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Limited range

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Limited range of expressive movements. Depression look sad, depressed and anxious.

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Psychomotor retardation

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All bodily movements, including gestures may be diminished or absent. Severe depression - walk slowly, bowed down, sit still.

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Psychomotor agitation

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Restless and apprehensive movements. No direct or unvarying relation between severity and level of agitation Agitated or anxious depression - hand-wringing

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Expansive gestures

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Exaggeration of expressive movements. Patient unusually cheerful. Mania

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Ecstasy/exaltation

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Rapt intense look and is not restless, overactive and interfering. In extreme ecstasy, patient is incommunicative, completely absorbed by the intense experience. Psychosis, schizophrenia, epilepsy, certain personalities post religious training

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Disorders of reactive movements

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Problems with immediate automatic adjustments to new stimuli

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Obstruction/sperrung

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Irregular hindrance to motor activity Catatonia, stupor

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Mannerisms

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Unusual repeated performances of a goal-directed motor action or the maintenance of an unusual modification of an adaptive posture Non-psychosis - when person need to be noticed, or reflect lack of control over motor behaviour, or lack of self confidence Schizophrenia - may result from delusional ideas, expression of catatonic MD, negativism.

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Echopraxia

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Imitation of simple actions that patients see such as hand clapping, snapping the fingers, etc.

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Echolalia

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Patient echos a part of the whole of what has been said to them. Words are echoed irrespectively of patient understanding. ?echo speech in children, disinhibition of speech pattern Schizophrenia

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Perseveration

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An induced movement because it is a senseless repetition of a goal-directed action that has already served its purpose. Special form: logoclonia (last syllable is repeated), palilalia (repeats word with increasing frequency) Schizophrenia, catatonia

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Negativism

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Accentuation of opposition; apparently motiveless resistance to all interference +/- outspoken defensive attitude. Can be used to describe hostility, motivated refusal, failure to cooperate. Catatonia, severe learning disability, dementia

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Tortocollis

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Spasm of the neck muscles, especially the sternomastoid, pulls head towards the same side and twists the face in the opposite direction. *not examined

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Perseveration of posture/catalepsy

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No resistance to passive movements but when when examiner releases the body, muscles that fixed the body into position can be felt to contract Maintenance of a posture that have arisen fortuitously or imposed for extended periods. Can be evoked in strange positions if comfortable positions do not elicit it Catatonia

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Waxy flexibility/flexibilitas cerea

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Plastic like resistance when moving the patient's body resembling bending of soft wax rod.

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Stupor

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State of more or less complete loss activity where there is no reaction to external stimuli; regards as an extreme form of hypokinesia. Sub-stuperose → reply in muttered monosyllables Complete → mute Shock, dissociative or conversion disorder, depression, psychosis, catatonia, organic brain disease (SOL)

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Excitement

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Opposite to stupor. But can co-exist in same disease Psychogenic, depression, manic, delirium

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Consciousness

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State of awareness of the self and the environment

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Dream-like change of consciousness

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Rise of the threshold for incoming stimuli Thinking shows excessive displacement, condensation, misuse of symbols Hallucinations frequent Misinterpretations (threats)

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Lowering of consciousness

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Apathy General slowing Perseveration No hallucinations or delusions

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Restriction of consciousness

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Awareness narrowed down to a few ideas Often slight bemusement Relatively well ordered behaviours "twilight state"

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Aphasia or dysphasia

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Disorder of speech resulting from interference with the functioning of certain areas of the brain

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Receptive dysphasia

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Difficulty in interpreting and comprehending speech

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Pure word deafness

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Type of receptive dysphasia. Patient hears words but cannot understand. Dominant temporal lobe lesion

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Agnostic alexia

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Type of receptive dysphasia. Patient can see but cannot read words. Left visual cortex and corpus callosum lesion

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Visual asymbolia

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Type of receptive dysphasia. Aka cortical visual aphasia, disorganisation of visual words schemas so that words cannot be recognised and motor word schemas cannot be activated. Difficulty to read and write. Angular and supramarginal gyri

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Expressive dysphasia

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Inability to express or coordinate speech

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Cortical motor aphasia/Broca's area/verbal aphasia/expressive aphasia

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Type of expressive dysphasia. Difficulty putting their thoughts into words and in severe cases speech may be restricted to expletives and a few words. Patient can realize they are making mistake but tries to correct → omission of words, telegram style, stress unusual and intonation and speech sound is odd. Broca area lesion

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Pure word-dumbness

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Type of expressive dysphasia. Unable to speak spontaneously, to repeat words, to read aloud, write sponstaneously, copy and write to dictation. Lesion beneath the region of the insula.

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Agnosia

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Patient experiences sensation in a given modality but they cannot recognise objects. *not examined

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Stammering and stuttering

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Normal flow of speech is interrupted by pauses or by repetition of fragments of the word Anxiety, severe adolescent crisis, onset of acute schizophrenia *not examined

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Mutism

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Complete loss of speech. Almost always present in catatonic stupor Hysteria, depression, schizophrenia, organic brain disorders Elective mutism refuse to sepak to certain people.

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Pressured speech

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Speaking as if in a rush; rapidly and frenziedly

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Talking past the point (vorbeireden) Approximate answers (Ganser syndrome)

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The content of the patient's replies to questions shows that they understand what has been asked but have responded by talking about an associated topic. Seen in Ganser syndrome

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Ganser syndrome

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Type of factitious disorder, a mental illness in which a person deliberately and consciously acts as if he or she has a physical or mental illness when he or she is not really sick. People will mimic behavior that is typical of a mental illness, such as schizophrenia.

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Neologisms

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New words that are constructed by the patient or ordinary words that are used in a new way

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Schizophasia/word salad

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Speech that is profoundly confused but are, none the less, able to carry out responsible work that does not involve the use of words.

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Flight of ideas

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Thoughts follow each other rapidly, no general direction of thinking and the connections between successive thoughts appear to be due to chance factors which can usually be understood. By assonance, alliteration, cland associations, proverbs, maxims and cliché. Easily diverted to external stimuli or internal superficial associations. Manic. Hypomania = ordered flight of ideas, able to return to task in hand, clang/verbal associations not marked, not as fast Schizophrenia, lesions of the hypothalamus

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Inhibition or slowing of thinking

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Train of thought is slowed down and the number of ideas and mental images that present themselves decreased. Exp. By patient as: difficulty in making decisions, lack of concentration, loss of clarity of thinking. Associated with: dim of attention, loss of memory, can develop overvalued or delusional idea that they are going out of their mind. Depression

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Circumstantiality

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Thinking proceeds slowly with many unnecessary and trivial details, but finally point is reached. Goal of thinking is never completely lost. Learning disability, obsessional personality traits, epilepsy

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Perseveration

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Mental operations persist beyond the point at which they are relevant and thus prevent progress of thinking. Verbal or ideational. E.g. replying question with same answer.

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Thought blocking

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Sudden arrest of the train of thought, leaving a 'blank'. An entirely new thought may then begin. Highly suggestive of schizophrenia. Exhausted and anxious patients.

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Verbal sterotypy

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Using the same word or phrase regardless of situation *not examined

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Desultory thinking

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Grammar and syntax intact. Thought form associated with loosening associations and sudden ideas

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Loosening of associations

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Associations of ideas become so shortened, fragmented, and disturbed as to lack logical relationship

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Sudden ideas

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Thoughts and ideas that force their way in from time to time

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Transitory thinking

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Grammar and syntax disturbed. Thought form associated with derailment, omissions, substitutions, fusion of thought.

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Derailment

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Thought slides on to a subsidiary thought

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Fusion

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Heterogenous elements of thought are interwoven with each other

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Substitutions

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Major thought is substituted with a subsidiary thought

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Omissions

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Senseless omissions of thoughts or part of it

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Drivelling thinking

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Grammar and syntax disturbed. Thought form associated with mixing and muddling of words/schizophasia/word salad.

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Schizophasia/word salad

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The mixing of random words together

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Obsession/rumination

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Unwanted, against the patient's will Persistent thought that dominates the person's thinking Recognised as purposeless or persisted and dominated thinking beyond relevance or usefulness Content of obsession causes great anxiety and even guilt Individual is aware of the thought Actively resisted (without success) May present as vivid images Obsessional states, depression, schizophrenia, organic states e.g. post-encephalitic parkinsonism

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Compulsion

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Compulsions are acted-upon obsessions (obsessional motor acts)

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Thought alienation

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Thoughts are under the control of an outside agency. Others can participate in one's thinking Schizophrenia

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Thought insertion

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Thoughts are inserted into their mind, patients recognise them as being foreign and coming from without. Schizophrenia

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Thought deprivation/withdrawal

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Patient finds that as they are thinking, their thoughts suddenly disappear and are withdrawn from their minds by a foreign influence. Subjective experience of thought blocking and omission → schizophrenia

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Thought broadcasting

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The patient knows that as they are thinking, everyone else is thinking in unison with them; one's thoughts are escaping so that other people can access; hearing one's thoughts spoken aloud and believing that other can hear it as a result. Important to record what the patient means verbatim Schizophrenia

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Preoccupations

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A subject or matter that engrosses someone

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Hebephrenia

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Preoccupation with the deepest questions

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Hypochondriasis

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Preoccupation with illness

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Anorexia/bulimia

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Preoccupation with food

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Anankastic personality

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Preoccupation with rules, details, procedure, protocol

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Overvalued ideas

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Acceptable, comprehensible idea pursued beyond the bounds of reason Takes precedence over all other ideas Maintains precedence over long periods of time Less fixed than delusions Tends to be based in reality (to a degree)

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Delusions/primary

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Fixed false idea out of keeping with the patient's social and cultural background Common theme: persecution, jealousy, grandiosity, ill health, guilt, nihilism, poverty, reference Schizophrenia

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Grief reaction

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Normal reaction to primary morbid psychological experience usually traumatic. Usually lasts up to 6-12 months

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Stress reaction

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Normal reaction to a stressful event

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Anxious foreboding

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Fear for no adequate reason + A sense that something terrible will happen but without the knowledge of what this will be

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Depressed mood

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Describe the appropriate sadness that is associated with bereavement, the low mood that comes from frustration and the profound gloom that is part of severe depressive illness.

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Dissociation of affect

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Converse or lack of emotional response, feeling of numbness, failure to express emotion

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Belle indifference

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Dissociation of affect. Patients who were undisturbed by suffering Conversion disorder

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Smiling depression

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Dissociation of affect. Compensate for lack of facial expression/mobility by smiling Depression

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Perplexity

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Tentative, bewildered, puzzled that occurs in anxiety, mild clouding of consciousness, emerging schizophrenia, new psychotic experiences.

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Incongruity of affect

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Misdirection of emotion, unaware of the morbidity in emotional expression even though it is apparent to observers. Schizophrenia

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Blunting/inadequacy of affect

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Indifference to self and others → insensitivity to the subtleties of social intercourse. Manifests as social awkwardness and inappropriateness. Can have sudden outbursts however. Vs flat or restricted affect where this outburst does not occur.

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Emotional flattening/restriction

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Limitation in the usual range of emotional responses so that the patient displays little emotional response in any direction. If expressed it is in the right direction.

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Lability of affect

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Rapid and abrupt changes in emotion, largely unrelated to external stimuli. Shifts occur without warning. Normal, mixed affective states (dysphoric mania)

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Affective incontinence

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Total loss of control of emotions (vs emotional lability which is less severe). Spontaneous outbursts of laughter or crying. Common in cerebral atherosclerosis and MS.

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Anhedonia

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Inability to enjoy anything in life or even get pleasure from everyday occurrences

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Somatization

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Misattribution of symptoms as due to physical illness rather than having a psychiatric cause. Corrected with education.

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Loss of emotional resonance

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Loss of normal reactive changes of emotion → inner emptiness of deadness, cannot feel that they are participating in the world any more.

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Diurnal mood variation

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Variation of the mood depending on time of the day

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Apathy

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Emotional indifference, often with a sense of futility. Manifest as lack of motivation.

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Elation

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Extremely elevated mood over long periods of time (weeks, every day)

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Illusion

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Misinterpretations of stimuli arising from an external object. Stimuli from a perceived object are combined with a mental image to produce a false perception

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Completion illusion

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Due to inattention. E.g. misreading words in text or missing misprints because we read the word as if complete. May misread based on previous experience, interest, etc.

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Affect illusion

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Arise in the context of a particular mood state. E.g. bereaved person believe that see the deceased person.

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Pareidolia

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Vivid illusions occur without the patient making an effort. Result of excessive fantasy thinking and vivid visual imagery. Can be against his or her will.

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Hallucinosis

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Persistent hallucinations in any modality in absence of other psychotic features

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