Tariq Halim, MD
Purpose of Trip
Promote understanding of psychiatric
terms used in documentation
Foster better written and verbal
communication between staff
Improve patient care!!!
Train Stops
Behavior
Speech
Mood & Affect
Thought Form/Process
Thought Content
Perceptual Disturbances
Satilla Community Services – Waycross, GA
Destination
Behavior
Psychomotor Agitation
Psychomotor Retardation
Automatism
Echopraxia
Echolalia
Speech
Pressured
Poverty of Speech
Dysprosody
Dysarthria
Mood and Affect
Mood vs. Affect
Mood Descriptions
Dysthymic Euthymic Elated
Affect Expression
Flat Blunted Constricted
Normal Labile
Appropriateness
Congruency
Thought Form/Process
Circumstantiality
Tangentiality
Flight of Ideas
Loosening of Associations
Thought Blocking
Word Salad
Clang Associations
Thought Content
Delusions
Ideas of Reference
Ideas of Influence
Thought Broadcasting
Obsession
Compulsion
Phobia
Perceptual Disturbances
Hallucinations
Auditory
Visual
Tactile
Olfactory
Illusions
ALL ABOARD!
BEHAVIOR
Psychomotor Agitation vs. Retardation
Agitation: series of unintentional and purposeless
motions that stem from mental tension of an
individual
Example: Manic patient
Retardation: slowing down of thought and a
reduction of physical movements in a person
Example: Severely depressed patient
Automatism
Activity performed without conscious
awareness
Aimless behavior
Echopraxia and Echolalia
Echopraxia: involuntary imitation of the
movements of another; echomotism
Echolalia: repetition of echoing of verbal
utterances made by another person
SPEECH
Pressured Speech
Speech that is increased in amount, accelerated, and difficult or impossible to interrupt
Usually loud and emphatic
Example: Manic patient who talks without social stimulation even though no one is listening
Poverty of Speech
Marked deficit in spontaneous speech
Example: Catatonic schizophrenic
patient
Dysarthria
Difficulty producing speech
Example: Stroke patient who has word-
finding issues
Dysprosody
Speech impairment characterized by a loss of control of intonation and rhythm
Example: Stroke patient has difficulty in the expression or comprehension of the emotional components of speech, such as melody, emphasis, inflection, and gesturing
MOOD & AFFECT
Mood vs. Affect
Emotional state
recorded in the
patient’s own words
Example: Current
weather - rainy
Interviewer’s
observation of the
patient’s emotional
state
Example: Climate –
Humid subtropical
Mood Affect
Mood Descriptions
Affect Expression
Appropriateness and Congruency of
Affect
In relation to current situation:
Appropriate – in concordance
Not appropriate – not in concordance
Example: laughing uncontrollably when discussing wife’s
cancer diagnosis
In relation to thought content:
Congruent – in concordance
Incongruent – not in concordance
Example: Bland affect when describing a very distressing
experience
THOUGHT FORM/PROCESS
Circumstantiality
Thought/Speech style that is logical but is difficult to
follow because it dwells on irrelevant details and
takes an inordinate length of time coming to the point
Example: “My mother's job? She used to sit around
the house doing nothing but drinking, she'd just sit
there and stew, making noises, chugging her drinks.
She threw my dad out of the house. I'll never forget
that, the way she did it. Anyways, my mom was a
waitress."
Tangentiality
A disturbance in the associative thought process in
which one tends to digress readily from one topic
under discussion to other topics that arise through
association
Example: “I love ice cream. Its getting pretty cold
outside. Man, I love playing football during the fall.
My grandmother fell yesterday and hit her head. I
had this really bad migraine headache yesterday.”
– typically seen in a Manic patient
Loosening of Associations
Manifestation of a severe thought disorder
characterized by the lack of an obvious connection
between one thought or phrase and the next
Example: “Sometimes my dog eats its own poop. I
seem to have forgotten my pen. Who said Santa
Clause doesn’t exist? I hate vegetables.” – typically
seen in a Schizophrenic patient
Word Salad
Confused, and often repetitious, thought/language
with no apparent meaning or relationship attached
to them
Example: “Pizza. I hate you. Friends are forever!
We all grew up on McArthur Milk. Multiplication.
Super, lets go! Shut your mouth!” – typically seen in
a Schizophrenic patient
Thought Blocking
Interruption of train of thought/speech before
completion
Example: “I have good news and bad news. The
good news is that your mother made it through
surgery. The bad news is. (silence)” – typically seen
in a Schizophrenic (catatonic) or Demented patient
Clang Associations
Confused, and often repetitious, thought/speech
with no apparent meaning or relationship attached
to them
Example: “The train rain brained me. He ate the
skate, inflated yesterdays gate toward the cheese
grater. Sing song, ding dong, it won’t be long
before you give me some Geodon.” – typically in a
Schizophrenic patient
THOUGHT CONTENT
Delusions
A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary
The belief is not one ordinarily accepted by other members of the person's culture or subculture (e.g., it is not an article of religious faith)
Examples: Persecutory, Paranoid, Nihilistic, Delusional, Delusion of Guilt/Sin, Somatic, Grandiose
Ideas of Reference vs. Influence
Reference: belief or perception that irrelevant,
unrelated or innocuous things in the world are
referring to them directly or have special personal
significance
Influence: thoughts that one's own action is caused
by someone else's will or some other external cause
Thought Broadcasting
Delusion that one is capable of "inserting" thoughts
into other individual's minds, or that others can
perceive them (telepathy)
Obsession vs. Compulsion
Obsession: excessive or unreasonable disturbing
thoughts or images that reoccur over and over
Examples: concerns about becoming dirty; sexual
thoughts and images
Compulsion: repetitive action thought to relieve the
anxiety over an obsession
Examples: washing hands over and over again;
masturbation
Phobia
Negative attitudes or prejudices towards the named
subjects
Examples: chemophobia – prejudice against
artificial substances; gynophobia – fear or dislike
of women; homophobia – fear or dislike of
homosexuals
PERCEPTUAL DISTURBANCES
Hallucination
Perceptions in a conscious and awake state in the
absence of external stimuli which have qualities of
real perception
Examples: Auditory, Visual, Tactile, Olfactory
Illusion
Mistaken or erroneous perception of an object
external to the individual
Thank you for riding with us!
LAST STOP – St. Illa Hospital