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PSYCHIATRIC SYMPTOMS & SIGNS DR GIAN LIPPI CONSULTANT PSYCHIATRIST UNIVERSITY OF PRETORIA & WESKOPPIES HOSPITAL FORENSIC UNIT CONTENTS BEHAVIOURAL SYMPTOMS ABNORMALITIES OF SPEECH MOOD & AFFECT ANXIETY & RELATED SYMPTOMS PSYCHOSIS, & DISORDERED THOUGHT & PERCEPTION - THOUGHT FORM DISORDER WITH ITS DIFFERENT TYPES - DISORDERED THOUGHT CONTENT, INCLUDING DELUSIONS - PERCEPTUAL ABNORMALITIES, INCLUDING HALLUCINATIONS BEHAVIOURAL SYMPTOMS MOTOR BEHAVIOUR, CONATION, PSYCHOMOTOR ACTIVITY - MOTOR BEHAVIOUR / ACTIVITY EXPRESSING A PERSON’S IMPULSES, DRIVES, WISHES, INSTINCTS, CRAVINGS & MOTIVATIONS - DECREASED (PSYCHOMOTOR RETARDATION) - INCREASED (PSYCHOMOTOR AGITATION) CATATONIA - CATATONIC RIGIDITY - CATATONIC POSTURING - WAXY FLEXIBILITY (CATALEPSY) - CATATONIC STUPOR - AKINESIA - CATATONIC EXCITEMENT NEGATIVISM - MOTIVELESS RESISTANCE AGAINST INSTRUCTION, QUESTIONING OR TO BE MOVED STEREOTYPED BEHAVIOUR - REPETITIVE FIXED PATTERN OF MOTOR BEHAVIOUR MANNERISMS & TICS - INGRAINED, HABITUAL, UNCONSCIOUS MOVEMENTS - UNCONSCIOUS, SPASMODIC MOTOR MOVEMENTS BEHAVIOURAL SYMPTOMS ECHOPRAXIA - PATHOLOGICAL IMITATION OF ANOTHER PERSON’S MOVEMENT ATAXIA - MUSCLE INCOORDINATION TREMOR - INVOLUNTARY, RAPID, RHYTHMICAL, ALTERNATING MOVEMENT CHOREA - INVOLUNTARY, RAPID, RANDOM, JERKY, PURPOSELESS MOVEMENT DYSKINESIA - DIFFICULTY PERFORMING VOLUNTARY MOVEMENTS DYSTONIA - SUSTAINED CONTRACTIONS OF OPPOSING MUSCLE GROUPS OF THE TRUNK OR LIMBS AKATHISIA - SUBJECTIVE FEELING OF INNER RESTLESSNESS & MUSCLE TENSION SECONDARY TO ANTIPSYCHOTIC MEDICATION, PRESENTING WITH PACING & OTHER SIGNS OF PSYCHOMOTOR AGITATION SPEECH LOGORRHOEA - INCREASE IN QUANTITY OF SPEECH POVERTY OF SPEECH - DECREASE IN QUANTITY OF SPEECH POVERTY OF SPEECH CONTENT - ADEQUATE AMOUNT OF SPEECH, BUT LACKS INFORMATION DUE TO VAGUENESS PRESSURE OF SPEECH - RAPID SPEECH OF INCREASED QUANTITY THAT IS DIFFICULT TO INTERRUPT NONSPONTANEOUS SPEECH - SPEECH ONLY IN RESPONSE TO QUESTIONS DYSPROSODY - LOSS OF NORMAL MELODY / PROSODY / RHYTHM OF SPEECH STUTTERING - FREQUENT REPITITION / PROLONGATION OF A SOUND / SYLLABLE LEADING TO IMPAIRED SPEECH FLUENCY DYSARTHRIA - PROBLEMS WITH ARTICULATION (PRONOUNCIATION, NOT LANGUAGE) APHASIA - DIFFICULTIES WITH LANGUAGE OUTPUT (LANGUAGE, NOT PRONOUNCIATION) MOOD & AFFECT MOOD IS A PERVASIVE AND SUSTAINED EMOTION SUBJECTIVELY EXPERIENCED - DYSPHORIC / MELANCHOLIC (UNPLEASANT LOW MOOD) - EUTHYMIC MOOD (NORMAL RANGE OF MOOD) - ECSTATIC / ELEVATED / EUPHORIC / ELATED (ABNORMALLY INCREASED / “HIGH” MOOD STATE) - DEPRESSED (PSYCHOPATHOLOGICALLY SAD / DYSPHORIC / MELANCHOLIC MOOD STATE) - MANIA (MOOD CHARACTERIZED BY ELATION, HYPERACTIVITY, HYPERSEXUALITY, AS WELL AS PRESSURED SPEECH & THOUGHT) - IRRITABLE (EASILY ANGERED) - LABILE (OSCILLATIONS BETWEEN DEPRESSION & ELATION) - ALEXITHYMIC (INABILITY TO BE AWARE OF / DESCRIBE ONE’S OWN EMOTIONS) - ANHEDONIC (LOSS OF INTEREST IN ALL PLEASURABLE ACTIVITIES) AFFECT IS THE OBJECTIVELY OBSERVED EXPRESSION OF EMOTION - RESTRICTED (SEVERE REDUCTION OBSERVABLE EXPRESSION OF EMOTION) - BLUNTED (EVEN GREATER REDUCTION IN OBSERVABLE EXPRESSION OF EMOTION) - FLAT (ABSENCE / NEAR ABSENCE OF OBSERVABLE EXPRESSION OF EMOTION) - APPROPRIATE (OBSERVABLE EXPRESSION OF EMOTION IS IN HARMONY WITH THE MOOD DESCRIBED) - INAPPROPRIATE (OBSERVABLE EXPRESSION OF EMOTION ISN’T IN HARMONY WITH THE MOOD DESCRIBED) ANXIETY & RELATED SYMPTOMS ANXIETY - FEELING OF APPREHENSION CAUSED BY ANTICIPATION OF DANGER FEAR - ANXIETY CAUSED BY A REAL / REALISTIC DANGER PHOBIA - PERSISTENT, IRRATIONAL, EXAGGERATED, PATHOLOGICAL DREAD OF A SPECIFIC STIMULUS / SITUATION PANIC ATTACK - ACUTE, EPISODIC, INTENSE ATTACK OF ANXIETY WITH AUTONOMIC SYMPTOMS ASSOCIATED WITH OVERWHELMING FEELINGS OF DREAD OBSESSION - PATHOLOGICAL PERSISTENCE OF AN IRRESISTABLE THOUGHT OR FEELING THAT CAN’T BE ELIMINATED FROM CONSCIOUSNESS BY LOGICAL EFFORT (ASSOCIATED WITH ANXIETY) COMPULSION - PATHOLOGICAL NEED TO ACT ON AN IMPULSE / OBSESSION THAT, IF RESISTED, PRODUCES ANXIETY PSYCHOSIS PSYCHOSIS IS THE INABILITY TO DISTINGUISH REALITY FROM FANTACY 3 GROUPS OF PSYCHOTIC SYMPTOMS DISORDERED THOUGHT FORM (HOW WE THINK) - MANEFESTS AS DISORGANIZED SPEECH DISORDERED THOUGHT CONTENT (WHAT WE THINK OF) - DELUSIONS DISORDERED PERCEPTION - HALLUCINATIONS - ILLUSIONS THOUGHT FORM DISORDER NORMAL THOUGHT FORM THOUGHT FORM DISORDER CIRCUMSTANTIALITY THOUGHT FORM DISORDER TANGENTIALITY THOUGHT FORM DISORDER DERAILMENT THOUGHT FORM DISORDER LOOSENING OF ASSOCIATIONS THOUGHT FORM DISORDER INAPPROPRIATE / IRRELEVANT ANSWER THOUGHT FORM DISORDER THOUGHT BLOCKING THOUGHT FORM DISORDER FLIGHT OF IDEAS THOUGHT FORM DISORDER OVERINCLUSIVENESS - SPEECH CONTAINING UNNECESSARILY EXCESSIVE DETAIL PERSEVERATION - PERSISTING RESPONSE TO A PREVIOUS STIMULUS, EVEN FOLLOWING A NEW STIMULUS VERBIGERATION - MEANINGLESS REPITITION OF SPECIFIC WORDS OR PHRASES WORD SALAD - INCOHERENT MIXTURE OF WORDS / PHRASES NEOLOGISMS - MADE UP WORDS THAT DON’T FORM PART OF ANY LANGUAGE ECHOLALIA - PATHOLOGICAL REPEATING OF WORDS / PHRASES OF ONE PERSON BY ANOTHER DELUSIONS DELUSION - FIXED FALSE BELIEFS, BASED ON INCORRECT INFERENCES ABOUT EXTERNAL REALITY, & THAT CANNOT BE CORRECTED BY REASONING DIFFERENT TYPES DELUSION OF PERSECUTION - BELIEF OF BEING HARRASSED, CHEATED OR PERSECUTED DELUSION OF GRANDEUR - BELIEF OF EXAGERRATED IMPORTANCE, POWER OR IDENTITY DELUSION OF REFERENCE - BELIEF OF BEHAVIOUR OF OTHERS REFERS TO HIMSELF / HERSELF DELUSION OF POVERTY - BELIEF OF BEING BEREFT OF ALL MATERIAL POSSESSIONS NIHILISTIC DELUSION - BELIEF THAT ONE’S SELF, OTHERS OR THE WORLD IS NONEXISTENT OR IS COMING TO AN END SOMATIC DELUSION - BELIEF SURROUNDING A PART OF THE BODY DELUSION OF CONTROL - BELIEF OF ONE’S WILL, THOUGHTS OR FEELINGS ARE BEING CONTROLLED BY EXTERNAL FORCES BIZARRE DELUSION - ABSURD, TOTALLY IMPLAUSABLE, STRANGE BELIEF PERCEPTUAL DISTURBANCES HALLUCINATION - FALSE SENSORY PERCEPTION NOT ASSOCIATED WITH REAL EXTERNAL STIMULI TYPES CATAGORIZED ACCORDING TO SENSES INVOLVED: - AUDITORY HALLUCINATION (PERCEPTION OF SOUND, USUALLY VOICES) - VISUAL HALLUCINATION (PERCEPTION OF SEEING IMAGES) - OLFACTORY HALLUCINATION (PERCEPTION OF SMELL) - GUSTATORY HALLUCINATION (PERCEPTION OF TASTE) - TACTILE HALLUCINATION (PERCEPTION OF TOUCH) OTHER HALLUCINATIONS: - CENESTHETIC HALLUCINATION (PERCEPTION OF SENSATION IN AN ORGAN UNABLE TO EXPERIENCE SENSATION) - HYPNAGOGIC HALLUCINATION (NONPATHOLOGICAL PERCEPTION OCCURRING WHILE FALLING ASLEEP) - HYPNOPOMPIC HALLUCINATION (NONPATHOLOGICAL PERCEPTION OCCURRING WHILE AWAKENING FROM SLEEP) ILLUSION - MISPERCEPTION / MISINTERPRETATION OF REAL EXTERNAL SENSORY STIMULI THE END