S1L3_PART 2_Typical Signs & Symptoms of Psychiatric Illness

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

Type of Attention: Suddenly, the fire alarm rings, and you smell smoke. These distracters capture your full attention (__), and their importance causes you to change your attention and behavior (__) as you hurriedly head for the door

disengagement from lecture

set shifting

Disturbances of Attention

• Distractibility

• Selective Attention

• Hypervigilance

• Trance

• Disinhibition

Inability to focus attention

Distractibility

Patient does not respond to task at hand but attends to irrelevant unimportant external stimuli

Distractibility

Blocking out only those that generate anxiety

Selective Attention

Excessive attention to and focus on all internal and external stimuli

Hypervigilance

Usually seen in delusional or paranoid states

Hypervigilance

Sleeplike state of reduced consciousness and activity

Trance

Usually seen in hypnosis, dissociative disorders, ecstatic religious experience

Trance

Removal of inhibitory effect as in reduction of the inhibitory function of the cerebral cortex (ex. alcohol)

Disinhibition

Greater freedom to act in accordance with inner drives or feelings with less regard to restraints dictated by cultural norm or one’s superego

Disinhibition

Compliant and uncritical response to an idea or influence

Suggestibility

State of uncritical compliance with influence or of uncritical acceptance of an idea, belief, or attitude

Suggestibility

Tendency (of a hypnotized patient) to accept signals and information with a relative suspension of normal critical judgment

Suggestibility

Disorders of suggestibility

• Folie a deux (Folies a trois)

• Hypnosis

Mental illness formed by 2 (3) persons, usually involving a common delusional system

Folie a deux (Folies a trois)

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

Hypnosis

A reaction to personally significant events, where ‘reaction’ is taken to include biological, cognitive and behavioural reactions, as well as subjective feelings of pleasure or displeasure

Emotion

Can be aroused so quickly that they can start to happen before we are aware of them

Emotion

For each distinct emotion, there are 3 components:

• Subjective feeling

• Physiological changes

• Associated behaviour

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

Anxiety

Severe, pervasive, generalized anxiety that is not attached to

any particular idea, object or event

Free-floating Anxiety

Unpleasurable emotional state consisting of psychophysiological changes in response to a realistic threat or danger

Fear

Other emotions

• Agitation

• Tension

• Panic

• Apathy

• Ambivalence

• Abreaction

• Shame

• Guilt

• Impulse control

• Ineffability

• Cathexis

Severe anxiety associated with motor restlessness

Agitation

Characterized by excessive excitability with easily triggered annoyance or anger

Agitation

Physiological or psychic arousal, uneasiness or pressure toward action

Tension

Unpleasurable alteration in mental or physical state that seeks relief through action

Tension

Acute, intense attack of anxiety associated with personality disorganization

Panic

When anxiety is overwhelming and accompanied by feelings of impending doom

Panic

Dulled emotional tone associated with detachment or indifference

Apathy

Coexistence of 2 opposing impulses toward the same thing in the same person at the same time

• Seen in schizophrenia, borderline state and OCDs

Ambivalence

A process by which represses material, particularly a painful experience or conflict, is brought back to consciousness

Abreaction

The person recalls and relieves the repressed material, often accompanied by appropriate affective response

Abreaction

Failure to live up to self-expectations, often associated with fantasy of how person will be seen by others

Shame

Emotional state associated with self reproach and need for punishment

Guilt

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

Impulse control

Ecstatic state in which person insists that their experience is inexpressible and indescribable and that it is impossible to convey what it is like to one who never experienced it

Ineffability

A conscious or unconscious investment of psychic energy in an idea, concept, object or person

Cathexis

Types of cathexis

Acathexis

Decathexis

Lack of feeling associated with an ordinary emotionally charged subject

Acathexis

Patient’s detaching or transferring of emotion from thoughts or ideas

• occurs in anxiety, dissociative, schizophrenic and bipolar disorders

Decathexis

Pervasive and sustained emotion or feeling tone that influences a person’s behavior and colors his perception of being in the world

Mood

Subjective

• Use patient’s own words

• Sad, angry, guilty, anxious

Mood

Observed expression of mood or what the patient’s mood appears to be to the clinician

Affect

Elements that describe affect

Quality

Quantity (intensity)

Range (restricted, normal, labile)

Appropriateness (correlation to setting)

Congruence (to described mood and thought content)

Affect or Mood: Dysphoric, happy, euthymic, irritable, angry, agitated, tearful, sobbing, flat

Affect

Severely restricted range of affect

Flat

Types under descriptors of affect - Appropriateness

Appropriate affect

Inappropriate affect

Emotional tone is in harmony with the accompanying idea, though, or speech

Appropriate affect

Emotional tone out of harmony with the idea, thought, or speech accompanying it

Inappropriate affect

Types under descriptors of affect - Range

• Flat affect

• Blunted affect

• Restricted affect

• Labile affect

Absence or near absence of any sign of affective expression

Flat affect

Disturbance of affect manifested by severe reduction in the intensity of externalized feeling or tone

Blunted affect

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

Restricted affect

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

Labile affect

Descriptors of mood

• Dysphoria

• Euthymia

• Expansive mood

• Irritable mood

• Labile mood

• Elevated mood

• Euphoria

• Elation

• Depressed mood

• Anhedonia

• Grief (Mourning)

• Alexithymia

• Hypomania

• Mania

• Melancholia

• Mood congruent delusion / hallucination

• Mood incongruent delusion / hallucination

Feeling of unpleasantness or discomfort, mood of general dissatisfaction and restlessness

• Occurs in depression and anxiety

Dysphoria