Signs and symptoms of psychiatric disorders

Signs and symptoms of psychiatric disorders

Dr. Safeya Alchalabi

Descriptions of symptoms and signs

Disturbances of emotion and mood
Disturbances of perception
Disturbances of thoughts
Disturbances of thinking processes
Depersonalization and derealization
Motor symptoms and signs
Disturbances of the body image
Disturbances of the self
Disturbances of memory
Disturbances of consciousness
Disturbances of attention and concentration
Insight

Descriptions of symptoms and signs

Changes in the way that emotions and mood vary
lability of mood
emotional incontinence
blunting or flattening
Apathy
incongruous or inappropriate

Changes in the way that emotions and mood vary

lability of mood
Increased variation in emotion and mood.

Changes in the way that emotions and mood vary

emotional incontinence
extreme variation in emotion and mood.

Changes in the way that emotions and mood vary

blunting or flattening
Reduced variation in emotion and mood.

Changes in the way that emotions and mood vary

Apathy
Severe flattening


Changes in the way that emotions and mood vary
incongruous or inappropriate
Emotional variation in a way that is not in keeping with the person’s circumstances and thoughts.

Clinical associations of emotional and mood disturbances

Mood disorders
Anxiety disorders.
Eating disorders
Substance-induced disorders
Delirium
Dementia
Schizophrenia

Disturbances of perception

Perception and imagery
Illusions
Hallucinations

Description of hallucinations

Description of hallucinations


Disturbances of thoughts
Delusions
Obsessional and compulsive symptoms
Overvalued ideas

Descriptions of delusions

Obsessional and compulsive symptoms
Obsessions
Thoughts
Ruminations
Doubts
Impulses
Obsessional phobias
Compulsions (rituals)
Obsessional slowness

The content (or themes) of obsessions can be grouped into one or other of six categories:

● dirt and contamination
● aggression
● orderliness
● illness
● sex
● religion.


Overvalued ideas
An overvalued idea is a comprehensible and understandable idea which is pursued beyond the bounds of reason. It may preoccupy and dominate a person’s life for many years, and affect their actions.

Overvalued ideas differ from delusions in two main ways.

The content of, and basis for, the overvalued idea is usually understandable when the person’s background is known, whereas delusions and the person’s explanation of them tend to be bizarre.

Overvalued ideas differ from delusions in two main ways.

The theme also tends to be culturally common and acceptable, as in the overvalued ideas about body shape that characterize anorexia nervosa.

Disturbances of thinking processes

Disturbances of the stream of thought
Disorders of the form of thought

Disturbances of the stream of thought

Thought block
Sometimes the stream of thought is interrupted suddenly.
The patient feels that his mind has gone blank,
observer notices a sudden interruption in the patient’s speech.
E.g. when a person is tired, anxious, or distracted (minor degree); schizophrenia.

Disorders of the form of thought (formal thought disorder)

It is usually recognized from 
speech
Writing
patient’s behaviour


Disorders of the form of thought (formal thought disorder)
Perseveration
Flight of ideas
Loosening of associations

Disorders of the form of thought (formal thought disorder)

Perseveration
Perseveration is the persistent and inappropriate repetition of the same thoughts.
The disorder is detected by examining the person’s words or actions.
Perseveration occurs in dementia and frontal lobe injury.

Disorders of the form of thought (formal thought disorder)

Loosening of associations
This denotes a loss of the normal structure of thinking.
To the interviewer the patient’s discourse seems muddled,illogical, or tangential.

Disorders of the form of thought (formal thought disorder)

Three characteristic kinds of loosening of associations have been described, all of which are seen most often in schizophrenia.
talking past the point (Vorbeireden)
Knight’s move or derailment
Verbigeration


Disorders of the form of thought (formal thought disorder)
talking past the point (Vorbeireden)
the patient seems always about to get to the endpoint of the topic in question, but then skirts round it and never in fact reaches it.

Disorders of the form of thought (formal thought disorder)

Knight’s move or derailment
refers to a transition from one topic to another, either between sentences or in mid-sentence, with no logical relationship between the two topics and no evidence of the associations.

Disorders of the form of thought (formal thought disorder)

Verbigeration
is said to be present when speech is reduced to the senseless repetition of sounds, words, or phrases.
This abnormality can occur with severe expressive aphasia and occasionally in schizophrenia.
When this abnormality is extreme, the disorder is called word salad.

Other disorders of thinking

Neologisms
words or phrases invented by the patient, often to describe a morbid experience.
Before deciding that a word is a neologism, the interviewer should ask the patient what he means by it.
Neologisms occur most often in chronic schizophrenia.

Depersonalization and derealization

Depersonalization
is a change of self-awareness such that the person feels unreal, detached from his own experience, and unable to feel emotion.


Depersonalization and derealization
Derealization
is a similar change in relation to the environment, such that objects appear unreal and people appear as lifeless two-dimensional ‘cardboard’ figures.

Depersonalization and derealization

Depersonalization and derealization are experienced 
quite commonly by healthy people—especially when they are tired after sleep deprivation
sensory deprivation,
as an effect of hallucinogenic drugs.
They occur in anxiety disorders,
post-traumatic stress disorder,
Depressive disorders,
schizophrenia,
temporal lobe epilepsy.
depersonalization–derealization syndrome.

Motor symptoms and signs

Tics
Mannerisms
Stereotypies
Catatonia
Catalepsy (waxy flexibility, flexibilitas cerea)
Posturing
Grimacing
Negativism
Echopraxia
Mitgehen
Ambitendence


Motor symptoms and signs
Tics
are irregular repeated movements involving a group of muscles—for example, sideways movement of the head or the raising of one shoulder.

Motor symptoms and signs

Mannerisms
are repeated movements that appear to have some functional significance—for example, saluting.

Motor symptoms and signs

Stereotypies
are repeated movements that are regular (unlike tics) and without obvious significance (unlike mannerisms)—for example, rocking to and fro.

Motor symptoms and signs

Catatonia
is a state of increased muscle tone that affects extension and flexion and is abolished by voluntary movement.

Motor symptoms and signs

Catalepsy (waxy flexibility, flexibilitas cerea)
is a term used to describe the tonus in catatonia.
It is detected when a patient’s limbs can be placed in a position in which they then remain for long periods while at the same time muscle tone is uniformly increased.
Patients with this abnormality sometimes maintain the head a little way above the pillow in a position that a healthy person could not maintain without extreme discomfort (psychological pillow).


Motor symptoms and signs
Posturing
is the adoption of unusual bodily postures continuously for a long time.
The posture may appear to have a symbolic meaning (e.g. standing with both arms outstretched as if being crucified), or may have no apparent significance (for example, standing on one leg).

Motor symptoms and signs

Negativism.
Patients are said to show negativism when they do the opposite of what is asked, and actively resist efforts to persuade them to comply.

Motor symptoms and signs

Echopraxia
occurs when the patient imitates the interviewer’s movement automatically, even when asked not to do so.

Motor symptoms and signs

Mitgehen (going along with)
describes another kind of excessive compliance in which the patient’s limbs can be moved into any position with the slightest pressure.

Motor symptoms and signs

Ambitendence.
Patients are said to exhibit ambitendence when they alternate between opposite movements—for example, putting out the arm to shake hands, then withdrawing it, extending it again, and so on repeatedly.