objective findings observed by the clinician

ex: constricted affect or psychomotor retardation

subjective experiences described by the patient

ex: depressed mood or decreased energy

observed expression of emotion = what we see or what people show us

ex: a smile when something is funny . . .

***This is an objective finding

may be inconsistent with the patient's description of emotion

the emotional tone is consistent with the accompanying idea, thought, or speech

may be further described as broad or full affect, in which a full range of emotions is appropriately expressed

inconsistency between the emotional feeling tone and the idea, thought, or speech accompanying it

ex: the patient has had a bad day and they are laughing at the same time

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

--> ex: Schizophrenia

(there is still a connection between what they are saying, but the connection is reduced)

reduction in intensity of feeling tone; less severe than blunted affect but clearly reduced;

the ability to experience only one set of feelings (ex: depression)

absence or near absence of any signs of affective expression; voic is monotonous; face is immobile; represents a severe form of blunted affect

- without any signs of expression - face looks flat

ex: Parkinson's

rapid and abrupt changes in emotional feeling tone; changes are unrelated to external stimuli

ex: 1) borderline personality (character in "Fatal Attraction" = screaming one second, calm the next)

2) bipolar disorder

a pervasive and sustained emotion;

subjectively experienced and reported by the patient

ex: depression, anger, elation, etc.

expression of one's feelings without restraint; ofent accompainied by an overestimation of one's importance

- their emotions are more than you anticipate (both below (depressed) and high (happy)

ex: Bipolar disorder; histrionic personality

similar to labile affect

MOOD SWINGS; frequent shifts between euphoria and depression or anxiety

ex: cyclothymia; bipolar disorder (aka: manic depressive)

intense elation with feelings of grandeur

typical of mania (which is the high side of bipolar illness)

loss of interest in everything

loss of interest in and withdrawal from all regular and pleasurable activities

often associated with depression

inability or difficulty in describing or being aware of one's emotions or mood; may be a sx of atypical depression

they can't describe how they are feeling

patholocial imitation of movements of one person by another

ex: schizophrenia, disorganized type

also in mental retardation

motor abnormalities characterized by the absence of spontaneous movements, rigidity, stupor, posturing, or purposeless agitated behavior (no spontaneous movement)

these monor symptoms constitute one subtype of schizophrenia - bipolar, medical illness

too much or too little movement

1) catalepsy (immobile position)

2) catatonic excitement (excess motor activity; worry about them getting dehydrated or hurting themselves)

3) Catatonic stupor (less activity)

4) catatonic rigidity (lead-pipe rigid - hyperthermia/dehydration)

5) catatonic posturing (their arms posture - like in a statue)

6) waxy flexibility (cerea flexibilitas) - ther person can be MOLDED into a position which is maintained

excessive motor and cognitive overactivity usually nonproductive and in response to inner tension (anxious, angry)

often seen during the manic phase of bipolar disorder; also drug-induced (PCP, ectasy)

subjective feeling of muscular tension secondary to antipsychotic medication; manifestations include restlessness, pacing, repeated sitting and standing

can be mistaken for psychotic agitation --> so we give more meds and make it worse

the patient feels an inner tension and they pace, but they don't know why; they are NOT psychotic when they tell you something is wrong; due to meds

uncontrollable impulse to perform an act repettitvely; core symptom of obsessive compulsive disorder

ex: the urge to go back home and check you turned off the stove

(an obsession is a thought that won't leave your mind - also called rumination)

decreased motor and cognitive activity; visible slowing of thought, speech, or movements

also known as hypokinesis or psychomotor retardation

common sx of depression

LACK OF MOVEMENT

it is how thoughts are developed and put together

involves 2 components:

1) Content - what is in the thinking

2) process - the way you are thinking

inability to distinguish reality from fantasy

impaired reality testing with the creation of a new reality

examples: schizophrenia, delusional disorders, schizoaffective disorder, psychotic depression

the objective evaluation and judgement of the external world; the ability to accurately perceive one's environment

ability to judge world as real

*** disturbance in the form of thought rather than the content of thought;

thought that is characterized by: loosness of association, neologisms, illogical constructs

this represents one type of psychosis

a new word created by the patient which has special meaning not apparent to others; often combines syllables of other words; characteristic sx of schizophrenia

only the patient understands what it means (it can rhyme or be a combination)

involves thought PROCESS

indirect speech that is delyaed in reacing the point, but eventually gets from original point to desired goal - speech that goes in a circle

characterized by an overinclusion of details and parenthetical remarks

never reaches the point; don't understand where they are heading

inability to have goal-directed associations of thought; the patient never gets from original point to desired goal; speech tends to be rambling and purposeless

pathological repeating of another person's words or pharases; patient repeats the interviewer's statements in a repetitive manner; often spoken in a mocking or staccato intonation

ex: disorganized schizophrenia

flow of thought in which ideas shift from one subject to another in a completely unrelated way; absence of connections btw thoughts; speech may be incoherent in severe cases; characteristic sx of schizophrenia

talks about one subject then completely switches to another - there is no connection between the 2 thoughts; more severe than tangentiality

markedly accelerated thought processes; the ideas are generally related to one another, but are verbalized so rapidly that it is difficult to understand; characteristic of manic phase of bipolar dz

rapid changing of thoughts seen in mania; they can relate ideas, but not totally; speech is FAST and RAPID

abrupt cessation of thought before an idea is finished; after a brief pause, the person has no recall of what was being said or what was going on

they are talking then STOP - usually start back up again; you worry about if it is an absence seizure

1) poverty of content

2) delusion

3) hypochondria

4) obsession

5) compulsion

6) phobia

thought that gives little information because of the vagueness, empty reptitions, or obscure phrases

they are talking but they are not saying anything

 it is a belief, NOT a hallucination

a false belief, based on incorrect inference about external reality, that cannot be corrected by reasoning;

they are not consistent with the patient's intelligence and cultural background

• paranoid - ex: ppl are following them
• somatic - they have worms in their visceral organs (for example)
• self-accusation
• grandiose - delusion of importance
• nihilistic
• control
• bizarre (ex: they have an implant in their brains that is controlled by a space ship)
• systematized - every aspect of life is affected = one huge delusion
• erotomania - love
• infidelity - convinced significant other is cheating

false belief that self, others, or the world is nonexistent or ending

belief that world is ending (often in elderly or severly depressed)

false feeling that one's will, thoughts, or feelings are being controlled by external forces

ex: thought withdrawal, thought insertion, thought broadcasting, thought control

belief that thoughts are controlled by others

delusion that one's thoughts are being removed from one's head by other people or forces

someone is taking the thoughts out of their heads

delusion that thoughts are being implanted in one's mind by other people or forces

people are implanting their thoughts; patients try to hide sx

celebrity stalkers

delusional belief that someone is deeply in love with them; more common in women than in men

false belief derived from pathological jealousy that one's lover is unfaithful

also called delusional jealousy

exaggerated concern about one's health that is based not on real organic pathology, but, rather, on unrealistic interpretation of physical signs or sensations as abnormal

often in our age group (and in med students who just learned that pathology ;)

pathological persistence of an irresistible thought or feeling that cannot be eliminated from consciousness by logical effort

also termed rumination (often happens at night, ex: happens to students when they are obessing about a test the next day)

associated with anxiety

usually accompanied by compulsive behavior

it is an urge that you have to get rid of

• specific phobia
• social phobia
• agoraphobia
• acrophobia (heights)
• claustrophobia
• xenophobia (fear of strangers)
• zoophobia
• panphobia (fear of EVERYthiNG)
  

rapid speech that is increased in rate and amount; difficult to understand; associated with flight of ideas; characteristic of manic episodes

they keep getting louder and faster; they don't stop talking

say few words

a decrease in the amount of speech; replies may be brief and monosyllabic

mental process by which sensory stimuli are brought into awareness

- it is the way we view things (visual + auditory)

false sensory perceptions not associated with real external stimuli; there may or may not be a delusional interpretation of teh hallucinatory experience

they hear voices and turn them into delusions

• auditory
• visual (generally with medical disorders)
• olfactory (seizures - temporal lobe epilepsy)
• gustatory
• tactile (haptic) (think about substance abuse or withdrawal)
• hypnagogic (right as you fall into sleep)
  
• hypnopompic (right as you come out of sleep)
  

misperception or misinterpretation of real external sensory stimuli (ex: drapery blowing)

examples: delirium; schizotypal personality

a subjective sense of being unreal, strange, or unfamiliar to oneself

ex: stress reactions, borderline personality

subjective sense that the environment is strange or unreal

feelings of changed reality

taking on a new identiy with amnesia for the old personality

often involves travel or wandering to new environments

ex: dissociative fugue

*traveling away*