CHAPTER 3 ABPSYCH.pdf

CHAPTER 3: CLINICAL ASSESSMENT AND DIAGNOSIS P. 100 Typical Signs and Symptoms of Psychopathology signs- is based from clinician’s objective observation. symptoms- is the subjective experiences of the patient Consciousness- State of Awareness Disturbance of Consciousness: TACCCCSSSSDDDD App...

CHAPTER 3: CLINICAL ASSESSMENT AND DIAGNOSIS P. 100 Typical Signs and Symptoms of Psychopathology signs- is based from clinician’s objective observation. symptoms- is the subjective experiences of the patient Consciousness- State of Awareness Disturbance of Consciousness: TACCCCSSSSDDDD Apperception is perception modified by a person’s own emotions and thoughts. refers to the process by which new experiences or information are understood and assimilated in light of past experiences or knowledge. Sensorium is the state of cognitive functioning of the special senses (sometimes used as a synonym for consciousness). Disturbances of consciousness are most often associated with brain pathology. Disorientation: disturbance of orientation in time, place, or person. a person experiences confusion about time, place, or personal identity. Clouding of consciousness: incomplete clear-mindedness with disturbances in perception and attitudes. Stupor: lack of reaction to, unresponsive, and unawareness of, surroundings. Delirium: bewildered, restless confused, disoriented reaction associated with fear and hallucinations. Coma: profound unconsciousness, prolonged state of deep unconsciousness in which a person is unresponsive to their environment and cannot be awakened by external stimuli. Coma vigil: coma in which a patient appears to be awake with eyes open but cannot be aroused/unresponsive (also known as akinetic mutism). Twilight state: disturbed consciousness with hallucinations. refers to a transitional phase between wakefulness and sleep or a state of altered awareness, often accompanied by feelings of dreaminess or confusion. Dreamlike state: condition of consciousness characterized by sensations, thoughts, and perceptions that resemble those experienced during dreaming, often used as a synonym for complex partial seizure or psychomotor epilepsy. Somnolence: abnormal drowsiness, excessive sleepiness, where an individual has a strong desire to sleep or is difficult to awaken. Confusion: disturbance of consciousness to which reactions to environmental stimuli are inappropriate; manifested by disordered orientation in relation to time, place, or person. Drowsiness: a state of impaired awareness associated with a desire or inclination to sleep. Sundowning: syndrome in older persons that usually occurs at night and is characterized by drowsiness, confusion, ataxia, and falling as the result of being overly sedated sedated with medications; also called sundowner’s syndrome. Disturbances of Attention DASHT Attention is the amount of effort exerted in focusing on certain portions of an experience; ability to sustain a focus on one activity; ability to concentrate. Distractability: inability to concentrate attention; state in which attention is drawn to unimportant or irrelevant external stimuli. Selective inattention: blocking out only those things that generate anxiety, ignoring or filtering out stimuli that are deemed irrelevant or distracting. Hypervigilance: excessive attention and focus on all internal and external stimuli, usually secondary to delusional or paranoid states; similar to hyperpragia- excessive thinking and mental activity. Trance: state of altered consciousness characterized by heightened focus or concentration, often accompanied by a lack of awareness of the environment, usually seen in hypnosis, dissociative disorders, and ecstatic religious experiences. Disinhibition: removal of an inhibitory effect that permits persons to lose control of impulses as occurs in alcohol intoxication. Disturbances in Suggestibility FH Compliant and uncritical response to an idea or influence. Folie a deux (or folie a trios): communicated emotional illness between two (or three) persons, share the same delusions or psychotic experiences.  Hypnosis: artificially induced modification of consciousness characterized by heightened suggestibility. Typical Signs and Symptoms of Psychopathology Emotion- A complex feeling state with psychic, somatic and behavioural components that is related to affect the mood. A. Affect- The expression of emotion as observed by others. Affect has outward manifestations that can be observed. Affect can vary over time, in response to changing emotional states. FRAILB 1. Appropriate affect – the normal condition in which emotional tone is in harmony with the accompanying idea, thought, or speech; full range of emotions is appropriately expressed. 2. Inappropriate affect – disharmony between the emotional feeling tone and the idea, thought, or speech accompanying it. Emotional response that are out of context. 3. Flat affect – absence or near absence of any signs of effective expression; voice monotonous, face immobile. 4. Blunted affect – disturbance in affect manifested by a severe reduction in the intensity of externalized feeling tone. Scientific term describing less of emotional reactivity (affect display) on the part of an individual. 5. Restricted or Constricted affect – reduction in intensity of feeling tone that is less severe than that of blunted affect. 6. Labile affect – affective expression characterized by rapid and abrupt changes, unrelated to external stimuli. Pathological expression of laughter, crying or smiling. B. Mood- A pervasive and sustained emotion, subjectively experienced and reported by the patient, as well as observed by others. DDIEEEEEMAAG 1. Dysphoric mood – feeling of unpleasantness or discomfort; a mood of general dissatisfaction and restlessness. - A person suffering from dysphoric mood is afflicted with a general feeling of unhappiness. 2. Euthymic mood – normal range of mood, implying absence of depressed or elevated mood. 3. Expansive mood – expression of feelings without restraint, frequently with an overestimation of their significance or importance. 4. Irritable mood – state in which one is easily annoyed and provoked to anger. 5. Mood swings – oscillation of a person’s emotional feeling tone between euphoria and depression. 6. Elevated mood – air of confidence and enjoyment; a mood more cheerful than normal but necessarily pathological. 7. Euphoria – exaggerated feeling of well-being that is inappropriate to real events. A desirable and natural occurrence when it results from happy or exciting events. 8. Ecstasy – feeling of intense rapture. 9. Depression – psychopathological feeling of sadness. It can be caused by mental trauma, illness or genetic predisposition. 10. Anhedonia – loss of interest in and withdrawal from all regular and pleasurable activities; often associated with depression. People with have an incredibly flat mood. They can’t react properly or feel anything. 11. Grief of Mourning – alteration of mood and affect consisting of sadness appropriate to real loss. 12. Alexithymia – inability to identify and verbally describe emotions and feelings in oneself as well as in others. The word alexithymia literally means “no word for emotion”. C. Other Emotions PFFAAAAT 1. Anxiety – feeling of apprehension caused by anticipation of danger, which may be internal or external. Can cause such distress that it interferes with a person’s ability to lead a normal life. 2. Free-floating anxiety – severe, pervasive, generalized anxiety that is not attached to any particular idea, object, or event. Generalized Anxiety Disorder, or GAD, is the common medical term often used to refer to free-floating anxiety. 00000 3. Fear – anxiety caused by consciously recognized and realistic danger. 4. Agitation – severe anxiety associated with motor restlessness; associated with a state of tension or anxiety. 5. Tension – a state of mental or emotional strain or suspense; an unpleasurable alteration in mental or physical state that seeks relief through action. 6. Apathy – a state of indifference, or the suppression emotions such as concern, excitement, motivation and passion, lack of interest, enthusiasm, or concern about important aspects of life. 7. Panic – acute, intense attack of anxiety associated with overwhelming feelings of dread and autonomic  discharge; characterized by extreme and frequent panic attacks. During the attack, the person suffers from unexpected and repeated periods of strong fear and physical symptoms such as chest pain, heart palpitations, shortness of breath, dizziness, or abdominal problems. 8. Ambivalence – coexistence of two opposing impulses toward the same thing in the same person at the same time. It is experienced as psychologically unpleasant when the positive and negative aspects of a subject are both present in a person’s mind at the same time. A person experiences uncertainty or indecisiveness concerning something. HHAICDD D. Physiological disturbances associated with mood- Signs that refer to somatic dysfunction of the person 1. Anorexia – loss of or decrease in appetite; an eating disorder. Low body weight, body image distortion, and an obsessive fear of gaining weight characterizes this disorder. 2. Hyperphagia – increase in appetite and intake of food; pathological overeating. Abnormally increased appetite for and consumption of food, thought to be associated with lesion or injury in the hypothalamus. 3. Insomnia – lack of or diminished ability to sleep. IMT a) Initial – difficulty in falling asleep. b) Middle – difficulty in sleeping through the night without waking up and difficulty in going back to sleep. c) Terminal – early-morning awakening. 4. Hypersomnia – excessive sleeping. Characterized by recurrent episodes of excessive daytime sleep or prolonged night time sleep. 5. Diurnal variation – a pattern of feeling worse during a particular part of the day. Mood is regularly worst in the morning, immediately after awakening, and improves as day progresses. 6. Constipation – inability or difficulty in defecating. 7. Diminished libido – decreased sexual interest, drive, and performance. Occurs from psychological causes such as loss of privacy and/or intimacy, stress, distraction or depression. May also derived from the presence of environmental stressors such as prolonged exposure to elevated sound levels or bright light. Other causes may include depression, stress or fatigue, childhood sexual abuse, assault, trauma, neglect, body image issues, or sexual performance, anxiety. Motor Behavior- aspect of the psyche that includes impulses, motivations, wishes, drives, instincts, and cravings, as expressed by a person’s behavior or motor activity. 1. Echopraxia – pathological imitation of movements of one person by another. 2. Catatonia and postural abnormalities – seen in catatonic schizophrenia and some patients with brain diseases, such as encephalitis, significant disruptions in movement, posture, and response to the environment. CCCCCCA a) Catalepsy – general term for an immobile position that is constantly maintained. b) Catatonic Excitement – extreme restlessness, excessive movements, agitated, purposeless motor activity, uninfluenced by external stimuli. c) Catatonic Stupor – markedly slowed activity, often to the point of immobility and seeming unawareness of surroundings. d) Catatonic Rigidity – voluntary assumption of a rigid posture, held against all efforts to be moved. e) Catatonic Posturing – voluntary assumption of an inappropriate or bizarre posture, generally maintained for long periods. f) Cerea flexibilitas (waxy flexibility) – condition in which a person can be molded into a position that is then maintained; when an examiner moves the person’s limb, the limb feels as if it were made of wax. g) Akinesia – lack of physical movement, as in the extreme immobility of catatonic schizophrenia; may also occur as an extrapyramidal adverse effect of antipsychotic medication, loss or impairment of voluntary movement. 3. Negativism – motiveless resistance to all attempts to be moved or to all instructions. 4. Cataplexy – temporary loss of muscle tone and weakness precipitated by a variety of emotional states. 5. Stereotypy – repetitive fixed pattern of physical action or speech. 6. Mannerism – ingrained, habitual involuntary movement. 7. Automatism – automatic performance of an act or acts generally representing unconscious symbolic activity. 8. Command Automatism – automatic following of suggestions (also automatic obedience). 9. Mutism – voicelessness without structural abnormalities, inability or refusal to speak 10. Overactivity SAACHTTFPP a) Psychomotor Agitation – excessive motor and cognitive activity, usually nonproductive and in response to inner tension. b) Hyperactivity (hyperkinesis) – restless, aggressive, destructive activity, often associated with some underlying brain pathology. c) Tic – involuntary, spasmodic motor movement, sudden, repetitive, non-rhythmic motor movements or vocalizations that can be difficult to control. d) sleepwalking (somnambulism) – motor activity during sleep. e) 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 psychotic agitation. overwhelming sense of restlessness and an uncontrollable need to be in constant motion. f) Compulsion – uncontrollable impulse to perform an act repetitively. SRTKND i. Dipsomania – compulsion to drink alcohol. ii. Kleptomania – compulsion to steal. iii. Nymphomania – excessive and compulsive need for coitus (sex) in a woman. iv. Satyriasis – excessive and compulsive need for coitus in a man. v. Trichotillomania – compulsion to pull out hair. vi. Ritual – automatic compulsive activity, anxiety reducing in origin. g) Ataxia – failure of muscle coordination; irregularity of muscle action h) Polyphagia – pathological overeating. i) Tremor – rhythmical alteration in movement, which is usually faster than one beat a second; typically, tremors decrease during periods of relaxation and sleep and increase during periods of anger and increased tension, involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. j) Floccillation – aimless picking usually a clothing or bedclothes, commonly seen in delirium. 11. Hypoactivity (hypokinesis) – decreased motor and cognitive activity, as in psychomotor retardation; visible slowing of thought, speech, and movements. 12. Mimicry – simple, imitative motor activity of childhood. 13. Aggression – forceful, goal-directed action that may be verbal or physical; the motor counterpart of the affect of rage, anger, or hostility. 14. Acting out – direct expression of an unconscious wish or impulse in action; living out unconscious fantasy impulsively in behavior. 15. Abulla – reduced impulse to act and think, associated with indifference about consequences of action; a result of neurological deficit, lack of will or initiative. 16. Anergia – lack of energy (anergy). 17. Astasia abasia – inability to stand or walk in a normal manner, even though normal leg movements can be performed in a sitting or lying down position. The gait is bizarre and does not suggest a specific organic lesion; seen in conversion disorder. 18. Coprophagia – eating of filth or feces. 19. Dyskinesia – difficulty performing voluntary movements, as in extrapyramidal disorders. 20. Muscle rigidity – state in which the muscles remain immovable; seen in. 21. Twirling – a sign present in autistic children who continually rotate in the direction in which the head is turned. 22. Bradykinesia – slow motor activity with decreased normal, spontaneous movement. 23. Chorea – random and involuntary quick, jerky purposeless movements. 24. Convulsion – involuntary, violent muscular contraction or spasm. CT a. Clonic convulsion – convulsion in which the muscles alternately contract and relax. b. Tonic convulsion – convulsion in which the muscle contraction is sustained. 25. Seizure – an attack or sudden onset of certain symptoms, such as convulsions, loss of consciousness, and psychic or sensory disturbances seen in epilepsy and can be substance induced. sudden, uncontrolled electrical disturbance in the brain that can cause changes in behavior, movements, feelings, and consciousness. GCS a. Generalized tonic-clonic seizure – generalized onset of tonic-clonic movements of the limbs, tongue biting, and incontinence followed by slow, gradual recovery of consciousness and cognition; also called grand mal seizure and psychomotor seizure.  b. Simple partial seizure – localized ictal onset of seizure without altered consciousness. c. Complex partial seizure – localized ictal onset of seizure with altered consciousness. 26. Dystonia – slow, sustained contractions of the trunk or limbs; seen in medication-induced dystonia. 27. Amimia – inability to make gestures or to comprehend those made by others. E. Thinking- Goal directed flow of ideas, symbols, and associations initiated by a problem of tasks and leading toward a reality-oriented conclusion. Parapraxis is considered part of normal thinking. unintentional error in speech, memory, or action that is believed to reveal unconscious thoughts, desires, or feelings. Abstract thinking is the ability to grasp the essentials of the whole into its parts, and to discern common properties. Disturbances in form of thinking: FRIEDPPAMM 1. Mental Disorder: clinically significant behavioral or psychological syndrome, associated with distress or disability, not just an expectable response to a particular event or limited relations between a person and society. 2. Psychosis: inability to distinguish reality from fantasy; impaired reality testing, with creation of a new reality as opposed to neurosis in which reality testing is intact and symptoms are experienced as ego-dystonic (refers to thoughts, behaviors, or feelings that are in conflict with a person’s self-perception, values, or ideal self), behavior does not violate gross social norms, relatively enduring or recurrent without treatment. 3. Reality testing: the objective evaluation and judgment of the world outside the self. 4. Formal thought disorder: disturbance in the form of thought instead of the content of thought. 5. Illogical thinking: thinking containing erroneous conclusions or internal contradictions. 6. Dereism: mental activity not concordant with logic or experience. 7. Autistic thinking: thinking that gratifies unfulfilled desires but has no regard for reality; preoccupation with inner, private world. 8. Magical thinking: a form of dereistic thought; thinking that is similar to that of the preoperational phase in the children. 9. Primary process thinking: general term for thinking that is dereistic, illogical, magical; normally found in dreams, abnormal in psychosis. 10. Emotional insight: deep level of understanding or awareness that is likely to lead to positive changes in personality and behavior. Specific Disturbances in form of thought BGFNVCCCTIPWEILD 1. Neologisms: new word created by patients, often from combining syllables of other words, for idiosyncratic. 2. Word Salad: incoherent mixtures of words and phrases. 3. Circumstantiality: indirect speech that is delayed in reaching the point, but eventually gets from the original point to desired goal; characterized by an over-inclusion of detail and parenthetical remarks. 4. Tangentiality: inability to have goal directed associations of thought; patient never gets from desired point to desired goal. 5. Incoherence: speech that, generally, is not understandable; running together of thoughts with no logical or grammatical connection, resulting in disorganization. 6. Perseveration: persisting response to a prior stimulus after a new stimulus has been presented, often associated with organic brain disease. 7. Verbigeration: meaningless repetition of specific words or phrases. 8. Echolalia: psychopathological repeating of words or phrases of one person by another. 9. Condensation: fusion of various concepts into one. 10. Irrelevant answer: answer that is not in harmony with questioned asked. 11. Loosing of associations: flow of thought in which ideas shift from one subject in a completely unrelated way; when severe, speech may be incoherent. 12. Derailment: gradual or sudden deviation in train of thought without blocking; sometimes used synonymously with loosening of association. 13. Flight of ideas: rapid, continuous verbalizations or play on words produce constant shifting from one idea to another; the ideas tend to be connected and in less severe form may be followed by a listener. 14. Clang associations: association of words similar in sound, but not in meaning; words have no logical connections, may include rhyming and punning. 15. 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 or was going to be said. 16. Glossolalia: the expression of a relevatory message through unintelligible words. Specific Disturbances in content of Thought CCEEMMPPHOOND 1. Poverty of content: speech that gives little information due to vagueness, empty repetitions, or obscure phrases. 2. Overvalued idea: unreasonable, sustainable false beliefs maintained less firmly than delusional thinking. 3. Delusion: false belief, based on incorrect inference about external reality, not consistent with patient’s intelligence and cultural background that cannot be corrected by reasoning. SPPENDDDDDDDMMBS a. Bizarre delusion: absurd, totally implausible, very strange false beliefs. b. Systematized delusion: false belief or beliefs united by single event or theme. c. Mood-congruent delusion: delusions whose content is mood appropriate. d. Mood-incongruent delusion: delusion whose content has no association to mood or is mood- inappropriate. e. Nihilistic delusion: false feeling that self, others, or the world is non-existent or ending. f. Delusion of poverty: false belief that one is bereft, or will be, of all material possessions. g. Somatic delusion: false belief involving functioning of one’s body. h. Paranoid delusions: includes persecutory delusions, as well as delusions of reference, control, grandeur. i. Delusions of persecution: false belief that one is being harasses, cheated, or persecuted; often found in litigious patients who have pathological tendency to take legal action because of imagined mistreatment. j. Delusions of grandeur: exaggerated conception of one’s importance, power of one’s importance, power, or identity. k. Delusions of reference: false belief that the behavior of others refers to one’s self; that the events, objects, or other people have a particular and unusual significance, usually of negative nature; derived from ideas of reference in which one falsely feels that one is being talked by others. l. Delusion of self-accusations: false feeling or remorse and guilt. m. Delusions of control: false feeling that one’s will, thoughts, or feelings are being controlled by external forces. Delusions of control can be of the following types: thought withdrawal, thought insertion, or thought broadcasting. TTT n. Delusions of infidelity: false belief derived from pathological jealousy that one’s lover is unfaithful. o. Erotomania: delusional belief, almost exclusively in women, that a man is deeply in love with them. p. Pseudologia phantastica: a type of lying, in which the person appears to believe in the reality of his fantasies and acts on them. individual compulsively tells falsehoods or fabricates stories that are often elaborate and fantastical. 4. Trend or preoccupation of thought: centering of thought control content around a particular idea, associated with a strong affective tone, such as paranoid trend or suicidal preoccupation. 5. Egomania: pathological self-preoccupation. 6. Monomania: preoccupation with a single object. 7. Hypochondria: exaggerated concern over one’s health that is not based on a real organic pathology, but rather on unrealistic interpretation of physical signs and sensations as abnormal. 8. Obsession: pathological persistence of an irresistible thought. 9. Compulsion: pathological need to act on an impulse which is resisted, produces anxiety; repetitive behavior in response to a obsession or performed according to certain rules, with no true end in itself other than to prevent something from occurring in the future. 10. Coprolalia: compulsive utterance of obscene words. 11. Phobia: persistent; irrational, exaggerated, and invariably pathological dread of some specific type of stimulus or situation; results in compelling desire to avoid the feared stimulus. 12. Noesis: a revelation in which immensed illumination occurs in association with a sense that one has been chosen to lead or command. 13. Unio mystica: an oceanic feeling, one of mystic unity with an infinite power. Advance Pyshcopathology Perception- process of transferring physical stimulation into psychological information; mental process by which sensory stimuli are brought to awareness. A. Disturbances of Perception 1. Hallucination: false sensory perception not associated with real external stimuli; there may or may not be a delusional interpretation of the hallucinatory experience. SSTTHHHAMMVLOG a. Hypnagogic hallucination: false sensory perception occurring while falling asleep; generally considered a nonpathological phenomenon. b. Hypnopompic hallucination: false perception occurring while awakening from sleep; generally considered nonpathological. c. Auditory hallucination: false perception of sound, usually voices but also other noises, such as music; most common hallucination in psychiatric disorders. d. Visual hallucination: false perception involving sight consisting of both formed images (for example, persons) and unformed images (for example, flashes of light); most common in medically determined disorders. e. Olfactory hallucination: false perception of smell; most common in medical disorders. f. Gustatory hallucination: false perception of taste, such as unpleasant taste caused by an uncinate seizure; most common in medical disorders. g. Tactile (haptic) hallucination: false perception of touch or surface sensation, as from an amputated limb (phantom limb), crawling sensation on or under the skin (formication). PF h. Somatic hallucination: false sensation of things occurring in or to the body, most often visceral in origin (also known as cenesthesic hallucination). i. Lilliputian hallucination: false perception in which objects are seen as reduced in size (also termed micropsia). j. Mood-congruent hallucination: hallucination in which the content is consistent with either a depressed or a manic mood (for example, a depressed patient hears voices saying that the patient is a bad person; a manic patient hears voices saying that the patient is of inflated worth, power, and knowledge). k. Mood-incongruent hallucination: hallucination in which the content is not consistent with either depressed or manic mood (for example, in depression hallucinations not involving such themes as guilt, deserved punishment, or inadequacy; in mania hallucinations not involving such themes as inflated worth or power). l. Hallucinosis: hallucinations, most often auditory, that are associated with chronic alcohol abuse and that occur within a clear sensorium, as opposed to delirium tremens (DTs), hallucinations that occur in the context of a clouded sensorium, presence of persistent hallucinations without a significant alteration in consciousness. m. Synesthesia: sensation or hallucination caused by another sensation (for example, an auditory sensation is accompanied by or triggers a visual sensation; a sound is experienced as being seen or a visual experience is heard). n. Trailing (delay) phenomenon: perceptual abnormality associated with hallucinogenic drugs in which moving objects are seen as a series of discrete and discontinuous images. 2. Illusion- misperception or misinterpretation of real external sensory stimuli. B. Disturbances associated with cognitive disorder SSPAAAAAV 1. agnosia – an inability to recognize and interpret the significance of sensory impressions. 2. Anosognosia (ignorance of illness): inability to recognize a neurological deficit as occurring to oneself. 3. Somatopagnosia (ignorance of the body): inability to recognize a body part as one’s own (also called autopagnosia). 4. Visual agnosia: inability to recognize objects or persons. 5. Astereogenesis: inability to recognize objects by touch. 6. Prosopagnosia: inability to recognize faces. 7. Apraxia: inability to carry out specific tasks. 8. Simultagnosia: inability to comprehend more than one element of a visual scene at a time or to integrate the parts into a whole. 9. Adiadochokinesia: inability to perform rapid alternating movements. C. Disturbances associated with conversion and dissociative FHMMMDDD Phenomena- somatization of repressed material or the development of physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder.  1. Hysterical anesthesia: loss of sensory modalities resulting from emotional conflicts. 2. Macropsia: state in which objects seem larger than they are. 3. Micropsia: state in which objects seem smaller than they are (both macropsia and micropsia can also be associated with clear organic conditions, such as complex partial seizures). 4. Depersonalization: a subjective sense of being unreal, strange, or unfamiliar to oneself. 5. Derealization: a subjective sense that the environment is strange or unreal; a feeling of changed reality. 6. Fugue: taking on a new identity with amnesia for the old identity; often involves travel or wandering to new environments. 7. Multiple personality: one person who appears at different times to be two or more entirely different personalities and characters (called dissociative identity disorder in the fourth edition of Diagnostic and Statistical Manual of Mental Disorders [DSM-IV]). 8. Dissociation: unconscious defense mechanism involving the segregation of any group of mental or behavioural process from the rest of the person’s psychic activity; may entail separation of an idea from its accompanying emotional tone, as seen in dissociative and conversion disorders. Memory Function by which information stored in the brain is later recalled to consciousness (Sadock and Sadock, 2003). The mental process by which information is encoded and stored in the brain, and later retrieved (Franzoi, 2006). A. Disturbances of memory BRASHELP 1. Amnesia From the Greek word “amnēsiā”, which means forgetfulness; From “amnēstos”, which means “not remembered” It is a partial or total inability to recall past experiences (Sadock & Sadock, 2003). It refers to the difficulty of learning new information or in remembering the past; Inability to recall information that is stored in memory It may be an Organic/Neurological or Functional/Psychogenic. FO a. Organic/neurological- Is characterized by a loss of declarative memory- refers to the conscious knowledge of facts and events. It occurs following a brain injury or disease that damages the areas of our brain that create memories: the cortex – particularly in the temporal lobe and the hippocampus. It causes severe difficulty in learning new facts and events; It may also cause difficulty in remembering facts and events that were acquired before the onset of amnesia. Causes: Head injury, tumor, stroke, viral infection, brief loss of blood or oxygen flow to the brain, Electroconvulsive therapy (ECT – used to treat severe depression, and alcohol abuse causing thiamine deficiency). Bilateral temporal lobe disease, inflammatory and degenerative diseases of the brain which causes dementia, temporal lobe tumors, herpes encephalitis, severe anoxia or hypoglycemia, and in some cases, bilateral rostral leucotomy. b. Functional/psychogenic- Is a rarer kind of amnesia than of the neurological amnesia, Can occur as the result of an emotional trauma, Is characterized by a profound retrograde amnesia with little or no anterograde amnesia. Causes are psychological factors, such as defense mechanisms Usually, memory about the past is lost, especially autobiographical memory and even personal identity. This is caused by an emotional shock, such as: Being the victim of a violent crime, Sexual abuse, Child abuse, Being involved in combat (soldiers), Being involved in a natural disaster, Being present during terrorist act. basically, any intolerable life situation which causes severe psychological stress and internal conflict. It may be mild or severe, permanent or transitory, and may involve either anterograde or retrograde defects as their most obvious feature: o Anterograde amnesia- From the Latin word “antero” which means “forward” It is the inability to form new memories after the onset of an illness. It is characterized by an inability to learn new information with an associated inability to learn new skills and to retain the knowledge of events after the onset of the amnesic period. o Retrograde amnesia- From the Latin word “retro” which means “backward” It is the loss of memory before a particular event has occurred. It is the difficulty in recalling events that occurred before the injury ▪ The patient cannot remember events that occurred before his/her trauma, but remembers things that happened after it normally. 2. Paramnesia- Was introduced by a German psychiatrist, Emil Kraepelin in 1886 to denote errors of memory. It is a falsification of memory by distortion of recall. CRFFJDDD a. Fausse Reconnaissance – literally mean “false recognition”  b. Déjà Vu - French word which literally mean “already seen”. Illusion of visual recognition in which a new situation is incorrectly regarded as a repetition of a previous memory. A memory illusion in which people feel a sense of familiarity in a situation that they know they have never encountered before (Franzoi, 2006). A more cognitive and less extraordinary explanation is that people are simply implicitly remembering similar, but unidentifiable, situations they have previously experienced in their present lives (Brown, 2003). c. Déjà Entendu - Literally mean “already heard”. Illusion of auditory recognition. Is the experience of feeling sure that one has already heard something, even though the exact details are uncertain and/or were perhaps imagined (Grinnel, 2008) d. Déjà Pensé - French word which literally mean “ever thought”. Illusion that a new thought is recognized as a thought previously felt or expressed. A completely new thought sounds familiar to the person and he feels as if he has thought the same thing before at some time. e. Jamais Vu - French word which literally means “never seen”. Is more commonly explained as when a person momentarily does not recognize a word, person, or place that he or she already knows (Skatssoon, 2006). Involves a sense of eeriness and the observer’s impression of seeing the situation for the first time, despite rationally knowing that he or she has been in the situation before. f. Retrospective Falsification - Memory becomes unintentionally (unconsciously) distorted by being filtered through a person’s present emotional, cognitive, and experiential state. Unconscious distortion of memory as dictated by one’s present psychological needs. Distortion happens over time and is due to the fact that the person is re-telling it and adding/embellishing the story (Fournier, 2008). g. Confabulation - Unconscious filling of gaps in memory by imagined or untrue experiences that a person believes but that have no basis in fact. Most often associated with organic pathology. Is a memory disturbance that is characterized by verbal statements and/or actions that inaccurately describe history, background, and present situations (Dalla Barbara, 1993). Confabulation is considered “honest lying”, but is distinct from lying because there is typically no intent to deceive and the individual is unaware that their information is false (Moscovitch, 1995). Is a memory disorder that may occur in patients who have sustained damage to both the basal forebrain and the frontal lobes, as after an aneurysm of the anterior communicating artery. Individuals who confabulate are generally very confident about their recollections, despite evidence contradicting its truthfulness (Nalbantian et al., 2010) The most known causes of confabulation are traumatic and acquired (e.g., aneurysm, edema) brain damage, and psychiatric or psychological disorders. h. False Memory - A patient’s recollection of, and belief in, an event that did not actually occur. - Refers to the recollection of an event, or the details of an event, that did not occur. 3. Hypermnesia- Exaggerated degree of retention and recall 4. Eidetic image- From the Greek word “eidos” which means “form”, and “idein”, meaning “to see”. Visual memory of almost hallucinatory vividness. The patient claims to LITERALLY SEE, in exceptional detail, an image of some recently-seen object. Although the image is “mental” it appears to be in physical space. a vivid and detailed mental image or recollection that can be recalled with great precision after only a brief exposure to the stimulus. 5. Screen memory- A consciously tolerable memory covering for a painful memory 6. Repression- A defense mechanism characterized by unconscious forgetting of unacceptable ideas or impulses 7. Lethologica- From the Greek words “Lēthē” which means “forgetfulness” and “Logos” which means “word”.. Was first identified as a debilitating disorder by the Swiss Psychologist Carl Jung in 1913. Temporary inability to remember a name or a proper noun. 8. Blackout- Amnesia experienced by alcoholics about their behavior during drinking bouts. Usually indicates that reversible brain damage occurred. Blackout-specific studies have indicated that alcohol specifically impairs the brain’s ability to take short-term memories and experiences and transfer them to long-term memory (Acheson et al., 2006)., temporary loss of consciousness or memory, often characterized by an inability to recall events that occurred during a specific period. B. Levels of memory RRRI 1. Immediate- Reproduction or recall of perceived material within seconds to minutes. Is the ability to remember a small amount of information over a few seconds  2. Recent- Recall of events over past few days. Is the ability to remember information from hours, or days ago. 3. Recent past- Recall of events over past few months 4. Remote- Recall of events in distant past. The ability to remember things that happened years ago. Intelligence CAPDA Intelligence is the ability to understand, recall, mobilize, and constructively integrate previous learning in meeting new situations. The approach to understanding intelligence with the most supporters and published research over the longest period of time is based on psychometric testing. It is also by far the most widely used in practical settings. Intelligence Quotient (IQ) tests include the Stanford-Binet, Raven’s Progressive Matrices (abstract reasoning and fluid intelligence) , the Wechsler Adult Intelligence Scale and the Kaufman Assessment Battery for Children. SRWK A. Mental retardation- Defined as sufficient lack of intelligence to interfere with social and vocational performance. PSMM Mild (IQ of 50 or 55 to approximately 7.0), moderate (IQ of 35 or 40 to 50 or 55), severe (IQ of 20 or 25 to 35 or 40), or profound (IQ below 20 or 25); obsolete terms are idiot (mental age less than 3 years), imbecile (mental age of 3 to 7 years), and moron (mental age of about 8). MII B. Dementia- Organic and global deterioration of intellectual functioning without clouding of consciousness. DDD a. Dyscalculia (acalculia): loss of ability to do calculations; not caused by anxiety or impairment in concentration. b. Dysgraphia (agraphia): loss of ability to write in cursive style; loss of word structure. c. Dyslexia (alexia): learning disability that impairs a person’s fluency or comprehension accuracy in being able to read C. Pseudodementia: clinical features resembling a dementia not caused by an organic condition; most often caused by depression (dementia syndrome of depression) How to know if a person has a true dementia or pseudodementia? The history of disturbance in pseudodementia is often short and abrupt onset, while dementia is more often insidious. Clinically, people with pseudodementia differ from those with true dementia when their memory is tested. They will often answer that they don’t know the answer to a question, and their attention and concentration are often intact, and they may appear upset or distressed. Those with true dementia will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned. Investigations such as SPECT imaging of the brain show reduced blood flow in those with pseudodementia. D. Concrete thinking- Literal Thinking; limited use of metaphor without understanding nuances of meaning; one- dimensional thought E. Abstract thinking- Ability to appreciate nuances of meaning; multi-dimensional thinking with ability to use metaphors and hypotheses appropriately