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Basic Psychiatry Symptoms and Signs (Psychopathology)

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Basic Psychiatry Symptoms and Signs (Psychopathology) Basic Psychiatry Symptoms and Signs (Psychopathology) In psychiatry 1 Psychiatric symptoms and signs are common in patients of all kinds; therefore, medical students require sound knowledge of these symptoms and signs. In psychiatric Clinical practice diagnosis is not made on a single symptom or sign, but on the pattern of several clinical features. This chapter provides a concise description of the most common symptoms and signs of various psychiatric disorders. Following chapters, however, will clarify how to elicit these symptoms and signs through the psychiatric interview, and how to organize symptoms and signs into various diagnostic categories. For simplification, symptoms and signs in psychiatry can be grouped into the following categories: • Abnormalities of behavior and movements. • Abnormalities of mood and emotion. • Abnormalities of speech. • Abnormalities of thinking. • Abnormalities of perception. • Abnormalities of awareness of self and others. • Abnormalities of consciousness. • Abnormalities of attention and concentration. • Abnormalities of memory. • Abnormality of judgment. • Abnormality of insight. • Abnormality of sleep, eating and sex. 2 ABNORMALITIES OF BEHAVIOR AND MOVEMENTS Very important to understand. 1. *Psychomotor Retardation: slowed mental and motor activities, the most common diagnosis are major depressive disorder. 2. *Stupor: a state in which a person, although is fully awake with open eyes, does not react to the surroundings: mute, immobile and unresponsive. It can be due to organic or functional psychiatric disorders. 3. Catatonic Stupor: stupor with rigid muscles and posturing seen mainly in schizophrenia; catatonic type. 4. *Agitation: restlessness with psychological tension. Patient is not fully aware of restlessness. It can be due to many psychiatric disorders: mania, depression, schizophrenia, substance abuse, delirium …e t c. 5. Catatonic Excitement: marked sudden unprovoked impulsive and aggressive behavior seen mainly in schizophrenia. 6. Aggression: hostile physical or verbal behavior, with rage and anger. 7. *Akathisia: inability to keep sitting still, due to a compelling subjective feeling of restlessness. Patient is fully aware of restlessness. It is due to antidopaminergic drugs. 8. Dyskinesia: restless movement of group of muscles, mainly in the orofacial and hands muscles.Tardive dyskinesia is a late onset type induced by several years use of antidopaminergics. 9. *Dystonia: painful severe muscle spasm mainly due to recent use of antidopaminergics. 3 10. Torticollis: contraction of neck muscles, tilting the head to oneside. It is mainly due to recent use of antidopaminergics. 11. Tics: sudden repeated involuntary muscle twisting e.g. repeatedblinking, grimacing , seen in normal people but when excessive and severe they indicate a psychiatric disorder e.g. Tic disorder. 12. *Compulsions: compulsive actions associated with obsessions e.g. compulsive hand washing, seen in obsessive compulsive disorder. 13. Echopraxia: imitative repetition of movement of somebody. It indicates an organic mental pathology. 14. *Waxy Flexibility: patient’s limbs may be moved like wax, holding position for long period of time before returning to previous position, seen mainly in schizophrenia ;catatonic type. 15. Stereotypies: purposeless repetitive involuntary movements.e.g. foot tapping, thigh rocking, seen in normal people but when severe they indicate psychiatric disorder. 16. Mannerism: odd goal-directed movements. e.g. repeated hand movement resembling a military salute. 4 ABNORMALITIES OF MOOD / EMOTION 1. *Anxiety: feeling of apprehension accompanied by autonomic symptoms (such as muscles tension,perspiration and tachycardia), caused by anticipation of danger. Free-floating anxiety: diffuse, unfocused anxiety, not attached to a specific danger. 2. *Fear: anxiety caused by realistic consciously recognized danger. 3. *Panic: acute, self-limiting, episodic intense attack of anxiety associated with overwhelming dread and autonomic symptoms. 4. *Phobia: irrational exaggerated fear and avoidance of a specific object, situation or activity. 5. Irritable mood: easily annoyed and provoked to anger. 6. Dysphoria: mixture feelings of sadness and apprehension. 7. Depressed mood: feeling of sadness, pessimism and a sense of loneliness. 8. Anhedonia: lack of pleasure in acts which are normally pleasurable. 9. *Grief: sadness appropriate to a real loss (e.g. death of a relative) 10. *Guilt: unpleasant emotion secondary to doing what is perceived as wrong. 11. Shame: unpleasant emotion secondary to failure to live up to self- expectations. 12. Perplexity: anxious mood with bewilderment. 13. Ambivalent Mood: coexistence of two opposing emotional tones towards the same object in the same person at the same time. 5 14. Alexithymia: inability to, or difficulty in, expressing one’s own emotions. 15. Elevated Mood: a mood more cheerful than usual. 16. Elation:- feeling of elevated mood with optimism and self satisfaction 17. Euphoria: intense elation with feeling of grandeur. 18. Ecstasy: very intense elation beyond reason and control. 19. Expansive Mood: expression of euphoria with overestimation of self- importance. 20. Grandiosity: feeling and thinking of great importance (in identity or ability). 21. Constricted Affect: significant reduction in the normal emotional responses. 22. Flat Affect: absence of emotional expression. 23. Apathy: lack of emotion, interest or concern, associated with detachment. 24. Labile Affect: rapid, abrupt changes in emotions in the same setting, unrelated to external stimuli. 25. La Belle Indifference: inappropriate denial of expected affect and lack of concern about physical disability (seen in conversion disorders). 26. Inappropriate Affect: disharmony between emotions and the idea, thought, or speech, accompanying it. 6 ABNORMALITIES OF SPEECH 1. Echolalia: imitation of words or phrases made by others, seen in some schizophrenic patients, mentally retarded and some organic mental disorders. 2. Pressure of Speech: rapid, uninterrupted speech that is increased in amount seen in patients with mania or stimulant abuse. 3. Circumstantialities: over inclusion of details delaying reaching the desired goal, seen in people with obsession personality. 4. Elective Mutism: refusal to speak in certain circumstances. 5. Poverty of Speech: restricted amount of speech seen in depression and schizophrenia. 6. Stuttering (Stammering): frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency. 7. Cluttering: dysrhythmic rapid and jerky speech. 8. Clang Associations (Rhyming): association of word similar insound but not in meaning (e.g. deep, keep, sleep) seen in patients with mania or substance abuse. 9. Punning: playing upon words, by using a word of more than one meaning (e.g. ant, aunt). Seen in patients with mania or substance abuse. 10. Word Salad: incoherent mixture of words and phrases, seen in chronic schizophrenia. 11. Dysarthria: difficulty in articulation and speech production. 7 12. Sensory Aphasia: nonsensical fluent speech due to lesion affecting Wernick‟s (receptive) area. 13. Motor Aphasia: impairment in the ability to formulate fluent speech due to lesion affecting Broca‟s (motor) area. 14. Dysphonia: difficulty in voicing speech clearly, due to dysfunction of vocal cords or soft palate. ABNORMALITIES IN THINKING Poverty of Thoughts A- Abnormal Thought Stream Pressure of Thoughts Thought Block B- Abnormal Thought Link Loosening of Association Flight of Ideas Thought Perseveration Overvalued Ideas Obsessions C- Abnormal Thought Content - Delusions 8 A. Abnormal Thought Stream 1. Poverty of Thoughts: few, slow, unvaried thoughtsassociated with poverty of speech, seen in schizophreniaand depression. 2.*Pressure of Thoughts: rapid abundant varying thoughts associated with pressure of speech and flight ofideas, seen in mania and stimulant abuse. 3. Thought Block: sudden cessation of thought flow withcomplete emptying of the mind, not caused by an external influence, seen inschizophrenia. B. Abnormal Thought Link Also called „formal thought disorders‟. 1.*Loosening of Associations: lack of logic connection betweenthoughts seen in chronic schizophrenia. 2.* Flight of Ideas: successive rapidly shifting incomplete ideas but with an understandable link, seen in mania and stimulant intoxication. 3. Thought Perseveration: repeating the same sequence of thoughts persistently and inappropriately, seen in organic brain pathology (e.g. dementia) C. Abnormal Thought Content 1. Overvalued Ideas: Strongly held false ideas but shakable (e.g. personal conviction that vitiligo is a contagious disease). 2. *Obsessions (mental ruminations): 9 Repetitive ideas, images, feelings or urges insistently entering person‟s mind despite resistance. They are unwanted, distressful and recognized as senseless and irrational. Obsessions are frequently, but not always, followed by compelling actions (which are called compulsions or rituals). Common Obsessional Contents: dirt/contamination/cleaning /doubts about religious matters. 3. *Delusions: Unshakable false beliefs out of keeping with the person‟s cultural background, not arrived at through logic thinking and not amenable to reasoning. Common Delusional Contents: 1. Persecutory delusion: Delusion of being persecuted (cheated, mistreated, harassed, followed for harm etc.). Persecutory delusion is sometimes called paranoid delusion , however, paranoid delusion means not only being ersecuted but being persecuted
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