PSYCHIATRIC NURSING TYPICAL SIGNS AND SYMPTOMS OF PSYCHIATRIC ILLNESS DEFINED I. CONSCIOUSNESS: State of awareness A.

DISTURBANCES OF o Apperception: Perception modified by one’s own emotions & thoughts CONSCIOUSNESS 1. 2. 3. 4. Disorientation Clouding of consciousness Stupor Delirium o Sensorium: State of cognitive functioning of the special senses Disturbance of orientation in time, place, or person. Incomplete clearmindedness w/ disturbances in perception & attitudes Lack of reaction to & unawareness of surroundings. Bewildered, restless, confused, disoriented reaction associated with fear & hallucinations. Profound degree of unconsciousness. Coma in w/c a px appears to be asleep but ready to be aroused (akinetic mutism) Disturbed consciousness w/ hallucinations Often used as a synonym for complex partial seizure or psychomotor epilepsy Abnormal drowsiness Disturbance of consciousness in w/c reactions to environmental stimuli are inappropriate: manifested by a disordered orientation in relation to TPP A state of impaired awareness associated with a desire or inclination to sleep Syndrome in older people that usually occurs at night & is characterized by drowsiness, confusion, ataxia & falling as the result of being overly sedated w/ medications (Sundowner’s Syndrome) Is the amount of effort exerted in focusing on certain portions of an experience; Ability to sustain a focus on one activity ; Ability to concentrate Inability to concentrate attention; state in w/c attention is drawn to unimportant or irrelevant external stimuli Blocking out only those things that generate anxiety Excessive attention & focus on all internal & external stimuli, usually 2ndary to delusional or paranoid states Focused attention & altered consciousness, usually seen in hypnosis, dissociative d/o’s, & ecstatic religious experiences Compliant & uncritical response to an idea or influence Communicated emotional illness bet 2 (3) persons Artificially induced modification of consciousness characterized by a heightened suggestibility Complex feeling state w/ psychic, somatic, & behavioral components that is r/t affect & mood Observed expression of emotion Condition in w/c the emotional tone is in harmony w/ the accompanying idea, thought, or speech Disharmony bet the emotional feeling tone & the idea, thought, or speech accompanying it Disturbance in affect manifested by a severe reduction in the intensity of externalized feeling tone Reduction in intensity of feeling tone les severe than blunted affect but clearly reduced Absence or near absence of any signs of affective expression; voice monotonous, face immobile Rapid & abrupt changes in emotional feeling tone, unrelated to external stimuli A pervasive & sustained emotion, subjectively experienced & reported by a px & observed by others an unpleasant mood normal range of mood, implying absence of depressed or elevated mood a person's expression of feelings without restraint, frequently with an overestimation of their significance or importance. oscillations between euphoria & depression or anxiety Air of confidence & enjoyment; a mood more cheerful than usual intense elation with feelings of grandeur Feeling of intense rapture psychopathological feeling of sadness A state in w/c a person is easily annoyed & provoked to anger loss of interest in and withdrawal from all regular and pleasurable activities, often associated with depression sadness appropriate to a real loss a person's inability to or difficulty in describing being aware of emotions or mood. thoughts or act of taking one's own life. Feelings of joy, .euphoria, triumph, intense self-satisfaction, or optimism.

5. Coma 6. Coma Vigil 7. Twilight state 8. Dreamlike state 9. Somnolence 10. Confusion 11. Drowsiness 12. Sundowning B. Disturbances of Attention

1. Distractibility 2. Selective inattention 3. Hypervigilance 4. Trance C. Disturbances in suggestibility 1. Folie a deux ( folie a trois) 2. Hypnosis II. Emotion: A. Affect 1. Appropriate affect 2. Inappropriate affect 3. Blunted affect 4. Restricted or Constricted 5. Flat affect 6. Labile affect B. MOOD 1. Dysphoric mood 2. Euthymic mood 3. Expansive mood 4. Mood swings (labile mood) 5. Elevated mood 6. Euphoria 7. Ecstasy 8. Depression 9. Irritable 10. Anhedonia 11. 12. 13. 14. Grief or mourning Alexithymia Suicidal ideation Elation

C. OTHER EMOTIONS

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1. Anxiety 2. Free-floating anxiety 3. Fear 4. A g ita tio n 5. Tension 6. Panic 7. Apathy 8. Ambivalence 9. Abreaction 10. Shame 11. Guilt 12. Impulse control 13. Melancholia D. PHYSIOLOGICAL DISTURBANCES ASSOCIATED WITH MOOD: 1. Anorexia 2. Hypcrphagia 3. Insomnia a. Initial b. Middle c. Terminal 4. Hypersomnia 5. Diurnal variation 6. Diminished libido 7. Constipation 8. Fatigue 9. Pica 10. Pseudocyesis

Feeling of apprehension caused by anticipation of danger, w hich m ay ibet e r n a lor n ex te rn al. P e rv a s iv e unfocused , fear nota t t a c h e dlo any idea. A n x i e t ycaused by consciously recognized r e a l i s t i cdanger. and severe a n x ie ty associatedw it h moto r restlessness. increased and unpleasant motor and psychological activity. acute, episodic, inten se a t t a c k of a n x ie t y associated with overwhelming feelings of dread and autonomic discharge. d u ll e d emotional tone associated i t h detachment or indifference w coexistence of two opposing im pulses toward the sameh in g in the same thing in t the same person th e same tim e. at emotional release or discharge after recalling a painful experience. failure to live up to self-expectations. emotion secondary to doing what is perceived as wrong. ability to resist an impulse, drive, or temptation to perform an action. severe depressive state; used in the term involutional melancholia both descriptively and also in reference to adistinct diagnostic entity signs of somatic (usually autonomic) dysunction, most often associatedwith f depression(Also called vegetative signs). loss of or decrease in appetite. increase in appetite and intake of food. lack of or diminished ability to sleep. difficulty in falling asleep difficulty in sleeping through thenight without waking up and difficulty in going back to sleep. early morning awakening excessive sleeping mood is regularly worst in themorning, immediately after awakening, and improves as the day progresses. decreased sexual interest, drive, and performance (increasedlibido is o f ten associated with manic states). inability to defecate or difficulty in defecating. a feeling of weariness, sleepiness, orirritability following a period of mental or bodily activity. craving and eating of nonfood substances, such as paint and clay (usually girls) rare condition in which a patienthas the signs and symptoms of pregnancy,such as abdominal distention, breast enlargement, pigmentation, cessation of menses, and morning sickness. insatiable hunger and voracious eating; seen in bulimia nervosa and a typical depression aspect of the psyche that includes impulses, motivations, wishes, drives, instincts, and cravings, as-expressed by a person's behavior or motor activity. pathological imitation of movements of one person by another. seen in catatonic schizophrenia and some cases of brain diseases, such as encephalitis. general term for an immobile position that is constantly maintained agitated, purposeless motor activity uninfluenced by external stim uli markedly slowed motor activity, often a point of immobility and seeming ID unawareness of surroundings Voluntary assumption of a rigid posture,-held against all efforts to moved. be voluntary assumption of an inappropriate or bizarre posture, gen erally maintained for long periods condition of a person who can be molded into a position that is then maintained; when an examiner moves the person's limb, the limb feels as if it were made of wax. lack of physical movement, as in extreme immobility of catatonic schizo the phrenia; may also occur as an extrapyramidal side effect of antipsychotic medication. motiveless resistance to all at tempts to be moved or to all instructions temporary loss of muscle tone and weakness precipitated by a variety of emo tional states. repetitive fixed pattern of physical action or speech. ingrained, habitual involuntary movement. automatic performance of an act or acts generally representative of unconscious symbolic activity. automatic following of suggestions (also automatic obedience). voicelessness without structural ab normalities. Excessive & motor & cognitive overactivity, usually nonproductive & in response to inner tension. Restless, aggressive, destructive activity, often associated with some underlying brain pathology Involuntary, spasmodic motor movement motor activ y during sleep. it

11. Bulimia 12. Adynamia III. MOTOR BEHAVIOR BEHAVIOR (CONATION): 1. Echopraxia 2. Catatonia and postural abnormalities a. Catalepsy b. Catatonic excitement c. Catatonic stupor d. Catatonic rigidity e. Catatonic posturing f. Cerea flexibilitas (waxy flexibility) g. Akinesia 3. Negativism 4. Cataplexy 5. Stereotypy 6. Mannerism 7. Automatism 8. Command automatism 9. Mutism 10. Overactivity a. Psychomotor agitation b. Hyperactive (hyperkinesis) c. Tic d. Sleepwalking (somnambulism)

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subjective feeling of musculartension secondary to antipsychotic or other medication, which can cause restlessness,pacing, repeated sitting and standing; can be mistaken for psychotic agitation f. Compulsion uncontrollable impulse to perorm an act repetitively f i. Dipsomania compulsion to drink alcohol ii. Kleptomania compulsion to steal iii. Nymphomania excessive and compul ive need for coitus in a woman s iv. Satyriasis excessive and compulsive need for coitus in a man v. Trichotillomania compulsion to pull out hair vi. Ritual automatic activity, compulsivein nature, anxiety reducing in origin g. Ataxia failure of muscle coordination; ir egularity of muscle action r H. Polyphagia pathological overeating i. Tremor rhythmical alteration in movement,which is visually faster than one beat a second; typically, tremors decrease during periods of relaxation and sleep and increase during periods of anger and increased ten sion. | 1 1 . Hypoactivity (Hypokinesis) decreased motor and cognitive activity, as in psychomotor retar dation; visible slowing of thought, speech, and movements. 12. Mimicry simple, imitative motor activity of childhood. 13. Aggression forceful, goal-directed action thatmay be verbal or physical; the motor counterpart of the affect of rage, anger, or hostility 14. Acting Out direct expression of an uncon scious wish or impulse in action; living out unconscious fantasy impulsively in behavior 15. Abulia reduced impulse to act and think, associated with indifference about consequences of action; a result of neurological deficit 16. Anergia lack of energy (anergy) 17. Astasia abasia the inability to stand or walk in a normal manner, even though normal leg movements can be performed in asitting or lying down position. The gait is bizarre and is not suggestive of a specific organic lesion; seen in conversion disorder. 18. Coprophagia eating of filth or feces 19. Dyskinesia difficulty in performing voluntarymovements, as in extrapyramidal disorders. 20. Muscle rigidity state in which the muscles re main immovable; seen in schizophrenia. 21. Twirling a sign present in autistic childrenwho continually rotate in the direction in which their head is turned. 22. Bradykinesia slowness of motor activity w ith n decrease in normal spontaneous movement. 23. Chorea random and involuntary quick, jerky, purposeless movements. 24. Convulsion An involuntary, violent muscular contraction or spasm a. Clonic convulsion convulsion in which the muscles alternately contract and relax b. Tonic convulsion convulsion in which the muscle contraction is sustained 25. Seizure an attack or sudden onset of certain symptoms, such as convulsions, loss of consciousness, and psychic or sensory distur bances; seen in epilepsy and can be substance-induced a. Generalized tonic-clonic seizure generalized onset of tonic-clonic movements of the limbs, tongue biting, and incontinence fol lowed by slow, gradual recovery of con sciousness and cognition; also called grand mal seizure and psychomotor seizure b. Simple partial seizure localized ictal onset of seizure without alteration:; in conscious ness. c. Complex partial seizure Localized ictal on set of seizure with alterations in conscious ness 26. Dystonia slow, sustained contractions of the trunk or limbs; seen in medicationinduced dystonia Goal-directed flow of ideas, symbols, and associations initiated by a problem or task and leading toward a reality-oriented conclusion; when a logical sequence occurs, thinking is normal; parapraxis (un consciously motivated lapse from logic IV. THINKING is also called a freudian slip) considered part of normal thinking. A. GENERAL DISTURBANCES IN FORM OR PROCESS OF THINKING 1. Mental disorder Clinically significant behavior or psychological syndrome associated with dist ress or disability, not just an expected re sponse to a particular event or limited to rela tions between a person and society. 2. Psychosis inability to distinguish reality from fantasy; impaired reality testing, with the creat ion of a new reality (as opposed to neurosis: mental disorder in which reality testing is in tact; behavior may not violate gross social norms, but is relatively enduring or recurrent without treatment) 3. Reality testing Objective evaluation and judgment of the world outside the self. 4. Formal thought disorder disturbance in the form of thought rather than the content of thought; thinking characterized by loosened associations, neologisms, and illogical constructs; thought process is disordered and the person is defined as psychotic 5. Illogical thinking Thinking containing erroneous conclusions or intern al contradictions; psychopathological only when it is marked & when not caused by cultural values or intellectual deficit. 6. Dereism mental activity not concordant with logic or experience 7. Autistic thinking Preoccupation with inner, private world; term used somewhat synony mously with dereism. 8. Magical thinking A form of dereistic thought; thinking similar to that of the preoperational phase in children(jean piaget), in which thoughts, words, or actions assume power (e.g. to cause or prevent events) e. Akathisia

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9. Primary processthinking General term for thinking that is dereistic, illogical;-magical; normally found in dreams, abnormally in psy chosis. Deep level of understandingor awareness that is likely to lead to positive changes in personality and behavior. B. SPECIFIC DISTURBANCES IN FORM OF THOUGHT New word created by a patient, often by combining syllables of other words, for idiosyncratic psychological reasons. incoherent mixture of words and phrases. indirect speech that is delayed in reaching the point but eventually gets from original point to desired goal; characterized by an over inclusion of details and parenthetical remarks. Inability to have goal-directed associations of thought; speaker never gets from desired point to desired goal. Thought that generally is not understandable; running together of thoughts or words; with no logical or grammatical connection, re su ltin gin diso rganiza tion. Persisting response to p r e v i o u ss t i m u l u safter a new t i m u l u shas been presented; often a s associatedw i t h c o g n it i v ed is o rders. meaningless repetition of specific words or phrases psychopathological repeating of words or phrases of one person by another; tends to be repetitive and persistent; may be spoken with mocking or staccato intonation Fusion of various concepts into one Answer that is not in harmony with question asked (person appears to ignore or not attend to question). Flow of thought in which ideas shift from one subject to another in a completely unrelated way: when sever speech may be incoherent.

10. Emotional insight 1. Neologism 2. Word salad 3. Circumstantiality

4. Tangetiality 5. Incoherence 6. Perseveration 7. Verbigeration 8. Echolalia 9. condensation 10. irrelevant answer 11. Loosening of association 12. derailment 13. flight of ideas

Rapid, continuous verbalizations or plays on words produce constant shifting from one idea to another; ideas tend to be connected, & in the less severe from a listener may be able to follow them. 14. Clang association Association of words similar in sound but not in meaning; words have no logical connection; nay include rhyming and punning. 15. Blocking Abruption eruption in train of thinking before a though or idea is finished; after a brief pause, person indicates no recall of what was being said or was going to be said (also known as thought deprivation). 16. Glossolalia expression of a revelatory message through unintelligible words (also known as speaking in tongues); not considered a distur bance in thought if associated with practices of specific Pentecostal religions C. SPECIFIC DISTURBANCES IN CONTENT OF THOUGHT 1. Poverty of content Thought that gives little information because of vagueness, empty repeti tions, or obscure phrases. 2. Overvalued idea Unreasonable, sustained false belief maintained less firmly than a delusion 3. Delusion false belief, based on incorrect inference about external reality, not consistent with patient's intelligence, and cultural background; cannot be corrected by reasoning a. Bizarre delusion an absurd, totally implausible, strange false belief (for example, invaders from space have implanted electrodes in a person's brain). b. Systematized delusion False belief of beliefs united by a single event or theme (for example, a person is being persecuted by the CIA, the FBI, or the Mafia). c. Mood-congruent delusion Delusion with mood-appropriate content (for example, a depressed patient believes that he or she is responsible for the destruction of the world). d. Mood-incongruent delusion Delusion with content that has no association to mood or is mood neutral (for example, a depressed patient has delusions of thought control or thought broadcasting). e. Nihilistic delusion False feeling that self, others, or the world is nonexistent or, comin g to an end. f. delusion of poverty A person’s false belief that he or she is bereft or will be deprived of all material possessions. g. somatic delusion False belief involving functioning of the body h. paranoid delusion i. delusion of persecution ii. delusion of grandeur iii. delusion of reference A person’s false belief that the behavior of others refers to himself or herself; that events, objects, or other people have a particular & unusual significance, usually of a negative nature; derived from idea of reference, in which a person falsely feels that others are talking about him or her ( for example, belief that people on TV or radio are talking to or about the person) i. Delusion of self accusation False feeling of remorse or guilt j. delusion of control False feeling that a person’s will, thoughts, or feelings are being controlled by external forces. i. thought withdrawal Delusion that thoughts are being removed from a person’s mind by other people or forces

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ii. thought insertion iii. thought broadcasting iv. thought control K . delusion of infidelity (delusional jealousy) l. erotomania m. pseudologia phantastica 4. Trend or preoccupation of thought 5. Egomania 6. monomania 7. hypochondria 8. obsession 9. compulsion

10. coprolalia 11. phobia a. specific phobia b. social phobia c. acrophobia d. agoraphobia e. algophobia f. ailurophobia g. erythrophobia h. panphobia i. claustrophobia j. xenophobia k. zoophobia l. needle phobia 12. Noesis 13. Unio Mystica V. Speech A. DISTURBANCES IN SPEECH 1. Pressure of speech 2. Volubility(logorrhea) 3. poverty of speech 4. nonspontaneous speech

Delusion that thoughts are being implanted in a person’s mind by other people or forces Delusion that a person’s thoughts can be heard by others, as though they were being broadcast over the air. Delusion that a person’s thoughts are being controlled by other people or forces. False belief derived from pathological jealousy about a person’s lover being unfaithful. Delusional belief, more common in women than in men, that someone is deeply in love with them (also known as Clerambault-Kandinsky complex) A type of lying in which a person appears to believe in the reality of his or her fantasies and acts on them, associated with Munchausen’s syndrome, repeated feigning of illness. Centering of thought content on a particular idea, associated with a strong affective tone, such as a paranoid trend or a suicidal or homicidal preoccupation Pathological self-preoccupation Preoccupation with a single object Exaggerated concern about health that is based not on real organic pathology but, rather, on unrealistic interpretations of physical signs or sensations as abnormal. Pathological persistence of an irresistible thought or feeling that cannot be eliminated from consciousness by logical effort; associated with anxiety Pathological need to act on an impulse that, if rested, produces anxiety; repetitive behavior in response to an obsession or performed according to certain rules, with no true end in itself other than to prevent something from occurring in the future Compulsive utterance of obscene words Persistent, irrational, exaggerated, & invariably pathological dread of a specific stimulus or situation; results in a compelling desire to avoid the feared stimulus. Circumscribed dread of a discrete object or situation ( dread of spiders or snakes) Dread of public humiliation, as in fear of public speaking, performing, or eating in public. Dread in open places Dread of pain Dread of cats Dread of red (refers to a fear of blushing) Dread of Everything Dread of closed places Dread of strangers Dread of animals The persistent, intense, pathological fear of receiving an injection. A revelation in which immense illumination occurs in association with a sense that a person has been chosen to lead & command An oceanic feeling of mystic with an infinite power; not considered a disturbance in thought content if congruent with person’s religious or cultural milieu.

Rapid speech that is increased in amount & difficult to interrupt Copious, coherent, logical speech Restriction in the amount of speech used; replies may be monosyllabic Verbal responses given only when asked or spoken to directly; no selfinitiation of speech 5. Poverty of content of speech speech that is adequate in amount that conveys little information because of vagueness, emptiness, or stere otyped phrases. 6. Dysprosody loss of normal speech melody (called prosody). 7. dysarthria Difficulty in articulation, not in word finding or in grammar 8. excessive loud or soft speech loss of modu lation of normal speech volume; may reflect a variety of pathological conditions ranging from psychosis to depression to deafness. 9. Stuttering frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency 10. cluttering Erratic & dysrhytmic speech, consisting of rapid & jerky spurts B. APHASIC DISTURBANCES: DISTURBANCES IN LANGUAGE OUTPUT 1. Motor aphasia Disturbance of speech caused by a cognitive disorder in which understanding remains but ability to speak is grossly im paired; halting, laborious, and inaccurate speech (also known as Broca's, nonfluent, and expressive aphasia). 2. Sensory aphasia Organic loss of ability to comprehend the meaning of words; fluid

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3. Nominal aphasia 4. Syntactical aphasia 5. Jargon aphasia 6. Global aphasia 7. Alogia 8. copropregia VI. Perception: A. DISTURBANCES OF PERCEPTION 1. Hallucination a. Hypnagogic hallucination b. Hypnopompic hallucination c. Auditory hallucination d. Visual hallucination e. Olfactory hallucination f. Gustatory hallucination g. Tactile (haptic) hallucination h. Somatic hallucination i. Lilliputian hallucination j. Mood-congruent hallucination

and spontaneous but incoherent and nonsensical speech (also known as Wernicke's, fluent, and receptive aphasia). Difficulty in finding correct name for an object (also termed anomia and amnestic aphasia). Inability to arrange words in proper sequence. Words produced are tota lly neologistic; nonsense words repeated with various intonations and infle ctions . Combination of a grossly non- fluent aphasia and a severe fluent aphasia. Inability to speak because of a mental deficiency or an episode of dementia Involuntary use of vulgar or obscene language; seen in Tourette’s disorder and some cases schizophrenia process of transferring physical stimulation into psychological information; mental process by w/c sensory stimuli are brought to awareness. False sensory perception not as sociated with real external stimuli; there may or may no! be ade lus ion al-in terp re tationof the hallucinatory experience False sensory perception not associated with real external stimuli; there may or may not be delusional interpretation of the hallucinatory experience. False perception occurring while awakening from sleep False perception of sound, usually voices but also other noises, such as music; most common hallucination in psychiatric disorders. False perception in volving sight consisting of both formed im ages (for example, people) and unformed images (for example, flashes of Light); most common in medically determined disorders. False perception of smell; most common in medical disorders. False perception of ta s t e , such as unpleasantta ste , caused by an uncinate seizure; most common in medical disorders. False perception of touch or surface sensation, as from an amputated limb (phantom limb); crawling sensation on or under the skin (formication) False sensation of things occurring in or to the body, most often visceral in origin (also known as cenesthesic hallucination) False perception in which objects are seen as reduced in size (also termed micropsia) Hallucination in which the content is consistent with either a depressed or a manic mood (for ex ample, a depressed patient hears voices say ing that the patient is a bad person; a manic patient hears voices saying that the patient is of inflated worth, power, and knowledge). Hallucination in which the content is not consistent with either depressed or manic mood (in depression, hallucinations not involving such themes as guilt, deserved punishment or inadequacy; in mania, hallucinations not involving such themes as inflated worth or power. Hallucinations, most often auditory, that are associated with chronic alcohol abuse and that occur within a clear sensorium, as opposed to delirium tremens, hallucinations that occur in the text of a clouded sensorium. Perceptual abnormality associated with hallucinogenic drugs in which moving objects are seen as series of discrete and discontinuous images. Misperception or misinterpretation of real external sensory stimuli : agnosia – an inability to recognize & interpret the significance of sensory impressions. A person's inability to recognize a neurological deficit as occurring to himself or herself. A person’s inability to recognize a body part as his or her own (autotopagnosia) Inability to recognize objects or persons. inability to recognize objects by touch. inability to recognize faces Inability to carry out specific tasks inability to comprehend more than one element of a visual scene at a time or to integrate the parts into a whole inability to perform rapid alternating movements. warning sensations such as automatisms, fullness in the stomach, blushing, and changes in respiration; cognitive sensations, and affec tive states usually experienced before a seiz ure; a sensory prodrome that precedes a clas sic migraine headache. somatization of repressed material or the development of physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control an{! not explained by any physical disorder. loss of sensory modal ities resulting from emotional conflicts

k. Mood-incongruent hallucination

l. Hallucinosis

m. Trailing phenomenon n. command hallucination 2. Illusion B. DISTURBANCES ASSOCIATED WITH COGNITIVE DISORDER & MEDICAL CONDITIONS 1. Anosognosia (ignorance of illness) 2. Somatognosia (ignorance of the body) 3. Visual agnosia 4. Astereognosis 5. Prosopagnosia 6. apraxia 7. Simultagnosia 8. Adiadochokinesia 9. Aura

C. DISTURBANCES ASSOCIATED WITH CONVERSION AND DISSOCIATIVE PHENOMENA 1'. Hysterical anesthesia

:

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2. Macropsia 3. Micropsia

4. Depersonalization 5. Derealization 6. Fugue 7. Multiple personality 8. Dissociation

VII. Memory: A. DISTURBANCES OF MEMORY 1. Amnesia a. Anterograde b. Retrograde 2. Paramnesia a. Fausse reconnaissance b. Retrospective falsification c. Confabulation d. Déjà vu

state in which objects seem larger than they are State in which objects seem smaller than they are (both macropsia and micropsia can also be associated with clear organic con ditions, such as complex partial seizures). A person's subjective sense of being unreal, strange, or unfamiliar. A subjective sense that the environment is strange or unreal; a feeling of changed reality. Taking on a new identity with amnesia for the old identity; often involves travel or wandering to new environments. One person who appears at different times to be tow or more entirely different personalities and characters(called DID in the 4th edition DSM-IV) Unconscious defense mechanism involving the segregation of any group of mental or behavioral processes from the rest of the person’s psychic activity; may entail the separation of an idea from its accompanying emotional tone, as seen in dissociative & conversion disorders. function by which information stored in the brain is later recalled to consciousness Partial or total inability to recall past experiences; may be organic or emotional in o rigin. Amnesia for events occurring after a point in time Amnesia for -vents occurring b efore a point in time. Falsification of memory by distort ion of recall. false recognition Memory be comes unintentionally (unconsciously) dis torted by being filtered through a person's present emotional, cognitive, and experient ial state. Unconscious filling of gaps in memory by imagined (r untrue experi ences that a person believes but that have no basis in fact; most often associated with | organic pathology. Illusion of visual recognition in which a new situation is incorrectly regarded as a repetition of a previous mem ory. Illusion of auditory recognit ion. Illusion that a new thought is recognized as a thought previously fell or expressed. false feeling of unfamiliarity with a real situation that a person has experienced A person's recollection and belief by the patient of an event that did not actually occur. Exaggerated degree of retention and recall. Visual memory of almost hallucinatory vividness a consciously tolerable mem ory covering for a painful memory A defense mechanism characterized by unconscious forgetting of unacceptable ideas or impulses. Temporary inability to remember a name or a proper noun. Amnesia experienced by alcoholics about behavior during drinking bouts; usually indicates that reversible brain damage has oc curred. Reproduction or recall of perceived material within seconds to minutes Recall of events over past few days Recall of events over past few months Recall of events in distant past ability to understand, recall, mobilize, and constructively integrate previous learning in meet ing new situations. lack of intelligence to a de gree in which there is interference with social and vocational performance: mild (IQ of 50 or 55 to approximately 70), moderate (IQ of 35 or 40 to 5O or 55), severe (IQ of 20 or 25 to 35 or 40), or profound (IQ below 20 or 25); obsolete terms are id iot (mental age less than 3 years), imbecile (mental age of 3 to 7 years), and moron (mental age of about 8). Organic and global deterioration of in tellectual functioning without clouding of con sciousness. Loss of ability to do calculations; not caused by anxiety or impair ment in concentration. Loss of ability to write in cursive style; loss of word structure. Loss of a previously possessed reading facility; not explained by defective visual activ ity. Clinical features resembling a dementia not caused by an organic condition; most often caused by depression (dementia syndrome of depression). literal thinking; limited use of metaphor without understanding of nuances of meaning; one-dimensional thought. Ability to appreciate nuances of meaning; multidimensional thinking with ability to use metaphors and hypotheses appropriately. A person's ability to understand the true cause and meaning of a situation

e. Déjà entendu f. Déjà pense g. Jamais vu h. False memory 3. 4. 5. 6. Hypermnesia Eidetic image Screen memory Repression

7. Lethologica 8. Blackout 1. 2. 3. 4. B. LEVELS OF MEMORY Immediate Recent Recent past Remote VIII. INTELLIGENCE:

a. Mental retardation

b. Dementia I. Dyscalculia (acalculia) 2. Dysgraphia (agraphia) 3. Alexia c. Pseudodementia

d. Concrete thinking e. Abstract thinking IX. INSIGHT

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a. Intellectual insight B. True insight C. Impaired insight X. JUDGMENT A. Critical judgment b. Automatic judgment c. Impaired judgment

(such as a set of symp toms). Understanding of the objective reality of a set of circumstances without the ability to apply the understanding in any useful way to master the situation understanding of the objective real ity of a situation, coupled with the motivation and the emotional impetus to master the situation. diminished ability to understand the objective reality of a situation Ability to assess a situation correctly and to act appropriately in the situation. Ability to assess, discern, and choose among various options in a situation Reflex performance of an action. Diminished ability to Under stand a situation correctly and to act appropriately.

DEFENSE MECHANISMS Denial Distortion Splitting Projection Acting Out Blocking Hypochondriasi s Introjection PassiveAggressive Behavior Regression Fixation Somatization Schizoid Fantasy Controlling Displacement Dissociation Compensation Externalization Identification Inhibition Intellectualizati on Isolation Rationalization Reaction Formation Repression Substitution Sexualization Anticipation Humor Asceticism Sublimation Suppression

Means and ways of avoiding emotional stress, destructive impulses, or threat to self-esteem NARCISSISTIC DEFENSES Avoidance of the aw areness of som e painful aspects of reality by negating the sensory data

External reality is grossly reshaped to suit inner needs including the unrealistic beliefs, hallucinations, wish thinking, delusions External objects are divided into extrem e category to the other "all good" and "all bad" accom panied by abrupt shifting of an object from one Unconscious blam ing of unacceptable inclinations or thoughts on an external object IMMATURE DEFENSES

The person expresses an unconscious w ish or im pulse through action to avoid being conscious of an accompanying effect. A tem porary or transient inhibition of thinking which resem bles repression but differs in that tension arises when the im pulse, affect or thoughts are inhibited Reproach arising from bereavem ent, loneliness, or unacceptable aggressive im pulses toward others is transform ed into self-reproach and complaints of pain, som atic illness, and neurasthenia. Accepting another person's attitudes, beliefs, and values as one's own Aggression towards others is expressed indirectly through passivity, m asochism , and turning against the s

Person m oves back to the previous developm ental stage in order to feel safe or have needs m et. The immobilization of a portion of a personality resulting from unsuccessful com pletion of tasks in a developm ent stage. Converting psychic derivatives into bodily sym ptom s & tending to react with som atic m anifestations, rathe than psychic m anifestations Through fantasy, the person indulges autistic retreat to resolve conflicts and obtain gratification.

NEUROTIC DEFENSES An excessive attem pt to m anage or regulate events or objects in the environm ent to m inim ize anxiety and resolve inner conflicts Involves the ventilation of intense feelings towards persons less threatening than the one whom aroused t feelings A tem porary but drastic m odification of a person's character or of one's sense of personal identity takes pl to avoid em otional distress Presence of overachievem ent in one area to offset real or perceived deficiencies in another area The tendency to perceive elem ents of one's own personality, including instinctual im pulses, conflicts, mood attitudes and styles of thinking in the external environm ent Modeling actions and opinions of influential others, while searching for identity, or aspiring to reach a personal, social, or occupational goal Lim itation or renunciation of ego functions that occur consciously Excessive use of intellectual processes to avoid affective expressions or experiences by paying attention to external reality Separation of the idea from the repressed affect that accom panies it Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect Acting the opposite of w hat one feels Excluding em otionally painful or anxiety provoking thoughts and feelings from conscious awareness Replacing the desired gratification w ith one that is m ore readily available An object or function is endowed with sexual significance that did not previously have or that it possessed sim ilar degree in order to ward off anxieties associated with prohibited im pulses or their derivatives. MATURE DEFENSES Planning for future inner discom fort that is goal-directed and im plies careful planning or worrying and prem ature but realistic affective expectation of dire and potentially dreadful outcom es Perm its the overt expression of unpleasant effect on others; Elim inating the pleasurable effects of experiences. There is m oral elem ent in assigning values to specific pleasures. Substituting a socially acceptable activity for an im pulse that is unacceptable A conscious or sem iconscious decision to postpone attention to a conscious im pulse or conflict

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