TERMINOLOGY

Presenter: Edore Onigu-Otite, MD

DISCLOSURE None
 • Define terms used to describe human
behavior

OBJECTIVES • Apply terminology to describe mental status

• Identify key terminology that may be typical
of various psychiatric conditions.
 • Appearance
MENTAL • Behavior
STATUS • Motor Activity
EXAM • Mood and Affect
SERVES AS • Speech
YOUR • Perceptions
PHYSICAL • Thought Process

EXAM FOR • Thought Content

PSYCHIATRY • Sensorium & Cognition

• Judgement & Insight
 Catalepsy – general term for an immobile position
that is constantly maintained

Catatonic stupor – markedly slowed motor activity,

often to a point of immobility and seeming
unawareness of surroundings
MOTOR
Waxy flexibility – condition of a person who can be
molded into a position that is then maintained;
when the examiner moves the person’s limb, the
limb feels that it is made of wax
Akinesia – lack of physical movement, as in the
extreme immobility of catatonic schizophrenia
 • Cataplexy – temporary loss of muscle tone
and weakness precipitated by a variety of
emotional states
• Echopraxia – pathological imitation of
movements of one person by another
(compare to echolalia)
MOTOR • Tic – involuntary, spasmodic motor
movement
• Stereotypy – repetitive fixed pattern of
physical action or speech
• Mannerism – ingrained, habitual
involuntary movement
 Akathisia – subjective feeling of muscular tension
secondary to antipsychotic or other medication,
which can cause restlessness, pacing, repeated
sitting and standing; can be mistaken for agitation
Psychomotor agitation – excessive motor and
cognitive over activity, usually nonproductive and
in response to internal tension
MOTOR
Psychomotor retardation – decreased motor and
cognitive activity, visible slowing of thought,
speech, and movement

Ataxia – failure of muscle coordination; irregularity

of muscle action
 Dyskinesia – difficulty in performing voluntary
movements, and abnormal involuntary
movements, as in extrapyramidal disorders

Bradykinesia – slowness of motor activity with a

decrease in normal spontaneous movement

MOTOR
Chorea – random and involuntary quick, jerky,
purposeless movements

Dystonia – slow, sustained contractions of the

trunk or limbs; seen in medication induced dystonia
Mood – a pervasive and
sustained emotion,
subjectively experienced
and reported by the patient
and observed by others;
examples include
depression, elation, anger MOOD AND
AFFECT
Affect – the observed
expression of emotion,
possibly inconsistent with
the patient’s description of
the emotion
• Euthymic mood – normal range of
mood, implying absence of
depressed or elevated mood
• Dysphoric mood – an unpleasant,
somewhat sad mood
• Irritable mood – a state in which a
person is easily annoyed and
provoked to anger
• Labile mood – (mood swings)
MOOD DESCRIPTORS
oscillations between euphoria,
depression, or anxiety
• Expansive mood – a person’s
expression of feelings without
restraint, frequently with an
overestimation of their significance
or importance
• Elevated mood – air of confidence
and enjoyment, a mood more
cheerful than usual
 Anxiety – a feeling of apprehension caused by and in
anticipation of danger, which may be internal or external

Depression – pathological feeling of sadness

Anhedonia – loss of interest and withdrawal from all regular

and pleasurable activities, often associated with depression

MOOD Grief – sadness appropriate to a real loss

DESCRIPTORS
Alexithymia – a person’s difficulty in describing or being
aware of emotions or mood

Ecstasy – feeling of intense happiness

Elation – feelings of joy, euphoria, triumph, intense self

satisfaction, or optimism
 AFFECT
DESCRIPTORS

Appropriate affect – condition in which the

emotional tone is in harmony with the
accompanying idea, thought, or speech; also
further described as broad or full affect in
which a full range of emotions is
appropriately expressed
Inappropriate affect – disharmony between
the emotional feeling, tone and the idea,
thought, or speech accompanying it
 Labile affect – rapid and abrupt
changes in emotional feeling tone,
unrelated to external stimuli
Restricted or Constricted affect –
reduction in the intensity of externalized
AFFECT feeling tone
DESCRIPTORS Blunted affect – disturbance in affect
manifested by a severe reduction in the
intensity or externalized feeling tone
Flat affect – absence or near absence of
any signs of affective expression; voice
monotonous, face immobile
 A SPECTRUM OF
AFFECT

Constricted > Blunted > Flat

 • Pressured speech –
rapid speech that is
increased in amount and
difficult to interrupt
• Logorrhea – copious,
coherent, logical speech
• Poverty of speech –
SPEECH restriction in the
amount of speech used;
replies may be
monosyllabic
• Nonspontaneous speech
– verbal responses given
only when asked or
spoken to directly; no
self initiation of speech
 Poverty of content of speech – speech that
is adequate in amount but conveys little
information because of vagueness,
emptiness, or stereotyped phrases
Dysprosody – loss of the normal melody
of speech (prosody) “pseudoforeign
SPEECH accent”

Dysarthria – difficulty in articulation,

not in word finding or grammar
 Perception – process of
transferring physical
stimulation into
psychological information;
mental process by which
sensory stimuli are brought
into awareness
PERCEPTIONS • Hallucinations – false
sensory perception not
associated with real external
stimuli; there may or may
not be a delusional
interpretation of the
hallucinatory experience
• Illusion – misperception or
misinterpretation of real
external sensory stimuli
 Hypnagogic hallucination
– false sensory perception
occurring while falling
(going) to sleep; generally
considered a non-
pathological phenomenon
HALLUCINATIONS
ASSOCIATED WITH SLEEP
Hypnopompic
hallucination – false
perception occurring while
awakening from sleep
(popping out of bed);
generally considered non-
pathological
 HALLUCINATIONS

• Auditory hallucinations – false perception of sound,

usually voices but also other noises, such as music; most
common hallucination in psychiatric disorders
• Visual hallucinations – false perception involving sight
consisting of formed images (people, animals) and
unformed images (flashes of light); most common in
medically related disorders
• Olfactory hallucinations – false perception of smell; most
commonly related to medical disorders such as the pre-
ictus of seizures
• Gustatory hallucination – false perception of taste, usually
unpleasant, commonly related to medical disorders such as
the pre-ictus of seizures
 • Somatic hallucination
– false sense of things
occurring in the
body, most often
visceral in origin
HALLUCINATIONS • Command
hallucination - false
perception of orders
that a person may
feel obliged to obey
or unable to resist
(often dangerous)
 HALLUCINATIONS

• Mood congruent hallucination –

hallucination in which the
content is consistent with either
a manic or depressed mood; e.g.
the manic patient would hear
voices saying the patient is of
inflated worth, power, and
knowledge
• Mood incongruent hallucination –
hallucination in which the
content is not consistent with
either a depressed or manic mood
 • Dissociation – defense
mechanism involving the
segregation of any group of
DISSOCIATIVE PHENOMENA mental or behavioral processes
from the rest of the person’s
psychic activity (disconnect)
 DISSOCIATIVE
PHENOMENA

Macropsia – state in which objects

seem larger than they are
Micropsia – state in which objects
seem smaller than they are
(Both can be associated with
partial complex seizures,
 DISSOCIATIVE
PHENOMENA

• Depersonalization – a person’s
subjective sense of being unreal,
strange, or unfamiliar
• Derealization – a subjective sense that
the environment is strange or unreal; a
feeling of changed reality
• Fugue – taking on a new identity with
amnesia for the old identity; often
involves travel or wandering to new
environments
 Thought Process – the goal-
directed flow of ideas
symbols, and associations
initiated by a problem or task
and leading toward a reality
THOUGHT oriented conclusion

Thought Content – the reality-

drawn conclusions arising in
thoughts
 THOUGHT
PROCESS
DESCRIPTORS

• Word salad – incoherent

mixture of words and phrases
• Circumstantiality – indirect
speech that is delayed in
reaching the point but eventually
gets from the original point to the
desired goal; characterized by an
over inclusion of details and
parenthetical remarks
• Tangentiality – inability to have
goal directed associations of
thought; speaker never gets
from desired point to desired
goal
 • Neologism – new word created
by a patient, often combining
syllables of other words,
idiosyncratic and pathological
• Perseveration – persisting
response to a previous stimulus
after a new stimulus has been
presented; often associated with
THOUGHT PROCESS cognitive disorders
DESCRIPTORS • Verbigeration – meaningless
repetition of specific words or
phrases
• Echolalia – pathological
repeating of words or phrases
of one person by another; tends
to repetitive and persistent; may
be spoken with mocking tone
 THOUGHT PROCESS
DESCRIPTORS

• Loosening of associations – flow of thought

in which ideas shift from one subject to
another in a completely unrelated way;
when severe, speech may be incoherent
• Flight of ideas – rapid, continuous
verbalizations or plays on words produce
constant shifting from one idea to
another; ideas tend to be connected but
too fast for the listener to comprehend
 THOUGHT PROCESS
DESCRIPTORS

• Derailment – gradual or sudden deviation

in train of thought with blocking
• Blocking – abrupt interruption in train of
thinking before a thought or idea is
finished; after a brief pause, person
indicates no recall of what was being said
• Clang association – association of words
similar in sound but not in meaning; words
have no logical connection; may include
rhyming and punning
 DELUSIONS & MOOD

Mood-congruent delusion – delusion with a

mood appropriate content

Mood-incongruent delusion – delusions with

content that has no association to mood
 Overvalued idea – unreasonable,
sustained false belief maintained
less firmly than a delusion.
THOUGHT
CONTENT Delusion – a fixed false belief,
based on incorrect inference about
DESCRIPTOR external reality, not consistent with
S the patient’s intelligence and
cultural background, cannot be
corrected by reasoning.
 DELUSIONS

Bizarre delusion – an absurd, totally

implausible, strange belief (invaders from
space implanting electrodes in one’s brain)
Nihilistic delusion – false feeling that self,
others, or the world is coming to an end
Delusion of poverty – a person’s false belief
that he or she is destitute or will be
deprived of all material possessions
Somatic delusion – false belief involving
the functioning of the body (insides are
rotting or melting)
 Paranoid delusions –
includes persecutory
delusions and delusions
of reference, control, and
grandeur
DELUSIONS
Delusion of persecution –
a person’s false belief
that he or she is being
harassed, cheated, or
persecuted
 Delusion of grandeur – a
person’s exaggerated
conception of his or her
own importance or power

Delusion of reference – a
DELUSIONS person’s false belief that
the behavior of others
refers to himself or
herself; that events,
objects, or other people
have a particular and
unusual significance
 THOUGHT DELUSIONS

Thought withdrawal – delusion that thoughts

are being removed from a person’s mind by
other people or forces
Thought insertion – delusions that thoughts
are implanted in a person’s mind by other
people or forces
Thought broadcasting – delusions that a
person’s thoughts can be heard by others, as
though they were being broadcast over the air
Thought control – delusions that a person’s
thoughts are being controlled by other
people or forces
 Delusions of jealousy – false
belief derived from
pathological jealousy about
a person’s lover being
unfaithful
THOUGHT DELUSIONS
Erotomanic delusions­– a
delusional belief more
common in women than in
men, that someone is deeply
in love with them from afar
 Suicidal and homicidal ideation – preoccupation
with thoughts of harming self or others
Obsession – pathological persistence of an
irresistible thought or feeling that cannot be
eliminated from consciousness by logical effort,
associated with anxiety
OTHER THOUGHT
CONTENT Compulsion – pathological need to act on an
impulse that, if resisted, produces anxiety;
DESCRIPTORS repetitive behavior in response to an obsession
or performed according to certain rules
Phobia – persistent, irrational, exaggerated, and
invariably pathological dread of a specific
stimulus or situation, results in a compelling
desire to avoid the feared stimulus
 Disorientation – disturbance of orientation in time,
place, or person
Clouding of consciousness – incomplete clear
mindedness with disturbances in perception and attitude
Stupor – lack of reaction to and unawareness of
surroundings
Delirium – bewildered, restless, confused, disoriented
SENSORIUM: reaction associated with fear and hallucinations
ALERTNESS OR LEVEL Coma – profound degree of unconsciousness
OF CONSC IOUSNESS
Somnolence – abnormal drowsiness
Drowsiness – a state of impaired awareness associated
with a desire or inclination to sleep
Sundowning – syndrome in older people that usually
occurs at night and is characterized by drowsiness,
confusion, ataxia, and falling
 MEMORY

Amnesia – partial or total inability to

recall past experiences; may be medical
or emotional in origin
• Anterograde – amnesia for events
occurring after a point in time
• Retrograde – amnesia for events
occurring before a point in time
• Confabulation – unconscious filling
of gaps in memory by imagined or
untrue experiences that a person
believes but have no basis in fact
 MEMORY

Déjà vu – illusion of visual recognition in

which a new situation is incorrectly regarded
as a repetition of a previous memory
Levels of Memory
• Immediate – reproduction of recall of
perceived events within seconds to
minutes
• Recent – recall of events over the last
few days
• Recent past – recall of events over the
past few months
• Remote – recall of events in the distant
past
 CONCENTRATION
& ATTENTION

Distractibility – inability to concentrate

attention; a state in which attention is
drawn to unimportant or irrelevant
stimuli
Selective inattention – blocking out only
those things that generate anxiety
Hypervigilance – excessive attention
and focus on all internal and external
stimuli, usually secondary to delusional
or paranoid states
Trance – focused attention and altered
consciousness, usually, seen in hypnosis
and dissociative disorders
 ABSTRACT VS.
CONCRETE THINKING

Abstract Thinking - ability to appreciate

nuances of meaning; multidimensional
thinking with ability to use metaphors and
hypotheses appropriately

Concrete thinking – literal thinking; limited

use of metaphor without understanding of
nuances of meaning, one dimensional thought
 Intelligence – ability to recall,
understand, mobilize, and
constructively integrate previous
learning into new situations

Mental Retardation or Intellectual

Disability – lower intelligence of
such a degree that it interferes
INTELLIGENCE with social and vocational
performance
• Mild – IQ of 50 to 55 up to 70
• Moderate – IQ of 35 to 40 up to
50-55
• Severe – IQ of 20 to 25 up to 35
to 40
• Profound – IQ below 20 to 25
 Dementia – pathological and
global deterioration of
intellectual functioning with
clouding of consciousness

INTELLIGENCE DECLINE Pseudodementia – clinical

features resembling dementia not
caused by pathological
deterioration of the brain; most
often caused by depression
 JUDGEMENT & INSIGHT

Insight – a person’s ability to understand the true

cause and meaning of a situation (such as a set of
symptoms)
Impaired insight – diminished ability to
understand the objective reality of a situation
 
Judgment – ability to assess a situation correctly
and act appropriately in the situation
Impaired judgment – diminished ability to
understand a situation correctly and
appropriately, cannot analyze the risk and
benefits of decisions
QUESTIONS?
THANK YOU