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