Sign and

Symptoms in
Psychiatry

Kaplan & Sadock's

Comprehensive Textbook of
Psychiatry, 9th Edition
Three step psychiatric interview
 Observation
 Conversation
 Exploration
 General appearance  Perceptual
 Consciousness distortion
 Orientation  Contact
 Attitude and gross  Attention
behavior
 Judgment
 Affect/mood
 Insight
 Thought form
 Thought content
 Thought
progression/speech
General appearance
 Visual
description of the patient current
condition
 Sex
 Age
 Nutritional status
 Grooming
 Clothing
 Position
 Physical appearance
Consciuosness
 Compos mentis  Twilight state
 Disoriented  Dreamy state
 Cloudy  Somnolen
consciousness  Confusion
 Stupor  Drowsiness
 Delirium
 Coma
 Coma vigil
Orientation
 Orientation to
 People
 Time
 Place
 Situation
Attitude and gross behavior
 Attitude
 Cooperative
 Non cooperative

 Gross behavior
 Hypoactive
 Hyperactive – aggressive
 Normoactive
Motoric
 Catatonic rigidity  Negativism
 Catatonic posturing  Cataplexy
 Waxy flexibility  Stereotipy
 Akinesia  Mannerism
 Echopraxia  Automatism
 Catalepsy  Command automatism
 Catatonic exitation  Psychomotor agitation
 Catatonic stupor  EPS/Parkinsonism
Affect
Observable emotional
expression

 Appropriate/congruent → the
emotional tone is appropriate for the
accompanying ideas, thoughts, or
speeches
 Inappropriate/incongruent → the
emotional tone is inappropriate for
the accompanying ideas, thoughts,
or speeches
Affect
 Expansive
 Blunted → severe reduction in the
observable emotional tone
 Restricted → reduction in the
observable emotional tone, less severe
than blunted
 Flattened → no observable emotional
tone, monotonous speech, mask face
 Labil → rapid changes of emotional
tone in the absence of external stimuli
Mood
A pervasive emotional state that may last
for a prolonged period, subjectively
experienced and reported by patient

 Disphoryc → unpleasant emotional state

 Euthymic → normal emotional state
 Euphoric → normal emotional state
Mood
 Euthymic  Ecstasy
 Irritable  Depressed
 Labil  Anhedonia
 Elevate  Alexythymia
 Euphoria  Elated
 La belle indiference
Thought forms
 Realistic vs non realistic

 Illogical/non realistic thinking

 Dereistic
 Autistic
 Magical thinking
 Concrete thinking
Thought content
 Delusion→ false believes based on distorted
deduction of external stimuli
 non irrealistic
 illogical
 persistent
 egosentris
 firmly believed by the patient
 uncorrectable
 fully comprehended as reality by the patient
 patient live his/her delusion
 not a part of local believes/culture
Distortion of thought content
 Nihilistic  Hipochondria
 Poverty  Obsession
 Somatic  Phobia
 Persecutory  Jealousy
 Grandiose  Erotomania
 Reference  Poor thought content
 Guilt  Preoccupations
 Thought control  Egomania
 Thought withdrawal
 Thought insertion
 Thought broadcasting
Thought progress
 Two measure
 Qualitative  Quantitative
 Relevance  Mutism
 Coherence  Remming
 Normal
 Talkative
 Logorhea
Thought progress
 Irrelevant  Incoherence
 Loose association  Perseveration
 Derailment  Verbigeration
 Flight of idea  Echolalia
 Neologism  Condensation
 Word salad
 Circumstantiality
 Tangentiality
 Clang association
 Blocking
Perceptual distortion
 Hallucination → sensory perception without
external stimulation
 Hipnagogik
 Hipnapompik
 Auditoric
 Visual
 Olfactory
 Gustatory
 Tactil
 Somatic
 Congruent to mood
 Incongruent to mood
 Illusion → misperception toward external stimuli
Contact, attention, judgment
 Contact
 Interaction with the examiner

 Attention
 Ability to focus on the interview
 Ability to appropriately response the examiner

 Judgment
 Comprehension to current situation
Insight
The ability to perceive his/her own illness

 Intellectual insight
 True insight
 Poor insight