Symptomatology Part 2 PDF

Presented by Omaima Ezzat Mahmoud Assis.Prof. of psychiatric mental health nursing 1- Hallucination: False sensory perception not associated with real external stimuli. Types of hallucinations: They are manifested through the five senses: false perception of sound, usually voices but...

Presented by Omaima Ezzat Mahmoud Assis.Prof. of psychiatric mental health nursing 1- Hallucination: False sensory perception not associated with real external stimuli. Types of hallucinations: They are manifested through the five senses: false perception of sound, usually voices but also other noises in the absence of external stimuli. Example: "I keep hearing my mother's voice telling me I am bad. She died a year ago". Seeing a person, object, or animal that does not exist in the environment, most common in medical disorders. false perception in smell; are not present in the environment, most common in organic disorders. false perception in touch in the absence of stimuli. Example: - The sensation of something creeping or crawling on or under the skin. Experiencing tastes that have no stimulus in reality, most common in medical disorders. Example: A patient has a strange taste in his mouth without any stimulus. Misperception or misinterpretation of real external sensory stimuli. N.B. It may affect any of the special senses (auditory, visual, etc....). Example: Visual illusion: The individual who sees a rope and perceives that it is a snake. 1. Depersonalization: An alteration in the perception or experience of the self so that one feels detached from reality or different in some way that occurs under extreme stress or fatigue. Example: the patient feels he is no longer himself, when he looks in the mirror, he feels himself changed. An alteration in the perception or experience of the external world so that it seems strange or unreal that the environment is changed while actually nothing has changed in it. Example: everything seems bigger or smaller or unfamiliar. A Process whereby what is experienced or learned is established as record in CNS (registration), where it maintains information over periods of time (retention) and can be recollected from storage at will (recall) in which is a process of bringing stored memories into consciousness.  Immediate: Recall of perceived material within seconds to minutes.  Recent: Recall of events over past few days.  Recent past: Recall of events over the past few months.  Remote: Recall of events in distant past. 1. Amnesia: Partial or total inability to recall past experiences, may be organic or emotional in origin a- Anterograde amnesia: Inability to recall recent events b- Retrograde amnesia: Inability to recall remote events. c- Total amnesia (generalized): Inability to recall recent and remote events. d-Circumscribed amnesia:(amnesic gab) Inability to recall events for a limited time. Falsification of memory by distortion of recall it include: Retrospective falsification: Unconscious adding of false details to a true memory Confabulation: unconscious filling of gaps in memory by imagined or untrue experiences that patient believes but that have no basis in fact. 3. Déjà vu: An abnormal experience where an individual feels that a particular or unique event has happened before in exactly the same way. 4. Jamais vu: An abnormal experience where an individual feels that a routine or familiar event has never happened before. 5. Hypermnesia: exaggerated degree of retention and recall. It is excessive memory, the patient mentioned even unnecessary details Is a state of awareness of the self and the environment (time, place, persons) and ability to respond properly to stimuli (internal, external). The level of consciousness can vary between the extremes of alertness and coma.  Clouding of consciousness: Is a very mild form of altered mental status in which the patient has inattention and reduced wake fullness and not fully oriented. Dimming or clouding of consciousness. The mental functions show less than normal rather anything abnormal. All mental process is slow. Cognition: thinking is difficult, and it is hard to hold patient's attention Affect: poverty of emotions Behavior: no initiation with fatigue and laziness.  Acute, reversible mental disorder, Clouding of consciousness. The mental changes characterized by: Cognition: Hallucination, illusion. Behavior: Restlessness and inappropriate, impulsive, irrational, or violent behavior Affect: Anxiety, and fear. Patients appearing to be less than conscious, is immobile, mute, and unresponsive to internal or external stimuli, eyes are usually open but may be closed. Dissociative disorder characterized by a sudden unexpected travel away from with the assumption of a new identity and an inability to recall one’s previous identity; usually occurring in response to severe psychosocial stress. After recovery from fugue previous memory usually return intact, however there is complete amnesia for the fugue episode. This state is short. Lived (hours or days) but can last months or longer. A state of pathological sleepiness & drowsiness or feeling ready to fall asleep. From which one can be aroused to a normal state of consciousness. Is a state of un arousal, unresponsiveness or is a state of profound unconsciousness?  Attention: is the ability to focus on the matter on hand.  Concentration: is the ability to sustain that focus.  Distractibility: it is giving attention to every passing stimulus. e.g., someone coughing, a door opened or a bird flying.  Selective inattention: blocking only those things that generate anxiety. A State of awareness of oneself and one's surrounding in terms of time, place, and person Impaired ability to identify time, place, and person. Diminished ability to understand a situation correctly and to act appropriately. The ability to recognize that one's abnormal experiences are symptoms of psychiatric illness and that they require treatment. Diminished ability to understand the objective condition of one's mental illness. Emotion consists of emotional experiences internal feeling (mood) & emotional expression external manifestation of this emotion (affect) Pervasive and sustained feeling tone that is experienced internally and that is reported by the person own words. Pleasant mood: Euphoria: Exaggerated feeling of well-being that is inappropriate to real events. Can occur with drugs as amphetamines and alcohol. Elation: Elevated mood pppppp feelings of Joy and intense self-satisfaction associated with motor activity. Occurs in mania when not grounded in reality. Exaltation: Feeling of intense elation and grandeur. Depression: Psychopathological feeling of sadness, loneliness, despair, and low self- esteem. Irritable mood: A state in which individual easily annoyed and provoked to anger. Anhedonia: Loss of interest in, and withdrawal from all regular and pleasurable activities often associated with depression, schizophrenia. Anxiety: Feeling of apprehension caused by anticipation of danger which may be internal or external. Fear: Unpleasant emotional state in response to a realistic threat or danger. Phobia: An intense irrational fear of an object, situation, or place. The fear persists even though the object of the fear is perfectly harmless, and the person is aware of the irrationality. Also, tries to avoid the feared stimulus. Example: Although a person, is aware that cats would not 'harm him., he is afraid of cats and avoids being in a contact with them. Ambivalence: coexistence of two opposing impulses toward the same thing in the same person at the same time. Indifference: Absence of emotional expression but experience is present. Apathy: (Absence of affect) the patient neither experiences nor expresses emotions. Is the objective & immediate experience of emotion attached to ideas or mental representations of objects? Affect can be assessed by observing the client nonverbal behavior (facial expression) in conjunction with other verbal clues. Appropriate affect: emotional tone is in harmony with the accompanying idea, though or speech. Example: Juan cries when learning of the death of his father. 1. Inappropriate affects: Disharmony between the emotional feeling tone and the idea or speech accompanying it. (Incongruent affect). Example: When told it is time to turn off the TV and go to bed, Joe begins to laugh uproariously A disturbance in affect manifested by a severe reduction in the intensity of externalized feeling tone. Example: When tom learns of his full tuition scholarship, he responds with only a small smile.  A person with flat affect has no or nearly no emotional expression. He or she may not react at all to circumstances that usually evoke strong emotions in others.  Example: When Juanita's mother tells her that her favorite dog has died, Juanita simply says, oh, and gives no indication of an emotional response.  N.B the difference between flat, blunted affect is in degree Rapid and abrupt changes in emotional feeling tone, unrelated to external stimuli. Example: During a friendly checkers game, Sean, who has been laughing, suddenly knocks the board off the table in anger he then begins to laugh and wants to continue the game. It is the sum total of the psyche that includes impulses, motivations, wishes, drives, instincts, as expressed by a person’s behavior or motor activity.  1.Hyperactivity: It includes: a. Psychomotor agitation: it is a form of hyperactivity characterized by excessive motor and cognitive over activity, usually nonproductive. b. Excitement: it is severe form of hyperactivity; excessive purposeless motor activity and the patient may destruct himself or others. Subjective feeling of uneasiness, tension, and inability to sit still. It appears in form of: Pacing Rooming back and front on foot. Crossing and uncrossing legs frequently. Inability to relax. a. Psychomotor retardation ( psychomotor impairment): It involves slowdown in thought and motor movement (slow and difficult motor and cognitive activities that in the extremes can entail complete inactivity). b. Catatonic posturing (catalepsy): Voluntary assumption of an inappropriate or bizarre posture the patient initiates positions by himself, generally maintained for long periods of time. The absence of fatigue in such cases is remarkable. a. Stereotypy: A monotonous repetition of certain movement or speech without purpose. Examples: In movement: Touching the nose or pacing up and down the room. In speech: Some words are repeated. b. Mannerism: A repeated habitual involuntary movement, which is not monotonous and is keeping with the personality character Example: Paranoid patient salutes repeatedly in a grandiose manner c. Perseveration Involuntary repetition of the same recent thought, phrase, or motor response. Example: A patient, who was eating, continues to use the spoon as if eating even after the plate is empty. d. Waxy flexibility: The maintenance of imposed postures however abnormal they may be. The absence of fatigue in such cases is remarkable and when the examiner moves the person's limb, he feels as if it was made of wax. e. Echopraxia: Pathological imitation of movements of one person by another Verbal or nonverbal opposition or resistance to outside suggestions and advice or even doing the opposite. Motor: When the patient was asked to look up, he looked down. Speech: When he was asked a question, he didn't answer. Visceral: Retention of saliva, urine or feces. Strict obedience of command without critical judgment. The person may respond to an inner voice, as in schizophrenia, or to another person’s command, as in hypnosis. The performance of an unconscious wish , action that is sudden, abrupt, unplanned and directed toward immediate gratification. It is a pathological need to act on an impulse that, if resisted, produces anxiety; repetitive behavior in response to an obsession that is absurd and meaningless and the patient struggles with it.