[1] EVIDENCE OF DISEASE + CONSCIOUSNESS + JUDGEMENT

• Observations and objective clinical findings

• Manifestation of disease that the physician perceives

Example

• Fever

• Redness 

• Warmth 

• Rashes

SIGNS

• Subjective experiences expressed by the pt

• Manifestation of diseases apparent to pt himself

• Chief complaint

Example 

• Headache

• Numbness 

• Muscle pain

SYMPTOMS

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

• A condition characterized by a set of associated symptoms

SYNDROME

Dysfunction in sympathetic pathway

Horner’s Syndrome

3 Clinical presentations of Horner’s syndrome

• ptosis (drooping or falling of upper eyelid), 

• miosis (constricted pupil), 

• facial anhidrosis (loss of sweating)

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

• Exaggerated form of normal reactions 

• No loss of contact with reality 

• Insight is usually maintained

• May still significantly impair function

• Common language: “Nerves”, anxiety

• 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

• Symptoms, such as delusions or hallucinations, are not understandable and cannot be empathized with

• Impairment of mental functions

• Common language: “Madness” (baliw)

Psychosis

[NEUROTIC AND STRESS-RELATED DISORDERS BASED ON ICD 10]

• Generalized and persistent anxiety symptoms with the following elements:

  • Apprehension

  • Motor tension

  • Autonomic overactivity

Generalized Anxiety Disorder

[NEUROTIC AND STRESS-RELATED DISORDERS BASED ON ICD 10]

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

Mixed Anxiety and Depression

[NEUROTIC AND STRESS-RELATED DISORDERS BASED ON ICD 10]

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

• Comparative freedom from anxiety between attacks

Panic Disorder

[NEUROTIC AND STRESS-RELATED DISORDERS BASED ON ICD 10]

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

[NEUROTIC AND STRESS-RELATED DISORDERS BASED ON ICD 10]

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

Agoraphobia

[NEUROTIC AND STRESS-RELATED DISORDERS BASED ON ICD 10]

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

Social Phobias

[NEUROTIC AND STRESS-RELATED DISORDERS BASED ON ICD 10]

Recurrent obsessional thoughts or compulsive acts

OCD (Obsessive-Compulsive Disorder)

[NEUROTIC AND STRESS-RELATED DISORDERS BASED ON ICD 10]

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

PTSD (Post-Traumatic Stress Disorder)

[Freud's topographical model of the mind (Theory of Consciousness)]

• What we are fully aware of at any one time

Thoughts, perceptions

Conscious

[Freud's topographical model of the mind (Theory of Consciousness)]

• Can be easily retrieved

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

• Our thoughts and perceptions right now; can be easily retrieved

Memories, stored knowledge

Preconscious

[Freud's topographical model of the mind (Theory of Consciousness)]

Largest part of our consciousness

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

• Closely related to instinctual drives

• Can become conscious by passing through unconscious 

Things that we have repressed d/t instinctual tribes 

• Aggression and violence → need to kill animals 

• Libido → reproduction 

Motives, fears, unacceptable sexual desires, immoral urges, irrational wishes, shameful experiences, selfish needs

Unconscious

[PRIMARY OR SECONDARY CONSCIOUSNESS?]

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

  • Ex. Naiihi ka

Primary Consciousness

[PRIMARY OR SECONDARY CONSCIOUSNESS?]

• Self-conscious or awareness (Aware that you are aware)

• ability to experience onself as autonomous with subjective feelings

• conscious recognition that we are conscious beings 

  • Ex. I know na naiihi ako, I know that I need to go to toilet

Secondary Consciousness

[CONSCIOUSNESS]

Differentiate Arousal & Awareness

Arousal (everyone is awake)

Awareness (everyone is aware of their surrounding)

3 Components of Freud's Topographical Model of the Mind (Theory of Consciousness)

Conscious, Preconscious, Unconscious

Disorders of Consciousness

• Somnolence

• Disorientation

• Clouding of Consciousness

• Drowsiness

• Lethargy

• Obtundation

• Stupor

• Coma

• Delirium

[Disorders of Consciousness]

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

Somnolence

[Disorders of Consciousness]

Impaired awareness of time, place, person

Disorientation

[Disorders of Consciousness]

Very mild form of altered mental status in which patient has inattention and reduced wakefulness; not fully awake, alert, oriented

Clouding of Consciousness

[Disorders of Consciousness]

State of impaired awareness with a desire or inclination to sleep

Drowsiness

[Disorders of Consciousness]

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

• Needs to be aroused

Lethargy

[Disorders of Consciousness]

Similar to lethargy in which patient has lessened interest in the environment, slowed response to stimulation, tends to sleep more than normal with drowsiness in between keep states, physical but no painful stimuli

Obtundation

[Disorders of Consciousness]

• ONLY vigorous and retreated (painful) stimuli will arouse the pt and when undisturbed will inked lapse back to unresponsiveness

  • Chest rub, supraorbital press, nail beds

Stupor

[Disorders of Consciousness]
unarousable unresponsiveness

Coma

[Disorders of Consciousness]

• 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

Examples:

• Liver damage – unable to excrete toxins → travels around circulation and travels to brain

Delirium

[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

[ATTENTION]
The lecture is mildly interesting, and you are able to pay attention for the full 20-minute presentation

Sustained attention or vigilance

[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

[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 (______)

A fire engine goes by the lecture hall and you look up (distraction) but are then able to ignore the dimming noise of the siren (inhibition) and continue to listen to the lecture (sustained attention)

[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

Suddenly, the fire alarm rings, and you smell smoke. These distracters capture your full attention (disengagement from lecture), and their importance causes you to change your attention and behavior (set shifting) as you hurriedly head for the door

[DISTURBANCES OF ATTENTION]

• Inability to focus attention

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

DISTRACTABILITY

[DISTURBANCES OF ATTENTION]
Blocking out only those that generate anxiety

SELECTIVE ATTENTION

[DISTURBANCES OF ATTENTION]

• Excessive attention to and focus on all internal and external stimuli

• Usually seen in delusional or paranoid states

HYPERVIGILANCE

[DISTURBANCES OF ATTENTION]

• Sleeplike state of reduced consciousness and activity

• Usually seen in hypnosis dissociative disorders, ecstatic religious experience

TRANCE

[DISTURBANCES OF ATTENTION]

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

  • Great freedom to act in accordance w/ inner drives or feelings w/ less regard fro restraints dictated by cultural norms or one’s superego

Examples: Jaymee calling ex-bf! (nako)

• Think w/o thinking of consequences

DISINHIBITION

• Compliant and uncritical response to an idea or influence

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

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

  • You wont see it sas right ot wrong na whatever they say

SUGGESTIBILITY

[DISORDERS OF SUGGESTIBILITY]

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

Also called shared psychotic disorder

FOLIE A DEUX 

(FOLIES A TROIS)

[DISORDERS OF SUGGESTIBILITY]
artificially induced alteration of consciousness characterized by heightened suggestibility and receptivity to direction

HYPNOSIS

• 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

• Ability to anticipate the consequences of actions and how contemplated behaviour can affect others

  • Intact or normal - if the course of actions chosen is consonant with reality or with mature adult standards of behaviour.

Impaired - if maladaptive, results from impulsive decisions or not consistent with reality as measured by mature adult standards.

JUDGEMENT

[JUDGEMENT]
Essential component to good judgement

• Analyze information, identify biases and assumptions, evaluate evidences and make sound decisions.

CRITICAL THINKING

[JUDGEMENT]
Ability to think logically and objectively without being swayed by emotions, biases or other factors that may cloud judgement.

RATIONAL THINKING

[JUDGEMENT]
Reflex performance of an action

AUTOMATIC THINKING