Signs and Symptoms in Psychiatry Hakan Atalay, Assist. Prof. Of Psychiatry Yeditepe University Hospital.

Signs and Symptoms Signs and Symptoms in Psychiatryin Psychiatry

Hakan Atalay, Assist. Prof. Of PsychiatryHakan Atalay, Assist. Prof. Of PsychiatryYeditepe University HospitalYeditepe University Hospital

Signs are objective; symptoms are Signs are objective; symptoms are subjective. subjective.

Signs are the clinician's observations, Signs are the clinician's observations, such as noting a patient's agitation; such as noting a patient's agitation; symptoms are subjective experiences, symptoms are subjective experiences, such as a person's complaint of feeling such as a person's complaint of feeling depressed.depressed.

In psychiatry signs and symptoms are not In psychiatry signs and symptoms are not so clearly demarcated as in other fields of so clearly demarcated as in other fields of medicine; they often overlap. Because of medicine; they often overlap. Because of this, disorders in psychiatry are often this, disorders in psychiatry are often described as syndromes—a constellation of described as syndromes—a constellation of signs and symptoms that together make up signs and symptoms that together make up a recognizable condition. Schizophrenia, a recognizable condition. Schizophrenia, for example, is more often viewed as a for example, is more often viewed as a syndrome than as a specific disorder.syndrome than as a specific disorder.

The concept of normality is ambiguous, The concept of normality is ambiguous, has multiple meanings, and is has multiple meanings, and is influenced by diverse and complex influenced by diverse and complex value systems. Psychiatry has been value systems. Psychiatry has been criticized over the years by certain criticized over the years by certain groups for its portrayal of normality. groups for its portrayal of normality. The psychology of women, for The psychology of women, for example, has been criticized as sexist example, has been criticized as sexist because it was formulated initially by because it was formulated initially by men.men.

A much discussed issue is the change in A much discussed issue is the change in psychiatry's view of homosexuality from psychiatry's view of homosexuality from abnormal to normal that took place 25 abnormal to normal that took place 25 years ago, an evolution shaped by cultural years ago, an evolution shaped by cultural norms, society's expectations and values, norms, society's expectations and values, professional biases, individual differences, professional biases, individual differences, and the political climate of the time.and the political climate of the time.

acrophobia Dread of high places.

agitation Severe anxiety associated with motor restlessness.

agoraphobia Morbid fear of open places or leaving the familiar setting of the home. May be present with or without panic attacks.

akathisia Subjective feeling of motor restlessness manifested by a compelling need to be in constant movement; may be seen as an extrapyramidal adverse effect of antipsychotic medication. May be mistaken for psychotic agitation.

alexithymia Inability or difficulty in describing or being aware of one's emotions or moods; or elaboration of fantasies associated with depression, substance abuse, and posttraumatic stress disorder.

ambivalence Coexistence of two opposing impulses toward the same thing in the same person at the same time. Seen in schizophrenia, borderline states, obsessive-compulsive disorders.amnesia Partial or total inability to recall past experiences; may be organic (amnestic disorder) or emotional (dissociative amnesia) in origin.anhedonia Loss of interest in and withdrawal from all regular and pleasurable activities. Often associated with depression.anorexia Loss or decrease in appetite. In anorexia nervosa appetite may be preserved but patient refuses to eat.

anterograde amnesiaanterograde amnesia Loss of memory for events Loss of memory for events subsequent to the onset of the amnesia common subsequent to the onset of the amnesia common after trauma. Compare retrograde amnesia.after trauma. Compare retrograde amnesia.anxietyanxiety Feeling of apprehension caused by Feeling of apprehension caused by anticipation of danger, which may be internal or anticipation of danger, which may be internal or external.external.apathyapathy Dulled emotional tone associated with Dulled emotional tone associated with detachment or indifference; observed in certain detachment or indifference; observed in certain types of schizophrenia and depression.types of schizophrenia and depression.aphasiaaphasia Any disturbance in the comprehension or Any disturbance in the comprehension or expression of language caused by a brain lesion. expression of language caused by a brain lesion. For types of aphasia, see the specific term.For types of aphasia, see the specific term.

auditory hallucinationauditory hallucination False perception of sound, False perception of sound, usually voices but also other noises such as music. usually voices but also other noises such as music. Most common hallucination in psychiatric disorders.Most common hallucination in psychiatric disorders.autistic thinkingautistic thinking Thinking in which the thoughts are Thinking in which the thoughts are largely narcissistic and egocentric, with emphasis largely narcissistic and egocentric, with emphasis on subjectivity rather than objectivity, and without on subjectivity rather than objectivity, and without regard for reality; used interchangeably with autism regard for reality; used interchangeably with autism and dereism. Seen in schizophrenia, autistic and dereism. Seen in schizophrenia, autistic disorder.disorder.bizarre delusionbizarre delusion False belief that is patently absurd False belief that is patently absurd or fantastic (e.g., invaders from space have or fantastic (e.g., invaders from space have implanted electrodes in a person's brain). Common implanted electrodes in a person's brain). Common in schizophrenia. In nonbizarre delusion content is in schizophrenia. In nonbizarre delusion content is usually within range of possibility.usually within range of possibility.

blockingblocking Abrupt interruption in train of thinking Abrupt interruption in train of thinking before a thought or idea is finished; after a brief before a thought or idea is finished; after a brief pause, person indicates no recall of what was being pause, person indicates no recall of what was being said or was going to be said (also known as thought said or was going to be said (also known as thought deprivation). Common in schizophrenia and severe deprivation). Common in schizophrenia and severe anxiety.anxiety.blunted affectblunted affect Disturbance of affect manifested by a Disturbance of affect manifested by a severe reduction in the intensity of externalized severe reduction in the intensity of externalized feeling tone; one of the fundamental symptoms of feeling tone; one of the fundamental symptoms of schizophrenia, as outlined by Eugen Bleuler.schizophrenia, as outlined by Eugen Bleuler.bradykinesiabradykinesia Slowness of motor activity, with a Slowness of motor activity, with a decrease in normal spontaneous movement.decrease in normal spontaneous movement.bruxismbruxism Grinding or gnashing of the teeth, typically Grinding or gnashing of the teeth, typically occurring during sleep. Seen in anxiety disorder.occurring during sleep. Seen in anxiety disorder.

choreachorea Movement disorder characterized by random and Movement disorder characterized by random and involuntary quick, jerky, purposeless movements. Seen in involuntary quick, jerky, purposeless movements. Seen in Huntington's disease.Huntington's disease.circumstantialitycircumstantiality Disturbance in the associative thought Disturbance in the associative thought and speech processes in which a patient digresses into and speech processes in which a patient digresses into unnecessary details and inappropriate thoughts before unnecessary details and inappropriate thoughts before communicating the central idea. Observed in communicating the central idea. Observed in schizophrenia, obsessional disturbances, and certain schizophrenia, obsessional disturbances, and certain cases of dementia. See also tangentiality.cases of dementia. See also tangentiality.clang associationclang association Association or speech directed by the Association or speech directed by the sound of a word rather than by its meaning; words have sound of a word rather than by its meaning; words have no logical connection; punning and rhyming may no logical connection; punning and rhyming may dominate the verbal behavior. Seen most frequently in dominate the verbal behavior. Seen most frequently in schizophrenia or mania.schizophrenia or mania.

claustrophobiaclaustrophobia Abnormal fear of closed or confining Abnormal fear of closed or confining spaces.spaces.clouding of consciousnessclouding of consciousness Any disturbance of Any disturbance of consciousness in which the person is not fully awake, consciousness in which the person is not fully awake, alert, and oriented. Occurs in delirium, dementia, and alert, and oriented. Occurs in delirium, dementia, and cognitive disorder.cognitive disorder.compulsioncompulsion Pathological need to act on an impulse that, Pathological need to act on an impulse that, if resisted, produces anxiety; repetitive behavior in if resisted, produces anxiety; repetitive behavior in response to an obsession or performed according to response to an obsession or performed according to certain rules, with no true end in itself other than to certain rules, with no true end in itself other than to prevent something from occurring in the future.prevent something from occurring in the future.

confabulationconfabulation Unconscious filling of gaps in Unconscious filling of gaps in memory by imagining experiences or events memory by imagining experiences or events that have no basis in fact, commonly seen in that have no basis in fact, commonly seen in amnestic syndromes; should be differentiated amnestic syndromes; should be differentiated from lying. confusion Disturbances of from lying. confusion Disturbances of consciousness manifested by a disordered consciousness manifested by a disordered orientation in relation to time, place, or orientation in relation to time, place, or person.person.coprolaliacoprolalia Involuntary use of vulgar or Involuntary use of vulgar or obscene language. Observed in some cases obscene language. Observed in some cases of schizophrenia and in Tourette's disorder.of schizophrenia and in Tourette's disorder.

déjà entendudéjà entendu Illusion that what one is hearing one Illusion that what one is hearing one has heard previously. See also paramnesia.has heard previously. See also paramnesia.déjà pensédéjà pensé Condition in which a thought never Condition in which a thought never entertained before is incorrectly regarded as a entertained before is incorrectly regarded as a repetition of a previous thought. See also repetition of a previous thought. See also paramnesia.paramnesia.déjà vudéjà vu Illusion of visual recognition in which a new Illusion of visual recognition in which a new situation is incorrectly regarded as a repetition of a situation is incorrectly regarded as a repetition of a previous experience. See also paramnesia.previous experience. See also paramnesia.deliriumdelirium Acute reversible mental disorder Acute reversible mental disorder characterized by confusion and some impairment of characterized by confusion and some impairment of consciousness; generally associated with emotional consciousness; generally associated with emotional lability, hallucinations or illusions, and inappropriate, lability, hallucinations or illusions, and inappropriate, impulsive, irrational, or violent behavior.impulsive, irrational, or violent behavior.

delusiondelusion False belief, based on incorrect inference about external False belief, based on incorrect inference about external reality, that is firmly held despite objective and obvious reality, that is firmly held despite objective and obvious contradictory proof or evidence and despite the fact that other contradictory proof or evidence and despite the fact that other members of the culture do not share the belief.members of the culture do not share the belief.delusion of controldelusion of control False belief that a person's will, thoughts, or False belief that a person's will, thoughts, or feelings are being controlled by external forces.feelings are being controlled by external forces.delusion of grandeurdelusion of grandeur Exaggerated conception of one's importance, Exaggerated conception of one's importance, power, or identity.power, or identity.delusion of infidelitydelusion of infidelity False belief that one's lover is unfaithful. False belief that one's lover is unfaithful. Sometimes called pathological jealousy.Sometimes called pathological jealousy.delusion of persecutiondelusion of persecution False belief of being harassed or False belief of being harassed or persecuted; often found in litigious patients who have a persecuted; often found in litigious patients who have a pathological tendency to take legal action because of imagined pathological tendency to take legal action because of imagined mistreatment. mistreatment.

delusion of referencedelusion of reference False belief that the behavior of False belief that the behavior of others refers to oneself; that events, objects, or other others refers to oneself; that events, objects, or other people have a particular and unusual significance, people have a particular and unusual significance, usually of a negative nature; derived from idea of usually of a negative nature; derived from idea of reference, in which persons falsely feel that others are reference, in which persons falsely feel that others are talking about them (e.g., belief that people on television talking about them (e.g., belief that people on television or radio are talking to or about the person). See also or radio are talking to or about the person). See also thought broadcasting.thought broadcasting.delusion of self-accusationdelusion of self-accusation False feeling of remorse and False feeling of remorse and guilt. Seen in depression with psychotic features.guilt. Seen in depression with psychotic features.

depersonalizationdepersonalization Sensation of unreality concerning Sensation of unreality concerning oneself, parts of oneself, or one's environment that oneself, parts of oneself, or one's environment that occurs under extreme stress or fatigue. Seen in occurs under extreme stress or fatigue. Seen in schizophrenia, depersonalization disorder, and schizophrenia, depersonalization disorder, and schizotypal personality disorder.schizotypal personality disorder.derealizationderealization Sensation of changed reality or that one's Sensation of changed reality or that one's surroundings have altered. Usually seen in surroundings have altered. Usually seen in schizophrenia, panic attacks, dissociative disorders.schizophrenia, panic attacks, dissociative disorders.dipsomaniadipsomania Compulsion to drink alcoholic beverages. Compulsion to drink alcoholic beverages.

disorientationdisorientation Confusion; impairment of awareness of Confusion; impairment of awareness of time, place, and person (the position of the self in relation time, place, and person (the position of the self in relation to other persons). Characteristic of cognitive disorders.to other persons). Characteristic of cognitive disorders.dissociationdissociation Unconscious defense mechanism involving Unconscious defense mechanism involving the segregation of any group of mental or behavioral the segregation of any group of mental or behavioral processes from the rest of the person's psychic activity; processes from the rest of the person's psychic activity; may entail the separation of an idea from its may entail the separation of an idea from its accompanying emotional tone, as seen in dissociative accompanying emotional tone, as seen in dissociative and conversion disorders. Seen in dissociative disorders.and conversion disorders. Seen in dissociative disorders.distractibilitydistractibility Inability to focus one's attention; the patient Inability to focus one's attention; the patient does not respond to the task at hand but attends to does not respond to the task at hand but attends to irrelevant phenomena in the environment.irrelevant phenomena in the environment.

dysarthriadysarthria Difficulty in articulation, the motor activity Difficulty in articulation, the motor activity of shaping phonated sounds into speech, not in of shaping phonated sounds into speech, not in word finding or in grammar.word finding or in grammar.dyskinesiadyskinesia Difficulty in performing movements. Difficulty in performing movements. Seen in extrapyramidal disorders.Seen in extrapyramidal disorders.dysphagiadysphagia Difficulty in swallowing. Difficulty in swallowing.dystoniadystonia Extrapyramidal motor disturbance Extrapyramidal motor disturbance consisting of slow, sustained contractions of the consisting of slow, sustained contractions of the axial or appendicular musculature; one movement axial or appendicular musculature; one movement often predominates, leading to relatively sustained often predominates, leading to relatively sustained postural deviations; acute dystonic reactions (facial postural deviations; acute dystonic reactions (facial grimacing, torticollis) are occasionally seen with the grimacing, torticollis) are occasionally seen with the initiation of antipsychotic drug therapy.initiation of antipsychotic drug therapy.

erotomaniaerotomania Delusional belief, more common in women Delusional belief, more common in women than in men, that someone is deeply in love with them than in men, that someone is deeply in love with them (also known as De Clerembault's syndrome).(also known as De Clerembault's syndrome).erythrophobiaerythrophobia Abnormal fear of blushing. Abnormal fear of blushing.euphoriaeuphoria Exaggerated feeling of well-being that is Exaggerated feeling of well-being that is inappropriate to real events. Can occur with drugs such inappropriate to real events. Can occur with drugs such as opiates, amphetamines, and alcohol.as opiates, amphetamines, and alcohol.flat affectflat affect Absence or near absence of any signs of Absence or near absence of any signs of affective expression.affective expression.flight of ideasflight of ideas Rapid succession of fragmentary thoughts Rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech or speech in which content changes abruptly and speech may be incoherent. Seen in mania.may be incoherent. Seen in mania.

hallucinationhallucination False sensory perception occurring in False sensory perception occurring in the absence of any relevant external stimulation of the absence of any relevant external stimulation of the sensory modality involved. For types of the sensory modality involved. For types of hallucinations, see the specific term.hallucinations, see the specific term.hyperactivityhyperactivity Increased muscular activity. The term Increased muscular activity. The term is commonly used to describe a disturbance found is commonly used to describe a disturbance found in children that is manifested by constant in children that is manifested by constant restlessness, overactivity, distractibility, and restlessness, overactivity, distractibility, and difficulties in learning. Seen in difficulties in learning. Seen in attention-deficit/hyperactivity disorder.attention-deficit/hyperactivity disorder.hypomaniahypomania Mood abnormality with the qualitative Mood abnormality with the qualitative characteristics of mania but somewhat less intense. characteristics of mania but somewhat less intense. Seen in cyclothymic disorder.Seen in cyclothymic disorder.

illusionillusion Perceptual misinterpretation of a real Perceptual misinterpretation of a real external stimulus. Compare hallucination.external stimulus. Compare hallucination.inappropriate affectinappropriate affect Emotional tone out of harmony Emotional tone out of harmony with the idea, thought, or speech accompanying it. with the idea, thought, or speech accompanying it. Seen in schizophrenia.Seen in schizophrenia.jamais vujamais vu Paramnestic phenomenon characterized Paramnestic phenomenon characterized by a false feeling of unfamiliarity with a real situation by a false feeling of unfamiliarity with a real situation that one has previously experienced.that one has previously experienced.kleptomaniakleptomania Pathological compulsion to steal. Pathological compulsion to steal.

la belle indifferencela belle indifference Inappropriate attitude of calm or lack Inappropriate attitude of calm or lack of concern about one's disability. May be seen in patients of concern about one's disability. May be seen in patients with conversion disorder.with conversion disorder.labile affectlabile affect Affective expression characterized by rapid Affective expression characterized by rapid and abrupt changes, unrelated to external stimuli.and abrupt changes, unrelated to external stimuli.Lilliputian hallucinationLilliputian hallucination Visual sensation that persons or Visual sensation that persons or objects are reduced in size, more properly regarded as objects are reduced in size, more properly regarded as an illusion. See also micropsia.an illusion. See also micropsia.logorrhealogorrhea Copious, pressured, coherent speech; Copious, pressured, coherent speech; uncontrollable, excessive talking; observed in manic uncontrollable, excessive talking; observed in manic episodes of bipolar disorder. Also called tachylogia; episodes of bipolar disorder. Also called tachylogia; verbomania; volubility.verbomania; volubility.

loosening of associationsloosening of associations Characteristic schizophrenic Characteristic schizophrenic thinking or speech disturbance involving a disorder in the thinking or speech disturbance involving a disorder in the logical progression of thoughts, manifested as a failure to logical progression of thoughts, manifested as a failure to communicate verbally adequately; unrelated and communicate verbally adequately; unrelated and unconnected ideas shift from one subject to another. See unconnected ideas shift from one subject to another. See also tangentiality.also tangentiality.neologismneologism New word or phrase whose derivation cannot New word or phrase whose derivation cannot be understood; often seen in schizophrenia. It has also be understood; often seen in schizophrenia. It has also been used to mean a word that has been incorrectly been used to mean a word that has been incorrectly constructed but whose origins are nonetheless constructed but whose origins are nonetheless understandable (e.g., "headshoe" to mean "hat"), but understandable (e.g., "headshoe" to mean "hat"), but such constructions are more properly referred to as word such constructions are more properly referred to as word approximations.approximations.nymphomanianymphomania Abnormal, excessive, insatiable desire in Abnormal, excessive, insatiable desire in a female for sexual intercourse.a female for sexual intercourse.

obsessionobsession Persistent and recurrent idea, thought, or Persistent and recurrent idea, thought, or impulse that cannot be eliminated from consciousness by impulse that cannot be eliminated from consciousness by logic or reasoning; obsessions are involuntary and ego-logic or reasoning; obsessions are involuntary and ego-dystonic. See also compulsion.dystonic. See also compulsion.phobiaphobia Persistent, pathological, unrealistic, intense fear Persistent, pathological, unrealistic, intense fear of an object or situation; the phobic person may realize of an object or situation; the phobic person may realize that the fear is irrational but, nonetheless, cannot dispel that the fear is irrational but, nonetheless, cannot dispel it. For types of phobias, see the specific term.it. For types of phobias, see the specific term.psychomotor agitationpsychomotor agitation Physical and mental overactivity Physical and mental overactivity that is usually nonproductive and is associated with a that is usually nonproductive and is associated with a feeling of inner turmoil, as seen in agitated depression.feeling of inner turmoil, as seen in agitated depression.

tangentialitytangentiality Oblique, degressive, or even Oblique, degressive, or even irrelevant manner of speech in which the central irrelevant manner of speech in which the central idea is not communicated.idea is not communicated.thought broadcastingthought broadcasting Feeling that one's thoughts Feeling that one's thoughts are being broadcast or projected into the are being broadcast or projected into the environment. See also thought withdrawal.environment. See also thought withdrawal.thought insertionthought insertion Delusion that thoughts are Delusion that thoughts are being implanted in one's mind by other people or being implanted in one's mind by other people or forces.forces.thought withdrawalthought withdrawal Delusion that one's thoughts Delusion that one's thoughts are being removed from one's mind by other are being removed from one's mind by other people or forces. See also thought broadcasting.people or forces. See also thought broadcasting.