2. General Signs and Symptoms of Psychiatric Disorders
Outlines:
- Signs and symptoms categories.
- Somatic manifestations of psychiatric disorder.
- Thought disturbances.
- Disturbances of judgment.
- Disturbances of consciousness.
- Disturbances of orientation.
- Disturbances of memory.
- Disturbances of perception.
- Disturbances of mood.
- Disturbances in motor aspects of behavior.
- Language disorder.

3. Typical Signs and Symptoms of Psychiatric Disorders Psychiatric nurses develop their ability to detect people's mental conditions for several reasons to carry out effective care of patients; to analyze psychiatric issues as fully as possible, and to communicate fruitfully with other team member. To accomplish these aims, they must be come experts in the language of psychiatry. They must learn to recognize and define behavioral and emotional signs and symptoms.

4. ** Characteristics of psychiatric signs and symptoms:- The distinction between the two is clear. Symptom: are subjectively experienced disturbances that are not necessarily observable by others Signs: are abnormalities that are observable by an examiner. In psychiatry the line between symptoms and sign is often considered to be symptoms of psychiatric disorders may not be experienced as psychiatric problems by patients.

5. ** Signs and symptoms categories: ## Physiological manifestations of psychiatric disorders: 1-Insomnia: lack of or diminished ability to sleep. 2-Hypersomina: excessive nighttime sleep or excessive sleeping during the day with loss of muscle tone. 3. Anorexia: loss of or decrease in appetite. 4. Hyper phagia: increased in appetite and intake of food. 5. Diminished libido: decreased sexual interest, drive, and performance 6. Constipation

6. ## Thinking: - Goal – directed flow of ideas, symbols, and aid associations initiated by a problem or a task and leading toward a reality – oriented conclusion Disorders of thinking can be divided into the following categories: 1-Disorder of the stream of thought- (speech and pressure). 2-Disorder of content of thought. 3-Disorder of form of thought.

7. I- Disorders of the stream of thought:
In this category there is an alteration in either the amount or speed of speech:
1-Pressure of thought: when ideas arise in unusual variety and pass through the mind rapidly.
2-Poverty of thought: where only a few thoughts; which lack variety and richness.
3-Thought blocking: stream of thought can be interrupted suddenly.

8. #.Specific disturbances in content of thought:-
1- Poverty of Content:- thought that gives little information because of vagueness, empty repetition or obscure phrases.
2-Delusion:- false fixed belief, based on incorrect inference about external reality, not consistent with cultural background that cannot be corrected by reasoning or logic
3- Preoccupation of thought:- centering of thought content on a particular idea, associated with a strong affective tone, such as a paranoid trend or a suicidal or homicidal preoccupation

9. 4- Hypochondria:- exaggerated concern about one's health that is based not on real organic pathology but, rather, on unrealistic interpretations of physical signs or sensations as abnormal 5- Obsession:- pathological persistence of an irresistible thought or feeling that cannot be eliminated from consciousness by logical effort which is associated with anxiety. 6- Compulsion :- pathological need to act on an impulse that, if resisted, produces anxiety; repetitive behavior in response to an obsession Suicidal ideation :-

10. Types of delusions: Bizarre delusion:- an absurd, totally implausible, strange false belief (for example, invaders from space have implanted electrodes in a parson's brain). 2-Systematized delusion:- false belief or beliefs united by a single event or theme (for example, a person is being persecuted by the CIA, FBI, or the Mafia or the boss). 3-Mood–congruent delusion:- delusion with mood-appropriate content (for example, a depressed patient believes that he or she is responsible for the destruction of the world).

11. 4- Mood – incongruent delusion: - delusion with content that has no association to mood (for example, a depressed patient has delusion of thought control or thought broadcasting). 5-Nihilistic delusion:- false feeling that self, others, or the world is nonexistent or ending. 6- Delusion of poverty:- false belief that one is bereft or will be deprived of all material possessions. 7-Somatic delusion: - false belief involving functioning of one's body (for example, belief that the brain is rotting or melting).

12. 8- Paranoid delusions: includes persecutory delusions and delusions of reference, control, and grandeur. * Delusion of persecution:- false belief that one is being harassed, cheated, or persecuted; often found in litigious patients who have a pathological tendency to take legal action because of imagined mistreatment. **Delusion of grandeur: - exaggerated conception of one's importance power, or identity. ***Delusion of reference: false belief that the behavior of others refers to himself or herself.

13. 9- Delusion of self-accusation: - false feeling of remorse and guilt
9- Delusion of self-accusation: - false feeling of remorse and guilt. 10-Delusion of control: - false feeling that a person's will, thoughts, or feelings are being controlled by external forces. *Thought withdrawal: delusion that one's thoughts are being removed from a person's mind by other people or forces. **Thought insertion: delusion that one's thoughts are being implanted in person’s mind by other people or forces. ***Thought broadcasting: delusion that a person's thoughts can be heard by others as though they were being broadcast into the air

14. 11- Delusion of infidelity (delusional jealousy):- a false belief derived from pathological jealousy that a person's lover is unfaithful Erotomania:- delusional belief, more common in women than in men, that someone is deeply in love with them

15. #. Specific disturbances in form of thoughts:-
1-Neologism: - new word created by the patient, and only understands by patient's, often by combining syllables of other words.
2-Word salad: - incoherent mixture of words and phrases.
3-Circumstantiality: - indirect speech that is delayed in reaching the point but eventually gets from original point to desired goal.
4-Tangentiality: - inability to have goal–directed associations of thought, speaker never gets from desired point to desired goal.

16. 5- Incoherence: - thought that generally is not understandable; running together of thoughts or words with no logical or grammatical resulting in disorganization connection 6- Preservation: - persisting repetition or continuous expression of an idea to a previous stimulus after a new stimulus has been presented. 7- Echolalia: - Psychopathological repeating of words or phrases of one person by another. 8- Irrelevant answer: - answer that is not in harmony with asked question (person appears to ignore or not attend to question).

17. 9- Loosening of associations: - flow of thought in which ideas shift from one subject to another in a completely unrelated way. 10- Flight of ideas: - rapid continuous verbalization or plays on words produce constant shifting from one idea to another. The ideas tend to be connected. 11- Clang association: - association of words similar in sound but not in meaning; words have no logical connection. 12- Blocking: - abrupt interruption in train of thinking before a thought or idea is finished

18. II Judgment:- Ability to assess a situation correctly and to act appropriately in the situation . III Consciousness:- State of awareness. A)- Disturbances of consciousness disturbances of consciousness are most often associated with brain pathology. *Clouding of consciousness:- incomplete clear mindedness with disturbance in perception and attitude *Stupor: - lack of reaction to and unawareness of surroundings. *Confusion:- disturbance of consciousness in which reaction to environmental stimuli are inappropriate, manifested by a disordered orientation in relation to time, place or person. *Drowsiness:- a state of impaired awareness associated with a desire or inclination to sleep. *Coma:- profound degree of unconsciousness

19. B)- Disturbances of attention:- attention is the amount of effort exerted in focusing on certain portion of an experience, ability to sustain a focus on one activity; ability to concentrate. *Distractibility: inability to concentrate attention, state in which attention is drawn to unimportant or irrelevant external stimuli **Selective inattention: blocking out only those things that generate anxiety ***Hyper vigilance: excessive attention and focus on internal and external stimuli, usually secondary to delusional or paranoid states.

20. IV Disturbances of orientation : Orientation refers to one's awareness of time, place and person . *Disorientation to time: - pathological time disorientation can be mild or severe. **Disorientation to place:- often signifies a greater degrees of cognitive impairment than disorientation to time ***Disorientation to person:- alack of awareness of one's own identity or others

21. Memory: function by which information stored in the brain is later recalled to consciousness. Disturbances of memory: 1- Amnesia: - partial or total inability to recall past experiences; may by organic or emotionally in origin. a. Anterograde: amnesia for events occurring after appoint in time. (Inability to recall recent events) b. Retrograde: amnesia for events occurring before a point in time. (Inability to recall remote events) C. Total amnesia: loss of memory for recent events and for remote events D. Circumscribed amnesia: loss of memory for limited time.

22. 2- Para menesia: falsification of memory by distortion of recall Retrospective falsification,. Memory becomes unintentionally (unconsciously) distorted by being filtered thought a person's present emotional, cognitive and experiential state. Confabulation: conscious filling of gaps in memory by imagined or untrue experience De ja vu: illusion of visual recognition in which a new situation is in correctly regarded as a repetition of pervious memory Jamais vu: false feeling of unfamiliarity with a real situation that person has experienced.

23. 3-Hypermensia: exaggerated degree of retention and recall B- Levels of memory: Immediate: reproduction or recall of perceived material within seconds to minutes 2. Recent: recall of events over past few days 3. Recent past: recall of events over past few months 4. Remote: recall of events in distant past

24. VI-Perception:-
process of transferring physical stimulation into psychological information; mental process by which sensory stimuli are brought to awareness.
A-Disturbances of perception :-
I- Hallucination: It is false sensory perception not associated with real external stimuli.
Types of hallucinations:
1-Hypnagogic hallucination: false sensory perception occurring while falling asleep
2-Hypnopompic Hallucination: false perception occurring while awakening from sleep
3-Auditory hallucination: false perception of sound, usually voices but also other noises such as music.

25. 4-Visual hallucination: false perception involving sight consisting of both formed images (for example, people) and unformed images ( for example, flashes of light) 5-Olfactory hallucination : false perception of smell 6-Gustatory hallucination: false perception of taste, such as unpleasant taste 7-Tactile hallucination: false perception of touch or surface sensation or under the skin. 8-Command hallucination: false perception of orders that a person may feel obliged to obey or unable to resist. 9-Somatic hallucination: false sensation of things occurring in or to the body.

26. 10-Mood – congruent hallucination : hallucination in which the content is consistent with either a depressed or a manic mood ( for example , a depressed patient hears voices saying that the patient is a bad person ; a manic patient hears voices saying that the patient is of inflated worth , power and knowledge ) 11-Mood- incongruent hallucination : hallucination in which the content is not consistent with either a depressed or a manic mood (for example , in depression hallucination not involving such themes as guilt , deserved punishment or inadequacy ; in mania , hallucinations not involving such themes as inflated worth or power )

27. 2- illusion: misperception or misinterpretation of real external sensory stimuli. B-Disturbances associated with conversion and dissociative phenomena:- 1- Macropsia: state in which objects seem lager than they are 2- Micropsia: state in which objects seem smaller than they are 3- Depersonalization: a person's subjective sense of being unreal, strange, or unfamiliar to oneself. 4- Derealization: a subjective sense that the environment is strange or unreal; a feeling of changed reality

28. VII Emotion (Mood):-
Complex feeling state with psychic, somatic, and behavioral components that is related to affect & mood .
Mood:
emotional subjective experienced and reported by the patient.
Affect:
observed expression of emotion, may be consistent with patient’s description of emotion

29. 1- Affect: Appropriate affect: condition in which the emotional tone is in harmony with the accompanying idea, thought, or speech; also described as broad full affect Inappropriate affect: disharmony between the emotional feeling tone and the idea, thought, or speech accompanying it Blunted affect: disturbance in affect manifested by a sever reduction in the intensity of externalized feeling tone Restricted or constricted affect: reduction in intensity of feeling tone less severe than blunted affect by clearly reduced. Flat affect: absence or near absence of any signs of affective expression, voice monotonous, face immobile Labile affect: rapid and abrupt changes in emotional feeling tone, unrelated to external stimuli

30. B-Mood: a pervasive and sustained emotion subjectively experienced and reported by a patient and observed by others, examples include depression, elation and anger. 1-Dysphoric mood: an unpleasant mood 2-Euthymic mood: normal range of mood, implying absence of depressed or elevated mood 3-Irritable mood: a state in which a person is easily annoyed and provoked to anger 4-Labile mood ( mood swings): oscillation between euphoria and depression or anxiety 5-Elevated mood: air of confidence and enjoyment; a mood more cheerful than usual

31. 6-Elation: feeling of joy, euphoria, intense self – satisfaction, or optimism 7-Euphoria: intense elation with feeling of grandeur 8-Ecstasy: feeling of intense rapture 9-Depression: Psychopathological feeling of sadness 10-Anhedonia: loss of interest in and withdrawal from all regular and pleasurable activities, often associated with depression. 11-Grief or mourning: feeling of sadness appropriate to real loss 12-Alexithymia: inability or difficulty in describing or being aware of one's emotions or moods.

32. Other emotions: 1-Phobia: persistent, irrational, exaggerated and invariably pathological dread of a specific stimulus or situation; results in a compelling desire to avoid the feared stimulus. 2. Anxiety: feeling of apprehension caused by anticipation of danger, which may be internal or external. 3. Fear: anxiety caused by consciously recognized and realistic danger 4. Agitation: severe anxiety associated with motor restlessness 5. Tension: increased motor and psychological activity that is unpleasant.

33. 6. Panic: a cute, episodic, intense attack of anxiety associated with over whelming feelings of dread and autonomic discharge 7. Apathy: dulled emotional tone associated with detachment or indifference 8. Ambivalence: coexistence of two opposing impulses toward the same thing in the same person at the same time 9. Guilt: emotion secondary to doing what is perceived as wrong.

34. VIII-Motor behavior: aspect of the psyche that includes impulses, motivation, wishes, drives, instincts, and cravings, as expressed by a person’s behavior or motor activity 1- Echopraxia: pathological imitation of movements of one person by another. 2-Catatonia and postural abnormalities: seen in catatonic schizophrenia and some cases of brain diseases, such as encephalitis

35. a-Catalepsy (posturing): sustained immobile position the patient initiate positions by him self. b-Waxy flexibility: condition of a person who can be molded in to a position that is the maintained, when examiner moves the person’s limb, the limb feels as if it were made of wax c-Akinesia: lack of physical movement, an in the extreme immobility of catatonic schizophrenia. It may also occur an extrapyamidal side effect of antipsychotic medication

36. 3-Negativism: motiveless resistance to all attempts to be moved or to all instruction 4-Stereotype: It's a monotonous repetition of certain movement without purpose& it involves the head or arms. E.g. foot tapping body rocking ( These seen in schizophrenia mental sub normality) 5-Mannerism: Its repetitive movement which isn't monotonous & is keeping with the personality character. 6-Automatic obedience: the performance of all simple commands in a robot – like fashion.

37. 7-Over activity: 1-Psychomotor agitation: excessive motor and cognitive over activity, usually nonproductive and in response to inner tension characterized by pacing and restlessness. 2-Hyperactivity (hyper kinesis): restless, aggressive, destructive activity, often associated with some underlying brain pathology 3-Tics: sudden involuntary, spasmodic motor movement of small groups of muscle. 4- Sleepwalking: motor activity during sleep

38. 5-Akathisia: subjective feeling of muscular tension secondary to antipsychotic or other medication, which can cause restlessness, pacing, repeated sitting and standing 6-Compulsion: uncontrollable impulse to perform an act repetitively Ataxia: failure of muscle coordination, irregularity of muscle action 7-Static Tremor: rhythmical alteration in movement, which is usually faster than one beat a second; typically, tremors decrease during periods of relaxation and sleep and increase during periods of anger and increased tension, involve hand occur in anxiety.

39. 8-Hypoactivity: decreased motor and cognitive activity, as in psychomotor – retardation, visible slowing of thought, speech and movements 9-Aggression: forceful – goal – directed action that may be in verbal or physical; the motor counterpart of the affect of rage, anger or hostility 10-Dyskinesia: difficulty in per forming voluntary movements, as in extra pyramidal disorders 11-Convulsion (seizure) an involuntary, violent muscular contraction or spasm

40. X-Insight: ability of the patient to understand the true cause and meaning of a situation (such as a set of symptoms) Another definition: ability of the patient to understand the objective condition of his illness. Types: A. Complete insight B. Loss of insight