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(Also: Clouding of Consciousness)
Thought Broadcasting, Though Insertion, Thought Withdrawal
Schneiderian First-rank Symptoms
"Human sculptures" are patients who freeze in any posture and function that they are placed, regardless of how painful and unusual. Typical of catatonics.
A set of signals in depression which includes loss of appetite, sleep disorder, loss of sexual drive, loss of weight, and constipation. May also indicate an eating disorder.
Feeling that one's body has changed shape or that specific organs have become elastic and are not under one's control. Usually coupled with "out of body" experiences. Common in a variety of mental health and physiological disorders: depression, anxiety, epilepsy, schizophrenia, and hypnagogic states. Often noticed in adolescents. See: Derealization.
In catatonia, complete opposition and resistance to suggestion.
Chaotic thinking that is the result of a severely impaired reality test ( the patient cannot tell inner fable from outside reality). Some psychotic states are short-lived and transient (microepisodes). These last from a few hours to a few days and are sometimes reactions to stress. Persistent psychoses are a fixture of the patient's mental life and manifest for months or years.
The contents of mood-congruent hallucinations and delusions are consistent and well suited with the patient's mood. During the manic phase of the Bipolar Disorder, for instance, such hallucinations and delusions involve grandiosity, omnipotence, personal identification with great personalities in history or with deities, and magical thinking. In depression, mood-congruent hallucinations and delusions revolve around themes like the patient's self-misperceived faults, shortcomings, failures, worthlessness, guilt – or the patient's impending doom, death, and "well-deserved" sadistic punishment.
False perceptions based on pretend sensa (sensory input) not triggered by any external event or entity. The patient is normally not psychotic – he is aware that he what he sees, smells, feels, or hears is not there. Still, some psychotic states are accompanied by hallucinations (e.g., formication – the feeling that bugs are crawling over or under one's skin).
Complete (though often momentary) loss of orientation in relation to one's location, time, and to other people. Usually the result of impaired memory (often occurs in dementia) or attention deficit (for instance, in delirium). Also see: Disorientation.
The first encounter between psychiatrist or therapist and patient (or client) is multi-phased. The mental health practitioner notes the patient's history and administers or prescribes a physical examination to rule out certain medical conditions. Armed with the consequences, the diagnostician now observes the patient carefully and compiles lists of signals and symptoms, grouped into syndromes.
Olfactory – The pretend perception of smells and scents (e.g., burning flesh, candles)
Incomprehensible speech, rife with severely loose associations, distorted grammar, tortured syntax, and idiosyncratic definitions of the words used by the patient ("non-public language"). A loosening of associations. A pattern of speech in which unrelated or loosely-associated ideas are expressed hurriedly and forcefully, using broken, ungrammatical, non-syntactical sentences, an idiosyncratic vocabulary ("non-public language"), topical shifts, and inane juxtapositions ("word salad"). See: Loosening of Associations; Flight of Ideas; Tangentiality.
Stereotyping or Stereotyped movement (or motion)
Thought and speech disorder which involves the translocation of the center of attention of attention from one subject to an extra for no apparent reason. The patient is normally unaware of the very fact that his practice of thoughts and his speech are incongruous and incoherent. A sign of schizophrenia and some psychotic states. See: Incoherence; Flight of Ideas; Tangentiality.
Tactile – The pretend sensation of being touched, or crawled upon or that events and processes are taking place under one's skin. Usually supported by an appropriate and relevant delusional content.
Delirium is a syndrome which involves clouding, confusion, restlessness, psychomotor disorders (retardation or, on the opposite pole, agitation), and mood and affective disturbances (lability). Delirium is not a relentless state. It waxes and wanes and its onset is sudden, normally the result of some organic affliction of the brain.
Experiencing imagined sexual acts couple with delusions attributed to forces, "energy", or hypnotic suggestion.
The delusion that one's acts, thoughts, feelings, perceptions, and impulses are directed or influenced by other people.
Inability or unwillingness to center of attention on a idea, issue, question, or theme of conversation. The patient "takes off on a tangent" and hops from one topic to an extra in accordance along with his own coherent inner agenda, frequently changing subjects, and ignoring any attempts to restore "discipline" to the communication. Often co-occurs with speech derailment. As distinct from loosening of associations, tangential thinking and speech are coherent and logical but they seek to evade the issue, issue, question, or theme raised by the other interlocutor.
Folie a Deux (Madness in Twosome, Shared Psychosis)
Abstention from speech or refusal to speak. Common in catatonia.
We have all come across situations and dilemmas which evoked equipotent – but opposing and conflicting – feelings or ideas. Now, imagine someone with a permanent state of inner turmoil: her feelings come in mutually exclusive pairs, her thoughts and conclusions arrayed in contradictory dyads. The result is, of course, extreme indecision, to the point of utter paralysis and inaction. Sufferers of Obsessive-Compulsive Disorders and the Obsessive-Compulsive Personality Disorder are highly ambivalent.
The conviction that one is important, omnipotent, possessed of occult powers, or a historic figure.
Attaching unusual meanings and significance to genuine perceptions, normally with some variety of (paranoid or narcissistic) self-reference.
Automatic, unquestioning, and immediate obeisance of all commands, even the most manifestly absurd and dangerous ones. This suspension of vital judgment is sometimes a demonstration of incipient catatonia.
Pervasive and sustained feelings and feelings as subjectively described by the patient. The same phenomena noticed by the clinician are called affect. Mood can be either dysphoric (unpleasant) or euphoric (elevated, expansive, "good mood"). Dysphoric moods are characterized by a reduced sense of well-being, depleted energy, and negative self-regard or sense of self-worth. Euphoric moods typically involve an increased sense of well-being, ample energy, and a stable sense of self-worth and self-esteem. Also see: Affect.
Inability to incorporate reality-based facts and logical inference into one's thinking. Fantasy-based thoughts.
When the practice of thought and speech is often derailed by unrelated digressions, based on chaotic associations. The patient finally succeeds to express his or her main idea but merely after lots effort and wandering. In extreme cases considered to be a communication disorder.
Hypnagogic and Hypnopompic – Images and trains of events experienced whereas falling asleep or when waking up. Not hallucinations in the strict sense of the word.
A belief, idea, or conviction firmly held despite abundant information to the contrary. The partial or complete loss of reality test is the first indication of a psychotic state or episode. Beliefs, ideas, or convictions shared by other people, members of the same collective, are not, strictly speaking, delusions, although they may be hallmarks of shared psychosis. There are many sorts of delusions:
Assuming and remaining in irregular and contorted bodily positions for prolonged periods of time. Typical of catatonic states.
Not knowing what year, month, or day it is or not knowing one's location (country, state, city, street, or building one is in). Also: not knowing who one is, one's identity. One of the signals of delirium.
The way one thinks about, perceives, and feels reality.
Symptoms are the patient's complaints. They are highly subjective and amenable to suggestion and to alterations in the patient's mood and other mental processes. Symptoms are no more than mere indications. Signs, on the other hand, are objective and measurable. Signs are evidence of the existence, level, and extent of a pathological state. Headache is a symptom – short-sightedness (which can well be the cause of the headache) is a sign.
Gustatory – The pretend perception of tastes
Sudden, overpowering feelings of imminent threat and apprehension, bordering on fear and terror. There normally is no external cause for alarm (the attacks are uncued or unforeseen, and not using a situational trigger) – though some panic attacks are situationally-bound (reactive) and follow exposure to "cues" (most likely or truly dangerous events or circumstances). Most patients display a mixture of both sorts of attacks (they are situationally predisposed).
Rapidly verbalized practice of unrelated thoughts or of thoughts associated merely via relatively-coherent associations. Still, in its extreme forms, flight of ideas involves cognitive incoherence and disorganization. Appears as a sign of mania, certain organic mental health disorders, schizophrenia, and psychotic states. Also see: Pressure of Speech and Loosening of Associations.
Loosening of Associations
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Halted, frequently interrupted speech to the point of incoherence indicates a parallel disruption of thought processes. The patient appears to aim hard to remember what it was that he or she have been saying or thinking (as if they "lost the thread" of conversation).
Feeling that one's immediate environment is unreal, dream-like, or somehow altered. See: Depersonalization.
The constant and unnecessary fabrication of information or events to fill in gaps in the patient's memory, biography or wisdom, or to substitute for unacceptable reality. Common in the Cluster B personality disorders (narcissistic, histrionic, borderline, and antisocial) and in organic memory impairment or the amnestic syndrome (amnesia).
Bodily manifestations include shortness of breath, sweating, pounding heart and increased pulse as well as palpitations, chest pain, overall discomfort, and choking. Sufferers often describe their enjoy as being smothered or suffocated. They are afraid that they may be going crazy or about to lose control.
Hallucinations are commonplace in schizophrenia, affective disorders, and mental health disorders with organic origins. Hallucinations are also commonplace in drug and alcohol withdrawal and among substance abusers.
There are a few classes of hallucinations:
Poverty of Content (of Speech)
A variety of unpleasant (dysphoric), mild fear, and not using a apparent external reason. Anxiety is akin to dread, or apprehension, or fearful anticipation of some imminent but diffuse and unspecified danger. The mental state of anxiety (and the concomitant hypervigilance) has physiological complements: tensed muscle tone, elevated blood pressure, tachycardia, and sweating (arousal).
In certain mental health disorders, the affect is inappropriate. For instance: such people laugh when they recount a sad or horrifying event or when they locate themselves is morbid settings (e.g., in a funeral). Also see: Mood.
In schizophrenia and other psychotic disorders, the invention of new "words" which are meaningful to the patient but meaningless to everyone else. To form the neologisms, the patient fuses together and combines syllables or other elements from existing words.
Mounting internal tension associated with immoderate, non-productive (not goal orientated), and repeated motor activity (hand wringing, fidgeting, and similar gestures). Hyperactivity and motor restlessness which co-occur with anxiety and irritability.
The delusion that one's thoughts are taken over and controlled by others and then "drained" from one's brain.
three. Referential (ideas of reference)
Rhyming or punning associations of words and not using a logical connection or any discernible relationship between them. Typical of manic episodes, psychotic states, and schizophrenia.
The misperception or misinterpretation of real external – visual or auditory – stimuli, attributing them to non-existent events and actions. Incorrect perception of a material object. See: Hallucination.
Mood Congruence and Incongruence
More precisely: autistic thinking and inter-relating (relating to other people). Fantasy-infused thoughts. The patient's cognitions derive from an overarching and all-pervasive fable life. Moreover, the patient infuses people and events around him or her with gorgeous and solely subjective meanings. The patient regards the external world as an extension or projection of the internal one. He, thus, often withdraws solely and retreats into his inner, non-public realm, unavailable to communicate and interact with others.
Here is a partial list of the most necessary signals and symptoms in alphabetical order:
Visual – The pretend perception of objects, people, or events in broad daylight or in an illuminated environment with eyes wide open.
Imitation by way of exactly repeating an extra person's speech. Involuntary, semiautomatic, uncontrollable, and repeated imitation of the speech of others. Observed in organic mental disorders, pervasive developmental disorders, psychosis, and catatonia. See: Echopraxia.
Comparing one's reality sense and one's hypotheses concerning the way issues are and how issues function to objective, external cues from the environment.
Poverty of Speech
The belief that one is being controlled or persecuted by stealth powers and conspiracies.
We all enjoy feelings, but each and every one in all us expresses them differently. Affect is HOW we express our innermost feelings and how other people observe and interpret our expressions. Affect is characterized by the variety of emotion involved (sadness, happiness, anger, etc.) and by the intensity of its expression. Some people have flat affect: they care for "poker faces", monotonous, immobile, apparently unmoved. This is typical of the Schizoid Personality Disorder Others have blunted, constricted, or broad (healthy) affect. Patients with the dramatic (Cluster B) personality disorders – especially the Histrionic and the Borderline – have exaggerate and labile (changeable) affect. They are "drama queens".
The belief that external, objective events carry hidden or coded messages or that one is the subject of discussion, derision, or opprobrium, even by total strangers.
Visible slowing of speech or movements or both. Usually affects the total range of performance (entire repertory). Typically involves poverty of speech, delayed response time (subjects answer questions after an inordinately long silence), monotonous and flat voice tone, and constant feelings of overwhelming fatigue.
Asperger's Disorder, one in all the spectrum of autistic disorders, is sometimes misdiagnosed as Narcissistic Personality Disorder (NPD)
Automatic obeisance or obedience
A consistent disturbance that affects the process or content of thinking, the use of language, and, consequently, the ability to communicate comfortably. An all-pervasive failure to observe semantic, logical, or even syntactical legislation and forms. A fundamental feature of schizophrenia.
Somatic – The pretend perception of processes and events that are happening inside the body or to the body (e.g., piercing objects, electricity running through one's extremities). Usually supported by an appropriate and relevant delusional content.
A syndrome comprised of diverse signals, amongst which are: catalepsy, mutism, stereotypy, negativism, stupor, automatic obedience, echolalia, and echopraxia. Until recently it was thought to be associated to schizophrenia, but this view has been discredited when the biochemical basis for schizophrenia had been discovered. The current thinking is that catatonia is an exaggerated form of mania (in other words: an affective disorder). It is a feature of catatonic schizophrenia, though, and also appears in certain psychotic states and mental disorders that have organic (medical) roots.
Hearing conversations between a few imaginary "interlocutors", or one's thoughts spoken out loud, or a running background commentary on one's actions and thoughts.
A form of severe anxiety attack accompanied by a sense of losing control and of an impending and imminent life-threatening danger (where there may be none). Physiological markers of panic attacks include palpitation, sweating, tachycardia (fast heart beats), dyspnea or apnoea (chest tightening and difficulties breathing), hyperventilation, light-headedness or dizziness, nausea, and peripheral paresthesias (an irregular sensation of burning, prickling, tingling, or tickling). In ordinary people it is a reaction to sustained and extreme stress. Common in many mental health disorders.
The sharing of delusional (often persecutory) ideas and beliefs by two or more (folie a plusieurs) persons who cohabitate or form a social unit (e.g., a family, a cult, or a corporation). One of the members in each of these groups is dominant and is the source of the delusional content and the instigator of the idiosyncratic behaviors that accompany the delusions.
A list of symptoms compiled by Kurt Schneider, a German psychiatrist, in 1957 and indicative of the presence of schizophrenia. Includes:
Repeating the same gesture, behavior, idea, idea, phrase, or word in speech. Common in schizophrenia, organic mental disorders, and psychotic disorders.
Literally: wax-like flexibility. In the commonplace form of catalepsy, the patient provides no resistance to the re-arrangement of his limbs or to the re-alignment of her posture. In Cerea Flexibilitas, there may be some resistance, though it is very mild, lots like the resistance a sculpture made of soft wax would provide.
Sleep disorder or disturbance involving difficulties to either fall asleep ("initial insomnia") or to remain asleep ("middle insomnia"). Waking up early and being not able to resume sleep is also a form of insomnia ("terminal insomnia").
Inability or diminished capacity to form abstractions or to think using abstract categories. The patient is not able to consider and formulate hypotheses or to grasp and apply metaphors. Only one layer of meaning is attributed to each word or phrase and figures of speech are taken literally. Consequently, nuances are not detected or appreciated. A commonplace feature of schizophrenia, autism spectrum disorders, and certain organic disorders.
The patient is wide awake but his or her awareness of the environment is partial, distorted, or impaired. Clouding also occurs when one gradually loses consciousness (for instance, as a result of intense pain or lack of oxygen).
Involuntary repetition of a stereotyped and ritualistic action or movement, normally in connection with a wish or a fear. The patient is aware of the irrationality of the compulsive act (in other words: she knows that there may be not any real connection between her fears and wishes and what she is repeatedly compelled to do). Most compulsive patients locate their compulsions tedious, bothersome, distressing, and unpleasant – but resisting the urge results in mounting anxiety from which merely the compulsive act provides lots needed relief. Compulsions are commonplace in obsessive-compulsive disorders, the Obsessive-Compulsive Personality Disorder (OCPD), and in certain sorts of schizophrenia.
Rapid, condensed, unstoppable and "driven" speech. The patient dominates the conversation, speaks loudly and emphatically, ignores attempted interruptions, and doesn't care if anyone is listening or responding to him or her. Seen in manic states, psychotic or organic mental disorders, and conditions associated with stress. See: Flight of Ideas.
Delusion of control
There is a thin line separating nonpsychotic from psychotic perception and ideation. On this spectrum we also locate the schizotypal personality disorder.
Auditory – The pretend perception of voices and sounds (such as buzzing, humming, radio transmissions, whispering, motor noises, and so on).
Diminished appetite to the point of refraining from eating. Whether it is an element of a depressive illness or a body dysmorphic disorder (erroneous perception of one's body as too fat) is still debated. Anorexia is one in all a family of eating disorders which also includes bulimia (compulsive gorging on foodstuff and then its forced purging, normally by vomiting).
Ideas of Reference
The delusion that thoughts are being implanted or inserted into one's mind involuntarily.
Imitation by way or exactly repeating an extra person's movements. Involuntary, semiautomatic, uncontrollable, and repeated imitation of the movements of others. Observed in organic mental disorders, pervasive developmental disorders, psychosis, and catatonia. See: Echolalia.
Recurring and intrusive images, thoughts, ideas, or wishes that dominate and exclude other cognitions. The patient often finds the contents of his obsessions unacceptable or even repulsive and actively resists them, but to no avail. Common in schizophrenia and obsessive-compulsive disorder.
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Vanishing act. A sudden flight or wandering away and disappearance from home or work, followed by the assumption of a new identity and the commencement of a new life in a new place. The previous life is solely erased from memory (amnesia). When the fugue is over, it is also forgotten as is the new life adopted by the patient.
Reactive, non-spontaneous, extremely brief, intermittent, and halting speech. Such patients often remain silent for days on end unless and until spoken to.
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A loosening of associations. A pattern of speech in which unrelated or loosely-associated ideas are expressed hurriedly and forcefully, with frequent topical shifts and and not using a apparent internal logic or reason. See: Incoherence.
Pressure of Speech
Psychotics are fully aware of events and people "out there". They cannot, however separate data and experiences originating in the outside world from information generated by internal mental processes. They confuse the external universe with their inner feelings, cognitions, preconceptions, fears, expectations, and representations.
Consequently, psychotics have a distorted view of reality and are not rational. No amount of objective evidence can cause them to doubt or reject their hypotheses and convictions. Full-fledged psychosis involves complex and ever more weird delusions and the unwillingness to confront and consider contrary data and information (preoccupation with the subjective rather than the objective). Thought becomes utterly disorganized and gorgeous.
Weak delusions of reference, devoid of inner conviction and with a stronger reality test. See: Delusion.
See: Schneiderian First-rank Symptoms
When we lose the urge to seek exhilaration and to prefer it to nothingness or even pain, we become anhedonic. Depression inevitably involves anhedonia. the depressed are not able to conjure sufficient mental energy to get off the couch and do something because they locate the entire thing equally boring and unattractive.
Restricted and constricted consciousness akin in some respects to coma. Activity, both mental and physical, is limited. Some patients in stupor are unresponsive and seem to be unaware of the environment. Others sit motionless and frozen but are clearly cognizant of their surroundings. Often the result of an organic impairment. Common in catatonia, schizophrenia, and extreme depressive states.
Flight of Ideas
The delusion that everyone can read one's mind, as though one's thoughts have been being broadcast.
Simultaneous impairment of diverse mental faculties, especially the intellect, memory, judgment, abstract thinking, and impulse control due to brain damage, normally as an outcome of organic illness. Dementia ultimately results in the transformation of the patient's entire personality. Dementia does not involve clouding and can have acute or slow (insidious) onset. Some dementia states are reversible.
Dread of a specific object or situation, acknowledged by the patient to be irrational or immoderate. Leads to all-pervasive avoidance behavior (attempts to avoid the feared object or situation). A persistent, unfounded, and irrational fear or dread of one or more classes of objects, activities, situations, or locations (the phobic stimuli) and the resulting overwhelming and compulsive desire to avoid them. See: Anxiety.
Repetitive, urgent, compulsive, purposeless, and non-functional movements, such as head banging, waving, rocking, biting, or picking at one's nose or skin. Common in catatonia, amphetamine poisoning, and schizophrenia.
Psychotic grandiose and persecutory delusions. Paranoids are characterized by a paranoid style: they are rigid, sullen, suspicious, hypervigilant, hypersensitive, envious, guarded, resentful, humorless, and litigious. Paranoids often suffer from paranoid ideation – they think (though not firmly) that they are being stalked or followed, plotted against, or maliciously slandered. They constantly gather information to prove their "case" that they are the objects of conspiracies against them. Paranoia is not the same as Paranoid Schizophrenia, which is a subtype of schizophrenia.
Persistently vague, overly abstract or concrete, repetitive, or stereotyped speech.
The contents of mood-incongruent hallucinations and delusions are inconsistent and incompatible with the patient's mood. Most persecutory delusions and delusions and ideas of reference, as well as phenomena such as control "freakery" and Schneiderian First-rank Symptoms are mood-incongruent. Mood incongruence is especially prevalent in schizophrenia, psychosis, mania, and depression.