OT FOR PSYCHOSOCIAL DYSFUNCTION PSYCHIATRIC SIGNS AND

SYMPTOMS
I. Consciousness: State of awareness A. Disturbances of consciousness - Apperception is perception modified by a persons own emotions and thoughts - Sensorium is the state of cognitive functioning of the special senses (synonym of apperception) - Disturbances of consciousness are most often associated with brain pathology Disorientation Disturbance of orientation in time, place, person or situation Clouding of Incomplete clear-mindedness with disturbances in consciousness perception and attitudes Stupor Lack of reaction to, and unawareness of, surroundings Delirium Bewildered, restless, confused, disoriented reaction associated with fear and hallucinations Coma Profound unconsciousness Coma vigil Coma in which a patient appears to be awake with eyes Aka: akinetic mutism open but cannot be aroused Twilight state Disturbed consciousness with hallucinations Dreamlike state Often used as a synonym for complex partial seizure or psychomotor epilepsy Somnolence Abnormal drowsiness Confusion Disturbance of consciousness in which reactions to environmental stimuli are inappropriate; manifested by disordered orientation in relation to time, place or person Drowsiness A states of impaired awareness associated with desire or inclination to sleep Sundowning Syndrome in older persons that usually occurs at night Aka: sundowners and is characterized by drowsiness, confusion, ataxia and syndrome falling as a result of being overly sedated with medications Somnambulism Sleep walking B. Disturbances of attention - Attention is the amount of effort exerted in focusing on certain portions of an experience - Ability to sustain a focus on one activity - Ability to concentrate Distractibility Inability to concentrate attention State in which attention is drawn to unimportant or irrelevant external stimuli Selective inattention Blocking out only those things that generate anxiety Hypervigilance Excessive attention and focus on all internal and external stimuli Usually secondary to delusional or paranoid states Similar to hyperagia (excessive thinking and mental activity) Trance Focused attention and altered consciousness

Disinhibition

Usually seen in hypnosis Dissociative disorders and ecstatic religious experiences Removal of an inhibitory effect that permits persons to lose control of impulses as occurs during alcohol intoxication

C. Disturbances in suggestibility - Compliant and uncritical response to an idea or influence Folie a deux (or folie a Communicated emotional illness between two (or three) trios) persons) Hypnosis Artificially induced modifications of consciousness characterized by heightened suggestibility II. Emotion - Complex feeling state with psychic, somatic and behavioural components that is related to affect and mood A. Affect - Observed expression of emotion, possibly inconsistent with patients description of emotion Appropriate affect Condition in which the emotional tone is in harmony with the accompanying idea, thought or speech Described as broad or full affect in which a full range of emotion is appropriately expressed Inappropriate affect Disharmony between the emotional feeling tone and the idea, thought or speech accompanying it Blunted affect Disturbance in affect manifested by severe reduction in the intensity of externalized feeling tone Restricted or Reduced in intensity of feeling tone constricted affect Less severe than blunted affect but clearly reduced Flat affect Absence or near absence of any signs of affective expression Voice monotonous Face immobile Labile affect Rapid and abrupt changes in emotional feeling tone Unrelated to external stimuli Full affect You can see patients affect Levels of affect 1. Full 2. Blunted 3. Restricted or constricted 4. Flat B. Mood - Pervasive and sustained emotion subjectively experienced and reported by a patient and observed by others - Examples: depression, elation and anger Dyphoric mood An unpleasant mood Euthymic mood Normal range of mood

Implying absence of depressed or elevated mood Expansive mood A persons expression of feelings without restraint Frequently qith overestimation of their significance or importance Irritable mood State in which a person is easily annoyed and provoked to anger Mood swings (labile Oscillations between euphoria and depression or anxiety mood) Elevated mood Air of confidence and enjoyment Mood more cheerful than usual Euphoria Intense elation with feeling of grandeur Ecstasy Feelings of intense rapture Depression Psycopathological feeling of sadness Anhedonia Loss of interest in, and withdrawal from all regular and pleasurable activities Often associated with depression Grief or mourning Sadness appropriate to a real loss Aka: bereavement Alexithymia A persons inability to or difficulty in describing or being aware of mood Suicidal ideation Thoughts or act of taking ones own life Elation Feelings of joy, euphoria, triumph, intense self-satisfaction or optimism Hypomania Mood abnormality with the qualitative characteristics of mania but somewhat less intense Mania Mood state characterized by elation, agitation, hyperactivity, hypersexuality, and accelerated thinking and speaking Melancholia Severe depressive state Used in the term involutional melancholia both descriptively Also in reference to an distinct diagnostic entity Le belie indifference Inappropriate attitude of calm or lack of concern about ones disability C. Other emotions Anxiety Free-floating anxiety Fear Agitation Tension Panic Apathy Feeling of apprehension caused by anticipation of anger Which may be internal or external Pervasive unfocused fear not attached to any idea Anxiety caused by consciously recognized and realistic danger Severe anxiety associated with motor restlessness Similar to irritability characterized by excessive excitability with easily triggered anger or annoyance Increased and unpleasant motor and psychological activity Acute, episodic, intense attack of anxiety associated with overwhelming feelings of dread and autonomic discharge Dulled emotional tone associated with detachment or indifference

Ambivalence Abreaction Shame Guilt Impulse control Ineffability Acathexis Decathexis

Coexistence of two opposing impulses toward the same thing in the same person at the same time Emotional release or discharge after recalling a painful experience Failure to live up to self-expectations Emotion secondary to doing what is perceived wrong Ability to resist an impulse, drive or temptation to perform an action Ecstatic state in which a person states it is indescribable, inexpressible and impossible to convey to another person Lack of feeling associated with an ordinarily emotionally charged subject In cathexis feeling is connected Detaching emotions from thoughts, ideas or persons

D. Physiological disturbances associated with mood - Signs of somatic (usually autonomic) dysfunctions, most often associated with depression - Aka: vegetative signs Anorexia Loss of, decrease in appetite Hyperphagia Increase intake of food Insomnia: Lack of, or diminished ability to sleep Initial a. Initial: difficulty falling asleep Middle b. Middle: difficulty sleeping through the night without Terminal waking up and difficulty going back to sleep c. Terminal: early morning awakening Hypersomnia Excessive sleeping Diurnal variation Mood is regularly worse in the morning immediately after awakening Improves as the day progresses Diminished libido Decreased sexual interest, drive and performance Increased libido is often associated with manic states Constipation Inability to defecate or difficulty defecating Fatigue A feeling of weariness, sleepiness or irritability following a period of mental or bodily activity Pica Craving and eating non-food substances, such as paint and clay Pseudocyesis Rare condition in which a patient has the signs and symptoms of pregnancy such as abdominal distention, breast enlargement, pigmentation, cessation of menses and morning sickness Bulimia Insatiable hunger and voracious eating Seen in bulimia nervosa and atypical depression Adynamia Weakness and fatigability III. Motor behavior (conation)

- Aspect of the psyche that includes impulses, motivations, wishes, drives, instincts and cravings as expressed by a persons behavior or motor activity Echopraxia Pathologic imitation of movements of one person by another Catatonia and Seen in catatonic schizophrenia and some patients with postural brain diseases such as encephalitis abnormalities: a. Catalepsy: general term for an immobile position Catalepsy that is constantly maintained Catatonic excitement b. Catatonic excitement: agitated, purposeless motor Catatonic stupor activity, uninfluenced by external stimuli Catatonic rigidity c. Catatonic stupor: markedly slowed motor activity, Catatonic posturing often to the point of immobility and seeming Cerea flexibilitas unawareness of surroundings Akinesia d. Catatonic rigidity: voluntary assumption of a rigid posture, held against all efforts to be moved e. Catatonic posturing: voluntary assumption of an inappropriate or bizarre posture, generally maintained for long periods f. Cerea flexibilitas (waxy flexibility): condition in which a person can be molded into a position that is then maintained. When the examiner moves the persons limb feels as if it were made of wax g. Akinesia: lack of physical movement as in the extreme immobility of catatonic schizophrenia. May occur as an extrapyramidal adverse effect of antipsychotic medication Negativism Motiveless resistance to all attempts to be moved or to all instructions Cataplexy Temporary loss of muscle tone and weakness precipitated by a variety of emotional states Stereotypy Repetitive fixed pattern of physical action or speech Mannerism Ingrained, habitual involuntary movement Automatism Automatic performance of an act or acts generally presenting unconscious symbolic activity Command automatism Automatic following of suggestion Also automatic obedience Mutism Voicelessness without structural abnormalities Overactivity: a. Psychomotor agitation: excessive motor and Psychomotor agitation cognitive activity. Usually non-productive and in Hyperactivity response to inner tension Tic b. Hyperactivity (hyperkinesis): restless, aggressice, Sleepwalking destructive activity, often associated with some Akathisia underlying brain pathology Compulsion c. Tic: involuntary spasmodic motor movement - Dipsomania d. Sleepwalking (somnambulism): motor activity - Kleptomania during sleep - Nymphomania e. Akathisia: subjective feeling of muscular tension - Satiriasis secondary to antipsychotic or other medication, - Trichotillomania which can cause restlessness, pacing, repeated - Ritual sitting and standing. Can be mistaken for psychotic

Ataxia Polyphagia Tremor Floccillation

Hypoactivity (hypokinesis) Mimicry Aggression

Acting out Abulia Anergia Astasia abasia

Coprophagia Dyskinesia Muscle rigidity Twirling

agitation f. Compulsion: uncontrollable impulse to perform an act repetitively Dipsomania: compulsion to drink alcohol Kleptomania: compulsion to steal Nymphomania: excessive and compulsice need for coitus in a woman Satiriasis: excessive and compulsive need for coitus in a man Trichotillomania: compulsion to pull out hair Ritual: automatic, compulsive activity, anxiety reducing in origin g. Ataxia: failure of muscle coordination; irregularity of muscle action h. Polyphagia: pathological overeating i. Tremor: rhythmical alteration in movement, which is usually faster than one beat a second. Decreased during period of relaxation and sleep and increase during periods of anger and increased tension. j. Floccillation: aimless picking usually at clothing or bedclothes, commonly seen in delirium Decreased motor and cognitive activity Psychomotor retardation Visible slowing of thought, speech and movements Simple, imitative motor activity of childhood Forceful, goal-directed action that may be verbal or physical The motor counterpart of the affect of rage, anger or hostility Direct expression of an unconscious wish or impulse in action Living out unconscious fantasy impulsively in behavior Reduced impulse to act and think Associated with indifference about consequences of action Result of a neurological deficit Lack of energy Inability to stand or walk in a normal manner, even though normal leg movements can be performed in a sitting or lying down position The gait is bizarre and does not suggest a specific organic lesion Seen in conversion disorder Eating of filth or feces Difficulty performing voluntary movements as in extrapyramidal disorder State in which the muscles remain immovable Seen in schizophrenia a sign present in autistic children who continually rotate in the direction in which their head is turned

Bradykinesia

Slow motor activity decreased normal, spontaneous movement Chorea Random and involuntary quick, jerky, purposeless movements Convulsion Involuntary violent muscular contraction or spasm Clonic convulsion a. Clonic convulsion: convulsion in which muscles Tonic convulsion alternately contract and relax b. Tonic convulsion: convulsion in which the muscles contraction is sustained Seizure An attack or sudden onset of certain symptoms, such as Generalized tonic-clonic convulsion, loss of consciousness and psychic or sensory seizure disturbances seen in epilepsy and can be substance Simple partial seizure induced Complex partial seizure a. Generalized tonic-clonic seizure: generalized onset of tonic-clonic movements o fthe limbs, tongue biting and incontinence followed by slow, gradual recovery of consciousness and cognition. Aka: grand mal seizure and psychomotor seizure b. Simple partial seizure: localized ictal onset of seizure without altered consciousness c. Complex partial seizure: localized ictal onset of seizure with altered consciouness Dystonia Slow sustained contractions of the trunk or limbs Seen in medication0induced dystoria Amimia Inability to make gestures or to comprehend those made by others

IV. Thinking - Goal-directed flow of ideas, symbols and associations initiated by a problem or task and leading towards a reality-oriented conclusion - When a logical sequence occurs, thinking is normal - Parapraxis: unconsciously motivated lapse from logic (aka: Freudian slip) is considered part of normal thinking - Abstract thinking is the ability to grasp the essentials of a whole to break it into its parts and to discern common properties Mental disorder Clinically significant behavior or psychological syndrome associated with distress or disability Not just an expected response to a particular event or limited to relations between a person and society Psychosis Inability to distinguish reality from fantasy Impaired reality testing, with the creation of a new reality Opposed to neurosis; mental disorder in which reality testing is intact Behavior may not violate gross social norms but is relatively enduring or recurrent without treatment Reality testing Objective evaluation and judgement of the world outside the self

Formal disorder

thought Disturbance in the form of thought rather than the content of thought Thinking characterized by loosened associations Neologism and illogical constructs Thought process is disordered and the person is defined as psychotic Illogical thinking Thinking containing erroneous conclusions or internal contraindications Psychopathological only when it is marked and when not caused by cultural values or intellectual deficits Dereism Mental activity not concordant with logic or experience Autistic thinking Preoccupation with inner private world Term used somewhat synonymously with dereism Magical thinking A form of dereistic thought Thinking similar to that of the preoperational phase in children (Jean Piaget) in which thought, words or actions assume power (e.g. to cause or prevent events) Primary process General term for thinking that is dereistic, illogical, thinking magical Normally found in dreams, abnormally in psychosis Emotional insight Deep level of understanding or awareness that is likely to lead to positive changes in personality and behavior B. Specific disturbances in form of thought Neologism New word created by a patient often by combining syllables of their words For idiosyncratic psychological reasons Words salad Incoherent mixture of words and phrases Circumstantiality Indirect speech that is delayed in reaching the point but eventually gets from original point to desired goal Characterized by overinclusion of details and parenthetical remarks Tangentiality Inability to have goal-directed associations of thought Speaker never gets from point to desired goal Incoherence Thought that is generally not understandable Running together of thoughts or words with no logical or grammatical connection Resulting in disorganization Perseveration Persisting response to a previous stimulus after a new stimulus has been presented Often associated with cognitive disorders Verbigeration Meaningless repetition of specific words or phrases Echolalia Psychopathological repeating of words or phrases of one person by another Tends to be repetitive and persistent May be spoken with mocking or staccato intonation Condensation Fusion of various concepts into one Irrelevant answer Answer that is not in harmony with question asked Person appears to ignore or not attend to question

Loosening association Derailment

Flight of ideas

Clang associations Blocking

Glossolalia

of Flow of thought in which ideas shift from one subject to another in a completely unrelated way, when sever: speech may be incoherent Gradual or sudden deviation in train of thought without blocking Sometimes used synonymously with loosening of associations Rapid, continuous verbalizations or play on words produce constant shifting from one idea to another Ideas ten to be connected and in the less severe form a listener may be able to follow them Association of words similar in sound but not in meaning Words have no logical connections, may include rhyming and punning Abrupt interruption in train of thought before a thought or idea is finished After a brief pause, person indicates no recall of what was being said or was going to be said Aka: thought deprivation Expression of revelatory message through unintelligible words Aka: speaking in tongues Not considered a disturbance in thought if associated with practices of specific Pentecostal religions; cryptolalia, a private spoken language

C. Specific disturbances in content of thought Poverty of content Thought that gives little information because of vagueness, empty repetitions or obscure phrases Overvalued idea Unreasonable, sustained false belief maintained less firmly than a delusion Delusion False belief based on incorrect inference about external Bizarre delusion reality Systematized delusion Not consistent with patients intelligence and cultural Mood-congruent delusion background Mood-incongruent Cannot be corrected by reasoning delusion a. Bizarre delusion: an absurd, totally Nihilistic delusion implausible, strange false belief Delusion of poverty b. Systematized delusion: false belief or beliefs Somatic delusion united by a single event or theme Paranoid delusions c. Mood-congruent delusion: delusion with - Delusion of mood appropriate content persecution d. Mood-incongruent delusion: delusion with - Delusion of grandeur content that has no association to mood or is mood - Delusion of reference neutral Delusion of selfe. Nihilistic delusion: feeling that self, others or accusation the world is nonexistent or coming to end Delusion of control f. Delusion of poverty: a persons false belief - Thought withdrawal that he or she is bereft or will be deprived of all - Thought insertion material possessions

- Thought broadcasting - Thought control Delusion of infidelity Erotomania Pseudologia phantastica

g. Somatic delusions: false belief involving functioning of the body h. Paranoid delusions: include persecutory delusions and delusions of reference, control and grandeur Delusion of persecution: a persons false belief that he or she is being harassed, cheated or persecuted. Often found in litigious patients who have pathological tendency to take legal action because of imagines mistreatment. Delusion of grandeur: a persons exaggerated conception of his or her importance, power or identity Delusion of reference: a persons false belief that the behavior of others refers to himself or herself that events, objects or other persons have a particular and unusual significance, usually of a negative nature. Derived from idea of reference in which a person falsely feels that others are talking about him or her. i. Delusion of self-accusation: false feeling of remorse and guilt j. Delusion of control: false feeling that a persons will, thoughts or feelings are being controlled by external forces Thought withdrawal: delusion that thoughts are being removed from a persons mind by others or forces Thought insertion: delusion that thoughts are being implanted in a persons mind by other persons or forces Thought broadcasting: delusion that a persons thought can be heard by others, as though they were being broadcasting over the air Thought control: delusion that a persons thoughts are being controlled by other persons or forces k. Delusion of infidelity (delusional jealousy): false belief derived from pathological jealousy about a persons lover being unfaithful l. Etotomania: delusional belief more common in women that someone is deeply in love with them. Aka: clerambault-kandinsky complex m. Pseudologia phantastica: type of lying in which a person appears to believe in the reality of his or her fantasies and acts on them. Associated

Trend preoccupation thought Egomania Monomania Hypochondria Obsession Compulsion

with Munchausen syndrome, repeated feigning of illness. or Centering of thought content on a particular idea of Associated with a strong affective tone Pathological self-preoccupation Preoccupation with a single object Exaggerated concern about health that is based not on real organic pathology but rather on unrealistic interpretations of physical signs or sensations as abnormal Pathological persistence of an irresistible thought or feeling that cannot be eliminated from consciousness by logical effort associated with anxiety 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 Compulsive utterance of obscene words Persistent irrational exaggerated and invariably pathological dread of specific stimulus or situation Results in a compelling desire to avoid fear stimulus a. Specific phobia: circumscribed dread of a discrete object or situation b. Social phobia: dread of public humiliation as in fear of public speaking, performing, eating in public c. Acrophobia: dread of high places d. Agoraphobia: dread of open places e. Algophobia: dread of pain f. Ailurophobia: dread of cats g. Eryhtrophobia: dread of red (fear of blushing) h. Panphobia: dread of everything i. Claustrophobia: dread of closed spaces j. Xenophobia: dread of strangers k. Zoophobia: dread of animals l. Needle phobia: the persistent intense pathological fear of receiving an injection (aka: blood injection phobia) A revelation in which immense illumination occurs in association with a sense that a person has been chosen to lead and command An oceanic feeling of mystic unity with an infinite power Not considered a disturbance in thought content if congruent with persons religious or cultural mileu

Coprolalia Phobia Specific phobia Social phobia Acrophobia Agoraphobia Algophobia Ailurophobia Erythrophobia Panphobia Claustrophobia Xenophobia Zoophobia Needle phobia

Noesis Unio mystica

V. Speech - Ideas, thoughts, feelings as expressed through language, communication through the use of words and language A. Disturbances in speech

Pressure of speech

Rapid speech that is increased in amount and difficult to interrupt Volubility (logorrhea) Copious, coherent, logical speech Poverty of speech Restriction in the amount of speech used Replies may be monosyllable Nonspontaneous Verbal responses gives only when asked or spoken to speech directly No self-initiation of speech Poverty of content of Speech that is adequate in amount but conveys little speech information because of vagueness, emptiness or stereotyped phrases Dysprosody Loss of normal speech melody called prosody Disarthria Difficulty in articulation not in word finding or grammar Excessively loud or Loss of modulation of normal speech volume soft speech May reflect a variety of pathological conditions ranging from psychosis to depression to deafness Stuttering Frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency Cluttering Erratic and dysrhythmic speech consisting of rapid and jerky spurts Aculalia Nonsense speech associated with markedly impaired comprehension Bradylalia Abnormally slow speech Dysphonia Difficulty or pain in speaking B. Aphasic disturbances - Disturbances in language output Motor aphasia Disturbance of speech caused by a cognitive disorder in which understanding remain but ability to speak is grossly impaired Halting, laborious and inaccurate speech Aka: brocas nonfluent and expressive aphasia Sensory aphasia Organic loss of ability to comprehend the meaning of words Fluid and spontaneous but incoherent and nonsensical speech Aka: wernickes fluent and receptive aphasia Norminal aphasia Difficulty finding correct name for an object Also termed anomia and amnestic aphasia Synctactical aphasia Inability to arrange words in proper sequence Jargon aphasia Words produced are totally neologistic Nonsense words repeated with various intonations and inflections Global aphasia Combination of a grossly non-fluent aphasia and a severe fluent aphasia Alogia Inability to speak because of mental deficiency or a episode of dementia Coprophasia Involuntary use of vulgar or obscene language Seen in tourettes disorder and some patients with

schizophrenia VI. Perception - Process of transferring physical stimulation into psychological information - Mental process by which sensory stimuli are brought to awareness A. Disturbances of perception 1. Hallucination False sensory perception not associated with real external stimuli There may or may not be a delusional interpretation of the hallucinatory experiences Hypnagogic hallucination hypnopompic hallucination Auditory hallucination False sensory perception occurring while falling asleep Generally considered non-pathological False perception occurring while awakening from sleep Generally considered non-pathological False perception of sound Usually voices but also other noises Visual hallucination False perception involving sight consisting of both formed images and unformed images Most common in medically determined disorders Olfactory False perception of smell hallucination Most common in medically determined disorders Gustatory False perception of taste, such as unpleasant taste hallucination Cause by an uncinate seizure; most common in medical disorders Tactile (haptic) False perception of touch or surface sensation, as in from hallucination an amputated limb (phantom limb) Crawling sensation on or under the skin (formication) Somatic hallucination False sensation of things occurring in or to the body Aka: cenesthesic Most often of visceral origin hallucination Lilliputian False perception in which objects are seen as reduced in hallucination size Also termed (micropsia) Mood-congruent Hallucination in which the content is not consistent with hallucination either depressed or manic mood In depression, hallucinations not involving such themes as guilt, deserved punishment or inadequacy In mania, hallucinations not involving such themes as inflated worth or power Hallucinosis Hallucinations, most often auditory Associated with chronic alcohol abuse that occur within clear sensorium as opposed to delirium tremens (DTs) Hallucinations that occur in the context of a clouded sensorium Synesthesia Sensation of hallucination caused by another sensation An auditory sensation accompanied by or triggering a visual sensation

Trailing phenomenon Command hallucination

Perceptual abnormality associated with hallucinogenic drugs in which moving objects are seen as a series discrete and discontinuous images False perception of orders that a person may feel obliged to obey or unable to resist

2. Illusion Misperception or misinterpretation of real external stimuli B. Disturbances associated with cognitive disorder and medical conditions Agnosia An inability to recognize and interpret the significance of sensory impressions Anosognosia Persons inability to recognize a neurological deficit as (ignorance of illness) occurring to himself or herself Somatopagnosia Persons inability to recognize body part as his or her own (ignorance of body Aka: autopagnosia part) Visual Agnosia Inability to recognize object or persons Astereognosis Inability to recognize objects by touch Prosopagnosia Inability to recognize faces Apraxia Inability to carry out specific tasks Simultagnosia Inability to comprehend more than one element of visual scene at a time or to integrate the parts into a whole Adiadochokinesia Inability to perform rapid alternating movements Aura Warning sensations such as automatisms, fullness in the stomach, blushing and changes in respiration, cognitive sensations, and affective states usually experienced before a seizure sensory C. Disturbances associated with conversion and dissociative phenomena - Somatisation of repressed material or the development of physical symptoms and distortions involving the voluntary muscles or special sense organs - Not under voluntary control and not explained by any physical disorder Hysterical anesthesia Loss of sensory modalities resulting from emotional conflicts Marcopsia State in which objects seem larger than they are Micropsia State in which objects seem smaller than they are (both Macropsia and micropsia can also be associated with clear organic conditions, such as complex partial seizures) Depersonalization A persons subjective sense of being unreal, strange or unfamiliar Derealisation A subjective sense that the environment is strange or unreal Feeling of changed reality Fugue Taking on a new identity with amnesia for the old identity Often involves travel or wandering to new environments Multiple Personality One person who appears at different times to be two or more entirely different personalities and characters

Dissociation

Also called: dissociative identity disorder in DSM-IV Unconscious defense mechanism involving the segregation of a group of mental or behavior processes from the rest of the persons psychic activity May entail separation of an idea from its accompanying emotional tone As seen in dissociative and coversion disorders

VII.

Memory - Function by which information stored in the brain is later recalled to consciousness - Orientation is the normal state of oneself and ones surroundings in terms of time, place and person

A. Disturbance of memory Amnesia Partial or total inability to recall past experiences Anterograde May be of organic or emotional origin Retrograde a. Anterograde: amnesia for events occurring after a point of time b. Retrograde: amnesia for events occurring before a point of time Paramnesia Falsification of memory by distortion of recall Fausse reconnaissance a. Fausse reconnaissance: false recognition Retrospective b. Retrospective falsification: memory becomes falsification emotionally (unconsciously) distorted by being Confabulation filtered through a persons present emotional, Dj vu cognitive and experiential state Dj entendu c. Confabulation: unconscious filling of a gap in Dj pense memory by imagined or untrue experiences that a Jamais vu person believes but that have no basis in fact. Most False memory often associated with organic pathology d. Dj vu: illusion of visual recognition in which a new situation is incorrectly regarded as a repetition of a previous memory e. Dj entendu: illusion of auditory recognition f. Dj pense: illusion that a new thought is recognized as a thought previously felt or expressed g. Jamais vu: false feeling of unfamiliarity with a real situation that a person has experienced h. False memory: a patients recollection of an belief in and event that did not actually occur Hypermnesia Exaggerated degree of retention and recall Eidetic image Visual memory of almost hallucinatory vividness Screen memory A consciously tolerable memory covering for a painful memory Repression A defense mechanism characterized by unconscious forgetting of unacceptable ideas or impulses Lethologica Temporary inability to remember a name r proper noun Blackout Amnesia experience by alcoholics about behavior during

drinking bouts Usually indicates that reversible brain damage has occurred B. Levels of memory Immediate Recent Recent past Remote Reproduction or recall of perceived material within seconds to minutes Recall of events over past few days Recall of events over past few months Recall of events in distant past

VIII. Intelligence - Ability to understand, recall, mobilize and constructively integrate previous learning in meeting new situations A. Mental retardation - Sufficient lack of intelligence to interfere with social and vocational performance i. Mild: IQ of 50 or 55 ro approximately 70 ii. Moderate: IQ of 30 or 40 to 55 iii. Severe: IQ of 20 or 25 to 35 or 40 iv. Profound: IQ below 20 or 25 Obsolete terms Idiot: mental age less than 3 years Imbecile: mental age of 3 to 7 years Moron: mental age of about 8 years B. Dementia - Organic and global deterioration of intellectual functioning without clouding of consciousness Dyscalculia (acalculia) Loss of ability to do calculations Not caused by anxiety of impairment in concentration Dyspragphia Loss of ability to write in cursive style (agraphia) Loss of word structure Alexia Loss of a previously possessed reading facility Not explained by defective visual acuity C. Pseudodementia - Clinical features resembling dementia not caused by an organic condition - Most often cause by depression (dementia syndrome of depression) D. Concrete thinking - Literal thinking one dimensional thought - Limited use of metaphor without understanding nuances of meaning E. Abstract thinking - Ability to appreciate nuances of meaning - Multidimensional thinking with ability to use metaphors and hypotheses appropriately

IX. Insight - Ability to understand the true cause and meaning of a situation (such as a set of symptoms) A. Intellectual Insight - Understanding of the objective reality of a set of circumstances without the ability to apply the understanding in any useful way to master the situation B. True insight - understanding of the objective reality of a situation, couple with the motivation and emotional impetus to master the situation C. Impaired insight - Diminished ability to understand the objective reality of a situation X. Judgement - Ability to assess a situation correctly and to act appropriately in the situation A. Critical judgement - Ability to assess, discern and choose among various options in a situation B. Automatic judgement - Reflex performance of an action C. Impaired judgement - Diminished ability to understand a situation correctly and to act appropriately