S1L3_ PART 1_Typical Signs & Symptoms of Psychiatric Illness

Observations and objective clinical findings

Signs

Manifestation of disease that the physician perceives

Signs

Subjective experiences expressed by the patient

Symptoms

Manifestation of disease apparent to patient himself

Symptoms

Chief complaint

Symptoms

A group of signs and symptoms that, together, make a recognizable condition

Syndrome

Characterized by a set of associated symptoms

Syndrome

Mental illness where symptoms that are understandable (reality-based) and can be empathized with

Neurosis

Exaggerated forms of normal reactions to stressful events

Neurosis

No loss of contact with reality

Neurosis

Insight is usually maintained

Neurosis

May still significantly impair function

Neurosis

“Nerves,” anxiety

Neurosis

Abnormal psychogenic reactions, maladaptive reactions to stress that reflect excessive and inappropriate use of defense mechanisms

Neurosis

2 components of neurosis

• Vulnerable personality

• Stress factors triggering the reaction

Mental illness where there is loss of contact with reality, and the symptoms, such as delusions or hallucinations, are not understandable and cannot be empathized with

Psychosis

Impairment of mental functions

Psychosis

“Madness”

Psychosis

• This is madness- baliw= psychosis

Neurotic & stress-related disorders based on ICD 10

• Generalized Anxiety Disorder

• Mixed Anxiety and Depression

• Panic Disorder

• Phobic Disorder

• Agoraphobia

• Social Phobias

• OCD

• PTSD

Generalized Anxiety Disorder

Generalized and persistent anxiety symptoms with the following elements:

• Apprehension

• Motor tension

• Autonomic overactivity

Symptoms of both anxiety and depression are both present but neither predominates

Mixed Anxiety and Depression

Recurrent attacks of severe anxiety not restricted to any particular situation or set of circumstances

Panic disorder

Comparative freedom from anxiety between attacks

Panic Disorder

Anxiety is evoked only or predominantly by well-defined situations or objects external to the subject, which are not currently dangerous, and these are characteristically avoided or endure with dread

Phobic Disorder

Fear of open spaces, crowds, and difficulty of immediate easy escape

Agoraphobia

Fear of scrutiny by other people in comparatively small groups, leading to avoidance of social situations

Social Phobias

Recurrent obsessional thoughts or compulsive acts

OCD

Delayed or prolonged response to stressful event or situation of threatening or catastrophic nature, likely to cause distress in anyone

PTSD

2 Components of Consciousness

• Arousal

• Awareness

2 Types of Consciousness

Primary consciousness

Secondary consciousness

Sensory awareness, attention, perception, memory (learning), emotion and action

Primary Consciousness

Self-conscious or aware

Secondary Consciousness

Conscious recognition that we are conscious beings

Secondary Consciousness

Ability to experience oneself as autonomous with subjective feelings

Secondary Consciousness

What we are fully aware of at any one time

Conscious

What we could become aware of quite easily if we switched our attention to it

Preconscious

Serves to maintain repressive barrier and to censor unacceptable wishes and desires

Preconscious

What have pushed out of our conscious minds, through repression, making it inaccessible, although it continues to influence our throughs, feelings, and behaviors

Unconscious

Closely related to instinctual drives

Unconscious

Can become conscious by passing through __

Unconscious

Iceberg diagram: What fall under these categories (from top to bottom)

Conscious:

Preconscious:

Unconscious:

Disorders of Consciousness

COLDDD CoCo CoSST (Consciousness)

• Clouding of consciousness

• Obtundation

• Lethargy

• Disorientation

• Delirium

• Drowsiness

• Coma

• Coma Vigil

• Concentration/Focus

• Stupor

• Somnolence

• Twilight State

Confusion

Disorientation

Impaired awareness of time, place and person

Disorientation

Very mild form of altered mental status in which a patient has inattention and reduced wakefulness

Clouding of consciousness

Not fully awake, alert and oriented

Clouding of consciousness

Severe drowsiness in which patient can be aroused by moderate stimuli and then drift back to sleep

Lethargy

Similar to lethargy in which a patient has lessened interest in the environment, slowed response to stimulation and tends to sleep more than normal with drowsiness in between sleep states physical but non painful stimuli

Obtundation

Only vigorous and repeated (painful) stimuli will arouse the patient and when undisturbed, will immediately lapse back to unresponsiveness

Stupor

Unarousable unresponsiveness

Coma

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

Delirium

Persistent vegetative state

Coma vigil

Coma in which a patient appears to be awake with eyes open but cannot be aroused

Coma vigil

Disturbed consciousness with hallucinations

Twilight State

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

Somnolence

State of impaired awareness with a desire or inclination to sleep

Drowsiness

Aspect of consciousness that relates to the amount of effort exerted in focusing on certain aspects of an experience, activity, or task

Concentration / Focus

Type of Attention: Suppose you arrive at a lecture hall, open your notebook, and rather than scanning the room indiscriminately, turn your attention to the instructor, who is just beginning to speak

Selective attention

Type of Attention: The lecture is mildly interesting, and you are able to pay attention for the full 20-minute presentation

Sustained attention or vigilance

Type of Attention: At the same time that you are listening to the instructor, you are taking handwritten notes incorporating headings and subheadings. It appears that you are able simultaneously to listen, write, and organize rather effortlessly, although you are probably shifting your attention among these competing tasks

Divided Attention

Type of Attention: A fire engine goes by the lecture hall and you look up (__) but are then able to ignore the dimming noise of the siren (__) and continue to listen to the lecture (__)

Distraction

Inhibition

Sustained attention