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AFFECT
•A pattern of “observable” behaviors that express a person’s subjectively experienced feeling state (emotion)
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•Disturbances in affect include the
following:
Restricted or Constricted
Blunted
Flat
Labile
Inappropriate
- Restricted or Constricted- Mild reduction in range of emotion
- Blunted- Significant reduction in the intensity of emotion
- Flat- Absence or near absence of emotion
- Labile- Abnormal variation in affect with abrupt, rapid shifts in expression
- Inappropriate- An incongruence between a person’s expression of affect and what is contained in his/her speech
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Agitation (psychomotor agitation)
- •Excessive motor activity associated with an inner feeling of tension
- •A person’s activity is usually unproductive
- •Common behaviors are: pacing, fidgeting, pulling at one’s clothing, wringing of hands, and difficulty sitting still
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Alogia
- •Impoverished thinking, inferred from observing one’s speech
- •Replies to questions may be brief, concrete (poverty of speech)
- •Speech may be adequate, but it conveys minimal information (poverty of content)
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Amnesia
–Two types of amnesia
•Loss of memory
- •Anterograde
- – loss of memory after the onset of the condition
- •Retrograde
- – loss of memory before the onset of the condition
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Anxiety
- •Apprehensive anticipation of future danger or misfortune
- •Additionally, feelings of dysphoria or somatic feelings of tension are experienced
- •The focus of danger may be internal or external
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Aphasia
- •Impairment in “understanding” or “transmitting” ideas by any form of language (speaking, writing, reading)
- •Caused from an injury or disease to the language centers of the brain
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Ataxia
•Either partial or complete loss of ordination of voluntary muscle movement
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Attention
- •Ability to sustain one’s focus on an activity or a particular stimulus
- •Disturbance in attention is observed when a person is:
- –Easily distracted
- –Has difficulty finishing tasks, or
- –Has difficulty concentrating on tasks
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Avolition
- •When a person does not initiate and persist in goal-directed activities
- •When severe, it prevents a person from completing different types of tasks (work, self-care, recreation)
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Catalepsy
- •Rigid maintenance of a body position
- •Continues for an extended period of time
- •A person has what is referred to as a “waxy flexibility”
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Cataplexy
- •Periods of sudden and bilateral loss of muscle tone
- •The person collapses
- •It is often associated with intense emotions (laughter, surprise, anger, fear)
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Catatonic behavior
- •Distinct motor abnormalities:
- –Motoric immobility– stupor, catalepsy
- –Excessive motor activity – agitation that is purposeless i.e. not influenced by external stimuli
- –Extreme negativism– motiveless resistance to attempts to be moved or to instructions
- –Mutism, posturing, stereotyped movements, echolalia, or echopraxia
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Circumstantiality
- •Speech that is indirect or delayed in reaching the point
- •Due to the overuse of tedious remarks
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Confabulation
- •Fabrication of facts or events in response to questions about events that a person cannot recall
- •Due to memory impairment
- •It is not purposeful lying
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Conversion symptom
- •Loss or alteration in voluntary motor or sensory
- functioning
- •The loss suggests a neurological or medical problem, but this doesn’t fully explain the condition
- •Psychological factors are determined to be associated with symptom development
•Symptoms are not intentionally produced, feigned, nor are they culturally sanctioned
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Delusion
- •False belief
- •Based on an incorrect inference about external reality
- •It’s firmly believed despite obvious proof and evidence to the contrary
- •The belief is not generally accepted by one’s culture or subculture
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Types of Delusions
–Bizarre
–Jealousy
–Erotomanic
–Grandiose
–Of being controlled
–Of reference
–Persecutory
–Somatic
–Thought broadcasting
–Thought insertion
Bizarre-involves content that is viewed by one’s culture has been totally implausible
Jealousy– one’s sexual partner is unfaithful
Erotomanic– another person, usually of higher status, is in love with the individual
Grandiose – inflated sense of self-worth, power, knowledge, identity, or special relationship to a deity or famous person
- Of being controlled – where feelings, impulses, thoughts, or actions are experienced as being under the
- control of some external force, rather than oneself
- Of reference – the theme is that
- events, objects, or other persons in one’s immediate environment have a
- particular and unusual significance
Persecutory-the belief that oneself, or someone to whom one is close, is being attacked, harassed, cheated, persecuted, or conspired against
Somatic – content that pertains to the appearance or functioning of one’s body
Thought broadcasting – one’s thoughts are being broadcast out loud and can be perceived by others
Thought insertion – thoughts are inserted into one’s mind, they are not one’s own
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Depersonalization
- •Alteration in the perception or experience of one’s self
- •Thus, the person feels detached from and as if outside of one’s self (observer)
- •Person feels like being in a dream
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Derailment
- •Also referred to as “loosening of associations”
- •Speech pattern where a person’s ideas slip off one track and onto another that is completely or only vaguely related
- •The disturbance is between clauses
- •Occasional change of topics, without warning or obvious connection, is not derailment
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Disorientation
•Confusion about the time of day, the date, or season (time), where one is (place), or who one is (person)
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Dissociation
- •A disruption in the normal integrated functions of consciousness, memory, identity,
- or perception of the environment
- •The change may be gradual or abrupt, transient or chronic
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Distractibility
- •Inability to maintain attention
- •Shifting from one topic to another with minimal provocation, or
- •Attention that is frequently drawn to irrelevant/unimportant stimuli
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Dyskinesia
•Voluntary movements are distorted through involuntary muscular control
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Dyssomnia
- •A general term describing sleep disorders
- •Hypersomnia or insomnia
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Echolalia
•Parrot like senseless repetition of a word or phrase spoken by another person
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Echopraxia
- •Imitation of another’s movements
- •The behavior is not voluntary and has an uncontrollable quality
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Flight of ideas
- •A continuous flow of accelerated speech
- •There are abrupt changes from topic to topic
- •The associations between topics are usually based on:
- –Understandable associations
- –Distracting stimuli, or
- –A play on words
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Gender identity
•A person’s inner belief of being male or female
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Grandiosity
- •inflated sense of one’s importance, intelligence, knowledge, worth, power, or identity
- •In extreme cases it may become delusional
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Hallucination
- •It is a sensory perception that has the sense of reality of a real perception, but
- •It happens without external stimulation of a sensory organ
- •Person may or may not realize s/he is having a hallucination
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types of hallucinations:
Auditory
Gustatory
Olfactory
Somatic
Tactile
Visual
- Auditory
- •This involves a perception of sound
- •The most common form is “hearing voices”
- •Some professionals do not include those perceptions coming from inside the head, only those as being external from the person
- •DSM-IV makes no distinction between those inside or outside of one’s head
- Gustatory
- •This involves the perception of taste
- •It is usually reported as being unpleasant
- Olfactory
- •This involves the perception of odor
- •People commonly report smelling decaying flesh or burning rubber
- Somatic
- •This involves the perception of physical experience localized within one’s body
- •A person may report feeling electricity
- Tactile
- •This involves the perception of being touched or something under one’s skin
- •The most common forms are:
- –Sensation of electric shocks
- –Things crawling on or under one’s skin
- Visual
- •This involves one’s vision
- •It may consist of formed images such as people or
- •It may consist of unformed images such as flashes of light or shadows
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Ideas of reference
- •It’s a sense that external events have a particular and unusual meaning specific to the person
- •This belief does not have the same conviction as a delusion
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Incoherence
- •Speech that is essentially incomprehensible
- •There is no logical connection between words or phrases
- •The disturbance is “within” clauses
- •May also be referred to as “word salad”
- •The term is generally not used when the disturbance is due to aphasia
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Magical thinking
- •A belief that one’s actions, words, or thoughts will cause or prevent a specific outcome
- •Superstitious belief
- •Magical thinking may be a part of normal childhood development
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Mood
- •A sustained and pervasive emotion
- •It colors the individual’s perception of
- the world
- •Common examples include:
- –Depression
- –Anger
- –Anxiety
- –Elation
- •“Affect” refers to fluctuating changes in
- emotion
- •“Mood” refers to a sustained and
- pervasive emotional experience
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•The following are types of moods:
–Dysphoric
–Elevated
–Euthymic
–Expansive
–Irritable
- –Dysphoric– unpleasant mood such asirritability, anxiety, or sadness
- –Elevated– exaggerated sense ofwell-being or euphoria, “on top of the world”
- –Euthymic– mood within a “normal”range, it implies the absence of dysphoria or euphoria
- –Expansive– lack of restraint inexpressing one’s mood, often with an overvaluation of one’s importance
- –Irritable– easily annoyed andprovoked to anger
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Nystagmus
- •Eyes that move rhythmically
- •Movement is involuntary
- •Consists of small rapid traverse in one direction and a larger slower sweep in the opposite direction
- •Movement may be horizontal, vertical, or circular
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Overvalued idea
- •Sustained belief that it’s unreasonable yet sustained
- •It is not delusional
- •The belief is not ordinarily accepted in one’s culture
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Panic attacks
- •Discrete periods of sudden onset of intense apprehension, fearfulness, or terror
- •Generally associated with feelings of doom
- •Additionally, the following symptoms are
- experienced:
- –Shortness of breath or smothering sensations
- –Palpitations, pounding and/or racing heart
- –Chest pain or discomfort
- –Choking
- –Fear of going crazy or losing control
- •Panic attacks may be:
- –Unexpected- onset is not associated with a situation, it occurs out of the blue
- –Situationally bound– it almost always occurs when exposed to or in anticipation of a trigger
- –Situationally predisposed– more likely to occur when exposed to a situational trigger, but not necessarily bound to do so
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Paranoid ideation
- •Belief that is less than delusional
- •Involves being suspicious or the belief
- that one is being harassed, unfairly treated, or persecuted
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Personality
- •Sustained pattern of perceiving, relating
- to, and thinking about one’s environment and oneself
- •“Personality traits” are prominent
- aspects of personality seen in a wide range of social and personal settings
- •Only when personality traits are
- maladaptive and inflexible and cause significant impairment or subjective
- distress do they become a disorder
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Perseveration
- •Persistent repetition of words, ideas, or
- subjects
- •Once they are started the words, ideas
- keep recurring in the conversation
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Phobia
- •Persistent and irrational fear of a(n):
- - Specific object
- - Activity
- - Situation
- •Because of the fear, the object or
- activity is avoided or endured with dread
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Pressured speech
- •An increase in the amount and speed of speech
- •It is often loud and emphatic
- •Person may speak without any stimulation,
- or continue talking without someone listening
- •It is difficult or impossible to interrupt the person
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Prodromal
•The early or preliminary signs or symptoms of the disorder
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Psychomotor retardation
•A generalized slowing of movement and speech
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Psychotic
•A basic definition includes one who is experiencing delusions or prominent hallucinations
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Residual phase
•The phase of an illness that occurs when the florid symptoms have passed
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Tic
•Involuntary, sudden, rapid, recurrent, non-rhythmic, stereotyped motor movements, or vocalizations
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