TYPICAL SIGNS and SYMPTOMS of MENTAL ILLNESS

OBJECTIVES in IDENTIFYING SIGNS and SYMPTOMS of MENTAL ILLNESS

 To make accurate diagnoses
 To carry out effective treatments
 To offer reliable prognoses
 To analyze psychiatric issues as fully as possible
 To communicate fruitfully with other clinicians

DEFINITION of TERMS
 SIGN: Observation and objective finding
 SYMPTOM: Subjective experience described by patient
 SYNDROME: Group of signs and symptoms that make up a recognizable
condition

SOME SIGNS and SYMPTOMS of MENTAL ILLNESS

CONSCIOUSNESS
 State of awareness
 Disturbances of consciousness
 Disturbances of attention
 Disturbances in suggestibility

DISTURBANCES of CONSCIOUSNESS
 Impairment in perception and sensorium
 Most often associated with brain pathology

SOME DISTURBANCES of CONSCIOUSNESS

 Disorientation - disturbance of orientation in time, place, or person
 Clouding of consciousness – incomplete clear-mindedness with disturbances in
perception and attitudes
 Stupor – lack of reaction to an unawareness of surroundings
 Coma – profound degree of unconsciousness
 Somnolence – abnormal drowsiness

DISTURBANCES of ATTENTION
 Inability to focus on certain portions of an experience
 Inability to focus on one activity
 Inability to concentrate

SOME DISTURBANCES of ATTENTION

 Distractibility –attention is drawn to unimportant external stimuli
 Hypervigilance – excessive inattention and focus on all internal and external
stimuli
 Trance – focused attention and altered consciousness

DISTURBANCES in SUGGESTIBILITY

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 Compliant and uncritical response to an idea or influence
 Folie a deux/a trois – communicated emotional illness between two/three persons
 Hypnosis – artificially induced modification of consciousness characterized by a
heightened suggestibility

EMOTION
 Complex feeling state with psychic, somatic and behavioral components
 Affect
 Mood
 Other emotions
 Physiological disturbances associated with mood

AFFECT
 Observed expression of emotion
 Possibly inconsistent with description of emotion

DESCRIPTIONS of AFFECT
 Appropriate –emotional tone in harmony with accompanying idea, thought or
speech
 Inappropriate – disharmony between emotional tone and idea, thought or speech
 Blunted – severe reduction in intensity of external feeling tone
 Restricted or constricted – reduction in intensity of feeling tone less severe than
blunted affect
 Labile – rapid and abrupt changes in emotional feeling tone, unrelated to external
stimuli

MOOD
 Pervasive and sustained emotion
 Subjectively experienced and reported

DESCRIPTIONS of MOOD
 Dysphoric – unpleasant mood
 Euthymic – normal range of mood
 Expansive – expression of feelings without restraint
 Irritable – easily annoyed and provoked to anger
 Elevated – air of confidence and enjoyment; mood more cheerful than usual
 Elation – feelings of joy, triumph, intense self-satisfaction or optimism
 Euphoria – intense elation with feelings of grandeur
 Ectasy – feeling of intense rapture
 Depression – psychopathological feeling of sadness
 Labile (mood swings) – oscillations between euphoria and depression or anxiety
 Anhedonia – loss of interest in and withdrawal from all regular and pleasurable
activities
 Alixethymia – inability or difficulty in describing or being aware of emotions or
mood

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 OTHER EMOTIONS
 Anxiety – feeling of apprehension caused by anticipation of internal or external
danger
 Free-floating anxiety – pervasive, unfocused fear not attached to any idea
 Fear – anxiety caused by consciously recognized and realistic danger
 Agitation – severe anxiety associated with motor restlessness
 Apathy – dulled emotional tone associated with detachment or indifference
 Ambivalence – two opposing impulses toward same thing in same person at same
time
 Shame – failure to live up to self-expectations
 Guilt – emotion secondary to doing what is perceived as wrong

PHYSIOLOGICAL DISTURBANCES ASSOCIATED with MOOD

 Signs of somatic (usually autonomic) dysfunction
 Most often associated with depression
 Also called vegetative signs

SOME PHYSIOLOGICAL DISTURBANCES ASSOCIATED with MOOD

 Anorexia – loss of or decrease in appetite
 Bulimia – insatiable hunger and voracious eating
 Hyperphagia – increase in appetite and intake of food
 Insomnia – lack or diminished ability to sleep
 Hypersomnia – excessive sleeping
 Constipation – inability to defecate or difficulty in defecating

MOTOR BEHAVIOR (CONATION)

 Aspect of psyche that includes impulses, motivations, wishes, drives, instincts and
cravings
 Expressed by behavior or motor activity

SOME DISTURBANCES in MOTOR BEHAVIOR

 Echopraxia – pathological imitation of movements of one person by another
 Catalepsy – immobile position that is constantly maintained
 Cataplexy – temporary loss of muscle tone and weakness precipitated by a
variety of emotional states
 Negativism – motiveless resistance to all attempts to be moved or to all
instructions

THINKING
 Goal-directed flow of ideas, symbols and associations initiated by a problem or
task and leading toward a reality-oriented conclusion
 Normal thinking is characterized by a logical sequence
 Parapraxis
 Freudian slip
 Unconsciously motivated lapse from logic
 Considered normal

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 SOME GENERAL DISTURBANCES in FORM or PROCESS of THINKING
 Reality testing – objective evaluation and judgment of the world outside the self
 Psychosis – inability to distinguish reality from fantasy; impaired reality testing
 Autistic thinking – preoccupation with inner, private world
 Magical thinking – similar to preoperational phase in children (Jean Piaget);
thoughts, words or actions assume power

SOME SPECIFIC DISTURBANCES in FORM of THINKING

 Circumstantiality – indirect speech that is delayed in reaching the point but
eventually gets from original point to desired goal
 Tangentiality – inability to have goal-directed associations of thought
 Loosening of associations – flow of thought in which ideas shift from one
subject to another in a completely unrelated way
 Flight of ideas – rapid, continuous verbalizations or plays on words creating
constant shifting from one idea to another

SOME SPECIFIC DISTURBANCES in CONTENT of THOUGHT

 Delusion
 False belief, based on incorrect inference about external reality
 Not consistent with one’s intelligence and culutural background
 Cannot be corrected by reasoning

 Overvalued idea – unreasonable, sustained false belief maintained less firmly

than a delusion
 Obsession – pathological persistence of an irresistible thought or feeling that
cannot be eliminated from consciousness by logical effort
 Phobia – persistent, irrational, exaggerated and invariably pathological dread of a
specific stimulus or situation

SPEECH
 Ideas, thoughts, feelings as expressed through language
 Communication through the use of words and language

SOME DISTURBANCES in SPEECH

 Pressure of speech – rapid, increased in amount and difficult to interrupt
 Poverty of speech - restricted amount; replies may be monosyllabic
 Poverty of content of speech – adequate in amount but conveys littel information
because of vagueness, emptiness or stereotyped phrases

PERCEPTION
 Process of transferring physical stimulation into psychological information
 Mental process by which sensory stimuli are brought to awareness

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 SOME DISTURBANCES of PERCEPTION
 Hallucination – false sensory perception not associated with real external stimuli
 Illusion – misperception or misinterpretation of real external sensory sitmuli
 Depersonalization – subjective sense of being unreal, strange or unfamiliar
 Derealization – subjective sense that environment is strange or unreal

MEMORY
 Function by which information stored in the brain is later recalled to
consciousness

SOME DISTURBANCES of MEMORY

 Amnesia – partial or total inability to recall past experiences
 Anterograde - occuring after a point in time
 Retrograde – occuring before a point in time
 Paramnesia – falsification of memory by distortion of recall
 Deja vu – illusion of visual recognition in which a new situation is incorrectly
regarded as a repetition of a previous memory
 Jamais vu – false feeling of unfamiliarity with a real situation that a person has
experienced

LEVELS of MEMORY
 Immediate – reproduction or recall of perceived material within seconds to
minutes
 Recent – recall of events over past few days
 Recent past – recall of events over past few months
 Remote – recall of events in distant past

INTELLIGENCE
 Ability to understand, recall, mobilize and constructively integrate previous
learning in meeting new situations

SOME DISTURBANCES of INTELLIGENCE

 Mental retardation – lack of intelligence resulting in interference with social and
vocational performance
 Dementia – organic and global deterioration of intellectual functioning without
clouding of consciousness
 Concrete thinking
 Literal thinking
 Limited use of metaphor without understanding of nuances of meaning
 One-dimensional thought
 Abstract thinking
 Ability to appreciate nuances of meaning
 Multidimensional thinking with ability to use metaphors and hypotheses
appropriately

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 INSIGHT
 Ability to understand the true cause and meaning of a situation

LEVELS of INSIGHT
 Intellectual –understanding of objective reality of set of circumstances without
ability to apply understanding in any useful way to master situation
 True – understanding of objective reality of a situation coupled with motivation
and emotional impetus to master situation
 Impaired – diminished ability to understand objective reality of situation

JUDGMENT
 Ability to assess a situation correctly and to act appropriately in the situation

LEVELS of JUDGMENT
 Critical – ability to assess, discern and choose among various options in a
situation
 Automatic – reflex performance of an action
 Impaired – diminished ability to understand a situation correctly and to act
appropriately