Saturday, June 27, 2015


indian village peacock

express trains passing korappuzha bridge at kozhikode


The branch of medicine which deals with study of diagnosis, treatment ,outcome ,rehabilitation and prevention of disorders of mind.
 The sum total of functions  of brain that is significantly influenced by the environment.
Refers to a person’s consciousness, self-awareness or spirit
The study of human and animal behavior and of the mental and physiological  processes associated with the behavior.
PSYCHOPATHOLOGY- systematic study of abnormal experiences,cognition,and behaviour –the study of the products of disordered mind.    SIMS
PHENOMENOLOGY- study of events ,either  psychological or physical without embellishing those events with explanation of  cause or function(SIMS)
HEALTH- it is a state of complete physical ,mental and social well being and not merely the absence of disease or infirmity(ICD)
DISORDER- the existence of a clinically recognizable set of symptoms or behavior associated in most cases with distress and with interference with personal function.   (ICD)
 is a constellation of symptoms that are unique as a group

Functional syndromes
Refers to those syndromes in which there is no readily-apparent coarse brain disease, although increasingly it is recognised that some finer variety of brain disease may exist, often at a cellular level.

The axes in ICD−10 are as follow:
                     Axis I Current mental state diagnosis including personality disorder
                     Axis II Disabilities
                     Axis III Contextual factors

DSM−I, published by the American Psychiatric Association, first appeared in 1952 The 4th edition of the DSM (DSM−IV) 1994)
Different versions of  ICD−10 include
         the clinical version (World Health  Organization, 1992),
         a version with diagnostic criteria for research (World Health Organization, 1993)
         version for use in primary care (ICD−10−PC; World Health Organization, 1996), consisting of definitions for 25  common conditions  shorter version of 6 disorders for use by other primary care workers.

Sum total of the psyche that includes impulses, motivations, wishes, drives, instincts, and cravings, as expressed by a person's behavior or motor activity
Dynamic organization within individual of those psychophysical system that determine unique adjustment to environment    ALLPORT
Personality is the more or less stable and enduring organization of a person’s character, temperament, intellect and physique, which determine his unique adjustment to the environment EYESENCK
Totality of a persons emotional & behavioural traits that characterise their day to day living
Enduring pattern of inner experience and behavior that deviate markedly from expectation of individual  culture ,is pervasive & inflexible ,has onset in adolescent ,stable over time leading to distress /impairment.
Personality disorders are deeply ingrained, maladaptive patterns of behaviour, generally recognisable by adolescence and continuing throughout adult life
 Constitutionally based individual differences in reactivity & self regulation. MARY ROTHBART.
Relatively permanent & relatively consistent emotional, cognitive, behavioural predisposition that an individual exhibits in many situations and reflects a person’s personality.
Character refers to those aspects of the personality that are shaped by the results of life experiences.

Spontaneous  conscious feeling  of harmonious responsiveness that promotes development of constructive therapeutic alliance (KAPLAN)
Pervasive & sustained emotions that  colors the  persons perception of the world (AHUJA)
The subjective moment to moment emotional response attached to
external or internal stimulus. The outward manifestations of affect can be
described as
 (1) Appropriate – Emotional tone in harmony with the idea, thought or speech
accompanying it. Appropriate to the situation.
(2) Inappropriate - Emotional tone out of harmony with the idea, thought, or
speech accompanying it. Inappropriate to the situation.
(3) Restricted - Reduction in intensity of feeling tone that is less severe than
that of blunted affect.
(4) Blunted – Disturbance of affect manifested by a severe reduction in the
intensity of externalized feeling tone.
(5) Flattened - Absence or near absence of any signs of affective expression.
(6) Apathetic- Dulled emotional tone associated with detachment or
(7) Labile – Characterized by rapid shift between extreme emotional states
Positive or negative reaction to some experience. ‘ subjective experience of emotion.’  FISH
 Stirred up state due to physiological changes which occurs as a response to an event and tends to maintain or abolish that event/subjective experience with associated physiological changes  FISH
Is the “objective awareness of and insight into the feelings,emotions, and behavior of another

 is the loss of emotional expression in gesture, facial expression, and tone of voice.

Is reduced interest and activity associated with an absence of emotion,interest, and concern

Fear for no adequate reason/ an unpleasant affective state with the expectation, but not the certainty of something untoward happening.
Subjective psychological sense of well being
Subjective physical sense of well being
a loss of feeling; emotional indifference and a lack of activity, often associated with a lack of activity, often associated with a sense of futility.

Exaggerated feeling of well-being that is inappropriate to real events
Expansive mood state c/b inflated self esteem,grandiosity
Overactivity+flight of ideas
Frontal lobe damage with euphoria c/b silliness,lack of foresight,indifference
A sense of extreme well-being associated with a feeling of rapture, bliss and grace.
-Not associated with overactivity and flight of ideas
Is a tentative or bewildered, slightly puzzled state

It is defined as rapid and  abrupt changes in emotion largely unrelated to external stimuli

A state of poor control over aggressive impulses directed towards others, most frequently to those nearest and dearest.
Forceful, goal-directed attack on other living creatures or things.
Can be verbal or physical.
AGITATION - Severe anxiety associated with motor restlessness
Silly euphoria with lack of foresight and general indifference; found in frontal lobe lesions.
Incongruity of affect:
-A loss of the direction of emotions, so that an indifferent event may produce a severe affective outburst, but an event which is emotionally charged to the examiner has no effect on the pt.’s emotional expression.

 Patients ability to attend to  a specific stimulus  without being distracted by extraneous  internal  or  external stimuli
 Active/passive focussing of consciousness  on an experience or task in hand such as  sensory inputs ,motor programmes,memories,internal representation( SIMS)
The ability to maintain attention to a specific stimulus over an extended  period of time.(STRUB & BLACK)
The capacity  to highlight the one or two important stimuli  or ideas being dealt with while suppressing awareness of  competing distractions(SIMS)
The pt. is diverted by almost all new stimuli and habituation to new stimuli takes longer than usual.  
Mental process that allows the individual to  store information  for later recall
CONFABULATION-falsification of memory occurring in clear consciousness in association with an organically derived amnesia   (BERLYNE)
  It is a falsely retrieved memory often containing false details within its own context.
The pt is unaware that he/she is confabulating and often unaware of existence of memory deficit.
The pt may act on their confabulation,confirming their beliefs in the false memory
Most apparent in the autobiographical memory  (GILBOA & MOSCOVITCH)
Global capacity of a person   to act purposefully,   to think rationally,  to deal effectively  with  his   environment.” (WECHSLER)
CONSCIOUSNESS-state of awareness of self  and the environment  (FISH)

Awareness of  one setting in time and place and of the realities of one’s persons  and situation(sims)
A Concise description of all the important aspects of the case
Is an concise  assessment of the case rather than a restatement of the facts (OXFORD TEXTBOOK)
A person’s capacity to understand the nature, significance and severity of his or her own illness
Is the ability to anticipate the consequences of ones action and make decisions accordingly to the welfare of oneself and others
The process of being aware of information received through sense organs.
Active process that involves the construction of an external world that depends on internal templates.
 Is the internal mental representation of the world and is actively drawn from memory (SIMS)
ILLUSIONS- misinterpretations of stimuli arising from an external object.( FISH)
A perception without an object (ESQUIROL) 
.A false perception, which is not a sensory distortion or misinterpretation, but which occurs at the same time as real perception (JASPERS)
 Perceptual experience that occurs in inner subjective space, has all vividness & clarity of normal perception. Occurs independent of subject’s will; cannot be deliberately evoked
The mental activities  involved  in  acquiring and  processing  information
State of awareness of the self and environment   (FISH)
Fully aware of normal internal and external stimuli
·         VIGILANCE-faculty of deliberately rmaining alert when otherwise  one might be drowsy or asleep
·         LUCIDITY /CLOUDING- lesser stage of impairment of consciousness on a continum from full alertness to coma    (  LISCHMAN)
·         SELF CONSCONSCIOUSNESS-ability to experience self and an awareness of self
DROWSINESS- pt  is awake  but will drift to sleep if left without  sensory stimulation
CONFUSION-subjective symptoms and objective signs  indicating loss of capacity for clear and coherent thought
STUPOR- is a reduction in or absence  of relational functions ie action and speech (BERRIOS)/inability to initiate speech or action in a patient who appears awake and even alert.
Akinetic Mutism - Absence of voluntary motor movement & speech in a patient
who is apparently alert (as evidenced by eye movements). Also referred to as
stupor (in psychiatry).
DELIRIUM- a transient organic metal syndrome of acute onset ,characterized by global impairment of cognitive functions , a reduced level of consciousness,attentional abnormalities ,increased or decreased psychomotor activity ,and a disordered sleep wake  cycle  (LIPOWSKI)
                    - An etiologically non specific syndrome characterized by concurrent disturbance of consciousness and attention,perception,thinking ,memory ,psychomotor behavior ,emotion and the sleep wake cycle (WHO)
AUTOMATISM-is an  involuntary behaviour  over which  an individual has no control. The behavior itself  is usually inappropriate  to the circumstance and may be out of character for  the individual.It can be complex,coordinated and apparently purposeful and directed though lacking in judgement.Afterwards the individual may have no recollection or partial and confused memory for his actions.  (FENWICK)

A false morbid, unshakeable idea or belief which is out of keeping with the patient’s educational, cultural and social background held with extraordinary conviction and subjective certainty which cannot be changed by argument/evidence to contrary
A Judgement which cannot be accepted by people of the same class, education, race and period of life as the person who experiences it  ( Stoddart-)
Jaspers- 3 components namely
1.       they are held with unusual conviction
2.       not amenable to logic
3.       absurdity or erroneous of their content is manifest to other people
Hamilton - A false unshakeable belief which arises from internal morbid processes. It is easily recognizable when it is not keeping with the person’s educational and cultural background.
Delusion not occurring in response to another psychopathological form such as mood disorder Types (schneider)
  1. Autochthonous delusions (Delusional intuition, sudden delusional idea) - occurs as a single stage. Delusion appears fully formed in the mind.
  2. Delusional percept- Attribution of a new meaning usually in the sense of self reference to a normally perceived object (Fish). It is self referent, momentous, urgent, overwhelming personal significance and of course false (sims)
Two memberedness- There is a link from the  Perceived object to subject’s perception of this object and second link to the new significance of this perception.
Types (Matussek) – Verbal variety and perceptual variety
  1. Delusional atmosphere(Delusional mood) – Patient knows that something funny is going on aroud him which concerns him but he cannot tell what it is. Patient feels profoundly uncomfortable , perplexed and apprehensive. When a delusional perception or sudden delusional idea arises it becomes obvious and he accepts that with a feeling of relief
        4    Delusional memories

False belief is understandable as arising from some other morbid experience like because of the mood state
One basic delusion
Remainder of the system is logically built on this error
 Is something thought to be true because of observation or evidence. It can often be subjected to empirical testing or logic to derive facts, which tend to be objective and universally agreed

Is something thought to be good or important to an individual. Hence strongly held values are the principles on which one will not yield and are not subject to empirical testing

A thought that because of its associated feeling tone takes precedence over all other ideas & maintains this precedence permanently or for long period of time.

Recurrent intrusive ideas ,impulses,urges,thoughts, which enter into conscious awareness of individual inspite of efforts to resist it & recognize it as his own which is excessive & unreasonable with efforts to resist it leading to anxiety
An obsession) is a thought that persists and dominates an individual’s thinking despite the individual’s awareness that the thought is either entirely without purpose or else has persisted and dominated their thinking beyond the point of relevance or usefulness.

Is a goal directed flow of ideas ,symbols,& associations initiated by a problem /task, characterized by a rational  connection between successive ideas /thoughts & leading towards a reality oriented conclusion  (AHUJA)
 1) Undirected fantasy thinking: ‘autistic’ or ‘dereistic’ thinking.
 2) Imaginative thinking: This does not go beyond the rational and the
 3) Rational (conceptual) thinking: This attempts to solve a problem. The boundaries between these are not sharp.

When link between ideas ,words ,phrases ,sentences are lost

 The train of thought is slowed down and the no. of ideas and mental images which present themselves is decreased.
     A sudden arrest of the train of thought, leaving a blank. An entirely new thought may then begin.
 Often thinking stops in the middle of a thought instead of continuing the thought, new ideas crop up which neither the patient nor the observer can bring into any connection with the previous stream of thought

3 features of healthy thinking:
 1) Constancy: the characteristic persistence of a completed thought whether or not it is simple or complicated in its content.
2) Organization: the contents of the thoughts are related to each other in consciousness and do not blend with each other, but are separated in an organized way.
 3) Continuity: even the most heterogeneous thoughts, sudden ideas or observations which emerge are arranged in order in the whole content of the consciousness.

quick succession of ideas
There is no general direction of thinking.
connection btwn thoughts is by chance
diverted easily to external stimuli& internal superficial associations
verbal &clang associations
Clang associations are linked by the sound of the words more than their meaning

Ordered flight,despite several irrelevances pt returns to the task in hand.verbal & clang associations not so prominent ,thought emergence not very fast
 Thinking proceeds slowly with many unnecessary trivial details but finally the point is reached. The goal of thought is never completely lost and thinking proceeds towards it by an intricate and devious path
Behavioural patterns of family members who have been significantly affected by another family member’s substance abuse/addiction.

Abstractability is the ability to understand the general principle in a specific situation given. It involves the:
(1) Ability to grasp the essentials of a whole
(2) To break a whole into its parts, and
(3) To recognize common properties.

4 types:
1) A completely new word whose derivation cannot be understood.
2) A word which has been incorrectly constructed by the faulty use of the accepted rules of word formation.
3) A distortion of another word.
4) An ordinary word used in a special way.

      “Unusual repeated performances of a goal-directed motor action or the maintenance of an unusual modification of an adaptive posture”.
       Repetitive non-goal directed actions carried out in a uniform way

      Is a senseless repetition of a goal-directed action/Speech which has already served its purpose beyond relevance
    . Compulsive repetition: the act is repeated unless the pt. receives another instruction – is more frequent in schizophrenics
       Impairment of switching: the repetition continues after the pt. has been given a new task – more common among dements.
   § Ideational perseveration: the pt. repeats words and phrases during his reply to a question – equally common in both groups.
         Palilalia: the pt. repeats the perseverated word with increasing frequency.
          Logoclonia: the last syllable of the last word is repeated.

Recent Definitions of Bizarre delusion
  1. apparent physical or logical impossibility (implying extreme implausibility)
  2. presence of a belief that is not consensually shared in a given social or cultural context
  3. absence of historical or  genetic understanding: this refers to an inability to understand how a given state of mind could emerge from relevant biographical antecedents
  4. incomprehensibility, in the sense of a lack of "static understanding": this refers to the capacity to empathize with, to imaginatively identify with, a given state of mind
  5. notion of "not being derived from ordinary life situations."

Oblique, disgressive, irrelevant manner of speech in which the central idea is not
communicated at all. . It refers only to questions and not to transitions in spontaneous speech

Word salad:
 Incoherent, essentially incomprehensible mixture of words and phrases


         More than 150 words / minute
         Increase in amount of spontaneous speech
         Sentences left incomplete with new ideas coming up
         Absence of social stimuli
         Difficult to interrupt
         Loud and emphatic
   Decreased amount of spontaneous speech
   Concrete and unelaborated
   Replies are long
   Speech is adequate
   Conveys little information

DERAILMENT  (loose associations, flight of ideas) –
 A pattern of spontaneous speech, in which the ideas slip off the track onto another one.
a.   Flight of ideas is a derailment that occurs rapidly in the context of pressured speech.
b.   In circumstantiality, the speaker realizes that he has gotten off the track and return to his original subject
 Pattern of speech that is essentially incomprehensible at times.
                                                               i.      Rules of grammar and syntax are ignored
                                                             ii.      Portions of coherent sentences may be observed in the midst of a sentence that is incoherent as a whole
                                                            iii.      Semantic level – words are substituted in a sentence so that the meaning of the sentence is lost
Diff from derailment – Abnormality occurs at the level of the sentence, with in which words or phrases are joined incoherently while in derailment unclear or confusing connections between larger units like ideas or sentences is seen

 Slow, distal, writhing, involuntary movements with a propensity to affect
the arms and hands.
Rapid, semipurposeful, graceful, dancelike, non patterned involuntary
movements involving distal or proximal muscle groups.
TREMOR – Rhythmic oscillation of a body part produced by either alternating or synchronous contractions of reciprocally innervated antagonistic muscles
 Involuntary patterned sustained or repeated muscle contractions, often leading to twisting movements and abnormal posture
High amplitude, violent, flinging or flailing movements
 is a brief, rapid (<100 ms), shocklike, jerkymovement consisting of single or repetitive muscle discharges.
Subjective feeling of psychological restlessness associated with
motor restlessness manifested by a compelling need to be in constant
movement. It may occur as an extrapyramidal adverse effect of antipsychotic
medications and SSRIs. Akathisia has to be differentiated from psychotic
agitation. Motor restlessness in the absence of psychological restlessness is
referred to as pseudoakathisia.
an involuntary, compulsive, rapid, repetitive, stereotyped movement or vocalization, experienced as irresistible although it can be suppressed for some length of time
Paroxysmal event due  to abnormal excessive hyper synchronous electric discharge of neurons from CNS resulting in motor,sensory,automatic,behavioural,psychic manifestation with/out loss of consciousness and with/out aura.

 Tendency for recurrent unprovoked seizures

ABREACTION - A process by which repressed material, (which can be either a
painful experience or a conflict with another), is brought back to consciousness.
During this process, the person not only recalls, but also relives the repressed
material, which is accompanied by the appropriate affective response (CTP).

Acting out – Behavioral response to an unconscious drive or impulse that
brings about temporary partial relief of inner tension, by reacting to a
present situation as if it were the situation which originally gave rise to the
drive or impulse.

Inability to understand the importance or significance of sensory
stimuli, which cannot be explained by a defect in sensory pathways or cerebral
lesion. The term has also been used to refer to the selective loss or disuse of
knowledge of specific objects because of emotional circumstances, as seen in certain
schizophrenic, anxious, and depressed patients.
(1) Astereognosis (tactile agnosia) is defined by the inability to recognize
objects based on touch, although the primary somatosensory modalities—light
touch, pressure, pain, temperature, vibration, and proprioception—are intact The lesion in Astereognosis is, localized at the border of the somatosensory and association areas in the posterior parietal lobe.
(2) Visual Agnosia –
i. Apperceptive visual agnosia is the inability to identify and draw items
using visual cues, with preservation of other sensory modalities.
ii. Associative visual agnosia is the inability to name or use objects despite
the ability to draw them.
iii. Color agnosia is the inability to recognize a color despite being able to
match it.
(3) Auditory sound agnosia, is defined as the inability to recognize nonverbal sounds,
such as a horn or a cat's meow, in the presence of intact hearing and speech
recognition. This is considered the right hemisphere correlate of pure word

Alexithymia – Inability or difficulty in describing or being aware of one's
emotions or moods.
Mental retardation is a condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the development period which contribute to the overall level of intelligence, i.e., cognitive, language, motor and social abilities
Mental Retardation refers to substantial limitation in present functioning, characterized by significant and sub-average intellectual functioning, existing concurrently with related limitation in two or more of the adaptive skill areas like communication, home living, community use, help and safety, leisure, self care, social skills, self direction, functional academics and work. The manifestation of mental retardation is before the age of 18 years.

Disabilty-Restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being  

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