TYPICAL SIGNS & SYMPTOMS

OF PSYCHIATRIC ILLNESS

BY
DR/WAFAA OSMAN
Head of psychiatric/ mental nursing department

Faculty of nursing – Must University

 Objectives
At the end of this lecture, each student should
be able to:
•Differentiate between psychiatric signs and
symptoms.
•Determine the signs and symptoms as presented
by the patient.
•Record signs and symptoms in nursing record
accurately.
 Disorders of perception
Perception is Process of transferring physical
stimulation into psychological information; mental
process by which sensory stimuli are brought to
awareness.

Also, Perception is the meaningful organization of

sensory data and their interpretation in the light
of one's past experience.
 Abnormalities of
perception are classified into
•four
Sensory Distortions types:
1

• Sensory Deception (false perceptions)

2

3 • Perceptual disturbance to time and place

4 • perceptual disturbance of body image

 1. Sensory Distortion
These occur in all sensory modalities and
involve changes in intensity and quality.

✓ Hyperesthesia: it occurs when the former

of sensation become more intense and vivid.

In the hyperesthesia sounds appear louder,

color brighter and pain intolerable.

✓ In hypoesthesia they are all diminished.

 Cont.,

Hyperesthesia occurs under intense emotions, acute

psychoses and prior to epileptic seizures.

Hypoesthesia occurs in depression and delirium

where more intense stimuli are needed to arouse the

patient.
2. Sensory deception (false perceptions)

The occur in all sensory modalities and can

mainly be classified into two types:

A. Illusion

B. Hallucinations
 The Types of sensory
Deceptions
Sensory
Deceptions

Illusion Hallucinations
 Illusion

Illusion are misperceptions of external stimuli. In

the fading light a rope is misperceived as a snake.
Illusion may occur in the normal life when the
sensory data are inadequate or when one is fearful
and apprehensive.
 Hallucinations
Hallucinations are a false perception which occur
in the absence of corresponding sensory stimuli.

There are different types of Hallucination:

1. Auditory hallucination
False perception of sound, these are by far the most
common and experienced as noises, music , or voices.
Voices may seem to address the patient directly.
 Cont.,
2. Visual hallucination
False perception involving sight consisting of both
formed image(for example people) and unformed
images(for example flashes or light): most common
in medically disorders.
3. Olfactory hallucination
False perception of smell; most common in medical
disorders.
 Cont.,
4. Gustatory hallucination
False perception of taste, such as unpleasant
taste caused by seizure.

5. Tactile (Haptic) hallucination

False perception of touch or surface
sensation, as from an amputated
limb(phantom limb); crawling sensation on or
under the skin (formication).
3. Perceptual Disturbances of Time and
Spaces
Disturbance of time perception take several forms.
✓Perceived as too slow: The passage of
time is perceived too slowly as in depression
and anxiety.

✓ Perceived as too fast: As in mania and drug abuse.

✓ Standing still: As depressed patients reported.

✓pressure of time: Anxious patients often fear that
they wouldn't be able to complete a task in the
stipulated time.
 Cont.,
✓Macropsia: Disturbance of space perception are
experience as seeing objects being nearer and larger

✓Micropsia: Disturbance of space perception are

experience as seeing objects being smaller and far
away. This occur in schizophrenia, delirium and as
premonitory symptoms.
4. perceptual disturbance of body
image
✓Anosognosias: Ignoring the presence
of the Illness.

✓Autotopagnosia: Inability to
recognize one's body
parts.

The body appears mis-shapen and

grotesque, body parts appear reduplicated.
 Cont.,
Parts of body likes the nose appear to have change
in size or are misplaced. The body may appear to be
(floating in the space). Such changes occur in drug
intoxication and under the influence of
hallucinations drugs. Phantom limb and autoscopy
are other examples of bodily disturbances.
Brief Summary about disorders
of perceptions
Sensory • Hyperesthesia
Distortio
• Hypoesthesia
ns

Sensory • Illusion
Deception • Hallucination

• Perceived as too
slow
• Perceived as fast
Time and • Standing still
place • Pressure of time
• Macropsia
• Micropsia

Perceptual
disturbance
of body • Anosognosias
image • Autotopagnosia
 Disorders of Mood
- Emotion
A complex feeling state with psychic, somatic, and
behavioral components that related to affect and mood.

Affect is the feeling tone and refers to the

emotional state of an individual.
Affect sustained for long time is called mood.
Affect is observed expression of emotion, while the
mood is subjectively experienced and reported by the
patient and observed by other.
 Disorders of mood are present in
several ways
1. Their abnormal presence

2.Abnormality in depth and

duration

3. Inappropriateness

4. Their abnormal swings

 Disorders of Mood Con.

1. Abnormal presence
Fear, anxiety, depression, elation and anger
are examples.

2. Emotions vary in their depth and duration

They may be excessive and out of proportion to the
event or markedly reduced (blunted or flattened) and
lost ( apathetic).
 Cont.

✓Blunting: Refers to lack of emotional

sensitivity, whereas flattening is a limitation of
the usual range of emotion. Blunting and
apathy are common in schizophrenia.

✓Flat: Is absence or near absence of any sign

of affective expression; voice monotonous, and
face immobile.
 3. Inappropriateness
✓Appropriate and congruent: When it is proper to
the occasion, thinking, and action.

✓ Inappropriate: When it is not proper to the

occasion (feelings happy when tragedy strikes)
and incongruent ( laughing when a sad event is
narrated). In schizophrenia, incongruent affect is
very common.
 4.Abnormal swings

✓Euthymic mood: Normal range of mood,

implying absence of depressed or elevated mood.

✓Labile mood: The emotional changes are

very rapid e. g., from sorrow to joy.

✓ Dysphoric mood: An unpleasant mood.

 Cont.,
✓ Emotional incontinence: Refer to spilling of
emotions and the patient ability to control.
Lability and incontinence are particularly common
in organic condition.

✓Ambivalence: Refers to coexistence of

contradictory feelings and attitude towards the same
object simultaneously, which are common in
schizophrenia.
 Cont.
, annoyed and provoked to
✓Irritable mood: Easily
anger.

✓ Elevated mood: A mood more cheerful than usual.

✓ Euphoria: Intense elation with feelings of grandeur.

✓ Depression: Psychopathological feeling of sadness

✓Ecstasy: Pleasant sensation related to the religious
beliefs and attitude, or pleasure sensation from a
good relation with good.
- Anhedonia: ‫انعدام التلذذ‬ loss of interest in and
withdrawal from all regular and pleasurable
activities, often associated with depression.

- Grief or mourning: sadness appropriate to

real loss.
 Other emotions changes:
- Fear: anxiety caused by consciously recognized and realistic
danger.
- Anxiety: feeling of apprehension caused by anticipation of danger,
which may be internal or external.
- Agitation: severe anxiety associated with motor restlessness.
- Tension: increased motor and psychological activity that is
unpleasant.
- Panic: acute, episodic, intense attack of anxiety associated with
overwhelming feelings of dread and autonomic discharge.
- Apathy: dulled emotional tone associated with detachment or
indifference.
- Shame: failure to live up to self-expectations.
- Guilt: emotion secondary to doing that is perceived as wrong.
 D. Physiological disturbances
associated with mood:

 Signs of somatic (usually autonomic) by dysfunction of

the person, most often associated with depression.

- Anorexia: loss of or decrease in appetite.

- Hyperphagia: increase in appetite and intake of food.

- Insomnia: Lack of or diminished ability to sleep.

- Hypersomnia: excessive sleeping.

- Constipation: inability or difficulty in defecating.

 Disorders of Memory
Disorders of memory are present as:

I Amnesia

II Paramnesias

III Hypermnesias
 1.Amnesia
a.Anterograde: Amnesia for events occurring after
a point in time (loss of memory for recent event).

b.Retrograde: Amnesia prior to a point in time

(loss of memory for remote event.

c.Total amnesia: loss of memory for recent

and remote event.

d.Circumscribed amnesia: loss of memory

for limited time.
 2. Paramnesias

a.Falsification: Are distorted recall of events

in relation to details or their temporal relationship.

b.Confabulation: Is unintentional filling of

gap of memory martial which in

untrue and fanciful.

 Cont.
,
c. Déjà vu: Is an error of recognition where an

event or situation thought occurring for the first

time, strikes a familiar chore, as if it had

happened earlier.

d. Jamais vu: Is a feeling of strangeness to

familiar.
 3. Hypermnesias

✓Hypermnesias: Exaggerated degree of retention and

recall. It's excessive memory, the patient mention even

unnecessary details.
 Levels Of Memory
a. Immediate: Reproduction or recall of
perceived material within seconds to minutes.

b. Recent: Recall of events over past few days.

c. Recent past: Recall of events over past
few months.

d. Remote: Recall of events in distant past.

 Disorders of insight

Insight: Is the patient awareness of his

disability and needs for help.

a. Intellectual insight: 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.
 Cont.
,
b.True insight: Understanding of the objective
reality of a situation, coupled with the motivation
and the emotional impetus to master the situation.

c.Impaired insight: Diminished ability to

understanding the objective reality of a situation.
 Disorders of judgment
Judgment: Is ability to assess a situation
correctly and act appropriately within
that situation.

a.Critical judgment: Ability to assess, discern, and

choose among various options in a situation.

b.Automatic judgment: Reflex performance

of an action.
 Cont.
,
c. Impaired judgment: shirked ability to
understand a situation correctly and to act
appropriately.

❖When there is no insight there is a poor

judgment reflected in financial and relationships.