Signs and Symptoms in Psychiatry

Signs are objective; symptoms are subjective. Signs are the clinician’s observations, such as noting a patient’s agitation; symptoms are subjective experiences, such as a person’s complaint of feeling depressed. In psychiatry, signs and symptoms are not as clearly demarcated as in other fields of medicine; they often overlap. Because of this, disorders in psychiatry are often described as syndromes—a constellation of signs and symptoms that together make up a recognizable condition. Schizophrenia, for example, is more often viewed as a syndrome than as a specific disorder. This concept is expressed in the use of the terms schizophrenic spectrum or the group of schizophrenias.

GLOSSARY OF SIGNS AND SYMPTOMS

abreaction

A process by which repressed material, particularly a painful experience or a conflict, is brought back to consciousness; in this process, the person not only recalls but also relives the repressed material, which is accompanied by the appropriate affective response.

abstract thinking

Thinking characterized by the ability to grasp the essentials of a whole, to break a whole into its parts, and to discern common properties. To think symbolically.

abulia

Reduced impulse to act and to think, associated with indifference about consequences of action. Occurs as a result of neurological deficit, depression, and schizophrenia.

acalculia

Loss of ability to do calculations; not caused by anxiety or impairment in concentration. Occurs with neurological deficit and learning disorder.

acataphasia

Disordered speech in which statements are incorrectly formulated. Patients may express themselves with words that sound like the ones intended but are not appropriate to the thoughts, or they may use totally inappropriate expressions.

acathexis

Lack of feeling associated with an ordinarily emotionally charged subject; in psychoanalysis, it denotes the patient’s detaching or transferring of emotion from thoughts and ideas. Also called decathexis. Occurs in anxiety, dissociative, schizophrenic, and bipolar disorders.

acenesthesia

Loss of sensation of physical existence.

acrophobia

Dread of high places.

acting out

Behavioral response to an unconscious drive or impulse that brings about temporary partial relief of inner tension; relief is attained by reacting to a present situation as if it were the situation that originally gave rise to the drive or impulse. Common in borderline states.

aculalia

Nonsense speech associated with marked impairment of comprehension. Occurs in mania, schizophrenia, and neurological deficit.

adiadochokinesia

Inability to perform rapid alternating movements. Occurs with neurological deficit and cerebellar lesions.

adynamia

Weakness and fatigability, characteristic of neurasthenia and depression.

aerophagia

Excessive swallowing of air. Seen in anxiety disorder.

affect

The subjective and immediate experience of emotion attached to ideas or mental representations of objects. Affect has outward manifestations that may be classified as restricted, blunted, flattened, broad, labile, appropriate, or inappropriate. See also mood.

ageusia

Lack or impairment of the sense of taste. Seen in depression and neurological deficit.

aggression

Forceful, goal-directed action that may be verbal or physical; the motor counterpart of the affect of rage, anger, or hostility. Seen in neurological deficit, temporal lobe disorder, impulse-control disorders, mania, and schizophrenia.

agitation

Severe anxiety associated with motor restlessness.

agnosia

Inability to understand the import or significance of sensory stimuli; 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. Occurs with neurological deficit. For types of agnosia, see the specific term.

agoraphobia

Morbid fear of open places or leaving the familiar setting of the home. May be present with or without panic attacks.

agraphia

Loss or impairment of a previously possessed ability to write.

ailurophobia

Dread of cats.

akathisia

Subjective feeling of motor restlessness manifested by a compelling need to be in constant movement; may be seen as an extrapyramidal adverse effect of antipsychotic medication. May be mistaken for psychotic agitation.

akinesia

Lack of physical movement, as in the extreme immobility of catatonic schizophrenia; may also occur as an extrapyramidal effect of antipsychotic medication.

akinetic mutism

Absence of voluntary motor movement or speech in a patient who is apparently alert (as evidenced by eye movements). Seen in psychotic depression and catatonic states.

alexia

Loss of a previously possessed reading facility; not explained by defective visual acuity. Compare with dyslexia.

alexithymia

Inability or difficulty in describing or being aware of one’s emotions or moods; elaboration of fantasies associated with depression, substance abuse, and posttraumatic stress disorder.

algophobia

Dread of pain.

alogia

Inability to speak because of a mental deficiency or an episode of dementia.

ambivalence

Coexistence of two opposing impulses toward the same thing in the same person at the same time. Seen in schizophrenia, borderline states, and obsessive-compulsive disorders (OCDs).

amimia

Lack of the ability to make gestures or to comprehend those made by others.

amnesia

Partial or total inability to recall past experiences; may be organic (amnestic disorder) or emotional (dissociative amnesia) in origin.

amnestic aphasia

Disturbed capacity to name objects, even though they are known to the patient. Also called anomic aphasia.

anaclitic

Depending on others, especially as the infant on the mother; anaclitic depression in children results from an absence of mothering.

analgesia

State in which one feels little or no pain. Can occur under hypnosis and in dissociative disorder.

anancasm

Repetitious or stereotyped behavior or thought usually used as a tension-relieving device; used as a synonym for obsession and seen in obsessive-compulsive (anankastic) personality.

androgyny

Combination of culturally determined female and male characteristics in one person.

anergia

Lack of energy.

anhedonia

Loss of interest in and withdrawal from all regular and pleasurable activities. Often associated with depression.

anomia

Inability to recall the names of objects.

anorexia

Loss or decrease in appetite. In anorexia nervosa, appetite may be preserved, but the patient refuses to eat.

anosognosia

Inability to recognize a physical deficit in oneself (e.g., patient denies paralyzed limb).

anterograde amnesia

Loss of memory for events subsequent to the onset of the amnesia; common after trauma. Compare with retrograde amnesia.

anxiety

Feeling of apprehension caused by anticipation of danger, which may be internal or external.

apathy

Dulled emotional tone associated with detachment or indifference; observed in certain types of schizophrenia and depression.

aphasia

Any disturbance in the comprehension or expression of language caused by a brain lesion. For types of aphasia, see the specific term.

aphonia

Loss of voice. Seen in conversion disorder.

apperception

Awareness of the meaning and significance of a particular sensory stimulus as modified by one’s experiences, knowledge, thoughts, and emotions. See also perception.

appropriate affect

Emotional tone in harmony with the accompanying idea, thought, or speech.

apraxia

Inability to perform a voluntary purposeful motor activity; cannot be explained by paralysis or other motor or sensory impairment. In constructional apraxia, a patient cannot draw two- or three-dimensional forms.

astasia abasia

Inability to stand or to walk in a normal manner, even though normal leg movements can be performed in a sitting or lying down position. Seen in conversion disorder.

astereognosis

Inability to identify familiar objects by touch. Seen with neurological deficit. See also neurological amnesia.

asthenopia

Pain or discomfort of the eyes, for example, pressure, grittiness.

asyndesis

Disorder of language in which the patient combines unconnected ideas and images. Commonly seen in schizophrenia.

ataxia

Lack of coordination, physical or mental. (1) In neurology, refers to loss of muscular coordination. (2) In psychiatry, the term intrapsychic ataxia refers to lack of coordination between feelings and thoughts; seen in schizophrenia and in severe OCD.

atonia

Lack of muscle tone. See waxy flexibility.

attention

Concentration; the aspect of consciousness that relates to the amount of effort exerted in focusing on certain aspects of an experience, activity, or task. Usually impaired in anxiety and depressive disorders.

auditory hallucination

False perception of sound, usually voices, but also other noises, such as music. Most common hallucination in psychiatric disorders.

aura

(1) Warning sensations, such as automatisms, fullness in the stomach, blushing, and changes in respiration; cognitive sensations; and mood states usually experienced before a seizure. (2) A sensory prodrome that precedes a classic migraine headache.

autistic thinking

Thinking in which the thoughts are largely narcissistic and egocentric, with emphasis on subjectivity rather than objectivity, and without regard for reality; used interchangeably with autism and dereism

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