation. Sometimes described with metaphors referring to height, such as "high," "on top of the world," "ten feet tall," or "up in the clouds"

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euthymic (or sometimes normothymic) mood

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relatively normal in quality, intensity, and variability; not pathologically depressed or elevated

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expansive affect or mood:

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abnormally unrestrained in expression of feelings, usually including an overvaluation of one's significance or importance

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flat affect

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totally lacking in expression of affective signs; see blunted affect

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inappropriate affect

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expression of emotion out of harmony with thoughts, speech, or circumstances (e.g., laughing or grinning while describing a tragic event)

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irritable affect

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easily annoyed and provoked to anger

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labile affect

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unstable; frequently and easily changing, either in response to stimuli or without visible cause

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reactive affect or mood:

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showing changes in quality in response to ongoing events

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depersonalization

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an alteration in the perception or experience of the self, causing feelings of detachment and strangeness, as if in a dream

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derealization

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an alteration in the perception or experience of the external world, so that it seems strange or unreal

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agitation

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severe motoric restlessness associated with dysphoric affect

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hyperactivity

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abnormally increased motor activity, often with overtalkativeness and poor coordination, and sometimes with aggressiveness

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psychomotor retardation

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markedly abnormal slowing of mental and physical activity. Complete lack of movement is called akinesis.

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cataplexy

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abrupt generalized loss of muscle tone resulting in collapse but without alteration of consciousness, often in association with intense affects such as laughter, fear, or surprise; may be a sign of narcolepsy

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catatonia

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abnormally increased muscle tone and decreased responsiveness, usually resulting in stuporous immobility but occasionally in frenzied or excited motor activity. A catatonic syndrome may be seen in a variety of mental disorders but is most frequent in Mood Disorders.

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automatic obedience

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robotlike compliance with commands without critical judgment

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catalepsy

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generalized immobility with markedly diminished responsiveness to stimuli; also called catatonic stupor (N.B. be sure to distinguish this term from cataplexy.)

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catatonic excitement:

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severe, apparently purposeless hyperactivity not influenced by external stimuli

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catatonic mutism:

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inability to speak in a patient who has catalepsy

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catatonic negativism

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apparently involuntary or purposeless resistance to instructions, or rigid maintenance of posture against attempts to be moved

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catatonic posturing

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prolonged involuntary maintenance of fixed posture, even if awkward

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catatonic rigidity

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refers to catatonic posturing, negativism, or waxy flexibility

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echolalia

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morbid, parrotlike repetition of another person's speech; often seems involuntary

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echopraxia

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morbid, stereotyped, automatic mimicking of another person's movements and posture; often seems involuntary

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waxy flexibility or cerea flexibilitas

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passive resistance to movement, followed by prolonged maintenance (at least several minutes) of whatever posture one is placed in

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automatism

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apparently purposeless motor behavior performed without conscious awareness; sometimes seen in complex partial epilepsy

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mannerism

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an odd or eccentric gesture or pattern of movement

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stereotypy

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frequent mechanical repetition of speech or a pattern of motor activity, always or sometimes without apparent purpose; may occur as part of a catatonic syndrome

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