Med2B De Castro – Prelim Topics Psychopath

Psychiatric History
Outline of PSYCHIATRIC History Outline of PERSONAL History (ANAMNESIS)
1. Identifying data A. Prenatal and perinatal
2. Chief Complaint B. Early childhood (through age 3)
3. History of present illness C. Middle childhood (ages 3-11)
a) Onset D. Late childhood (puberty through adolescence)
b) Precipitating factors E. Adulthood
4. Past illnesses a. Occupational history
5. Psychiatric b. Marital and relationship history
6. Medical c. Military history
7. Alcohol and other substance history d. Educational
8. Family history e. Religion
f. Social activity
g. Current living situation
h. Legal history
F. Sexual history
G. Fantasies and dreams
H. Values

1. IDENTIFYING DATA
 Demographic summary of pt by name, age, sex, marital status, occupation, language ( if other than English), ethnic
background, and religion, insofar as they are pertinent, and current circumstances of the living.
 Thumbnail sketch of potentially important pt characteristics that may affect diagnosis, prognosis, treatment, and compliance.
2. CHIEF COMPLAINT
 In the patient’s own words, states why he or she has come or been brought in for help.
3. HISTORY OF PRESENT ILLNESS
 Comprehensive and chronologic picture of the events leading up to the current moment in the patient’s life.
 Record in patient’s own words as much as possible
Determine: Questions to ask:
 Devt of sx from time of onset to present  When did you first notice something happening to you?
 Relation of life events, conflicts, stressors.  Were you upset about anything when the sx began?
 Drugs  Did they begin suddenly or gradually?
 Change from levels of functioning
4, 5. PAST MEDICAL HISTORY
Includes: Importance:
 Previous psychiatric & medical illness  Many medical condns &their tx cause psychiatric sx and may be
 Psychiatric disorders mistaken for a 1psychiatric disorder.
 Major medical or surgical illnesses &major  Medical status will also guide psychiatric tz decisions.
traumas  Names and dosing schedules for all currently prescribed
 Psychosomatic illnesses nonpsychiatric drugs should be obtained to avoid adverse
 Neurological illnesses (craniocerebral trauma, interactions with prescribed psychiatric medication.
convulsions, tumors)
7. FAMILY HISTORY
Includes:
 Any psychiatric illness, hospitalization, and treatment of the patient’s immediate family members
 Medical and genetic illnesses in the family

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 If deceased, date and cause

 Family history of alcohol and other substance abuse or of antisocial behavior.
 Define the role each person played in pt’s upbringing and this person’s current relationship w/pt.
 Feelings about each family member

PAST PERSONAL HISTORY (Anamnesis)

Outline of a Developmental History

A. Prenatal and perinatal B. Infancy and early childhood

 Full-term pregnancy or premature (1 Year through Age 3 Years)
 Vaginal delivery or caesarian  Infant-mother relationship
 Drugs taken by mother during pregnancy (prescription  Problems with feeding and sleep
and recreational)  Significant milestones
 Birth complications  Standing/walking
 Defects at birth  First words/two-word sentences
 Bowel and bladder control
 Other caregivers
 Unusual behaviors, e.g., head banging
C. Middle childhood D. Adolescence
(Ages 3 to 11 Years) Onset of puberty
 Preschool and school experiences  Academic achievement
 Separations from caregivers  Organized activities (sport, clubs)
 Friendships/play  Areas of special interests
 Methods of discipline  Romantic involvements and sexual experience
 Illness, surgery, or trauma  Work experience
 Drug/alcohol use
 Symptoms (moodiness, irregularity of sleeping or eating,
fights and arguments)
E. Young adulthood F. Middle adulthood and Old age
 Meaningful long term relationships  Changing family constellation
 Academic and career decisions  Social activities
 Military experience  Work and career changes
 Work history  Aspirations
 Prison experience  Major losses
 Intellectual pursuits and leisure activities  Retirement and aging
 Current Living Situation
 Psychosexual History
 Fantasies and Dreams
 Values
 Pre-morbid Personality

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MENTAL STATUS EXAMINATION

The description of the patient's appearance, speech, actions, and thoughts during the interview.

GENERAL DESCRIPTION
A. APPEARANCE D. AFFECT
 Patient's appearance and overall physical impression as  Pt’s present emotional responsiveness, inferred from
reflected by the patient's facial expression, inclamount and range
o Poise of expressive behavior.
o Posture  In the following terms
o Clothing o constricted (limited variation)
o Grooming. o blunted (minimal variation)
o flat (no variation)
B. ATTITUDE TOWARD THE EXAMINER E. SPEECH
 Patient's facial expressions and attitude toward the  Infoon all aspects of the pt’s speech, incl
examiner. o Quality
 Can be described as cooperative, friendly, attentive, o Quantity
interested, frank, seductive, defensive, contemptuous, o rate of production
perplexed, apathetic hostile, playful, ingratiating, evasive or o volume
guarded.  of speech during the interview.
C. MOOD F. PERCEPTION
 "Pervasive and sustained emotion that colors the person's  Perceptual disturbances such as hallucinations and
perception of the world. illusions, ~experienced in reference to self or to
 " Ask questions such as "How do you feel most days?" in environment.
order to trigger a response.  The sensory system involved (auditory, visual, taste,
 Description should include the olfactory, or tactile), and the content of the illusion or
o Depth the hallucinatory experience should be described
o Intensity Depersonalization extreme feelings of detachment
o Duration and Derealization from self or environment
o Fluctuations Formication feeling of bugs crawling under the
 Common adjectives to describe mood include depressed, skin ( seen in cocainism)
despairing, irritable, anxious, angry, expansive, euphoric,
empty, guilty, hopeless, futile, self-contemptuous, frightened
and perplexed.
G. THOUGHT PROCESS (Form of thinking)
Refers to the way in which the person puts together ideas and associations, the form in which the person thinks. (logical
and coherent; completely illogical or incomprehensible.
Looseness of association irrelevance, do the ideas expressed seem unrelated and idiosyncratic
Flight of ideas change topics, rapid thinking
Tangential departure from topic with no return
Circumstantial being vague, i.e., “beating around the bush”, loss of capacity for goal-oriented thinking
Clanging rhyming words
Punning talking in riddles

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Thought blocking speech is halted, interruption of the train of thought before an idea has been completed
Poverty limited content
Neologism creating new words
Word salad nonsensical responses, i.e., jabberwocky), derailment (extreme irrelevance
H. THOUGHT CONTENT AND MENTAL TRENDS
Refers to what a person is actually thinking: ideas, beliefs, preoccupations, obsessions
Aspects of thought content are as follows:

Obsession and compulsions Phobias Suicidal ideation or intent Homicidal ideation or intent

SENSORIUM AND COGNITION

Perform the Folstein Mini-Mental State Examination (MMSE)- brief instrument designed to grossly assess cognitive
functioning, asses orientation, memory, calculations, reading and writing capacity, visiospatial ability and language
Consciousness 1. Coma: characterized by unresponsiveness 3. Lethargic: characterized by drowsiness
2. Stuporous: characterized by response to pain 4. Alert: characterized by full awareness.
Orientation Time, Place, Person
Concentration and Ask the patient to subtract 7 from 100, then to repeat the task from that response. This is known as "serial
attention 7s.” Next, ask the patient to spell the word world forward and backward.
Reading and writing Ask the patient to write a simple sentence (noun/verb). Then, ask patient to read a sentence (eg, "Close
your eyes."). This part of the MSE evaluates the patient's ability to sequence.
Visuospatial ability Have the patient draw interlocking pentagons in order to determine constructional apraxia.
Memory "What was the name of your first grade teacher?" (ie, for remote memory).
"What did you eat for dinner last night?" (ie, for recent memory).
"Repeat these 3 words: 'pen,' 'chair,' 'flag.' " Tell the patient to remember these words. Then, after 5
minutes, have the patient repeat the words. (ie, for immediate memory).
Abstract thought Assess the patient's ability to determine similarities. Ask the patient how 2 items are alike. For example,
an apple and an orange.
Assess pt ability to understand proverbs. Ask pt the meaning of certain proverbial phrases.
General fund of Test patient's knowledge by asking some of the following questions. "How many nickels are in $1.15?"
knowledge
Intelligence Based on the information provided by the patient throughout the interview, estimate the patient's
intelligence quotient (ie, below average, average, above average).

JUDGEMENT Estimate the patient's judgment based on the history or on an imaginary scenario.
IMPULSIVITY Estimate the degree of the patient's impulse control. Ask the patient about doing things without thinking or planning.
RELIABILITY The mental status part concludes with the psychiatrists impressions of the patient's reliability and capacity to report
his or her situation accurately.

INSIGHT
6 levels of insight

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1. Complete denial of illness

2. Slight awareness of being sick and needing help but denying it at the same time

3. Awareness of being sick but blaming it on others, on external factors or on organic factors

4. Awareness of that illness is due to something unknown in the patient

5. Intellectual insight: admission that the patient is ill and that symptoms or failures in social adjustment are due to the patient's
own particular irrational feelings or disturbances without applying this knowledge to future experiences

6. True emotional insight: emotional awareness of the motives and feelings

Signs and Symptoms in Psychiatry

Signs vs. Symptoms

Signs Symptoms Syndrome
• Observations and objective • Subjective experiences described • Group of signs and symptoms
findings elicited by clinician by the patient, often as the chief that together make up a
• Ex. Patient’s constricted affect complaint recognizable condition
or psychomotor retardation • Ex. Depressed mood or lack of
energy

Phenomenology “Personal World”

• School of philosophy and psychiatry developed by • The way a person thinks or feels, normal or otherwise.
Edmund Husserl and Karl Jaspers • Abnormal if
• Focus: sign or symptom that can be described and o It springs from a condition that is universally
experienced accepted as abnormal
• To be used as diagnostic tool, phenomenon must occur o Separates the person from others emotionally
repeatedly and be characteristic of a known disorder o Does not provide the person with a sense of
“spiritual or material” security

Neurosis vs. Psychosis

Neurosis Psychosis
DSM-III definition: American Psychiatric Glossary
• Mental disorder in which the predominant disturbance is • Impaired reality testing
a symptom or a group of symptoms that is distressing to o Persons incorrectly evaluate the accuracy of
the individual and is recognized by him or her as their perceptions and make incorrect inferences

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unacceptable and alien; reality testing is intact about external reality, even in face of contrary
…disturbance is relatively enduring and not limited to evidence
transitory reaction to stressors.

Note that most psychiatric signs and symptoms are rooted in normal behavior and can be understood as various points on
a spectrum of behaviors ranging from normal to pathological.

Consciousness Emotion Motor behavior Thinking Thinking

Speech Perception Memory Intelligence

Consciousness
Consciousness Attention
• State of awareness • Amount of effort exerted in focusing on certain portions
• Apperception: perception modified by person’s own of an experience;
emotions and thoughts • Ability to concentrate
• Sensorium: state of cognitive functioning of special
senses
• Note that disturbances in consciousness are most often
associated with brain pathology
Disturbances of Consciousness Disturbances of Attention
• Disorientation
• Clouding of consciousness 1. Distractibility Inability to concentrate
• Stupor 2. Selective State in which attention is drawn to
• Delirium inattention irrelevant or unimportant external
• Coma stimuli
• Coma vigil: cannot be aroused but with eyes open 3. Hypervigilance Excessive focus and attention on all
• Twilight state: disturbed consciousness with hallucination external and internal stimuli; usually
• Dreamlike state: complex partial seizure or psychomotor secondary to delusional or paranoid
epilepsy states
• Somnolence: state of near-sleep; strong desire for sleep; 4. Trance Focused attention and altered
long sleep consciousness (hypnosis)
• Confusion 5. Disinhibition Removal of an inhibitory effect that
• Drowsiness permits persons to lose control of
• Sundowning/Sundowner’s syndrome: drowsiness, impulses (alcohol intoxication)
confusion, ataxia and falling as result of excessive
medication; usually in older persons; happen at night

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Disturbances in Suggestibility
• Compliance to an idea or influence
• Folie a deux (folie a trois): communicated emotional illness between two to three people
• Hypnosis: heightened suggestibility

Emotion
Complex feeling state with psychic, somatic and behavioral components related to affect and mood

Affect
Observed expression of emotion, probably inconsistent with patient’s description of emotion
• Appropriate affect • Restricted or constricted affect
• Inappropriate affect • Flat affect: monotonous voice and immobile face
• Blunted affect: severe reduction in emotional intensity • Labile affect: rapid and abrupt change in emotional state,
unrelated to external stimulus

Other Emotions
• Anxiety • Tension
• Free-floating anxiety • Panic
• Fear • Apathy
• Agitation: motor restlessness • Ambivalence: two opposing impulses toward same thing
in the same person at the same time
Mood
Pervasive and sustained emotion subjectively experienced and reported by a patient and observed by
others
• Dysphoric: unpleasant mood
• Euthymic: normal range of mood; implies absence of depressed or evelated mood
• Expansive mood: expression without restraint, due to overestimation of significance
• Irritable mood
• Mood swings (labile mood): oscillations between euphoria and depression or anxiety
• Elevated mood
• Euphoria
• Ecstasy: feeling of intense rapture
• Depression: feelings of sadness, loneliness, despair, low self-esteem, and self-reproach. Signs include psychomotor
retardation and at times, agitation, withdrawal from personal contact, and vegetative symptoms such as anorexia and
insomnia. Refers to a mood or a disorder.
• Anhedonia: loss of interest in, or withdrawal from all pleasurable activities
• Grief or mourning: bereavement
• Alexithymia: inability to describe/lack of awareness of own emotions or moods
• Suicidal ideation: thought or act of taking one’s own life
• Emotion
• Mood
• Elation: feeling of joy, euphoria, triumph, and intense self-satisfaction or optimism

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• Mania: elation, hyperactivity, hypersexuality and accelerated thinking and speaking

• Hypomania: characteristics of mania but somewhat less intense; see cyclothymic disorder
• Melancholia: severe depressive state
• La belle indifference: inappropriate calm or lack of concern about one’s disability
• Abreaction: emotional release after recalling a painful experience
• Guilt
• Impulse control
• Ineffability: ecstatic state indescribable, inexpressible and impossible to convey to another person
• Acathexis: lack of feeling associated with ordinarily emotionally discharged subject
• Decathexis: detaching emotions form thoughts, ideas or persons

Physiological disturbances associated with mood

• Anorexia
• Hypersomnia
• Diurnal variation
• Hyperphagia
• Insomnia
• Initial: difficulty sleeping
• Middle: difficulty sleeping through the night without waking up and difficulty going back to sleep
• Terminal: early morning awakening
• Diminished libido
• Constipation
• Fatigue: weariness, sleepiness or irritability following a pd. of mental or bodily activity
• Pica: eating nonfood substances
• Pseudocyesis: rare; patient has symptoms of pregnancy
• Bulimia
• Adynamia: weakness and fatigability

Motor behavior (Conation)

Aspect of psyche that includes motivations, wishes, drives, instincts and cravings, as expressed by a person’s behavior or
motor activity

Motor activity
• Echopraxia: pathologic copying of • Catatonia and postural abnormalities
movement o Catalespy: constantly maintained immobile position
• Negativism: motiveless resistance to all o Catatonic excitement
instructions o Catatonic stupor
• Cataplexy: temporary loss of muscle tone o Catatonic rigidity: rigid posture; unmoving
due to variety of emotional states o Catatonic posturing: bizarre or inappropriate posture;
• Stereotypy: repetitive fixed pattern of action maintained for long peds.
and speech o Cerea flexibilitas (waxy flexibility): can be molded to a
• Mannerism subsequently maintained position

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o Akinesia:catatonic schizophrenia or effect of antipsychotic

drug

Motor behavior
• Command automism: automatic obedience
• Mutism: voicelessness in absence of structural damage
• Automism: represent unconscious symbolic activity
Overactivity: Psychomotor agitation Hypoactivity (hypokinesis)
• Hyperactivity (hyperkinesis) • Mimicry
• Tic: involuntary, spasmodic motor • Aggression
movement • Actingout
• Sleepwalking (somnambulism) • Abulia: reduced impulse to think and act; indifference about
• Akathisia: subjective feeling of muscle consequences of action as result of neurological deficit
tension secondary to antipsychotic or • Anergia: lack of energy
other medication; can be mistaken for • Astastia abasia: inability to stand or walk in normal manner as in
psychotic agitation conversion disorders
• Polyphagia: pathological overeating • Coprophagia: eating of filth
• Tremor: rhythmical alteration in • Dyskinesia: difficultly in performing movements; extrapyramidal
movement; usually more pronounced disorder
during periods of anger and tension, and • Muscle rigidity: muscles remain immovable. Schizophrenia.
less so in relaxed state or during sleep • Twirling: sign in autistic children who continuously rotate in the direction
• Ataxia: Lack of coordination, either in which their head is turned
physical or mental • Bradykinesia: slowness of motor activity; decrease in normal
• Floccillation: aimless picking usually at spontaneous movement
bedding or clothing as in delirium • Chorea: random, involuntary, quick, jerky, and purposeless movements.
• Compulsion Huntington’s diease.
o Dipsomania: alcohol intake • Dystonia: slow, sustained contractions of axial and appendicular
o Kleptomania: stealing muscles; one gesture usually predominates, leading to postural
o Satyriasis (nymphomania in deviations. Extrapyramidal motor disturbance.
women): coitus • Amimia: inability to make gestures or to understand those of others
o Trichitollomania: pulling out of • Seizure
hair o Generalized tonic-clonic seizure; grand mal seizure or
o Ritual: anxiety reducing psychomotor seizure
o Simple partial seizure; without altered consciousness
o Complex partial seizure: with altered consciousness
• Convulsion
o Clonic convulsion
o Alternate contraction and relaxation of muscles
o Tonic convulsion: muscle contraction is sustained

Thinking

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Goal-directed flow of ideas, symbols and associations initiated by a problem or task and leading toward a reality-oriented
conclusion
Parapraxis/Freudian slip: considered part of normal thinking
Abstract thinking: ability to grasp essentials of a whole & break a whole into parts and to discern common properties

General Disturbances in 
 Form or Process of Thinking


• Mental disorder • Dereism: mental activity not concordant with logic or
• Psychosis experience
• Reality testing • Autistic thinking: synonymous with dereism
• Formal thought disorder: loosened associations, • Magical thinking
neologisms, and illogical construct; person is defined • Primary process thinking: dereistic, illogical, magical,
as psychotic normally found in dreams, abnormally in psychosis
• Illogical thinking • Emotional insight

Specific disturbances in 
 FORM of thought


• Neologism: new word created by patient for idiosyncrtaic • Condensation: one symbol stands for a
psychological reasons number of components
• Word salad • Irrelevant answer
• Circumstantiability • Loosening of association
• Tangentiability • Derailment
• Incoherence • Flight of ideas
• Perseveration: same response with different stimuli • Clang association: association of words
• Verbigeration: meaningless repetition of specific words or phrases similar in sound but not meaning
• Echolalia: repeating words or phrases of others, repetitive and • Blocking
persistent; seen in schizophrenia, especially catatonic • Glossolalia: speaking in tongues; cryptolalia if
related to Pentecostal religions

Specific disturbances in 
 CONTENT of thought


• Poverty of content • Obsession
• Overvalued idea • Compulsion
• Delusion (see below) • Cropolalia
• Trend or preoccupation of thought • Noesis: revelation in which illumination occurs in association with sense
• Egomania that a person is chosen to lead or command
• Monomania • Unio mystica: oceanic feeling of mystic union w/ infinite power
• Hypochondria • Phobia(see below)

Delusion Phobia
Bizarre delusion Delusion of infidelity (delusional jealousy) • Specific phobia
Systematized delusion Erotomania/ Clerambault-Kandinsky • Social phobia
Mood-congruent delusion complex: delusional belief, more common • Acrophobia
Mood-incongruent delusion in women, that someone is deeply in love • Agoraphobia
Nihilistic delusion: false feeling that self, with them • Algophobia:pain
others, or the world is nonexistent or Pseudologia phantastica: a type of lying in • Ailurophobia:cats

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coming to an end which a person appears to believe in the • Erythrophobis: color red or
Delusion of poverty reality of his fantasies; associated with blushing
Somatic delusion Munchausen syndrome, repeated feigning • Panphobia
Delusion of self accusation of illness • Claustrophobia
Paranoid delusions Delusion of control • Xenophobia: strangers
• Delusion of persecution • Thought withdrawal • Zoophobia: animals
• Delusions of grandeur • Thought insertion • Needle phobia/blood injection
• Delusion of reference • Thought broadcasting phobia
• Thought control

Speech

Disturbances in speech
Pressure of speech Dysprosody loss of normal speech melody
Volubility (logorrhea) Dysarthria difficulty in articulation, not in word finding
Poverty of speech Stuttering repetition or prolongation of a syllable; impaired fluency
Nonspontaneous speech Cluttering rapid and jerky spurts, erratic and dysrythmic speech
Poverty of content of speech Aculalia nonsense speech associated with markedly impaired comprehension
Excessively soft or loud speech Bradylalia Abnormally slow speech
Dysphonia Difficulty of pain with speaking

Speech: Aphasic disturbances

Motor aphasia: Broca’s aphasia: Understanding but ability to speak is grossly impaired
Sensory aphasia: Wernicke’s aphasia: Organic loss of ability to comprehend the meaning of words
Nominal aphasia: Anomia or Amnestic aphasia: Difficulty finding correct name for an object
Syntactical aphasia: Inability to arrange words in proper sequence
Jargon aphasia: Fluent or receptive aphasia in which the patient’s speech is incomprehensible, but appears to make
sense to them.
Global aphasia: Commonly assoc w/large lesion in perisylvian area of the frontal, temporal &parietal lobes of the brain
causing an almost total reduction of all aspects of spoken & written language.
Alogia: Inability to speak due to mental deficiency or episode of dementia
Coprophasia: Seen in Tourette's syndrome; involuntary use of vulgar speech

Perception
Process of transferring physical stimulation into psychological information. Mental process by which sensory stimuli are
brought to awareness.

Disturbances of perception
• Illusion: Misinterpretation or misinterpretation of real or external sensory stimuli
• Hallucination: False sensory perception not associated with real stimuli

Types of Hallucinations:
• Hypnagogic hallucination: while • Gustatory hallucination • Mood-incongruent hallucination

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asleep; nonpathological • Tactile (haptic) hallucination • Hallucinosis: chronic alcohol

• Hypnopomnic hallucination: while • Somatic hallucination abuse
awakening from sleep; • Lilliputian hallucination/Micropsia: • Synesthesis: caused by another
nonpathological things seems reduced in size sensation
• Auditory hallucination • Mood-congruent hallucination • Trailing phenomenon
• Visual hallucination • Command hallucination
• Olfactory hallucination

Disturbances associated with cognitive disorder and medical conditions

Agnosia loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor
is there any significant memory loss
Anosognosia inability to recognize neurological illness of oneself
Somatopagnosia ignorance or inability to recognize part of body as his own
Visual agnosia inability of the brain to recognize or understand visual stimulus
Astereognosis inability to identify an object by touch without visual input
Apraxia inability to carry out certain tasks
Simultagnosia can’t comprehend more than one element of a visual scene at a time or integrate parts of a whole
Adiadokinesia inability to perform the rapid alternating movements
Aura warning sensations preceding a seizure or a classic migraine headache

Disturbances associated with conversion and dissociative phenomenon

Hysterical anesthesia Loss of sensory modalities resulting from emotional conflicts
Multiple Personality Manifestation of multiple personalities at different times
Dissociation Defense mechanism to segregate certain facts from memory
Depersonalization A person’s subjective sense of being strange or unfamiliar
Derealization A subjective sense that the environment is strange or unreal
Macropsia (megalopia) Perception that objects within an affected section of the visual field appear larger than normal, causing
the subject to feel SMALLER than they actually are
Micropsia Perception in which objects are perceived to be smaller than they actually are, causing the subject to
feel BIGGER than they actually are
Fugue Taking on new Identity with amnesia of the old identity

Memory
Function by which information stored in the brain is later recalled to consciousness
Orientation: normal state of oneself and one’s surroundings in terms of time, place and person.

Disturbances of memory
• Amnesia: partial or total inability to recall past experiences
o Anterograde: Loss of memory for events that happen after, subsequent, to onset of amnesia; common after trauma
o Retrograde: Loss of memory for events that happened before onset of amnesia
• Hypermnesia: excessive retention or recall

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Eidetic image visual memory of almost hallucinatory vividness

Screen memory consciously tolerable memory covering for a painful memory
Repression defense mechanism characterized by unconscious forgetting of unacceptable ideas or impulses
Lethologica temporary inability to recall a name or proper noun
Blackout amnesia experienced by alcoholics about behaviour during drinking bouts

Paramnesia: falsification of memory by distortion of recall

Fausse False recognition, can occur in delusional disorders
reconnaissance
Retrospective Memory becomes unintentionally (unconsciously) distorted by being filtered through a person’s present
falsification emotional, cognitive, and experimental status
Confabulation Unconscious filling of gaps
False memory Recollection and belief of an event that did not actually occur False memory syndrome: person erroneously
believes that they sustained emotional, physical, or sexual trauma early in life.
Déjà entada Illusion of auditory recognition
Déjà pense Illusion that a new thought is recognized as previously felt or expressed
Jamias vu False feeling of unfamiliarity with a real situation that one has previously experienced

Levels of Memory
1. Immediate Recall of perceived material within seconds to minutes
2. Recent Recall of events over the past few days
3. Recent past Recall of events over the past few moths
4. Remote Recall of events in the distant past

Intelligence
Ability to understand, recall, mobilize and constructively integrate previous learning in meeting new situations

Mental retardation: lack of intelligence to interfere with social and vocational performance
Mild: IQ of 50 or 55 to approximately 70 Idiot: mental age les than 3 years
Moderate: IQ of 35 or 40 to 50 or 55 Imbecile: mental age of 3 to 7 years
Severe: IQ of 20 or 25 to 35 or 40 Moron: mental age of about 8 years
Profound: IQ below 20 or 25

Dementia
Organic and global deterioration of intellectual functioning without clouding of consciousness
1. Dyscalculia loss of ability to do calculations
2. Dysgraphia loss of ability to write in cursive style
3. Alexia loss of a previously possessed reading facility: not explained by defective visual acuity

• Pseudodementia: clinical features resembling dementia NOT caused by an organic condition; dementia syndrome of
depression
• Concrete thinking: literal thinking; one dimensional thought

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• Abstract thinking: ability to appreciate nuances of meaning: multidimensional thinking with ability to use metaphors and
hypotheses appropriately

Insight
Ability to understand the true cause and meaning of a situation
1. Intellectual insight Understanding of the objective reality of a set of circumstances without the ability to apply the
understanding in any useful way to master the situation
2. True insight Understanding of the objective reality of a situation, coupled with the motivation and the emotional
impetus to master the situation
3. Impaired insight Diminished ability to understand the objective reality of a situation

Judgment
Ability to assess a situation correctly and to act appropriately in the situation
Critical judgment ability to assess, discern and choose among various options in a situation
Automatic judgment reflex performance of an action
Impaired judgment diminished ability to understand a situation correctly and to act appropriately

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