SYMPTOMATOLOGY: Signs and Symptoms of Psychiatric Disorders: February 2019

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SYMPTOMATOLOGY: Signs and Symptoms of Psychiatric Disorders
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Beni-Suef university
Faculty of Nursing
Psychiatric/Mental Health Nursing Department
SYMPTOMATOLOGY
Signs and Symptoms
of Psychiatric Disorders
Hussein M. Magdi
Lecturer of Psychiatric/Mental Health Nursing
Faculty of Nursing, Beni-Suef University
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Outline:
● Introduction
● Composition of Mind
1- Cognition
2- Emotion
3- Behavior
● References
Objectives
1. Recognize the composition of mind.

2. Recognize different terms related to psychiatric signs and symptoms.
3. Differentiate between psychosis and neurosis.
4. Discuss different psychiatric symptoms.
5. identify psychiatric symptoms presented by patients during
simulation/example.
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Introduction
A symptom is usually defined as a subjective experience described by the

patient, while a sign is defined as an objective finding observed by the nurse. In
psychiatry, the terms symptom and sign tend to be used synonymously because
abnormalities of mental state are largely elicited by exploring, with the patient,
their internal experiences.
Composition of Mind
The mind is composed of (3) spheres that represent the aspects of mental
functioning. These spheres are interrelated to each other.
They are:
❖ Cognition. [intellect/thinking/speech]
❖ Emotion. [mood/affect]
❖ Behavior.
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I. Cognition/Intellect/Thought/Speech
It includes the following functions:
● Thought
● Perception.
● Memory.
● Consciousness.
● Attention and concentration.
● Orientation.
● Judgment.
● Insight.
● General knowledge.
● Intelligence
1. Thought
Thinking is a mental activity which can be described only by patient speech.
Cannot be observed.
A) Stream of Thought:
a) Pressure of speech
b) Poverty of speech
c) Poverty of content of speech
d) Blocking
B) form of Thought:
a) General disturbances include:
i) Concrete thinking
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ii) Autistic thinking

b) Specific disturbance in the form of thought:
i) Tangentiality
ii) Circumstantiality
iii) Flight of ideas
iv) Loosening association
v) Incoherence
vi) World salad
vii) Clang Association
viii) Neologism
ix) Retardation
x) Echolalia
xi) Palalia
xii) Preservation
xiii) Irrelevant answer
C) Content of Thought
a) Delusion
b) Obsession
c) Preoccupation
d) Suicidal Ideation
A. Disturbances in stream of speech:
They are related to the amount and the speed of' thoughts which include the
following:
a) Pressure of speech: Forceful rapid loud speech that increases in the

amount and is difficult to interrupt. It is heard in schizophrenia, cognitive
disorder, a manic patient as a result of racing and overcrowded thoughts.
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b) Poverty of speech: restriction in the amount of speech used; replies may

be monosyllabic.
c) Poverty of content of speech: speech that is adequate in amount, but

conveys little information because of vagueness, emptiness, or
stereotyped phrases.
d) Blocking: Sudden cessation in the train of thinking before a thought or

idea is finished, usually in the middle of a sentence. After a brief pause,
the person indicates no recall of what was being said or was going to be
said. The patient feels suddenly that his mind has gone blank. It is
Common in schizophrenia and severe anxiety.
Example:
Patient: "I was going to get a new dress for...." after the patient stops
abruptly
Nurse: "What just happened now?"
Patient: "1 forgot what I was saying".
B. Disturbances in the form of thought:
a) General disturbances include:
Before discussing the disorder of the form of thought we should define abstract
thinking: is the ability to conceptualize ideas and to understand the implicit
meaning behind sentences and to make interpretations about a comment.
1. Concrete thinking:
Patients use literal meaning without understanding the implicit meaning behind
sentences. Patient with concrete thinking has not the ability to conceptualize the
words. So patients with concrete thinking did not understand what was said to
him and what he read so academic deterioration resulted.
Example:
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Proverb: people who live in glass houses shouldn’t throw stones).

Abstract thinking answer:
Don’t criticize others for faults you may have yourself.
Concrete thinking answer:
Don't throw stones because windows will break.
2. Autistic thinking
Thinking in which thoughts are largely egocentric with emphasis on subjectivity

rather than objectivity and without regard for reality. The patient is preoccupied
with the inner, private world in order to gratify in fantasy unfulfilled needs. It is
seen in young children, in those who have lost or never developed the ability to
generalize.
N.B. Delusions and hallucinations are examples of autistic thinking.

Concrete and autistic thinking are normal forms of thought during
the early stages of personality development.
b)Specific disturbance in the form of thought:
They are related to amount and association between thoughts, the goal
directed-sequences and the succession of thoughts.
1. Tangentiality:
The patient never gets from the desired point to the desired goal. So, he or she
goes off the core of the topic. The speaker introduces many unrelated topics,
until the original topic of discussion is lost, in which the central idea is not
communicated.
Example: The nurse asked the patient to talk more about his family. The
patient continuously left the topic and talked about his apartment,
his work and TV. Programs. Each time the nurse tried to help the
patient to focus, he would go off on another topic.
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2. Circumstantiality
The patient gives countless and unnecessary details before communicating the
central idea, but gets from desired point to the desired goal, observed in
schizophrenia, obsessional disturbances, and certain cases of dementia.
Example:
Nurse: Where are you going for the weekend?"
Patient: "Well,! First thought of going to my mother's place, but that was
before. I remembered that she was going to my sister's house. My
sister is having a picnic she always has. Picnics at the beach. The
beach that she goes to is large and gets crowded. That's why I don't
like that beach. So, I decided to go someplace else. I thought of
going to my brother's house. He has a large house on a quiet street
… I finally decided to stay home."
3. Flight of ideas:
Rapid, continuous jumping from one idea to another. The connection between
ideas is through stimuli from the last idea or from an external stimuli. Seen in
Mania.
Example: "Tell me, how is it going … going to my sister to get some money
… money, honey, bees give honey … honey is sweet .. "
4. Loosening associations:
Speech disturbance involving a disorder in the logical progression of thoughts,

manifested as a failure to communicate verbally adequately; unrelated and
unconnected ideas shift from one subject to another., when severe, speech may
be incoherent.
Example: When the-wind bowled, the shoe laces were uptight.
5. Incoherence:
Mixture of phrases that have no meaning with no logical connection. The
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extreme is word salad.
Example: "I am fine….apple pie…no sale….furniture store….take it slow…”
6. World salad:
Incoherent mixture of words & phrases. that have no meaning with no logical
connection.
Example: "Birds... fishes ....mud ..... stars....."
7. Clang Association:
Association or speech directed by the sound of a word rather than by its

meaning; words have no logical connection; punning and rhyming may
dominate the verbal behavior. Seen most frequently in schizophrenia or mania.
Example: "On the track...have a Big Mac...or get the sack...."
8. Neologism:
The person invents new words or phrases, often by combining syllables of other
words. These new words only have a special meaning for the person (e.g., head
shoe to mean hat).
Example: "I want all the vetchkisses to leave the room".
9. Retardation:
Refers to slow speech and prolonged latent period before responding.
10.Echolalia:
Pathological repeating of words or phrases of one person by another; tends to be

repetitive and persistent. Seen in certain kinds of schizophrenia, particularly the
catatonic types.
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Example:
Nurse: Mrs. Sally, come for your medication.
Sally: Mrs. Sally, come for your medication.
11.Palalial
Pathological repetition of the last word said.
Example:
Patient: "My name is Ahmed, Ahmed, Ahmed …"
12. Preservation:
Pathological repetition of the same response to different stimuli as in repetition

to the same answer in response to different questions. Seen in cognitive
disorders, schizophrenia, and other mental illnesses.
Example :
Nurse: How are you doing?
Patient: Fine nurse just fine.
Nurse: Did you go for a walk?
Nurse: Are you going out today?
13. Irrelevant answer:
The answer that is not in harmony with the question, asked (appears to ignore or
not attend to the question).
Example:
Nurse: Tell me your name ?
Patient: My mother is alive.
C. Disorder in content of thought:
Describe what the client saying it include:
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a. Delusions.
It is a false fixed belief which cannot be accepted by persons of the same social
standard as the patient expresses it, not consistent with the patient's educational
and cultural background, and cannot be corrected by logic or by reasoning and
patient fight for it.
(1) Paranoid delusions:
a. Delusion of grandeur:
The false fixed belief that one is a very powerful and important person.
Example: I am known in all universes as the smartest person.
b. Delusion of persecution:
False fixed belief of being harassed or persecuted or chased by another.
Example: They poison my food through telepathy.
c. Delusion of reference:
False fixed belief that the behavior of others refers to oneself
Example: People on television or radio are talking about the person.
d. Delusion of infidelity [pathological jealousy]:
False belief that one's lover is unfaithful.
e. Litigious delusion:
Pathological tendency to take legal actions because of imagined mistreatment,

the patient writes complaints and sends them to a responsible person.
f. Erotomanic delusion:
The patient believes that a high status person, a famous person, has a love
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relation with him.
(2) Delusion of control (influence)
False belief that a person's will, thoughts or feelings are being controlled by
external forces.
a. Though withdrawal:
False belief that one's thoughts are being removed from one's mind by other
people or forces.
b. Thought insertion:
Delusion that thoughts are being implanted in one's mind by other people or
forces.
c. Thought broadcasting:
Delusion that one's thoughts can be heard by others, as though they were being
broadcast into the air.
(3) depressive delusions:
a. Nihilistic delusion:
False feeling that self, a part of the body, others, or the world is nonexistent or
ending.
b. Delusion of self blame
False fixed belief that person is full of sins and unfit to live (worthless).
c. Delusion of poverty:
False belief that one is bereft or will be of all material possessions.
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(4) Hypochondriacal delusion:
False fixed belief that a person has a physical disease that is not based on a real
organic pathology but on unrealistic interpretations of physical signs or
sensations as abnormal.
(5) Somatic delusion:
False belief about body functions. that the body is changing in an unusual way.
Example: One's brain is rotting or melting, The bugs crawl under my skin and
eat my brain.
b. Obsession:
Pathological persistent & recurrent idea, thought, or impulse that cannot be

eliminated from consciousness by logical effort or reason, is associated with
anxiety, and in most cases ends with compulsion.
c. Preoccupation
Centering of thought content on particular ideas, associated with strong

affective tone, thus as a paranoid trend or suicidal preoccupation. it doesn’t
generate the same amount of anxiety as obsession and remains at the level of
cognition (doesn’t include constant compulsive acts).
d. Suicidal ideation
It is a recurrent idea affecting the individual to put an end by himself to his own
life.
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II. Perception:
It is the Process by which a person interprets sensory stimuli through the sense
organs. - Also, it means sensation.
Disturbance in perception:
1- Hallucination:
False sensory perception not associated with real external stimuli.
Types of hallucinations:
Hallucinations can have an organic or a functional etiology and they are

manifested through the five senses:
● Auditory hallucination: false perception of sound, usually voices but also

other noises in the absence of external stimuli.
Example: "I keep hearing my mother's voice telling me I am bad. She died a
year ago".
● Visual hallucination: Seeing a person, object, or animal that does not exist
in the environment, most common in medical disorders.
Example: A patient who is experiencing alcohol withdrawal, delirium, sees

hungry rats coming toward him.
● Olfactory hallucination: false perception in smell; are not present in the

environment, most common in organic disorders.
● Tactile (haptic) hallucination: false perception in touch in the absence of

stimuli.
Example: The sensation of something creeping or crawling on or under the

skin.
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● Gustatory hallucination: Experiencing tastes that have no stimulus in

reality, most common in medical disorders.
Example: A patient has a strange taste in his mouth without any stimulus.
2- Illusion:
Misperception or misinterpretation of real external sensory stimuli.
N.B. It may affect any of the special senses (auditory, visual, etc....).
Example:
Visual illusion: The individual who sees a rope and perceives that it is a snake.
Auditory illusion: The yowling of a cat may be heard by a mother as the cry of
her child.
2- Unreality states
● Depersonalization:
An alteration in the perception or experience of the self so that one feels

detached from reality or different in some way that occurs under extreme stress
or fatigue. Seen in schizophrenia, depersonalization disorder, and schizotypal
personality disorder.
Example: the patient feels he is no longer himself, when he looks in the

mirror he feels himself changed.
● Derealization:
An alteration in the perception or experience of the external world so that it

seems strange or unreal that the environment is changed while actually nothing
has changed in it.
Example: Everything seems bigger or smaller or familiar.
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III) Memory:
A Process whereby what is experienced or learned is established as a record in

CNS (registration), where it maintains information over periods of time
(retention) and can be recollected from storage at will (recall) in which is a
process of bringing stored memories into consciousness.
Four levels of memory:
● Immediate : Recall of perceived material within seconds to minutes.

● Recent: Recall of events over the past few days to months.
● Remote: Recall events in the distant past.
Disturbance in memory:
1- Amnesia:
Partial or total inability to recall past experiences, may be organic or emotional

in origin.
Types of amnesia:
a. Anterograde amnesia: Inability to recall recent events

b. Retrograde amnesia: Inability to recall remote events.
c. Total amnesia: Inability to recall recent and remote events.
d. Circumscribed amnesia: Inability to recall events for limited time.
2- Paramnesia:
Falsification of memory by distortion of recall it includes.
a. Falsification: memory becomes unintentionally (unconsciously) distorted

by being filtered through a patient's present emotional, cognitive, and
experiential state. Unconscious adding of false details to a true memory
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b. Confabulation: unconscious filling of gaps in memory by imagined or

untrue experiences that the patient believes but that have no basis in fact;
most often associated with organic pathology.
c. Déjà vu: An abnormal experience where an individual feels that a

particular or unique event has happened before in exactly the same way.
d. Jamais vu: An abnormal experience where an individual feels that a

routine or familiar event has never happened before.
e. Hypermnesia: exaggerated degree of retention and recall. It is excessive

memory, the patient mentions even unnecessary details.
IV) Consciousness:
Is a state of awareness of the self and the environment(time, place, persons)

and ability to respond properly to stimuli(internal, external). The level of
consciousness can vary between the extremes of alertness and coma .
Disturbance in consciousness/levels of consciousness
1. Metaconscious: Preternatural
People who possess the ability to monitor and control their own cognitive
processes in addition to meeting all the criteria indicative of a normal level of
consciousness.
2. Conscious: Normal
Assessment of loss of consciousness involves checking orientation: people who

are able quickly and spontaneously to state their name, location, and the date or
time are said to be directed to self, place, and time. A normal sleep stage from
which a person is easily awakened is also considered a normal level of
consciousness. "Clouding of consciousness" is a term for a mild alteration of
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consciousness with alterations in attention and wakefulness.
3. Confused: Disoriented; impaired thinking and responses
People who do not respond quickly with information about their name, location,
and the time are considered "obtuse" or "confused". A confused person may be
bewildered, disoriented, and have difficulty following instructions. The person
may have slow thinking and possible memory time loss. This could be caused
by sleep deprivation, malnutrition, allergies, environmental pollution, drugs
(prescription and nonprescription), and infection.
4. Delirious: Disoriented; restlessness, hallucinations, delusions
Some scales have "delirious" below this level, in which a person may be restless
or agitated and exhibit a marked deficiency in attention.
5. Somnolent: Sleepy
A somnolent person shows excessive drowsiness and responds to stimuli only

with incoherent mumbles or disorganized movements.
6. Obtunded: Decreased alertness; slowed psychomotor responses
In obtundation, a person has a decreased interest in their surroundings, slow

responses, and sleepiness.
7. Stuporous: Sleep-like state (not unconscious);

little / no spontaneous activity
People with an even lower level of consciousness, stupor, only respond by

grimacing or drawing away from painful stimuli.
8. Comatose: Can not be aroused; no response to stimuli
Comatose people do not even make this response to stimuli, have no corneal or
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gag reflex, and they may have no pupillary response to light.
V) Attention and concentration
Attention: is the ability to focus on the matter on hand.
Concentration: is the ability to sustain that focus.
Disturbance in attention and concentration:
● Distractibility: it is giving attention to every passing stimulus. e.g.

someone coughing, a door opened or a bird flying.
● Selective inattention: blocking only those things that generate anxiety.
IX- Orientation:
A State of awareness of oneself and one's surrounding in terms of time, place

and person.
Disturbance in orientation:
● Disorientation: Impaired ability to identify time, place and person.
X- Judgment
The ability to assess a situation correctly and to act appropriately within that
situation.
Disturbance in judgement:
● Impaired judgement: Diminished ability to understand a situation

correctly and to act appropriately.
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XI- Insight
The ability to recognize that one's abnormal experiences are symptoms of

psychiatric illness and that they require treatment.
Disturbance in orientation:
● Impaired insight: Diminished ability to understand the objective

condition of one's mental illness.
B) EMOTION
Emotion consists of emotional experiences internal feeling [mood] and

emotional expression external manifestation of this emotion [affect]
a- Mood:
Pervasive and sustained feeling tone that is experienced internally and that is
reported by the person's own words. Euthymic mood is the normal range of
mood, implying absence of depressed or elevated mood.
Disturbance in mood:
1. Euphoria:
Exaggerated feeling of well-being that is inappropriate to real events. Can occur

with drugs as amphetamines and alcohol.
2. Elation:
Consisting of feelings of Joy and intense self-satisfaction associated with motor

activity. Occurs in mania when not grounded in reality.
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3. Exaltation:
Feeling of intense elation and grandeur.
4. Ecstasy:
It is a feeling of intense happiness with mysterious air, it's met with mystical
experiences, epilepsy, and schizophrenia and under the effect of drugs.
5. Dysphoric mood:
Feeling of unpleasantness or discomfort, a mood of general dissatisfaction and

restlessness occur in depression and anxiety.
6. Irritable mood:
A state in which individuals are easily provoked to anger.
7. Anhedonia:
Loss of interest in, and withdrawal from all regular and pleasurable activities
often associated with depression, schizophrenia.
8. Mood swings (labile mood)
Oscillations between euphoria and depression or anxiety.
9. Anxiety:
Feeling of apprehension caused by anticipation of danger which may be internal

or external.
10. Fear:
Anxiety caused by consciously recognized and realistic danger.
11. Phobia:
An intense irrational fear of an object, situation, or place. The fear persists even
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though the object of the fear is perfectly harmless and the person is aware of the
irrationality. Also, tries to avoid the feared stimulus.
Example: Although a person is aware that cats would not harm him, he is
afraid of cats and avoids being in contact with them.
12. Ambivalence:
Coexistence of two opposing impulses toward the same thing in the same
person at the same time.
13. Apprehension:
Intense fear of any non fearful stimulus; fear of external danger. e.g car
accident.
14. Panic:
Acute, episodic, intense attack of anxiety associated with overwhelming

feelings of dread and autonomic discharge.
15. Indifference:
Absence of emotional expression but experience is present.
16. Apathy:
Dulled emotional tone associated with detachment or indifference or absence of

emotional experience and expression.
b- Affect:
Is the objective & immediate experience of emotion attached to ideas or mental

representations of objects. Affect can be assessed By observing the client
nonverbal behavior (facial expression) in conjunction with other verbal clues.
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Appropriate affect: emotional tone is in harmony with the accompanying idea,

though or speech.
Example: Juan cries when learning of the death of his father.
Disturbance in affect:
1. Inappropriate affects (incongruent affect):
Disharmony between the emotional feeling tone and the idea or speech
accompanying it. .
Example: When told it is time to turn off the TV and go to bed, Joe begins to
laugh uproariously.
2. Blunted affect
A disturbance in affect manifested by a severe reduction in the intensity of

externalized feeling tone.
Example: When tom learns of his full tuition scholarship, he responds with
only a small smile.
3. Flat affect:
Absence or near absence of any signs of affective expression; voice

monotonous, face immobile.
Example: When Juanita's mother tells her that her favorite dog has died,
Juanita simply says, Oh, and gives no indication of an emotional
response.
N.B. The difference between flat, blunted affect is in degree.
4. Labile affect (emotional instability) :
Rapid and abrupt changes in emotional feeling tone, unrelated to external

stimuli.
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Example: During a friendly checkers game, Sean, who has been laughing,
suddenly knocks the board off the table in anger he then begins to
laugh and wants to continue the game.
C) BEHAVIOR
It is the sum total of the psyche that includes impulses, motivations, wishes,
drives, instincts, and cravings, as expressed by a person’s behavior or motor
activity.
Disturbance in behaviour:
1. Hyperactivity: It includes:
a. Psychomotor agitation:
It is a form of hyperactivity characterized by excessive motor and cognitive

over activity, usually nonproductive and is associated with a feeling of inner
turmoil.
b. Excitement:
It is a severe form of hyperactivity , excessive purposeless motor activity and

the patient may destruct himself or others.
c. Restlessness:
Subjective feeling of uneasiness, tension, and inability to sit still. It

appears in form of:
● Pacing
● Rooming back and front on foot.
● Crossing and uncrossing legs frequently.
● Inability to relax.
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2. Hypoactivity: it includes
a. Psychomotor retardation (psychomotor impairment):
It involves slowdown in thought and motor movement (slow and difficult motor
and cognitive activities that in the extremes can entail complete inactivity).
b. Catatonic posturing (catalepsy):
Voluntary assumption of an inappropriate or bizarre posture the patient initiates

positions by himself, generally maintained for long periods of time. The absence
of fatigue in such cases is remarkable.
3. Repetitive activities:
a. Stereotypy:
A monotonous repetition of certain movement or speech without purpose.
Examples:
In movement: Touching the nose or pacing up and down the room.
In speech: Some words are repeated .
b. Mannerism:
A repeated habitual involuntary movement, which is not monotonous and is

keeping with the personality character
Example: Paranoid patient salutes repeatedly in a grandiose manner
c. Perseveration
Involuntary repetition of the same recent thought, phrase, or motor response.
Example: A patient, who was eating, continues to use the spoon as if eating
even after the plate is empty.
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d. Waxy flexibility:
The maintenance of imposed postures however abnormal they may be. The
absence of fatigue in such cases is remarkable and when the examiner moves
the person's limb, he feels as if it was made of wax.
e. Echopraxia:
Pathological imitation of movements of one person by another
4. Negativism:
Verbal or nonverbal opposition or resistance to outside suggestions and advice

or even doing the opposite.
● Motor: When the patient was asked to look up, he looked down.
● Speech: When he was asked a question, he didn't answer.
● Visceral: Retention of saliva, urine or feces.
5. Automatic obedience:
Strict obedience of command without critical judgment. The person may

respond to an inner voice, as in schizophrenia, or to another person’s
command, as in hypnosis.
6. Impulsiveness:-
The performance of an unconscious wish, action that is sudden, abrupt,

unplanned and directed toward immediate gratification.
7. Compulsion:
It is a pathological need to act on an impulse that, if resisted, produces anxiety;

repetitive behavior in response to an obsession that is absurd and meaningless
and the patient struggles with it.
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REFERENCES:
Dunlosky, J. & Bjork, R. A. (Eds), Handbook of Metamemory and Memory. Psychology

Press: New York.
Halter, M. J. (2017). Varcarolis' Foundations of Psychiatric-Mental Health Nursing - E-Book:
A Clinical Approach. Elsevier Health Sciences.
Kruse MJ (1986). Nursing the Neurological and Neurotrauma Patient. Totowa, N.J:
Rowman & Allanheld. pp. 57–58. ISBN 0-8476-7451-7.
Porth C (2007). Essentials of Pathophysiology: Concepts of Altered Health States.
Hagerstown, MD: Lippincott Williams & Wilkins. p. 835. ISBN 0-7817-7087-4.
Retrieved 2008-07-03.
Tindall SC (1990). "Level of consciousness". In Walker HK, Hall WD, Hurst JW. Clinical
Methods: The History, Physical, and Laboratory Examinations. Butterworth
Publishers. Retrieved 2008-07-04.
Townsend, M. C. (2013). Essentials of Psychiatric Mental Health Nursing: Concepts of Care
in Evidence-Based Practice. F.A. Davis.
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Presentation · February 2019

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The user has requested enhancement of the downloaded file.

1. Recognize the composition of mind.

A symptom is usually defined as a subjective experience described by the

ii) Autistic thinking

A. Disturbances in stream of speech:

a) Pressure of speech​: Forceful rapid loud speech that increases in the

b) Poverty of speech​: restriction in the amount of speech used; replies may

c) Poverty of content of speech​: speech that is adequate in amount, but

d) Blocking: ​Sudden cessation in the train of thinking before a thought or

B. Disturbances in the form of thought​:

a) General disturbances include​:

Proverb: people who live in glass houses shouldn’t throw stones).

Thinking in which thoughts are largely egocentric with emphasis on subjectivity

N.B. Delusions and hallucinations are examples of autistic thinking.

Speech disturbance involving a disorder in the logical progression of thoughts,

Example: When the-wind bowled, the shoe laces were uptight.

Mixture of phrases that have no meaning with no logical connection. The

extreme is word salad.

Example: "I am fine….apple pie…no sale….furniture store….take it slow…”

Example: "Birds... fishes ....mud ..... stars....."

Association or speech directed by the sound of a word rather than by its

Example: "On the track...have a Big Mac...or get the sack...."

Example: "I want all the vetchkisses to leave the room".

Refers to slow speech and prolonged latent period before responding.

Pathological repeating of words or phrases of one person by another; tends to be

Pathological repetition of the last word said.

Pathological repetition of the same response to different stimuli as in repetition

13. Irrelevant answer​:

C. ​Disorder in content of thought:

Describe what the client saying it include:

(1) Paranoid delusions:

Example: I am known in all universes as the smartest person.

False fixed belief of being harassed or persecuted or chased by another.

Example: They poison my food through telepathy.

False fixed belief that the behavior of others refers to oneself

Example: People on television or radio are talking about the person.

d. Delusion of infidelity [pathological jealousy]:

False belief that one's lover is unfaithful.

Pathological tendency to take legal actions because of imagined mistreatment,

relation with him.

(2) Delusion of control (influence)

(3) depressive delusions:

b. Delusion of self blame

False belief that one is bereft or will be of all material possessions.

(​4) Hypochondriacal delusion:

(5) Somatic delusion:

Pathological persistent & recurrent idea, thought, or impulse that cannot be

Centering of thought content on particular ideas, associated with strong

False sensory perception not associated with real external stimuli.

Hallucinations can have an organic or a functional etiology and they are

● Auditory hallucination: false perception of sound, usually voices but also

Example: A patient who is experiencing alcohol withdrawal, delirium, sees

● Olfactory hallucination: false perception in smell; are not present in the

● Tactile (haptic) hallucination: false perception in touch in the absence of

Example: The sensation of something creeping or crawling on or under the

● Gustatory hallucination: ​Experiencing tastes that have no stimulus in

Misperception or misinterpretation of real external sensory stimuli.

a) Pressure of speech: Forceful rapid loud speech that increases in the

b) Poverty of speech: restriction in the amount of speech used; replies may

c) Poverty of content of speech: speech that is adequate in amount, but

d) Blocking: Sudden cessation in the train of thinking before a thought or

B. Disturbances in the form of thought:

a) General disturbances include:

13. Irrelevant answer:

C. Disorder in content of thought:

(4) Hypochondriacal delusion:

● Gustatory hallucination: Experiencing tastes that have no stimulus in

Four levels of memory:

● Immediate : Recall of perceived material within seconds to minutes.

a. Falsification: memory becomes unintentionally (unconsciously) distorted

c. Déjà vu: An abnormal experience where an individual feels that a

V) Attention and concentration

Attention: is the ability to focus on the matter on hand.

Concentration: is the ability to sustain that focus.

● Distractibility: it is giving attention to every passing stimulus. e.g.

● Disorientation: Impaired ability to identify time, place and person.

● Impaired judgement: Diminished ability to understand a situation

● Impaired insight: Diminished ability to understand the objective

Emotion consists of emotional experiences internal feeling [mood] and

Appropriate affect: emotional tone is in harmony with the accompanying idea,

1. Inappropriate affects (incongruent affect):

4. Labile affect (emotional instability) :

1. Hyperactivity: It includes:

2. Hypoactivity: it includes

a. Psychomotor retardation (psychomotor impairment):