12.10 - Opioid

Authors: Sadock, Benjamin James; Sadock, Virginia Alcott

Title: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition

Copyright ©2007 Lippincott Williams & Wilkins

> Table of Contents > 8 - Signs and Symptoms in Psychiatry

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8

Signs and Symptoms in Psychiatry

Signs are objective; symptoms are subjective. Signs are the clinician's observations, such as noting a patient's agitation; symptoms are subjective experiences, such as a person's complaint of feeling depressed. In psychiatry, signs and symptoms are not as clearly demarcated as in other fields of medicine; they often overlap. Because of this, disorders in psychiatry are often described as syndromes—a constellation of signs and symptoms that together make up a recognizable condition. Schizophrenia, for example, is more often viewed as a syndrome than as a specific disorder. This concept is expressed in the use of the terms schizophrenic spectrum or the group of schizophrenias.

Descriptive Terms

Descriptions of signs and symptoms in psychiatry have remained fairly constant over the years; however, some terms fall in and out of favor. In the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), for example, some terms have been retained and others omitted, and some terms are not common to DSM and the International Classification of Diseases (ICD).

The fourth edition of DSM (DSM-IV) eliminated the diagnosis of organic mental disorder in an attempt to indicate that all mental disorders may have a biological basis, or medical cause. Thus, the diagnosis of organic mental disorder is now called “delirium, dementia, and amnestic and other cognitive disorders.” The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), however, retains the diagnostic category organic mental disorders to refer to these conditions.

In a further effort to emphasize the biological aspects of mental illness, DSM-IV and the text revision of DSM-IV (DSM-IV-TR) eschew the term psychogenic. Nevertheless, it still appears in ICD-10 to refer to the fact that life events or difficulties play an important role in the genesis of many psychiatric disorders. Similarly, DSM has eliminated the term neurosis, which is also used in ICD-10. Both terms—organic and neurosis—remain in common parlance among health professionals, however.

Neurosis

A neurosis is a chronic or recurrent nonpsychotic disorder characterized mainly by anxiety, which is experienced or expressed directly or is altered through defense mechanisms; it appears as a symptom, such as an obsession, a compulsion, a phobia, or a sexual dysfunction. In the third edition of DSM (DSM-III), a neurotic disorder was defined as follows:

A mental disorder in which the predominant disturbance is a symptom or group of symptoms that is distressing to the individual and is recognized by him or her as unacceptable and alien (ego-dystonic); reality testing is grossly intact. Behavior does not actively violate gross social norms (though it may be quite disabling). The disturbance is relatively enduring or recurrent without treatment, and is not limited to a transitory reaction to stressors. There is no demonstrable organic etiology or factor.

The term neuroses encompasses a broad range of disorders of various signs and symptoms. As such, it has lost precision, except to signify that the person's gross reality testing and personality organization are intact. However, a neurosis can be, and usually is, sufficient to impair the person's functioning in a number of areas. It remains a useful term, especially when compared to the term psychosis, described below, still used in DSM-IV-TR.

Psychosis

The traditional meaning of the term psychotic emphasized loss of reality testing and impairment of mental functioning—manifested by delusions, hallucinations, confusion, and impaired memory. In the most common psychiatric use of the term, psychotic became synonymous with severe impairment of social and personal functioning characterized by social withdrawal and an inability to perform the usual household and occupational roles. Another use of the term—based on psychoanalytic concepts—specifies the degree of ego regression as the criterion for psychotic illness. As a consequence of those multiple meanings, the term has lost its precision in current clinical and research practice.

According to the American Psychiatric Glossary of the American Psychiatric Association, the term psychotic means grossly impaired reality testing. The term can be used to describe the behavior of a person at a given time or a mental disorder in which at some time during its course all persons with the disorder have grossly impaired reality testing. With gross impairment in reality testing, persons incorrectly evaluate the accuracy of their perceptions and thoughts and make incorrect inferences about external reality, even in the face of contrary evidence. The term psychotic does not apply to minor distortions of reality that involve matters of relative judgment. For example, depressed persons who underestimate their achievements are not described as psychotic; those who believe that they have caused natural catastrophes are so described.

Patients are more than a collection of signs and symptoms. The trend toward collecting symptoms and its possible dehumanizing effects was described by Karl Menninger over 35 years ago. As if anticipating the mathematical device currently in use in

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DSM-IV-TR, he wrote: “If the patient has, let us say, five symptoms, one can look up each of these symptoms and find which disease is so characterized under all five headings. Then, voilà! The diagnosis!” Menninger suggested that the trend toward tabulating disease states was antithetical to understanding the person experiencing the illness and deemphasized the compassionate approach toward the patient that is the hallmark of psychiatry. The algorithms and decision trees used in DSM-IV-TR and in the various computer programs that record signs and symptoms to provide a diagnosis are useful; however, Menninger's cautionary note must not be forgotten. A description of signs and symptoms is the science of psychiatry; the skill of the observers and their creative imaginations and ability to empathize is the art of psychiatry.

Finally, as the physician–philosopher William Osler (1898–1919) said of medicine in general, “It is learned only by experience; it is not an inheritance; it cannot be revealed. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.” So it is with psychiatry. One sees the posture of depression, hears the neologisms in schizophrenia, smells the odor of alcoholism, and feels the violent patient's anger. Eventually, with practice, the psychiatrist learns the full range of signs and symptoms. It is the rare psychiatrist, however, who encounters them all.

The glossary that follows is a comprehensive list of signs and symptoms, each of which has a definition or description. Most psychiatric signs and symptoms are rooted in normal behavior and can be understood as various points on a spectrum of behavior ranging from normal to pathological. They are listed alphabetically.

Glossary of Signs and Symptoms

Glossary

abreaction

A process by which repressed material, particularly a painful experience or a conflict, is brought back to consciousness; in this process, the person not only recalls, but also relives the repressed material, which is accompanied by the appropriate affective response.

abstract thinking

Thinking characterized by the ability to grasp the essentials of a whole, to break a whole into its parts, and to discern common properties. To think symbolically.

abulia

Reduced impulse to act and to think, associated with indifference about consequences of action. Occurs as a result of neurological deficit, depression, and schizophrenia.

acalculia

Loss of ability to do calculations; not caused by anxiety or impairment in concentration. Occurs with neurological deficit and learning disorder.

acataphasia

Disordered speech in which statements are incorrectly formulated. Patients may express themselves with words that sound like the ones intended, but are not appropriate to the thoughts, or they may use totally inappropriate expressions.

acathexis

Lack of feeling associated with an ordinarily emotionally charged subject; in psychoanalysis, it denotes the patient's detaching or transferring of emotion from thoughts and ideas. Also called decathexis. Occurs in anxiety, dissociative, schizophrenic, and bipolar disorders.

acenesthesia

Loss of sensation of physical existence.

acrophobia

Dread of high places.

acting out

Behavioral response to an unconscious drive or impulse that brings about temporary partial relief of inner tension; relief is attained by reacting to a present situation as if it were the situation that originally gave rise to the drive or impulse. Common in borderline states.

aculalia

Nonsense speech associated with marked impairment of comprehension. Occurs in mania, schizophrenia, and neurological deficit.

adiadochokinesia

Inability to perform rapid alternating movements. Occurs with neurological deficit and cerebellar lesions.

adynamia

Weakness and fatigability, characteristic of neurasthenia and depression.

aerophagia

Excessive swallowing of air. Seen in anxiety disorder.

affect

The subjective and immediate experience of emotion attached to ideas or mental representations of objects. Affect has outward manifestations that can be classified as restricted, blunted, flattened, broad, labile, appropriate, or inappropriate. See also mood.

ageusia

Lack or impairment of the sense of taste. Seen in depression and neurological deficit.

aggression

Forceful, goal-directed action that can be verbal or physical; the motor counterpart of the affect of rage, anger, or hostility. Seen in neurological deficit, temporal lobe disorder, impulse-control disorders, mania, and schizophrenia.

agitation

Severe anxiety associated with motor restlessness.

agnosia

Inability to understand the importance or significance of sensory stimuli; cannot be explained by a defect in sensory pathways or cerebral lesion; the term has also been used to refer to the selective loss or disuse of knowledge of specific objects because of emotional circumstances, as seen in certain schizophrenic, anxious, and depressed patients. Occurs with neurological deficit.

agoraphobia

Morbid fear of open places or leaving the familiar setting of the home. May be present with or without panic attacks.

agraphia

Loss or impairment of a previously possessed ability to write.

ailurophobia

Dread of cats.

akathisia

Subjective feeling of motor restlessness manifested by a compelling need to be in constant movement; may be seen as an extrapyramidal adverse effect of antipsychotic medication. May be mistaken for psychotic agitation.

akinesia

Lack of physical movement, as in the extreme immobility of catatonic schizophrenia; can also occur as an extrapyramidal effect of antipsychotic medication.

akinetic mutism

Absence of voluntary motor movement or speech in a patient who is apparently alert (as evidenced by eye movements). Seen in psychotic depression and catatonic states.

alexia

Loss of a previously possessed reading facility; not explained by defective visual acuity. Compare with Dyslexia.

alexithymia

Inability or difficulty in describing or being aware of one's emotions or moods; elaboration of fantasies associated with depression, substance abuse, and posttraumatic stress disorder (PTSD).

algophobia

Dread of pain.

alogia

Inability to speak because of a mental deficiency or an episode of dementia.

ambivalence

Coexistence of two opposing impulses toward the same thing in the same person at the same time. Seen in schizophrenia, borderline states, and obsessive-compulsive disorders (OCDs).

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amimia

Lack of the ability to make gestures or to comprehend those made by others.

amnesia

Partial or total inability to recall past experiences; may be organic (amnestic disorder) or emotional (dissociative amnesia) in origin.

amnestic aphasia

Disturbed capacity to name objects, even though they are known to the patient. Also called anomic aphasia.

anaclitic

Depending on others, especially as the infant on the mother; anaclitic depression in children results from an absence of mothering.

analgesia

State in which one feels little or no pain. Can occur under hypnosis and in dissociative disorder.

anancasm

Repetitious or stereotyped behavior or thought usually used as a tension-relieving device; used as a synonym for obsession and seen in obsessive-compulsive (anankastic) personality.

androgyny

Combination of culturally determined female and male characteristics in one person.

anergia

Lack of energy.

anhedonia

Loss of interest in, and withdrawal from, all regular and pleasurable activities. Often associated with depression.

anomia

Inability to recall the names of objects.

anorexia

Loss or decrease in appetite. In anorexia nervosa, appetite may be preserved, but the patient refuses to eat.

anosognosia

Inability to recognize a physical deficit in oneself (e.g., patient denies paralyzed limb).

anterograde amnesia

Loss of memory for events subsequent to the onset of the amnesia; common after trauma. Compare with retrograde amnesia.

anxiety

Feeling of apprehension caused by anticipation of danger, which may be internal or external.

apathy

Dulled emotional tone associated with detachment or indifference; observed in certain types of schizophrenia and depression.

aphasia

Any disturbance in the comprehension or expression of language caused by a brain lesion.

aphonia

Loss of voice. Seen in conversion disorder.

apperception

Awareness of the meaning and significance of a particular sensory stimulus as modified by one's own experiences, knowledge, thoughts, and emotions. See also perception.

appropriate affect

Emotional tone in harmony with the accompanying idea, thought, or speech.

apraxia

Inability to perform a voluntary purposeful motor activity; cannot be explained by paralysis or other motor or sensory impairment. In constructional apraxia, a patient cannot draw two- or three-dimensional forms.

astasia abasia

Inability to stand or to walk in a normal manner, even though normal leg movements can be performed in a sitting or lying down position. Seen in conversion disorder.

astereognosis

Inability to identify familiar objects by touch. Seen with neurological deficit. See also neurological amnesia.

asyndesis

Disorder of language in which the patient combines unconnected ideas and images. Commonly seen in schizophrenia.

ataxia

Lack of coordination, physical or mental. (1) In neurology, refers to loss of muscular coordination. (2) In psychiatry, the term intrapsychic ataxia refers to lack of coordination between feelings and thoughts; seen in schizophrenia and in severe OCD.

atonia

Lack of muscle tone. See waxy flexibility.

attention

Concentration; the aspect of consciousness that relates to the amount of effort exerted in focusing on certain aspects of an experience, activity, or task. Usually impaired in anxiety and depressive disorders.

auditory hallucination

False perception of sound, usually voices, but also other noises, such as music. Most common hallucination in psychiatric disorders.

aura

(1) Warning sensations, such as automatisms, fullness in the stomach, blushing, and changes in respiration; cognitive sensations, and mood states usually experienced before a seizure. (2) A sensory prodrome that precedes a classic migraine headache.

autistic thinking

Thinking in which the thoughts are largely narcissistic and egocentric, with emphasis on subjectivity rather than objectivity, and without regard for reality; used interchangeably with autism and dereism. Seen in schizophrenia and autistic disorder.

behavior

Sum total of the psyche that includes impulses, motivations, wishes, drives, instincts, and cravings, as expressed by a person's behavior or motor activity. Also called conation.

bereavement

Feeling of grief or desolation, especially at the death or loss of a loved one.

bizarre delusion

False belief that is patently absurd or fantastic (e.g., invaders from space have implanted electrodes in a person's brain). Common in schizophrenia. In nonbizarre delusion, content is usually within the range of possibility.

blackout

Amnesia experienced by alcoholics about behavior during drinking bouts; usually indicates reversible brain damage.

blocking

Abrupt interruption in train of thinking before a thought or idea is finished; after a brief pause, the person indicates no recall of what was being said or was going to be said (also known as thought deprivation or increased thought latency). Common in schizophrenia and severe anxiety.

blunted affect

Disturbance of affect manifested by a severe reduction in the intensity of externalized feeling tone; one of the fundamental symptoms of schizophrenia, as outlined by Eugen Bleuler.

bradykinesia

Slowness of motor activity, with a decrease in normal spontaneous movement.

bradylalia

Abnormally slow speech. Common in depression.

bradylexia

Inability to read at normal speed.

bruxism

Grinding or gnashing of the teeth, typically occurring during sleep. Seen in anxiety disorder.

carebaria

Sensation of discomfort or pressure in the head.

catalepsy

Condition in which persons maintain the body position into which they are placed; observed in severe cases of catatonic schizophrenia. Also called waxy flexibility and cerea flexibilitas. See also command automatism.

cataplexy

Temporary sudden loss of muscle tone, causing weakness and immobilization; can be precipitated by a variety of emotional states and is often followed by sleep. Commonly seen in narcolepsy.

catatonic excitement

Excited, uncontrolled motor activity seen in catatonic schizophrenia. Patients in catatonic state may suddenly erupt into an excited state and may be violent.

catatonic posturing

Voluntary assumption of an inappropriate or bizarre posture, generally maintained for long periods of time. May switch unexpectedly with catatonic excitement.

catatonic rigidity

Fixed and sustained motoric position that is resistant to change.

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catatonic stupor

Stupor in which patients ordinarily are well aware of their surroundings.

cathexis

In psychoanalysis, a conscious or unconscious investment of psychic energy in an idea, concept, object, or person. Compare with acathexis.

causalgia

Burning pain that can be organic or psychic in origin.

cenesthesia

Change in the normal quality of feeling tone in a part of the body.

cephalagia

Headache.

cerea flexibilitas

Condition of a person who can be molded into a position that is then maintained; when an examiner moves the person's limb, the limb feels as if it were made of wax. Also called catalepsy or waxy flexibility. Seen in schizophrenia.

chorea

Movement disorder characterized by random and involuntary quick, jerky, purposeless movements. Seen in Huntington's disease.

circumstantiality

Disturbance in the associative thought and speech processes in which a patient digresses into unnecessary details and inappropriate thoughts before communicating the central idea. Observed in schizophrenia, obsessional disturbances, and certain cases of dementia. See also tangentiality.

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.

claustrophobia

Abnormal fear of closed or confining spaces.

clonic convulsion

An involuntary, violent muscular contraction or spasm in which the muscles alternately contract and relax. Characteristic phase in grand mal epileptic seizure.

clouding of consciousness

Any disturbance of consciousness in which the person is not fully awake, alert, and oriented. Occurs in delirium, dementia, and cognitive disorder.

cluttering

Disturbance of fluency involving an abnormally rapid rate and erratic rhythm of speech that impedes intelligibility; the affected individual is usually unaware of communicative impairment.

cognition

Mental process of knowing and becoming aware; function is closely associated with judgment.

coma

State of profound unconsciousness from which a person cannot be roused, with minimal or no detectable responsiveness to stimuli; seen in injury or disease of the brain, in systemic conditions, such as diabetic ketoacidosis and uremia; and in intoxications with alcohol and other drugs. Coma can also occur in severe catatonic states and in conversion disorder.

coma vigil

Coma in which a patient appears to be asleep, but can be aroused (also known as akinetic mutism).

command automatism

Condition associated with catalepsy in which suggestions are followed automatically.

command hallucination

False perception of orders that a person may feel obliged to obey or unable to resist.

complex

A feeling-toned idea.

complex partial seizure

A seizure characterized by alterations in consciousness that may be accompanied by complex hallucinations (sometimes olfactory) or illusions. During the seizure, a state of impaired consciousness resembling a dream-like state may occur, and the patient may exhibit repetitive, automatic, or semipurposeful behavior.

compulsion

Pathological need to act on an impulse that, if resisted, produces anxiety; repetitive behavior in response to an obsession or performed according to certain rules, with no true end in itself other than to prevent something from occurring in the future.

conation

That part of a person's mental life concerned with cravings, strivings, motivations, drives, and wishes as expressed through behavior or motor activity.

concrete thinking

Thinking characterized by actual things, events, and immediate experience, rather than by abstractions; seen in young children, in those who have lost or never developed the ability to generalize (as in certain cognitive mental disorders), and in schizophrenic persons. Compare with abstract thinking.

condensation

Mental process in which one symbol stands for a number of components.

confabulation

Unconscious filling of gaps in memory by imagining experiences or events that have no basis in fact, commonly seen in amnestic syndromes; should be differentiated from lying. See also paramnesia.

confusion

Disturbances of consciousness manifested by a disordered orientation in relation to time, place, or person.

consciousness

State of awareness, with response to external stimuli.

constipation

Inability to defecate or difficulty in defecating.

constricted affect

Reduction in intensity of feeling tone that is less severe than that of blunted affect.

constructional apraxia

Inability to copy a drawing, such as a cube, clock, or pentagon, as a result of a brain lesion.

conversion phenomena

The development of symbolic physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder. Most common in conversion disorder, but also seen in a variety of mental disorders.

convulsion

An involuntary, violent muscular contraction or spasm. See also clonic convulsion and tonic convulsion.

coprolalia

Involuntary use of vulgar or obscene language. Observed in some cases of schizophrenia and in Tourette's syndrome.

coprophagia

Eating of filth or feces.

cryptographia

A private written language.

cryptolalia

A private spoken language.

cycloplegia

Paralysis of the muscles of accommodation in the eye; observed, at times, as an autonomic adverse effect (anticholinergic effect) of antipsychotic or antidepressant medication.

Decompensation

Deterioration of psychic functioning caused by a breakdown of defense mechanisms. Seen in psychotic states.

déjà entendu

Illusion that what one is hearing one has heard previously. See also paramnesia.

déjà pensé

Condition in which a thought never entertained before is incorrectly regarded as a repetition of a previous thought. See also paramnesia.

déjà vu

Illusion of visual recognition in which a new situation is incorrectly regarded as a repetition of a previous experience. See also paramnesia.

delirium

Acute reversible mental disorder characterized by confusion and some impairment of consciousness; generally associated with emotional lability, hallucinations or illusions, and inappropriate, impulsive, irrational, or violent behavior.

delirium tremens

Acute and sometimes fatal reaction to withdrawal from alcohol, usually occurring 72 to 96 hours after the cessation of heavy drinking; distinctive characteristics are marked autonomic hyperactivity (tachycardia, fever, hyperhidrosis, and dilated pupils), usually accompanied by tremulousness, hallucinations, illusions, and delusions. Called alcohol withdrawal delirium in DSM-IV-TR. See also formication.

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delusion

False belief, based on incorrect inference about external reality, that is firmly held despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture do not share the belief.

delusion of control

False belief that a person's will, thoughts, or feelings are being controlled by external forces.

delusion of grandeur

Exaggerated conception of one's importance, power, or identity.

delusion of infidelity

False belief that one's lover is unfaithful. Sometimes called pathological jealousy.

delusion of persecution

False belief of being harassed or persecuted; often found in litigious patients who have a pathological tendency to take legal action because of imagined mistreatment. Most common delusion.

delusion of poverty

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

delusion of reference

False belief that the behavior of others refers to oneself or that events, objects, or other people have a particular and unusual significance, usually of a negative nature; derived from idea of reference, in which persons falsely feel that others are talking about them (e.g., belief that people on television or radio are talking to or about the person). See also thought broadcasting.

delusion of self-accusation

False feeling of remorse and guilt. Seen in depression with psychotic features.

dementia

Mental disorder characterized by general impairment in intellectual functioning without clouding of consciousness; characterized by failing memory, difficulty with calculations, distractibility, alterations in mood and affect, impaired judgment and abstraction, reduced facility with language, and disturbance of orientation. Although irreversible because of underlying progressive degenerative brain disease, dementia may be reversible if the cause can be treated.

denial

Defense mechanism in which the existence of unpleasant realities is disavowed; refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety.

depersonalization

Sensation of unreality concerning oneself, parts of oneself, or one's environment that occurs under extreme stress or fatigue. Seen in schizophrenia, depersonalization disorder, and schizotypal personality disorder.

depression

Mental state characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation or, at times, agitation, withdrawal from interpersonal contact, and vegetative symptoms, such as insomnia and anorexia. The term refers to a mood that is so characterized or to a mood disorder.

derailment

Gradual or sudden deviation in train of thought without blocking; sometimes used synonymously with loosening of association.

derealization

Sensation of changed reality or that one's surroundings have altered. Usually seen in schizophrenia, panic attacks, and dissociative disorders.

dereism

Mental activity that follows a totally subjective and idiosyncratic system of logic and fails to take the facts of reality or experience into consideration. Characteristic of schizophrenia. See also autistic thinking.

detachment

Characterized by distant interpersonal relationships and lack of emotional involvement.

devaluation

Defense mechanism in which a person attributes excessively negative qualities to self or others. Seen in depression and paranoid personality disorder.

diminished libido

Decreased sexual interest and drive. (Increased libido is often associated with mania.)

dipsomania

Compulsion to drink alcoholic beverages.

disinhibition

(1) Removal of an inhibitory effect, as in the reduction of the inhibitory function of the cerebral cortex by alcohol. (2) In psychiatry, a greater freedom to act in accordance with inner drives or feelings and with less regard for restraints dictated by cultural norms or one's superego.

disorientation

Confusion; impairment of awareness of time, place, and person (the position of the self in relation to other persons). Characteristic of cognitive disorders.

displacement

Unconscious defense mechanism by which the emotional component of an unacceptable idea or object is transferred to a more acceptable one. Seen in phobias.

dissociation

Unconscious defense mechanism involving the segregation of any group of mental or behavioral processes from the rest of the person's psychic activity; may entail the separation of an idea from its accompanying emotional tone, as seen in dissociative and conversion disorders. Seen in dissociative disorders.

distractibility

Inability to focus one's attention; the patient does not respond to the task at hand but attends to irrelevant phenomena in the environment.

dread

Massive or pervasive anxiety, usually related to a specific danger.

dreamy state

Altered state of consciousness, likened to a dream situation, which develops suddenly and usually lasts a few minutes; accompanied by visual, auditory, and olfactory hallucinations. Commonly associated with temporal lobe lesions.

drowsiness

State of impaired awareness associated with a desire or inclination to sleep.

dysarthria

Difficulty in articulation, the motor activity of shaping phonated sounds into speech, not in word finding or in grammar.

dyscalculia

Difficulty in performing calculations.

dysgeusia

Impaired sense of taste.

dysgraphia

Difficulty in writing.

dyskinesia

Difficulty in performing movements. Seen in extrapyramidal disorders.

dyslalia

Faulty articulation caused by structural abnormalities of the articulatory organs or impaired hearing.

dyslexia

Specific learning disability syndrome involving an impairment of the previously acquired ability to read; unrelated to the person's intelligence. Compare with alexia.

dysmetria

Impaired ability to gauge distance relative to movements. Seen in neurological deficit.

dysmnesia

Impaired memory.

dyspareunia

Physical pain in sexual intercourse, usually emotionally caused and more commonly experienced by women; can also result from cystitis, urethritis, or other medical conditions.

dysphagia

Difficulty in swallowing.

dysphasia

Difficulty in comprehending oral language (reception dysphasia) or in trying to express verbal language (expressive dysphasia).

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dysphonia

Difficulty or pain in speaking.

dysphoria

Feeling of unpleasantness or discomfort; a mood of general dissatisfaction and restlessness. Occurs in depression and anxiety.

dysprosody

Loss of normal speech melody (prosody). Common in depression.

dystonia

Extrapyramidal motor disturbance consisting of slow, sustained contractions of the axial or appendicular musculature; one movement often predominates, leading to relatively sustained postural deviations; acute dystonic reactions (facial grimacing and torticollis) are occasionally seen with the initiation of antipsychotic drug therapy.

echolalia

Psychopathological 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.

ego-alien

Denoting aspects of a person's personality that are viewed as repugnant, unacceptable, or inconsistent with the rest of the personality. Also called ego-dystonia. Compare with ego-syntonic.

egocentric

Self-centered; selfishly preoccupied with one's own needs; lacking interest in others.

ego-dystonic

See ego-alien.

egomania

Morbid self-preoccupation or self-centeredness. See also narcissism.

ego-syntonic

Denoting aspects of a personality that are viewed as acceptable and consistent with that person's total personality. Personality traits are usually ego-syntonic. Compare with ego-alien.

eidetic image

Unusually vivid or exact mental image of objects previously seen or imagined.

elation

Mood consisting of feelings of joy, euphoria, triumph, and intense self-satisfaction or optimism. Occurs in mania when not grounded in reality.

elevated mood

Air of confidence and enjoyment; a mood more cheerful than normal but not necessarily pathological.

emotion

Complex feeling state with psychic, somatic, and behavioral components; external manifestation of emotion is affect.

emotional insight

A level of understanding or awareness that one has emotional problems. It facilitates positive changes in personality and behavior when present.

emotional lability

Excessive emotional responsiveness characterized by unstable and rapidly changing emotions.

encopresis

Involuntary passage of feces, usually occurring at night or during sleep.

enuresis

Incontinence of urine during sleep.

erotomania

Delusional belief, more common in women than in men, that someone is deeply in love with them (also known as de Clérambault syndrome).

erythrophobia

Abnormal fear of blushing.

euphoria

Exaggerated feeling of well-being that is inappropriate to real events. Can occur with drugs such as opiates, amphetamines, and alcohol.

euthymia

Normal range of mood, implying absence of depressed or elevated mood.

evasion

Act of not facing up to, or strategically eluding, something; consists of suppressing an idea that is next in a thought series and replacing it with another idea closely related to it. Also called paralogia and perverted logic.

exaltation

Feeling of intense elation and grandeur.

excited

Agitated, purposeless motor activity uninfluenced by external stimuli.

expansive mood

Expression of feelings without restraint, frequently with an overestimation of their significance or importance. Seen in mania and grandiose delusional disorder.

expressive aphasia

Disturbance of speech in which understanding remains, but ability to speak is grossly impaired; halting, laborious, and inaccurate speech (also known as Broca's, nonfluent, and motor aphasias).

expressive dysphasia

Difficulty in expressing verbal language; the ability to understand language is intact.

externalization

More general term than projection that refers to the tendency to perceive in the external world and in external objects elements of one's own personality, including instinctual impulses, conflicts, moods, attitudes, and styles of thinking.

extroversion

State of one's energies being directed outside oneself. Compare with introversion.

false memory

A person's recollection and belief of an event that did not actually occur. In false memory syndrome, persons erroneously believe that they sustained an emotional or physical (e.g., sexual) trauma in early life.

fantasy

Daydream; fabricated mental picture of a situation or chain of events. A normal form of thinking dominated by unconsciousness material that seeks wish fulfillment and solutions to conflicts; may serve as the matrix for creativity. The content of the fantasy may indicate mental illness.

fatigue

A feeling of weariness, sleepiness, or irritability after a period of mental or bodily activity. Seen in depression, anxiety, neurasthenia, and somatoform disorders.

fausse reconnaissance

False recognition, a feature of paramnesia. Can occur in delusional disorders.

fear

Unpleasurable emotional state consisting of psychophysiological changes in response to a realistic threat or danger. Compare with anxiety.

flat affect

Absence or near absence of any signs of affective expression.

flight of ideas

Rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent. Seen in mania.

floccillation

Aimless plucking or picking, usually at bedclothes or clothing, commonly seen in dementia and delirium.

fluent aphasia

Aphasia characterized by inability to understand the spoken word; fluent but incoherent speech is present. Also called Wernicke's, sensory, and receptive aphasias.

folie à deux

Mental illness shared by two persons, usually involving a common delusional system; if it involves three persons, it is referred to as folie à trois, and so on. Also called shared psychotic disorder.

formal thought disorder

Disturbance in the form rather than the content of thought; thinking characterized by loosened associations, neologisms, and illogical constructs; thought process is disordered, and the person is defined as psychotic. Characteristic of schizophrenia.

formication

Tactile hallucination involving the sensation that tiny insects are crawling over the skin. Seen in cocaine addiction and delirium tremens.

free-floating anxiety

Severe, pervasive, generalized anxiety that is not attached to any particular idea, object, or event. Observed particularly in anxiety disorders, although it may be seen in some cases of schizophrenia.

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fugue

Dissociative disorder characterized by a period of almost complete amnesia, during which a person actually flees from an immediate life situation and begins a different life pattern; apart from the amnesia, mental faculties and skills are usually unimpaired.

galactorrhea

Abnormal discharge of milk from the breast; may result from the endocrine influence (e.g., prolactin) of dopamine receptor antagonists, such as phenothiazines.

generalized tonic-clonic seizure

Generalized onset of tonic-clonic movements of the limbs, tongue-biting, and incontinence followed by slow, gradual recovery of consciousness and cognition; also called grand mal seizure.

global aphasia

Combination of grossly nonfluent aphasia and severe fluent aphasia.

glossolalia

Unintelligible jargon that has meaning to the speaker but not to the listener. Occurs in schizophrenia.

grandiosity

Exaggerated feelings of one's importance, power, knowledge, or identity. Occurs in delusional disorder and manic states.

grief

Alteration in mood and affect consisting of sadness appropriate to a real loss; normally, it is self-limited. See also depression and mourning.

guilt

Emotional state associated with self-reproach and the need for punishment. In psychoanalysis, refers to a feeling of culpability that stems from a conflict between the ego and the superego (conscience). Guilt has normal psychological and social functions, but special intensity or absence of guilt characterizes many mental disorders, such as depression and antisocial personality disorder, respectively. Psychiatrists distinguish shame as a less internalized form of guilt that relates more to others than to the self. See also shame.

gustatory hallucination

Hallucination primarily involving taste.

gynecomastia

Female-like development of the male breasts; can occur as an adverse effect of antipsychotic and antidepressant drugs because of increased prolactin levels or anabolic-androgenic steroid abuse.

hallucination

False sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved. For types of hallucinations, see the specific term.

hallucinosis

State in which a person experiences hallucinations without any impairment of consciousness.

haptic hallucination

Hallucination of touch.

hebephrenia

Complex of symptoms, considered a form of schizophrenia, characterized by wild or silly behavior or mannerisms, inappropriate affect, and delusions and hallucinations that are transient and unsystematized. Hebephrenic schizophrenia is now called disorganized schizophrenia.

holophrastic

Using a single word to express a combination of ideas. Seen in schizophrenia.

hyperactivity

Increased muscular activity. The term is commonly used to describe a disturbance found in children that is manifested by constant restlessness, overactivity, distractibility, and difficulties in learning. Seen in attention-deficit/hyperactivity disorder (ADHD).

hyperalgesia

Excessive sensitivity to pain. Seen in somatoform disorder.

hyperesthesia

Increased sensitivity to tactile stimulation.

hypermnesia

Exaggerated degree of retention and recall. It can be elicited by hypnosis and may be seen in certain prodigies; also can be a feature of OCD, some cases of schizophrenia, and manic episodes of bipolar I disorder.

hyperphagia

Increase in appetite and intake of food.

hyperpragia

Excessive thinking and mental activity. Generally associated with manic episodes of bipolar I disorder.

hypersomnia

Excessive time spent asleep. Can be associated with underlying medical or psychiatric disorder or narcolepsy, can be part of the Kleine-Levin syndrome, or may be primary.

hyperventilation

Excessive breathing, generally associated with anxiety, which can reduce blood carbon dioxide concentration and can produce lightheadedness, palpitations, numbness, tingling periorally and in the extremities, and, occasionally, syncope.

hypervigilance

Excessive attention to, and focus on, all internal and external stimuli; usually seen in delusional or paranoid states.

hypesthesia

Diminished sensitivity to tactile stimulation.

hypnagogic hallucination

Hallucination occurring while falling asleep, not ordinarily considered pathological.

hypnopompic hallucination

Hallucination occurring while awakening from sleep, not ordinarily considered pathological.

hypnosis

Artificially induced alteration of consciousness characterized by increased suggestibility and receptivity to direction.

hypoactivity

Decreased motor and cognitive activity, as in psychomotor retardation; visible slowing of thought, speech, and movements. Also called hypokinesis.

hypochondria

Exaggerated concern about health that is based not on real medical pathology, but on unrealistic interpretations of physical signs or sensations as abnormal.

hypomania

Mood abnormality with the qualitative characteristics of mania, but somewhat less intense. Seen in cyclothymic disorder.

idea of reference

Misinterpretation of incidents and events in the outside world as having direct personal reference to oneself; occasionally observed in normal persons, but frequently seen in paranoid patients. If present with sufficient frequency or intensity or if organized and systematized, they constitute delusions of reference.

illogical thinking

Thinking containing erroneous conclusions or internal contradictions; psychopathological only when it is marked and not caused by cultural values or intellectual deficit.

illusion

Perceptual misinterpretation of a real external stimulus. Compare with hallucination.

immediate memory

Reproduction, recognition, or recall of perceived material within seconds after presentation. Compare with long-term memory and short-term memory.

impaired insight

Diminished ability to understand the objective reality of a situation.

impaired judgment

Diminished ability to understand a situation correctly and to act appropriately.

impulse control

Ability to resist an impulse, drive, or temptation to perform some action.

inappropriate affect

Emotional tone out of harmony with the idea, thought, or speech accompanying it. Seen in schizophrenia.

incoherence

Communication that is disconnected, disorganized, or incomprehensible. See also word salad.

incorporation

Primitive unconscious defense mechanism in which the psychic representation of another person or aspects of another person are assimilated into oneself through a figurative process of symbolic oral ingestion; represents a special form of introjection and is the earliest mechanism of identification.

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increased libido

Increase in sexual interest and drive.

ineffability

Ecstatic state in which persons insist that their experience is inexpressible and indescribable and that it is impossible to convey what it is like to one who has never experienced it.

initial insomnia

Falling asleep with difficulty; usually seen in anxiety disorder. Compare with middle insomnia and terminal insomnia.

insight

Conscious recognition of one's own condition. In psychiatry, it refers to the conscious awareness and understanding of one's own psychodynamics and symptoms of maladaptive behavior; highly important in effecting changes in the personality and behavior of a person.

insomnia

Difficulty in falling asleep or difficulty in staying asleep. It can be related to a mental disorder, a physical disorder, or an adverse effect of medication; or it can be primary (not related to a known medical factor or another mental disorder). See also initial insomnia, middle insomnia, and terminal insomnia.

intellectual insight

Knowledge of the reality of a situation without the ability to use that knowledge successfully to effect an adaptive change in behavior or to master the situation. Compare with true insight.

intelligence

Capacity for learning and ability to recall, integrate constructively, and apply what one has learned; the capacity to understand and to think rationally.

intoxication

Mental disorder caused by recent ingestion or presence in the body of an exogenous substance producing maladaptive behavior by virtue of its effects on the central nervous system (CNS). The most common psychiatric changes involve disturbances of perception, wakefulness, attention, thinking, judgment, emotional control, and psychomotor behavior; the specific clinical picture depends on the substance ingested.

intropunitive

Turning anger inward toward oneself. Commonly observed in depressed patients.

introspection

Contemplating one's own mental processes to achieve insight.

introversion

State in which a person's energies are directed inward toward the self, with little or no interest in the external world.

irrelevant answer

Answer that is not responsive to the question.

irritability

Abnormal or excessive excitability, with easily triggered anger, annoyance, or impatience.

irritable mood

State in which one is easily annoyed and provoked to anger. See also irritability.

jamais vu

Paramnestic phenomenon characterized by a false feeling of unfamiliarity with a real situation that one has previously experienced.

jargon aphasia

Aphasia in which the words produced are neologistic; that is, nonsense words created by the patient.

judgment

Mental act of comparing or evaluating choices within the framework of a given set of values for the purpose of electing a course of action. If the course of action chosen is consonant with reality or with mature adult standards of behavior, judgment is said to be intact or normal; judgment is said to be impaired if the chosen course of action is frankly maladaptive, results from impulsive decisions based on the need for immediate gratification, or is otherwise not consistent with reality as measured by mature adult standards.

kleptomania

Pathological compulsion to steal.

la belle indifférence

Inappropriate attitude of calm or lack of concern about one's disability. May be seen in patients with conversion disorder.

labile affect

Affective expression characterized by rapid and abrupt changes, unrelated to external stimuli.

labile mood

Oscillations in mood between euphoria and depression or anxiety.

laconic speech

Condition characterized by a reduction in the quantity of spontaneous speech; replies to questions are brief and unelaborated, and little or no unprompted additional information is provided. Occurs in major depression, schizophrenia, and organic mental disorders. Also called poverty of speech.

lethologica

Momentary forgetting of a name or proper noun. See blocking.

lilliputian hallucination

Visual sensation that persons or objects are reduced in size; more properly regarded as an illusion. See also micropsia.

localized amnesia

Partial loss of memory; amnesia restricted to specific or isolated experiences. Also called lacunar amnesia and patch amnesia.

logorrhea

Copious, pressured, coherent speech; uncontrollable, excessive talking; observed in manic episodes of bipolar disorder. Also called tachylogia, verbomania, and volubility.

long-term memory

Reproduction, recognition, or recall of experiences or information that was experienced in the distant past. Also called remote memory. Compare with immediate memory and short-term memory.

loosening of associations

Characteristic schizophrenic thinking or 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. See also tangentiality.

macropsia

False perception that objects are larger than they really are. Compare with micropsia.

magical thinking

A form of dereistic thought; thinking similar to that of the preoperational phase in children (Jean Piaget), in which thoughts, words, or actions assume power (e.g., to cause or to prevent events).

malingering

Feigning disease to achieve a specific goal, for example, to avoid an unpleasant responsibility.

mania

Mood state characterized by elation, agitation, hyperactivity, hypersexuality, and accelerated thinking and speaking (flight of ideas). Seen in bipolar I disorder. See also hypomania.

manipulation

Maneuvering by patients to get their own way; characteristic of antisocial personalities.

mannerism

Ingrained, habitual involuntary movement.

melancholia

Severe depressive state. Used in the term involutional melancholia as a descriptive term and also in reference to a distinct diagnostic entity.

memory

Process whereby what is experienced or learned is established as a record in the CNS (registration), where it persists with a variable degree of permanence (retention) and can be recollected or retrieved from storage at will (recall). For types of memory, see immediate memory, long-term memory, and short-term memory.

mental disorder

Psychiatric illness or disease whose manifestations are primarily characterized by behavioral or psychological impairment of function, measured in terms of deviation from some normative concept; associated with distress or disease, not just an expected response to a particular event or limited to relations between a person and society.

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mental retardation

Subaverage general intellectual functioning that originates in the developmental period and is associated with impaired maturation and learning, and social maladjustment. Retardation is commonly defined in terms of intelligent quotient (IQ): mild (between 50 and 55 to 70), moderate (between 35 and 40 to between 50 and 55), severe (between 20 and 25 to between 35 and 40), and profound (below 20 to 25).

metonymy

Speech disturbance common in schizophrenia in which the affected person uses a word or phrase that is related to the proper one but is not the one ordinarily used; for example, the patient speaks of consuming a menu rather than a meal, or refers to losing the piece of string of the conversation, rather than the thread of the conversation. See also paraphasia and word approximation.

microcephaly

Condition in which the head is unusually small as a result of defective brain development and premature ossification of the skull.

micropsia

False perception that objects are smaller than they really are. Sometimes called lilliputian hallucination. Compare with macropsia.

middle insomnia

Waking up after falling asleep without difficulty and then having difficulty in falling asleep again. Compare with initial insomnia and terminal insomnia.

mimicry

Simple, imitative motion activity of childhood.

monomania

Mental state characterized by preoccupation with one subject.

mood

Pervasive and sustained feeling tone that is experienced internally and that, in the extreme, can markedly influence virtually all aspects of a person's behavior and perception of the world. Distinguished from affect, the external expression of the internal feeling tone.

mood-congruent delusion

Delusion with content that is mood appropriate (e.g., depressed patients who believe that they are responsible for the destruction of the world).

mood-congruent hallucination

Hallucination with content that is consistent with a depressed or manic mood (e.g., depressed patients hearing voices telling them that they are bad persons and manic patients hearing voices telling them that they have inflated worth, power, or knowledge).

mood-incongruent delusion

Delusion based on incorrect reference about external reality, with content that has no association to mood or is mood inappropriate (e.g., depressed patients who believe that they are the new Messiah).

mood-incongruent hallucination

Hallucination not associated with real external stimuli, with content that is not consistent with depressed or manic mood (e.g., in depression, hallucinations not involving such themes as guilt, deserved punishment, or inadequacy; in mania, not involving such themes as inflated worth or power).

mood swings

Oscillation of a person's emotional feeling tone between periods of elation and periods of depression.

motor aphasia

Aphasia in which understanding is intact, but the ability to speak is lost. Also called Broca's, expressive, or nonfluent aphasias.

mourning

Syndrome following loss of a loved one, consisting of preoccupation with the lost individual, weeping, sadness, and repeated reliving of memories. See also bereavement and grief.

muscle rigidity

State in which the muscles remain immovable; seen in schizophrenia.

mutism

Organic or functional absence of the faculty of speech. See also stupor.

mydriasis

Dilation of the pupil; sometimes occurs as an autonomic (anticholinergic) or atropine-like adverse effect of some antipsychotic and antidepressant drugs.

narcissism

In psychoanalytic theory, divided into primary and secondary types: primary narcissism, the early infantile phase of object relationship development, when the child has not differentiated the self from the outside world, and all sources of pleasure are unrealistically recognized as coming from within the self, giving the child a false sense of omnipotence; secondary narcissism, when the libido, once attached to external love objects, is redirected back to the self. See also autistic thinking.

needle phobia

The persistent, intense, pathological fear of receiving an injection.

negative signs

In schizophrenia: flat affect, alogia, abulia, and apathy.

negativism

Verbal or nonverbal opposition or resistance to outside suggestions and advice; commonly seen in catatonic schizophrenia in which the patient resists any effort to be moved or does the opposite of what is asked.

neologism

New word or phrase whose derivation cannot be understood; often seen in schizophrenia. It has also been used to mean a word that has been incorrectly constructed but whose origins are nonetheless understandable (e.g., headshoe to mean hat), but such constructions are more properly referred to as word approximations.

neurological amnesia

(1) Auditory amnesia: loss of ability to comprehend sounds or speech. (2) Tactile amnesia: loss of ability to judge the shape of objects by touch. See also astereognosis. (3) Verbal amnesia: loss of ability to remember words. (4) Visual amnesia: loss of ability to recall or to recognize familiar objects or printed words.

nihilism

Delusion of the nonexistence of the self or part of the self; also refers to an attitude of total rejection of established values or extreme skepticism regarding moral and value judgments.

nihilistic delusion

Depressive delusion that the world and everything related to it have ceased to exist.

noeisis

Revelation in which immense illumination occurs in association with a sense that one has been chosen to lead and command. Can occur in manic or dissociative states.

nominal aphasia

Aphasia characterized by difficulty in giving the correct name of an object. See also anomia and amnestic aphasia.

nymphomania

Abnormal, excessive, insatiable desire in a woman for sexual intercourse. Compare with satyriasis.

obsession

Persistent and recurrent idea, thought, or impulse that cannot be eliminated from consciousness by logic or reasoning; obsessions are involuntary and ego-dystonic. See also compulsion.

olfactory hallucination

Hallucination primarily involving smell or odors; most common in medical disorders, especially in the temporal lobe.

orientation

State of awareness of oneself and one's surroundings in terms of time, place, and person.

overactivity

Abnormality in motor behavior that can manifest itself as psychomotor agitation, hyperactivity (hyperkinesis), tics, sleepwalking, or compulsions.

overvalued idea

False or unreasonable belief or idea that is sustained beyond the bounds of reason. It is held with less intensity or duration than a delusion, but is usually associated with mental illness.

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panic

Acute, intense attack of anxiety associated with personality disorganization; the anxiety is overwhelming and accompanied by feelings of impending doom.

panphobia

Overwhelming fear of everything.

pantomime

Gesticulation; psychodrama without the use of words.

paramnesia

Disturbance of memory in which reality and fantasy are confused. It is observed in dreams and in certain types of schizophrenia and organic mental disorders; it includes phenomena such as déjà vu and déjà entendu, which can occur occasionally in normal persons.

paranoia

Rare psychiatric syndrome marked by the gradual development of a highly elaborate and complex delusional system, generally involving persecutory or grandiose delusions, with few other signs of personality disorganization or thought disorder.

paranoid delusions

Includes persecutory delusions and delusions of reference, control, and grandeur.

paranoid ideation

Thinking dominated by suspicious, persecutory, or grandiose content of less than delusional proportions.

paraphasia

Abnormal speech in which one word is substituted for another, the irrelevant word generally resembling the required one in morphology, meaning, or phonetic composition; the inappropriate word may be a legitimate one used incorrectly, such as clover instead of hand, or a bizarre nonsense expression, such as treen instead of train. Paraphasic speech may be seen in organic aphasias and in mental disorders such as schizophrenia. See also metonymy and word approximation.

parapraxis

Faulty act, such as a slip of the tongue or the misplacement of an article. Freud ascribed parapraxes to unconscious motives.

paresis

Weakness or partial paralysis of organic origin.

paresthesia

Abnormal spontaneous tactile sensation, such as a burning, tingling, or pins-and-needles sensation.

perception

Conscious awareness of elements in the environment by the mental processing of sensory stimuli; sometimes used in a broader sense to refer to the mental process by which all kinds of data, intellectual, emotional, and sensory, are meaningfully organized. See also apperception.

perseveration

(1) Pathological repetition of the same response to different stimuli, as in a repetition of the same verbal response to different questions. (2) Persistent repetition of specific words or concepts in the process of speaking. Seen in cognitive disorders, schizophrenia, and other mental illness. See also verbigeration.

phantom limb

False sensation that an extremity that has been lost is, in fact, present.

phobia

Persistent, pathological, unrealistic, intense fear of an object or situation; the phobic person may realize that the fear is irrational but, nonetheless, cannot dispel it.

pica

Craving and eating of nonfood substances, such as paint and clay.

polyphagia

Pathological overeating.

positive signs

In schizophrenia: hallucinations, delusions, and thought disorder.

posturing

Strange, fixed, and bizarre bodily positions held by a patient for an extended time. See also catatonia.

poverty of speech content

Speech that is adequate in amount, but conveys little information because of vagueness, emptiness, or stereotyped phrases.

poverty of speech

Restriction in the amount of speech used; replies may be monosyllabic. See also laconic speech.

preoccupation of thought

Centering of thought content on a particular idea, associated with a strong affective tone, such as a paranoid trend or a suicidal or homicidal preoccupation.

pressured speech

Increase in the amount of spontaneous speech; rapid, loud, accelerated speech, as occurs in mania, schizophrenia, and cognitive disorders.

primary process thinking

In psychoanalysis, the mental activity directly related to the functions of the id and characteristic of unconscious mental processes; marked by primitive, prelogical thinking and by the tendency to seek immediate discharge and gratification of instinctual demands. Includes thinking that is dereistic, illogical, magical; normally found in dreams, abnormally in psychosis. Compare with secondary process thinking.

projection

Unconscious defense mechanism in which persons attribute to another those generally unconscious ideas, thoughts, feelings, and impulses that are in themselves undesirable or unacceptable as a form of protection from anxiety arising from an inner conflict; by externalizing whatever is unacceptable, they deal with it as a situation apart from themselves.

prosopagnosia

Inability to recognize familiar faces that is not caused by impaired visual acuity or level of consciousness.

pseudocyesis

Rare condition in which a nonpregnant patient has the signs and symptoms of pregnancy, such as abdominal distention, breast enlargement, pigmentation, cessation of menses, and morning sickness.

pseudodementia

(1) Dementia-like disorder that can be reversed by appropriate treatment and is not caused by organic brain disease. (2) Condition in which patients show exaggerated indifference to their surroundings in the absence of a mental disorder; also occurs in depression and factitious disorders.

pseudologia phantastica

Disorder characterized by uncontrollable lying in which patients elaborate extensive fantasies that they freely communicate and act on.

psychomotor agitation

Physical and mental overactivity that is usually nonproductive and is associated with a feeling of inner turmoil, as seen in agitated depression.

psychosis

Mental disorder in which the thoughts, affective response, ability to recognize reality, and ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality; the classic characteristics of psychosis are impaired reality testing, hallucinations, delusions, and illusions.

psychotic

(1) Person experiencing psychosis. (2) Denoting or characteristic of psychosis.

rationalization

An unconscious defense mechanism in which irrational or unacceptable behavior, motives, or feelings are logically justified or made consciously tolerable by plausible means.

reaction formation

Unconscious defense mechanism in which a person develops a socialized attitude or interest that is the direct antithesis of some infantile wish or impulse that is harbored consciously or unconsciously. One of the earliest and most unstable defense mechanisms, closely related to repression; both are defenses against impulses or urges that are unacceptable to the ego.

reality testing

Fundamental ego function that consists of tentative actions that test and objectively evaluate the nature and limits of the environment; includes the ability to differentiate between the external world and the internal world and to accurately judge the relation between the self and the environment.

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recall

Process of bringing stored memories into consciousness. See also memory.

recent memory

Recall of events over the past few days.

recent past memory

Recall of events over the past few months.

receptive aphasia

Organic loss of ability to comprehend the meaning of words; fluid and spontaneous, but incoherent and nonsensical, speech. See also fluent aphasia and sensory aphasia.

receptive dysphasia

Difficulty in comprehending oral language; the impairment involves comprehension and production of language.

regression

Unconscious defense mechanism in which a person undergoes a partial or total return to earlier patterns of adaptation; observed in many psychiatric conditions, particularly schizophrenia.

remote memory

Recall of events from the distant past.

repression

Freud's term for an unconscious defense mechanism in which unacceptable mental contents are banished or kept out of consciousness; important in normal psychological development and in neurotic and psychotic symptom formation. Freud recognized two kinds of repression: (1) repression proper, in which the repressed material was once in the conscious domain, and (2) primal repression, in which the repressed material was never in the conscious realm. Compare with suppression.

restricted affect

Reduction in intensity of feeling tone, which is less severe than in blunted affect, but clearly reduced. See also constricted affect.

retrograde amnesia

Loss of memory for events preceding the onset of the amnesia. Compare with anterograde amnesia.

retrospective falsification

Memory becomes unintentionally (unconsciously) distorted by being filtered through a person's present emotional, cognitive, and experiential state.

rigidity

In psychiatry, a person's resistance to change, a personality trait.

ritual

(1) Formalized activity practiced by a person to reduce anxiety, as in OCD. (2) Ceremonial activity of cultural origin.

rumination

Constant preoccupation with thinking about a single idea or theme, as in OCD.

satyriasis

Morbid, insatiable sexual need or desire in a man. Compare with nymphomania.

scotoma

(1) In psychiatry, a figurative blind spot in a person's psychological awareness. (2) In neurology, a localized visual field defect.

secondary process thinking

In psychoanalysis, the form of thinking that is logical, organized, reality oriented, and influenced by the demands of the environment; characterizes the mental activity of the ego. Compare with primary process thinking.

seizure

An attack or sudden onset of certain symptoms, such as convulsions, loss of consciousness, and psychic or sensory disturbances; seen in epilepsy and can be substance induced.

sensorium

Hypothetical sensory center in the brain that is involved with clarity of awareness about oneself and one's surroundings, including the ability to perceive and to process ongoing events in light of past experiences, future options, and current circumstances; sometimes used interchangeably with consciousness.

sensory aphasia

Organic loss of ability to comprehend the meaning of words; fluid and spontaneous, but incoherent and nonsensical, speech. See also fluent aphasia and receptive aphasia.

sensory extinction

Neurological sign operationally defined as failure to report one of two simultaneously presented sensory stimuli, despite that either stimulus alone is correctly reported. Also called sensory inattention.

shame

Failure to live up to self-expectations; often associated with fantasy of how person will be seen by others. See also guilt.

short-term memory

Reproduction, recognition, or recall of perceived material within minutes after the initial presentation. Compare with immediate memory and long-term memory.

simultanagnosia

Impairment in the perception or integration of visual stimuli appearing simultaneously.

somatic delusion

Delusion pertaining to the functioning of one's body.

somatic hallucination

Hallucination involving the perception of a physical experience localized within the body.

somatopagnosia

Inability to recognize a part of one's body as one's own (also called ignorance of the body and autotopagnosia).

somnolence

Pathological sleepiness or drowsiness from which one can be aroused to a normal state of consciousness.

spatial agnosia

Inability to recognize spatial relations.

speaking in tongues

Expression of a revelatory message through unintelligible words; not considered a disorder of thought if associated with practices of specific Pentecostal religions. See also glossolalia.

stereotypy

Continuous mechanical repetition of speech or physical activities; observed in catatonic schizophrenia.

stupor

(1) State of decreased reactivity to stimuli and less than full awareness of one's surroundings; as a disturbance of consciousness, it indicates a condition of partial coma or semicoma. (2) In psychiatry, used synonymously with mutism and does not necessarily imply a disturbance of consciousness; in catatonic stupor, patients are ordinarily aware of their surroundings.

stuttering

Frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency.

sublimation

Unconscious defense mechanism in which the energy associated with unacceptable impulses or drives is diverted into personally and socially acceptable channels; unlike other defense mechanisms, it offers some minimal gratification of the instinctual drive or impulse.

substitution

Unconscious defense mechanism in which a person replaces an unacceptable wish, drive, emotion, or goal with one that is more acceptable.

suggestibility

State of uncritical compliance with influence or of uncritical acceptance of an idea, belief, or attitude; commonly observed among persons with hysterical traits.

suicidal ideation

Thoughts or act of taking one's own life.

suppression

Conscious act of controlling and inhibiting an unacceptable impulse, emotion, or idea; differentiated from repression in that repression is an unconscious process.

symbolization

Unconscious defense mechanism in which one idea or object comes to stand for another because of some common aspect or quality in both; based on similarity and association; the symbols formed protect the person from the anxiety that may be attached to the original idea or object.

synesthesia

Condition in which the stimulation of one sensory modality is perceived as sensation in a different modality, as when a sound produces a sensation of color.

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syntactical aphasia

Aphasia characterized by difficulty in understanding spoken speech; associated with gross disorder of thought and expression.

systematized delusion

Group of elaborate delusions related to a single event or theme.

tactile hallucination

Hallucination primarily involving the sense of touch. Also called haptic hallucination.

tangentiality

Oblique, digressive, or even irrelevant manner of speech in which the central idea is not communicated.

tension

Physiological or psychic arousal, uneasiness, or pressure toward action; an unpleasurable alteration in mental or physical state that seeks relief through action.

terminal insomnia

Early morning awakening or waking up at least 2 hours before planning to wake up. Compare with initial insomnia and middle insomnia.

thought broadcasting

Feeling that one's thoughts are being broadcast or projected into the environment. See also thought withdrawal.

thought disorder

Any disturbance of thinking that affects language, communication, or thought content; the hallmark feature of schizophrenia. Manifestations range from simple blocking and mild circumstantiality to profound loosening of associations, incoherence, and delusions; characterized by a failure to follow semantic and syntactic rules that is inconsistent with the person's education, intelligence, or cultural background.

thought insertion

Delusion that thoughts are being implanted in one's mind by other people or forces.

thought latency

The period of time between a thought and its verbal expression. Increased in schizophrenia (see blocking) and decreased in mania (see pressured speech).

thought withdrawal

Delusion that one's thoughts are being removed from one's mind by other people or forces. See also thought broadcasting.

tic disorders

Predominantly psychogenic disorders characterized by involuntary, spasmodic, stereotyped movement of small groups of muscles; seen most predominantly in moments of stress or anxiety, rarely as a result of organic disease.

tinnitus

Noises in one or both ears, such as ringing, buzzing, or clicking; an adverse effect of some psychotropic drugs.

tonic convulsion

Convulsion in which the muscle contraction is sustained.

trailing phenomenon

Perceptual abnormality associated with hallucinogenic drugs in which moving objects are seen as a series of discrete and discontinuous images.

trance

Sleep-like state of reduced consciousness and activity.

tremor

Rhythmical alteration in movement, which is usually faster than one beat a second; typically, tremors decrease during periods of relaxation and sleep and increase during periods of anger and increased tension.

true insight

Understanding of the objective reality of a situation coupled with the motivational and emotional impetus to master the situation or change behavior.

twilight state

Disturbed consciousness with hallucinations.

twirling

Sign present in autistic children who continually rotate in the direction in which their head is turned.

unconscious

(1) One of three divisions of Freud's topographic theory of the mind (the others being the conscious and the preconscious) in which the psychic material is not readily accessible to conscious awareness by ordinary means; its existence may be manifest in symptom formation, in dreams, or under the influence of drugs. (2) In popular (but more ambiguous) usage, any mental material not in the immediate field of awareness. (3) Denoting a state of unawareness, with lack of response to external stimuli, as in a coma.

undoing

Unconscious primitive defense mechanism, repetitive in nature, by which a person symbolically acts out in reverse something unacceptable that has already been done or against which the ego must defend itself; a form of magical expiatory action, commonly observed in OCD.

unio mystica

Feeling of mystic unity with an infinite power.

vegetative signs

In depression, denoting characteristic symptoms such as sleep disturbance (especially early morning awakening), decreased appetite, constipation, weight loss, and loss of sexual response.

verbigeration

Meaningless and stereotyped repetition of words or phrases, as seen in schizophrenia. Also called cataphasia. See also perseveration.

vertigo

Sensation that one or the world around one is spinning or revolving; a hallmark of vestibular dysfunction, not to be confused with dizziness.

visual agnosia

Inability to recognize objects or persons.

visual amnesia

See neurological amnesia.

visual hallucination

Hallucination primarily involving the sense of sight.

waxy flexibility

Condition in which a person maintains the body position into which they are placed. Also called catalepsy.

word approximation

Use of conventional words in an unconventional or inappropriate way (metonymy or of new words that are developed by conventional rules of word formation) (e.g., handshoes for gloves and time measure for clock); distinguished from a neologism, which is a new word whose derivation cannot be understood. See also paraphasia.

word salad

Incoherent, essentially incomprehensible, mixture of words and phrases commonly seen in far-advanced cases of schizophrenia. See also incoherence.

xenophobia

Abnormal fear of strangers.

zoophobia

Abnormal fear of animals.

References

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