Psychiatry-Understanding Terminology
Dr. Milan H Balakrishnan
Consultant Psychiatrist & Principal Consultant
MINDCARES
DSM IV TR & ICD 10
DSM IV TR- US
2000
Multi-axial system
Axis I-Clinical disorder
Axis II-Personality disorder/Mental retardation
Axis III-General medical conditions
Axis IV-Psycho-social & Environmental problems
Axis V-Global Assessment of Functioning Scale
DSM V came in 2013
ICD10-Europe
Axis I-Clinical disorder
Axis II-Disability(WHO-DAS)
Axis III-Environmental/circumstantial/lifestyle/life management factors
Chapter F for mental and behavioral disorders
Old terms
Neurosis-
Psychosis-loss of reality testing and
impaired mental functioning
Understanding MSE
Appearance
Attitude-co-operative, hostile
Speech –slurred, staccato, talkative
Behaviour & psychomotor activity-mannerisms, tics, echo-praxia
Mood-Pervasive and sustained emotion that colours his perception of the
world
Affect-Present emotional responsiveness inferred from facial exp, amount
and range of expressive behaviour
May or may not congruent; Appropriate
Perception: Illusions & hallucinations (all sensory modalities)
Thought & Disorders
Sensorium
Attention
Concentration
Orientation
Memory - Immediate, Recent, Remote
Fund of knowledge
Abstract thinking
Insight-awareness and understanding of being ill
Judgement
Disorders of Thought
Stream
Form
Content
Possession
Stream
a. Flight of ideas-flow rapidly from one thought to other with
pressure of speech-Mania –increased distractabilty
b. Prolixity (ordered flight)-Hypomania-returns to task
c. Inhibition or slowing-difficulty conc, slowed activities &
decisions
Form(thought process)
a. Circumstantiality: Over-inclusion of unnecessary
details
b. Clang association: Rhyming words
c. Derailment: Loss of association-No sense to sentences
d. Neologism
e. Perseveration
f. Tangentiality: appropriate to the general topic but not
answer question
g. Thought blocking
Disorders of constancy lead to
Transitory thinking.
Disorders of continuity lead to
Desultory thinking.
Disorders of organization lead to
Drivelling thinking
Thought content
Overvalued ideas
Delusions
Pre-occupations
Obsessions
Compulsions
Phobias
Recurrent suicidal ideas
Depressive symptoms
Anxiety
Over-valued Idea: Solitary,not delusional, not obsession, pre-
occupies and dominates life, may not be unreasonable or
false
Delusions-false, unshakeable, not cultural, in spite of
evidence
Formation of delusion:
delusional mood
delusional perception
Sudden delusional idea
Autochtonous delusion
Systematized or not
Delusion of reference
Delusion of persecution
Delusion of infidelity
Delusion of love (Erotomania)
Delusion of grandiosity
Delusion of ill health
Delusion of guilt
Delusion of Nihilism
Delusion of Enormity
Delusion of poverty
Delusional zoopathy(parasitosis)
Obsessions and compulsion
own thoughts, image, ideas, fear, or an impulse
repetitive and intrusive and appear against the will.
senseless (Absurd)
ego-dystonic and causes significant distress, anxiety, even
guilt to the patient.
normally under the control of the patient and can be
resisted, though patient often finds it difficult to resist them.
Possession Of thought
Thought alienation
Thought control
Thought withdrawal
Thought broadcast
Thought insertion
Disorders of perception
Sensory distortion: Real stimulus is perceived as distorted
Intensity-Hypo-esthesia, hyper-esthesia
Quality-Xantho-opsia,chloro-opsia,erythro-opsia
Shape-dysmegalopsia
Micropsia – Objects appears smaller
Macropsia (megalopsia)—Objects appears larger
Porropsia—retreat of object into the distance
without any change in size.
Illusion: Misinterpretation of an external stimulus
Completion Illusions-inattention makes incomplete object appear complete
Affect illusions-depending on mood eg.
Pareidolia-perceives formed objects from ambiguous stimuli, for example seeing a
mans head in a cloud.
Hallucinations-
Sensory deprivation
Paranoid disorder in deaf
Black Patch Disease
Charles Bonnet syndrome-Elderly patients with normal consciousness and no
brain pathology, but with reduced visual acuity due to ocular problems
experience vivid, distinct formed hallucinations, often of men wearing hats.
CNS disorders- Diencephalic & Cortical
Auditory
Visual
Olfactory
Gustatory
Tactile:
Superficial hallucinations –skin
Thermic-temp
Haptic-touch
Hygric
Paraesthetic
Kinesthetic hallucination –muscles and joints
Visceral hallucination-organs
Special kind of hallucinations
Functional hallucination— when stimulus and
hallucination are experienced in same sensory modality.
Reflex hallucination—When stimulus and hallucination
are experienced in different sensory [Link].
Synaesthesia
Reflex hallucinations are a morbid form of synaesthesia.
Extracampine hallucination—Hallucination that is outside
the limits of the sensory field.
Autoscopy ( Phantom mirror image). It is the experience of
seeing oneself and knowing that is oneself. It is not just a visual
hallucination because kinaesthetic and somatic sensation must
also be present to give the subject the impression that the
hallucination is oneself.
Negative autoscopy- when patient looks in the mirror and sees
no image.
Internal autoscopy—when subject sees their own internal organs.
Hypngogic hallucination
Hypnopompic hallucination
Cenesthetic hallucinations: Unfound sensations of altered states
in the bodily organs. e.g. cutting sensation inside the bone.
Motor abnormalities
Snout spasm (Schnauzkrampf)
Emotional lability
Psychomotor retardation
Obstruction
Mannerisms- Spontaneous, repetitive, goal directed activity.
E.g Running hands through Hair
Stereotypy— Spontaneous, repetitive, non-goal directed
activity. E.g Shrugging shoulders
Verbigeration- Senseless repetition of long sentences.
Perseveration-- Induced, repetitive, goal
directed activity. This can be of three
types:-
Palilalia- Patient repeats the perseverated
word with increasing frequency.
Logoclonia—last syllable of the last word is
repeated e.g.-today-ay-ay-ay.
Psychological pillow- Patient lie with their head
few inches off the pillow.
Waxy flexibility- Feeling of plastic resistance as
the examiner moves the patient body, which
resembles the bending of a soft wax rod, and
when the passive movement stops the final
posture is preserved.
Problems of Memory
Sensory memory is registered for each of the senses. [Link] memory,
tactile memory etc.
Short term memory is also called as Working memory.
Autobiographical memory—Memories for the events and issues that relate
to oneself.
Explicit/Declarative/Relational memory- memory of specific event
Implicit/Procedural/Skill memory- Memory such as swimming, typing,
driving etc.
Hippocampus is believed to be the site where explicit memory is stored
while implicit memory is thought to reside in limbic system, the amygdale,
and the hippocampus.
Memory impairment can be divided into Amnesia (loss of
memory) and Paramnesia (Distortion of memory).
Amnesia is defined as partial or total inability to recall past
events and experiences and its origin may be organic or
psychogenic.
Psychogenic/dissociative amnesia is the sudden amnesia
that occurs during the periods of extreme trauma and can
last for hours or even days.
Katathymic amnesia or motivated forgetting is inability to
recall specific traumatic event.
Retrograde amnesia is amnesia for the events occurring just
before the injury
Anterograde amnesia is amnesia for the events occurring after
the injury.
These occur most commonly following accidents, alcoholic
blackouts, epileptic confusion, transient global amnesia, Electro-
convulsive therapy.
Confabulation-Filling-in of the gaps in the memory by imagined
or untrue experience.
Pseudologia fantastica or fluent plausible lying (pathological
lying)—Patient describe various major events/trauma or make
grandiose ideation to impress others.
Depersonalization
A change in awareness of one’s own activity
Feeling of detachment from one’s self
Capacity for feeling is diminished or absent
Changes in subjective experience of time and memory can
occur
Retention of ego boundaries
Seen in depression, schizophrenia, organic brain
syndromes, substance abuse, anxiety disorder (GAD, Panic
disorder) and dissociative conditions.
Capgras syndrome (Delusion of doubles)
Negative misidentification
Known person become unknown
Patient believes that a person to whom they are close, usually
a family member, has been replaced by an exact double.
Fregoli’s syndrome
Positive misidentification
Unknown person become known
Patient believes that various people whom he meets are really
the same person in disguise
Other Syndromes
Couvade syndrome : Person complains of obstetric symptoms
during his partner’s pregnancy
Diogenes syndrome : Gross self neglect especially among
elderly persons
Cotards syndrome:
more common in the elderly
consists of depressed mood and nihilistic and
hypochondriacal delusions
Ganser’s syndrome
Clinical features
1. approximate answers (vorbeireden), i.e. absurdly wrong but
almost correct
answers (e.g. ‘a horse has five legs’), which are inconsistent
2. may also be hysterical conversion symptoms (e.g. ataxia)
3. changeable clouding of consciousness
4. subsequent amnesia
·often sudden onset related to stressful (or criminal) circumstances
Seen in prisoners
• hysterical twilight state
• occasionally post-epileptic
• associated with depression and dementia
Treatment
usually recovers when stress removed
Gjessing’s syndrome
A rare disorder in which catatonic symptoms recurred in
phases
changes in nitrogen balance and in thyroid function
which could be treated by thyroxine
Lycanthropy-belief that a person has been transformed
into an animal
Klüver-Bucy syndrome
Seen in :
· Alzheimer’s disease
· Bilateral temporal lobe pathology
· arteriosclerosis
· Pick’s disease
· cerebral tumours
Characterized:
1. visual agnosia
2. hypermetamorphosis - stimulus bound to contact and touch every object in sight
3. sexual indiscretion
4. affective blunting
Gerstmann’s syndrome
lesion of dominant parietal lobe
1. right-left disorientation
2. finger agnosia
3. dysgraphia
4. dyscalculia
Anton’s syndrome
Due to a lesion of occipital lobe
1. denial of visual disability
2. confabulation of visual detail
Marchiafava-Bignami disease
Due to extensive demyelination of the corpus callosum, the optic
tracts, and the cerebellar peduncles
associated with alcohol misuse
probably related to vitamin B deficiency
1. ataxia
2. dysarthria
3. epilepsy
4. severe impairment of consciousness
5. more slowly progressive forms present with dementia and spastic
paralysis of the limbs
