Symptoms and Signs in Psychiatry

Dr. Wendel Abel

Objectives

Basic understanding of signs and symptoms in psychiatry

Classification
DSM Diagnostic and Statistical Manual

ICD International

Classification

Diagnostic and Statistical Manual

International Classification (ICD)

Definition

Signs: Objective findings elicited by clinician. Symptoms: Subjective experiences reported by the patient. Syndrome: Group of symptoms and signs

Major Disorders

Psychotic Disorder - Schizophrenia Mood Disorders Depression and Bipolar Disorder Anxiety Disorders

Emotion

Emotion: Complex feeling state and involves affect and mood.

Affect
Observed expression of emotion Warm affect: Expressed emotion is appropriate Blunted affect: Expressed emotion is reduced.

Mood

Pervasive emotion. Subjectively experienced and reported by the patient. Euthymic mood: Normal Depressed mood: Depression Elated mood: Mania

Expression of Mood I Message Techniques

I Feel . Because.. What I want/prefer..

Perception

Process by which sensory stimuli brought to awareness.

Disorders in Perception
Hallucination Illusion

Hallucination
Hallucination= Perception+ No stimulus

False sensory perception occurring in the absence of specific stimulus.

Hallucinations
Sense modality Hearing Hallucination Auditory most common Voices threatening, obscene, accusatory, insulting Voices- conversing, commenting Visual - Common Tactile, Somatic Olfactory Gustatory

Sight Touch Smell Taste

Hallucinations
Hypnogogic Occurring while falling asleep. Not pathological. Hypnopompic- Occurring while awakening. Not pathological. Hallucinations occur in psychotic

Illusion
Perception: Misperception of stimulus

Disorders in Thought

Thought form

Thought content - Delusions

Thought form

Neologism: New words Word salad: Incoherent mixture of words Loosening of association: Ideas shift from one subject o another

Delusion
Fixed, False Belief, inappropriate to socio-cultural background. Fixed not amenable to reasoning

Delusions

Delusions of persecution Delusions of Jealousy Delusions of Guilt Delusions of grandeur Religious delusions Somatic delusions Delusions of reference Delusions of being controlled

Psychotic Disorder
Hallucinations Delusions Disorder in thought Form

Depression

Mood Depressed

Bipolar Disorder

Mood elated

Mood Disorders Symptoms

Depression Mood Interest/pleasure Depressed Decreased Mania (Bipolar) Elevated/ elated Increased involvement in pleasurable activities Decreased need Increased goal directed activity/agitation Increased Grandiose Racing thoughts, flight of ideas Grandiose

Sleep Psychomotor

insomnia Decreased (typical)

Energy Feelings Thinking Ideation

Decreased (easily fatigued) Worthlesness/excessive guilt/may be delusional Decreased (difficulty concentrating) Thoughts of death/ suicidal

Major Depression

Depressed Mood (sad mood or tearfulness) Loss of interest/pleasure in all activities Weight loss or weight gain Sleep disturbances ( insomnia or hypersomnia) Fatigue or loss of energy Feelings of worthlessness/ excessive, inappropriate guilt Difficulty concentrating/ indecisiveness Thoughts of death or suicide

MAJOR DEPRESSION

5
symptoms

2
weeks

Anxiety Disorders

ANXIETY DISORDERS
Disorders characterized by anxiety symptoms: - Panic Disorder - Phobias - OCD - PTSD - Generalized Anxiety Disorder -

Anxiety Symptoms
SKIN: sweating, hot flushes, chills, paresthesias, tingling sensation CNS: dizziness, unsteady, lightheadedness PSYCHOLOGICAL: fear of going crazy, fear of losing control, fear of dying, depersonalization, derealization RESP: choking sensation, chest pain/discomfort, SOB CVS: palpitations, pounding heart GIT: nausea, abdominal distress

ANXIETY DISORDERS

PANIC DISORDER sudden onset, sporadic (recurrent), short lived PHOBIA associated with a stimulus (object, situation) OCD Obsessions and compulsions GENERALISED ANXIETY DISORDER PTSD ASSOCIATED WITH TRAUMA

PANIC DISORDER

Sudden onset Spontaneous (no stimulus) Short lived - minutes Sporadic (recurrent) Persistent worry/concern Agoraphobia Substance abuse

OCD

Obsessions thoughts (recurrent, intrusive) Compulsions- behavior Anxiety Anxiety

Obsessions Compulsions

PTSD

Trauma Exposure: (disaster, MVA,

rape etc)

Witness it, Experience it, Told about it

Re-experience trauma- (recollections,

flashbacks, nightmares, bad dreams)

Avoidance (thoughts, people, places,

things)

Memory

activated

GAD

Excessive anxiety and worry, for more days than not for 6 months, about a number of events or activities

Worry is difficult to control

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994.

32 year old male, presents with sudden onset of chest pain 2 weeks ago. Since then he has been having frequent episodes of SOB & palpitations. During these episodes he feels he is going to die. He has difficulty sleeping at nights. He cannot leave his house alone and he has to be

Cognitive Disorders

Delirium Dementia Amnestic Disorders

Cognitive Disorders

Delirium Dementia

Vascular Alzheimer's Disease

Delirium

Changes in consciousness Changes in cognition ( memory, orientation, language) Perceptual disturbance Acute onset, fluctuating course

Dementia

Memory impairment (short term first) Aphasia (language disturbance) Apraxia (inability to carry out motor activity despite intact motor function) Agnosia (failure to recognize objects despite intact sensory function) Executive function impaired (SOAP)

Case 1
32 year old male, presents with sudden onset of chest pain 2 weeks ago. Since then he has been having frequent episodes of SOB & palpitations. During these episodes he feels he is going to die. He has difficulty sleeping at nights. He cannot leave his house alone and he

Case 2

52 yo female. Presents to GP for the first time. She states that she is always keyed up and on edge and has been having nightmares about an accident that she was involved in some years ago. She states that her close friend died in the accident and she has been experiencing what she describes as movies of it all happening over again while awake. She reports that she has difficulty discussing these events as they are very distressing. She has

Case 3

59 yo female, teacher, retires next school year Presents with sad mood, difficulty sleeping at nights with early morning wakening, heaviness in head, crawling sensation on top of head X 6/12. Difficulty concentrating in class She was extremely tearful in office What is the diagnosis?