Couvade syndrome A conversion symptom seen in partners of expect- ant mothers during their pregnancy. The symptoms vary but mimic preg- nancy symptoms and so include nausea, vomiting , abdominal pain, and food cravings. It is not delusional in nature; the affected individua l does not believe they are pregnant (cf. pseudocyesis). This behavior is a cultural norm i n some societies. Craving A subjective sense of need to consume a particular substance (e.g. drugs or alcohol ) for which there may be dependence. Cyclothymia A personality characteristic in which there is cyclical mood variation to a les ser degree than in bipolar disorder. De Cl rambault syndrome A form of delusion of love. The patient, usually female, believes that another, higher-status individual is in love with them. There may be an additional per secutory delusional compo- nent where the affected individual comes to believe that individ uals are conspiring to keep them apart. The object may be an employer or doctor, or in some cases a prominent public \201 gure or celebrity. D j vu A sense that events being experienced for the \201 rst time have been experienc ed before. An everyday experience but also a non- speci \201 c symptom of a number of diso rders including temporal lobe epi- lepsy, schizophrenia, and anxiety disorders. Delirium A clinical syndrome of confusion, variable degree of clouding of consciousness, vi sual illusions, and/or visual hallucinations, lability of affect, and disorientation. The c linical features can vary markedly in severity hour by hour. Delirium is a stereotyped resp onse by the brain to a variety of insults and is similar in presentation whatever the prima ry cause. Delirium tremens The clinical picture of acute confusional state sec- ondary to alcohol wit hdrawal. Comprises confusion, withdrawals, visual hallucinations, and, occasionally, persec utory delusions and Lilliputian hallucinations. Delusion An abnormal belief which is held with absolute subjective certainty, which require s no external proof, which may be held in the face of contradic- tory evidence, and which h as personal signi \201 cance and importance to the individual concerned. Excluded are thos e beliefs which can be understood as part of the subject \200\231s cultural or religious ba ckground. While the content is usually demonstrably false and bizarre in nature, this is no t invariably so. Primary delusions are the direct result of psychopathology, while secondary delusions can b e understood as having arisen in response to other primary psychiatric conditions (e.g. a p atient with severely depressed mood developing delusions of poverty, or a patient with prog ressive memory impairment developing a delusion that people are entering his house and stea ling or moving items). Primary delusions can be subdivided by the method by which they are perceived as having arisen or into broad classes based on their content. 03_Semple_Chap03.indd 90 12/7/2012 6:56:49 PM DICTIONARY OF PSYCHIATRIC SYMPTOMS 91 If the patient is asked to recall the point when they became aware of the delusion and its signi \201 cance to them, they may report that the belief arose: \200\230out of the blue \200\231 (autochthonous delusion); on seeing a normal percept (delusional perception); on r ecalling a memory (delusional memory); or on a background of anticipation, odd experiences, and increased aware- ness (delusional mood). Based on their content, 12 types of primary delusion are commonly recognized: persecutory, grandiose, delusions of control, of thought interference, of reference, of guilt, of love, delusional misidenti \201 cation, jealousy, hypochondriacal delusions, nihilistic delusion s, and delusions of infestation. Delusional atmosphere Synonym for delusional mood. Delusional elaboration Secondary delusions which arise in a manner which is understandable as the patient attempting to \201 nd explanations for primary psychopathological processe s (e.g. a patient with persistent audi- tory hallucinations developing a belief that a tran smitter has been placed in his ear). Delusional jealousy A delusional belief that one \200\231s partner is being unfaithful. Thi s can occur as part of a wider psychotic illness, secondary to organic brain damage (e.g. f ollowing the \200\230punch drunk syndrome \200\231 in boxers), associated with alcohol dep endence, or as a monosymptomatic delusional disorder ( \200\230Othello syndrome \200\231). Whatever the primary cause, there is a strong association with violence, usually towards th e supposedly unfaithful partner. For this type of delusion the content is not bizarre or in conceivable and the central belief may even be true. Delusional memory A primary delusion which is recalled as arising as a result of a memory ( e.g. a patient who remembers his parents taking him to hospital for an operation as a child becoming convinced that he had been implanted with control and monitoring devices which ha ve become active in his adult life). Delusional misidenti \201 cation A delusional belief that certain individu- als are not wh o they externally appear to be. The delusion may be that familiar people have been replaced with outwardly identical strangers (Capgras syndrome) or that strangers are \200\230reall y \200\231 familiar people (Fr goli syndrome). A rare symptom of schizophrenia or of other psychotic illnesses. Delusional mood A primary delusion which is recalled as arising follow- ing a period when t here is an abnormal mood state characterized by antici- patory anxiety, a sense of \200 \230something about to happen \200\231, and an increased sense of the signi \201 cance of minor events. The development of the formed delusion may come as a relief to the patient in this situation. Delusional perception A primary delusion which is recalled as having arisen as a result of a perception (e.g. a patient who, on seeing two white cars pull up in front of his house be came convinced that he was therefore about to be wrongly accused of being a pedophile). The percept is a real external object, not a hallucinatory experience. 03_Semple_Chap03.indd 91 12/7/2012 6:56:49 PM CHAPTER 3 Symptoms of psychiatric illness 92 Delusions of control A group of delusions which are also known as passivity phenomena or de lusions of bodily passivity. They are considered \201 rst-rank symptoms of schizophrenia. The core feature is the delusional belief that one is no longer in sole control of one \200\231s own body. The indi- vidual delusions are that one is being forced by some externa l agent to feel emotions, to desire to do things, to perform actions, or to experience bod- ily sensations. Respectively these delusions are called: passivity of affect, passivity of impulse, passivity of volition, and somatic passivity. Delusions of guilt A delusional belief that one has committed a crime or other reprehensibl e act. A feature of psychotic depressive illness (e.g. an elderly woman with severe depress ive illness who becomes convinced that her child, who died by cot death many years before, was in fact mur- dered by her). Delusions of infestation A delusional belief that one \200\231s skin is infested with multi ple, tiny mite-like animals. As a monosymptomatic delusional disorder this is called Ekbom syndrome. It is also seen in acute confu- sional states (particularly secondary to drug or alcohol withdrawal), in schizophrenia, in dementing illnesses, and as delusional elaboratio n of tactile hallucinatory experiences. Delusions of love A delusion where the patient believes another individ- ual is in love wit h them and that they are destined to be together. A rare symptom of schizophrenia and other psychotic illnesses, one particular subtype of this delusion is de Cl rambault syndrome. Delusions of reference A delusional belief that external events or situ- ations have been a rranged in such a way as to have particular signi \201 cance for, or to convey a message t o, the affected individual. The patient may believe that television news items are referrin g to him or that parts of the Bible are about him directly. Delusions of thought interference A group of delusions which are considered \201 rst-rank symptoms of schizophrenia. They are thought insertion, thought withdrawal, and thought bro adcasting. Dementia Chronic brain failure \200\224in contrast with delirium (which is acute brain fail ure). In dementia, there is progressive and global loss of brain function. It is usually ir reversible. Different dementing illnesses will show different patterns and rate of function al loss but, in general, there is impairment of memory, loss of higher cognitive function, perceptual abnormalities, dyspraxia, and disintegration of the personality. Dependence The inability to control intake of a substance to which one is addicted. The dep endence syndrome (b p. 542) is characterized by pri- macy of drug-seeking behavior, inabili ty to control intake of the substance once consumption has started, use of the substance to avoid withdrawals, increased tolerance to the intoxicating effects of the substance, and r e- instigation of the pattern of use after a period of abstinence. Dependence has two compo nents: psychological dependence, which is the subjective feeling of loss of control, cravin gs, and preoccupation with obtaining the substance; and physiological dependence, which is the physical conse- quences of withdrawal and is speci \201 c to each drug. For some drugs (e.g. 03_Semple_Chap03.indd 92 12/7/2012 6:56:49 PM DICTIONARY OF PSYCHIATRIC SYMPTOMS 93 alcohol) both psychological and physiological dependence occur; for others (e.g. LSD) there are no marked features of physiological dependence. Depersonalization An unpleasant subjective experience where the patient feels as if they ha ve become \200\230unreal \200\231. A non-speci \201 c symptom occurring in many psychiatr ic disorders as well as in normal people. Depressed mood The core feature of depressive illness. Milder forms of depressed mood are p art of the human experience, but in its pathological form it is a subjective experience. Pa tients describe variously: an unremit- ting and pervasive unhappiness; a loss of the abilit y to experience the normal range of positive emotions ( \200\230feeling of a lack of feelin g \200\231); a sense of hopelessness and negative thoughts about themselves, their situatio n, and the future; somatic sensations of \200\230a weight \200\231 pressing down on head a nd body; and a sort of \200\230psychic pain \200\231 or wound. Depressive sleep disturbance Characteristic pattern of sleep disturbance seen in depressive illness. It includes initial insomnia and early morning waking. In addition, sleep is desc ribed as more shallow, broken, and less refreshing. There is increased rapid eye movement ( REM) latency, where the patient enters REM sleep more rapidly than normal and REM sleep is concentrated in the beginning rather than the end of the sleep period. Derailment A symptom of schizophrenic thought disorder in which there is a total break in t he chain of association between the meaning of thoughts. The connection between the two seq uential ideas is apparent neither to the patient nor to the examiner. Derealization An unpleasant subjective experience where the patient feels as if the world h as become unreal. Like depersonalization it is a non- speci \201 c symptom of a number of disorders. Diogenes syndrome Hoarding of objects, usually of no practical use, and the neglect of one \200\231s home or environment. May be a behavioral manifestation of an organic disorder, sc hizophrenia, depressive disorder, or obsessive \200\223compulsive disorder; or re \202 ect a reaction late in life to stress in a certain type of personality. Disinhibition Loss of the normal sense of which behaviors are appropri- ate in the current social setting. Symptom of manic illnesses and occurs in the later stages of dementing illn esses and during intoxication with drugs or alcohol. Disorientation Loss of the ability to recall and accurately update infor- mation as to curr ent time, place, and personal identity. Occurs in delirium and dementia. With increasing se verity of illness, orientation for time is lost \201 rst, then orientation for place, wit h orientation for person usually preserved until dysfunction becomes very severe. Dissociation The separation of unpleasant emotions and memories from consciousness awarenes s with subsequent disruption to the normal inte- grated function of consciousness and memor y. Conversion and dissociation are related concepts. In conversion the emotional abnormalit y produces physical symptoms; while in dissociation there is impairment of mental func- tio ning (e.g. in dissociative fugue and dissociative amnesia). 03_Semple_Chap03.indd 93 12/7/2012 6:56:49 PM CHAPTER 3 Symptoms of psychiatric illness 94 Distractibility Inability to maintain attention or the loss of vigilance on minimal distrac ting stimulation. Diurnal variation A variation in the severity of a symptom depending on the time of day (e. g. depressed mood experienced as most severe in the morning and improving later in the day) . Double depression A combination of dysthymia and depressive illness. Dysarthria Impairment in the ability to properly articulate speech. Caused by lesions in br ainstem, cranial nerves, or pharynx. Distinguished from dysphasia in that there is no impai rment of comprehension, writing, or higher language function. Dyskinesia The impairment of voluntary motor activity by superimposed involuntary motor act ivity. Dyslexia Inability to read at the level normal for one \200\231s age or intelligence level. Dysmorphophobia A type of over-valued idea where the patient believes one aspect of his bod y is abnormal or conspicuously deformed. Dysphasia Impairment in producing or understanding speech (expres- sive dysphasia and recep tive dysphasia respectively) related to cortical abnormality, in contrast with dysarthria w here the abnormality is in the organs of speech production. Dysphoria An emotional state experienced as unpleasant. Secondary to a number of symptoms ( e.g. depressed mood, withdrawals). Dyspraxia Inability to carry out complex motor tasks (e.g. dressing, eat- ing) although the component motor movements are preserved. Dysthymia Chronic, mildly depressed mood and diminished enjoyment, not severe enough to be considered depressive illness. Early morning waking (EMW) Feature of depressive sleep disturbance. The patient wakes in th e very early morning and is unable to return to sleep. Echo de la pens e Synonym for thought echo. Echolalia The repetition of phrases or sentences spoken by the exam- iner. Occurs in schizo phrenia and mental retardation. Echopraxia Motor symptom of schizophrenia in which the patient mirrors the doctor \200\231s body movements. This continues after being told to stop. Eidetic imagery Particular type of exceptionally vivid visual memory. Not a hallucination. More common in children than adults, cf. \202 ashbacks. Ekbom syndrome A monosymptomatic delusional disorder where the core delusion is a delusion of infestation. Elation Severe and prolonged elevation of mood. A feature of manic illnesses. Elemental hallucination A type of hallucination where the false per- ceptions are of very s imple form (e.g. \202 ashes of light or clicks and bangs). Associated with organic illnes s. 03_Semple_Chap03.indd 94 12/7/2012 6:56:49 PM DICTIONARY OF PSYCHIATRIC SYMPTOMS 95 Elevation of mood The core feature of manic illnesses. The mood is preternaturally cheerful , the patient may describe feeling \200\230high \200\231, and there is subjectively increa sed speed and ease of thinking. Entgleisen Synonym for derailment. Entgleiten Synonym for thought blocking or snapping off. Erotomania Synonym for delusions of love. Euphoria Sustained and unwarranted cheerfulness. Associated with manic states and organic i mpairment. Euthymia A \200\230normal \200\231 mood state, neither depressed nor manic. Expressive dysphasia Dysphasia affecting the production of speech. There is impairment of w ord- \201 nding, sentence construction, and articulation. Speech is slow and \200\230telegraphic \200\231, with substitutions, null words, and per- severation. The patient characteristically exhibits considerable frustration at his de \201 cits. Writing is similarly affected. Basic comprehension is largely intact and emotion al utterances and rote learned material may also be surprisingly preserved. Extracampine hallucination A hallucination where the percept appears to come from beyond th e area usually covered by the senses (e.g. a patient in Edinburgh \200\230hearing \200\231 voices seeming to come from a house in Glasgow). Extra-pyramidal side-effects (EPSEs) Side-effects of rigidity, tremor, and dyskinesia cause d by the anti-dopaminergic effects of psychotropic drugs, particularly neuroleptics. Unlike in idiopathic Parkinson \200\231s disease, bradykinesia is not prominent. Ey syndrome Synonym for Othello syndrome. False perceptions Internal perceptions which do not have a corre- sponding object in the ex ternal or \200\230real \200\231 world. Includes hallucinations and pseudo-hallucinations. Faseln Synonym for muddling. First-rank symptoms (of schizophrenia) A group of symptoms origi- nally described by Schnei der which are useful in the diagnosis of schizo- phrenia. They are neither pathognomic for, nor speci \201 c to, schizophrenia and are also seen in organic and affective psychoses. There are 11 symp- toms in 4 categories: Auditory hallucinations \200 \200\230Voices heard arguing \200\231. \200 Thought echo. \200 \200\230Running commentary \200\231. Delusions of thought interference \200 \200 \200 Thought insertion. Thought withdrawal. Thought broadcasting. 03_Semple_Chap03.indd 95 12/7/2012 6:56:50 PM CHAPTER 3 Symptoms of psychiatric illness 96 Delusions of control \200 Passivity of affect. \200 Passivity of impulse. \200 Passiv ity of volitions. \200 Somatic passivity. Delusional perception \200 A primary delusion of any content that is reported by the patient as having arisen followin g the experience of a normal perception. Flashbacks Exceptionally vivid and affect-laden re-experiencing of remembered experiences. Flashbacks of the initial traumatic event occur in PTSD and \202 ashbacks to abnormal per ceptual experiences initially expe- rienced during lysergic acid diethylamide (LSD) intoxic ation can occur many years after the event. Flattening of affect Diminution of the normal range of emotional expe- rience. A negative s ymptom of schizophrenia. Flexibilitas cerea Synonym for catalepsy. Flight of ideas Subjective experience of one \200\231s thoughts being more rapid than norma l, with each thought having a greater range of conse- quent thoughts than normal. Meaningfu l connections between thoughts are maintained. Folie deux Describes a situation where two people with a close rela- tionship share a de lusional belief. This arises as a result of a psychotic illness in one individual with deve lopment of a delusional belief, which comes to be shared by the second. The delusion resolv es in the second person on separation, the \201 rst should be assessed and treated in the usual way. Formal thought disorder A term which is confusingly used for three different groups of psyc hiatric symptoms: \200 \200 \200 To refer to all pathological disturbances in the form of thought. As a synonym for To mean the group of \201 rst-rank symptoms which are delusions regarding thought interference (i .e. thought insertion, thought withdrawal, and thought broadcasting). schizophrenic thought disorder. The \201 rst of these uses is to be preferred. Formication A form of tactile hallucination in which there is the sensa- tion of numerous i nsects crawling over the surface of the body. Occurs in alcohol or drug withdrawal, particu larly from cocaine. Free- \202 oating anxiety Anxiety occurring without any identi \201 able exter- nal stimu lus or threat (cf. Phobia). Fr goli syndrome A type of delusional misidenti \201 cation in which the patient believes that strangers have been replaced with familiar people. Fugue A dissociative reaction to unbearable stress. Following a severe external stressor (e .g. marital break-up) the affected individual develops global amnesia and may wander to a d istant location. Consciousness is 03_Semple_Chap03.indd 96 12/7/2012 6:56:50 PM DICTIONARY OF PSYCHIATRIC SYMPTOMS 97 unimpaired. Following resolution there is amnesia for the events which occurred during the fugue. Functional hallucination A hallucination experienced only when expe- riencing a normal perc ept in that modality (e.g. hearing voices when the noise of an air conditioner is heard). Fusion A symptom of schizophrenic thought disorder in which two or more unrelated concepts are brought together to form one compound idea. Ganser symptom The production of \200\230approximate answers \200\231. Here the patient gi ves repeated wrong answers to questions which are nonethe- less \200\230in the right ballp ark \200\231 (e.g. \200\230what is the capital of Scotland? \200\231 \200\224 \200\230Pari s \200\231). Occasionally associated with organic brain illness it is much more com- monly seen as a form of malingering in those attempting to feign mental illness (e.g. in prisoner s awaiting trial). Gedankenlautwerden Synonym for thought echo. Globus hystericus The sensation of a \200\230lump in the throat \200\231 occurring without oesophageal structural abnormality or motility problems. A symp- tom of anxiety and somati zation disorders. Glossolalia \200\230Speaking in tongues \200\231. Production of non-speech sounds as a sub stitute for speech. Seen in dissociative and neurotic disorders and accepted as a subcultur al phenomenon in some religious groups. Grandiose delusion A delusional belief that one has special powers, is unusually rich or po werful, or that one has an exceptional destiny (e.g. a man who requested admission to hospi tal because he had become con- vinced that God had granted him \200\230the greatest possib le sort of mind \200\231 and that coming into contact with him would cure others of mental illnesses). Occurs in all psychotic illnesses but particularly in manic illnesses. Grandiosity An exaggerated sense of one \200\231s own importance or abilities. Seen in mani c illnesses. Hallucination An internal percept without a corresponding external object. The subjective e xperience of hallucination is that of experiencing a normal percept in that modality of sen sation. A true hallucination will be perceived as in external space, distinct from imagined images, outside conscious control, and as possessing relative permanence. A pseudo- halluc ination will lack one or all of these characteristics. Hallucinations are subdivided according to their modality of sensation and may be auditory, visual, gustatory, tactile, olfactory, or kinaesthetic. Auditory hallucinations, particula rly of voices, are characteristic of schizophrenic ill- ness, while visual hallucinations a re characteristic of organic states. Hemiballismus Involuntary, large-scale, \200\230throwing \200\231 movements of one limb or one body side. Hypersomnia Excessive sleepiness with increased length of nocturnal sleep and daytime nappi ng. Occurs as core feature of narcolepsy and in atypical depressive states. Hypnagogic hallucination A transient false perception experienced while on the verge of fal ling asleep (e.g. hearing a voice calling one \200\231s name 03_Semple_Chap03.indd 97 12/7/2012 6:56:50 PM CHAPTER 3 Symptoms of psychiatric illness 98 which then startles you back to wakefulness to \201 nd no-one there). The same phenomenon experienced while waking up is called hypnopompic hallucination. Frequently experienced by healthy people and so not a symptom of mental illness. Hypnopompic hallucination See Hypnagogic hallucination. Hypochondriacal delusion A delusional belief that one has a serious physical illness (e.g. cancer, AIDS). Most common in psychotic depressive illnesses. Hypochondriasis The belief that one has a particular illness despite evidence to the contra ry. Its form may be that of a primary delusion, an over-valued idea, a rumination, or a moo d-congruent feature of depressive illness. Hypomania Describes a mild degree of mania where there is elevated mood but no signi \201 cant impairment of the patient \200\231s day-to-day functioning. Illusion A type of false perception in which the perception of a real world object is combi ned with internal imagery to produce a false internal percept. Three types are recognized: affect, completion, and pareidolic illusions. In affect illusion there is a combination of heightened emotion and mis- perception (e.g. whilst walking across a lonely park at night, brie \202 y seeing a tree moving in the wind as an attacker). Completion illusions rely on our brain \200\231s tendency to \200\230 \201 ll in \200\231 presumed missing parts of a n object to produce a meaningful percept and are the basis for many types of optical illusi on. Both these types of ilusions resolve on closer attention. Pareidolic illusions are mean ingful percepts produced when experiencing a poorly de \201 ned stimulus (e.g. seeing face s in a \201 re or clouds). Imperative hallucination A form of command hallucination in which the hallucinatory instruc tion is experienced as irresistible, a combination of command hallucination and passivity o f action. Impotence Loss of the ability to consummate sexual relationships. Refers to inability to ac hieve penile erection in men and lack of genital prepared- ness in women. It may have a pri mary medical cause, be related to psycho- logical factors, or can be a side-effect of many psychotropic medications. Incongruity of affect Refers to the objective impression that the displayed affect is not c onsistent with the current thoughts or actions (e.g. laughing while discussing traumatic ex periences). Occurs in schizophrenia. Initial insomnia Dif \201 culty getting off to sleep. Seen as a symptom of primary insomni a as well as in depressive sleep disturbance. Insightlessness See Lack of insight. Irritability Diminution in the stressor required to provoke anger or ver- bal or physical v iolence. Seen in manic illnesses, organic cognitive impair- ment, psychotic illnesses, and drug and alcohol intoxication. Can also be a feature of normal personality types and of per sonality disorder. Jamais vu The sensation that events or situations are unfamiliar, although they have been e xperienced before. An everyday experience but also a non-speci \201 c symptom of a number of disorders including temporal lobe epilepsy, schizophrenia, and anxiety disorders. 03_Semple_Chap03.indd 98 12/7/2012 6:56:50 PM DICTIONARY OF PSYCHIATRIC SYMPTOMS 99 Knight \200\231s move thinking Synonym for derailment. Lability of mood Marked variability in the prevailing affect. Lack of insight Loss of the ability to recognize that one \200\231s abnormal experiences ar e symptoms of psychiatric illness and that they require treatment. Lilliputian hallucination A type of visual hallucination in which the subject sees miniatur e people or animals. Associated with organic states, particularly delirium tremens. Logoclonia Symptom of Parkinson \200\231s disease where the patient gets \200\230stuck \200\231 on a particular word of a sentence and repeats it. Logorrhoea Excess speech or \200\230verbal diarrhea \200\231. Symptom of mania. Loosening of associations A symptom of formal thought disorder in which there is a lack of meaningful connection between sequential ideas. Loss of libido Loss of the desire for sexual activity. Common in depres- sive illness and s hould be inquired about directly as it is usually not men- tioned spontaneously. Should be distinguished from impotence. Magical thinking A belief that certain actions and outcomes are con- nected although there is no rational basis for establishing a connection (e.g. \200\230if you step on a crack, y our mother will break her back \200\231). Magical thinking is common in normal children and is the basis for most supersti- tions. A similar type of thinking is seen in psychotic pat ients. Malingering Deliberately falsifying the symptoms of illness for a second- ary gain (e.g. fo r compensation, to avoid military service, or to obtain an opiate prescription). Mania A form of mood disorder initially characterized by elevated mood, insomnia, loss of a ppetite, increased libido, and grandiosity. More severe forms develop elation and grandiose delusions. Mannerism Abnormal and occasionally bizarre performance of a volun- tary, goal-directed act ivity (e.g. a conspicuously dramatic manner of walk- ing. Imagine John Cleese \200\231s \200\230the minister of funny walks \200\231). Mental retardation Diminished intelligence below the second standard deviation (IQ <70). In creasing severity of retardation is associated with decreased ability to learn, to solve pr oblems, and to understand abstract concepts. Subdivided as: mild: 50 \200\22369; moderate 3 5 \200\22349; severe 20 \200\22334; pro- found 0 \200\22319. Micrographia Small \200\230spidery \200\231 handwriting seen in patients with Parkinson \200\231s disease; a consequence of being unable to control \201 ne movements. This is mo st easily recognized by comparing their current signature with one from a number of years p reviously. Middle insomnia Wakefulness and inability to return to sleep occurring in the middle part o f the night. 03_Semple_Chap03.indd 99 12/7/2012 6:56:50 PM CHAPTER 3 Symptoms of psychiatric illness 100 Mirror sign Lack of recognition of one \200\231s own mirror re \202 ection with the percep tion that the re \202 ection is another individual who is mimicking your actions. Seen in dementia. Mitgehen An extreme form of mitmachen where the patient \200\231s limbs can be moved to any position by very slight or \201 ngertip pressure ( \200\230angle-poise lamp sign \200 \231). Mitmachen A motor symptom of schizophrenia where the patient \200\231s limbs can be moved w ithout resistance to any position (cf. mitgehen). The limbs return to their resting state o nce the examiner lets go, in con- trast with catalepsy, where the limbs remain in their set positions for prolonged periods. Mood The subjective emotional state over a period of time, in contrast to affect which desc ribes the emotional response to a particular situation or event. Mood congruent A secondary symptom which is understandable in the light of an abnormal mood state (e.g. a severely depressed patient devel- oping a delusion that they are in severe d ebt, or a manic patient develop- ing a delusion that they are exceptionally wealthy). Morbid jealousy Synonym for delusional jealousy. Motor symptoms of schizophrenia. Schizophrenic illness is associ- ated with a variety of so ft neurological signs and motor abnormalities. In the modern era many motor abnormalities w ill be attributed to the side- effects of neuroleptic drugs, but all were described in schi zophrenic patients prior to the introduction of these drugs in 1952. Recognized motor symptoms in schizophrenia include: catatonia, cata- lepsy, automatic obedi ence, negativism, ambitendency, mitgehen, mit- machen, mannerism, stereotypy, echopraxia, a nd psychological pillow. Muddling A feature of schizophrenic thought disorder caused by simul- taneous derailment an d fusion. The speech so produced may be very bizarre. Multiple personality The \201 nding of two or more distinct \200\230personali- ties \200 \231 in one individual. These personalities may answer to different names, exhibit markedly different behaviors, and describe amnesia for periods when other personalities were active . This symptom is most probably an iatrogenic condition produced during exploratory psychot herapy in sug- gestible individuals. Mutism Absence of speech without impairment of consciousness. Negative symptoms (of schizophrenia) The symptoms of schizo- phrenia which re \202 ect imp airment of normal function. They are: lack of volition, lack of drive, apathy, anhedonia, \202 attening of affect, blunting of affect, and alogia. Believed to be related to cortica l cell loss. Negativism A motor symptom of schizophrenia where the patient resists carrying out the exam iner \200\231s instructions and his attempts to move or direct the limbs. 03_Semple_Chap03.indd 100 12/7/2012 6:56:50 PM DICTIONARY OF PSYCHIATRIC SYMPTOMS 101 Neologism A made-up word or normal word used in an idiosyncratic way. Neologisms are found in schizophrenic speech. Nihilistic delusions A delusional belief that the patient has died or no longer exists or t hat the world has ended or is no longer real. Nothing matters any longer and continued effo rt is pointless. A feature of psychotic depressive illness. Nystagmus Involuntary oscillating eye movements. Obsession An idea, image, or impulse which is recognized by the patient as their own, but w hich is experienced as repetitive, intrusive, and distress- ing. The return of the obsessio n can be resisted for a time at the expense of mounting anxiety. In some situations the anx iety accompanying the obses- sional thoughts can be relieved by associated compulsions (e.g . a patient with an obsession that his wife may have come to harm feeling compelled to phon e her constantly during the day to check she is still alive). Othello syndrome A monosymptomatic delusional disorder where the core delusion has the cont ent of delusional jealousy. Over-valued ideas A form of abnormal belief. These are ideas which are reasonable and under standable in themselves but which come to unrea- sonably dominate the patient \200\231s lif e. Palimpsest Episode of discrete amnesia related to alcohol or drug intoxi- cation. The indiv idual has no recall for a period when, although intoxicated, he appeared to be functioning normally. This is also commonly known as \200\230blackout \200\231, but the term palimpses t is preferable as it avoids confusion with episodes of loss of consciousness. Panic attack Paroxysmal, severe anxiety. May occur in response to a particular stimulus or occur without apparent stimulus. Paranoid delusion Strictly speaking this describes self-referential delu- sions (i.e. grand iose delusions and persecutory delusions). It is however more commonly used as a synonym fo r persecutory delusion. Paraphasia The substitution of a non-verbal sound in place of a word. Occurs in organic les ions affecting speech. Passivity phenomena Synonym for delusions of control. Persecutory delusion A delusional belief that one \200\231s life is being inter- fered with in a harmful way. Perseveration Continuing with a verbal response or action which was initially appropriate a fter it ceases to be apposite (e.g. \200\230Do you know where you are? \200\231 \200\224 \200\230in the hospital \200\231; \200\230do you know what day it is? \200\231 \200\224 \200\230in the hospital \200\231. Associated with organic brain disease and is occasionally seen in schizophrenia). Phantom mirror image Synonym for autoscopy. Phobia A particular stimulus, event, or situation which arouses anxiety in an individual an d is therefore associated with avoidance. The concept of \200\230biological preparedness \200\231 is that some fears (e.g. of snakes, \201 re, heights) had 03_Semple_Chap03.indd 101 12/7/2012 6:56:50 PM CHAPTER 3 Symptoms of psychiatric illness 102 evolutionary advantage and so it is easier to develop phobias for these stimuli than other, more evolutionarily recent threats (e.g. of guns or electric shock). Physiological dependence See Dependence. Pica The eating of things which are not food or of food items in abnormal quantities. Positive symptoms (of schizophrenia) The symptoms of schizophre- nia which are qualitativel y different from normal experience (i.e. delu- sions, hallucinations, schizophrenic thought disorder). Believed to be related to neuro-chemical abnormalities. Posturing The maintenance of bizarre and uncomfortable limb and body positions. Associated with psychotic illnesses and may have delusional sig- ni \201 cance to the patient. Pressure of speech The speech pattern consequent upon pressure of thought. The speech is ra pid, dif \201 cult to interrupt, and, with increasing severity of illness, the connection between sequential ideas may become increasingly hard to follow. Occurs in manic illness. Pressure of thought The subjective experience of one \200\231s thoughts occur- ring rapidly , each thought being associated with a wider range of conse- quent ideas than normal and wi th inability to remain on one idea for any length of time. Occurs in manic illness. Priapism A sustained and painful penile erection, not associated with sexual arousal. A rar e side-effect of antidepressant medication. If not relieved can cause permanent penile dama ge. Pseudocyesis A false pregnancy. May be hysterical or delusional in nature and can occur in both sexes although more commonly in women. The belief in the false pregnancy may be accomp anied by abdominal distension, lumbar lordosis, and amenorrhoea. Pseudodementia A presentation of severe depression in the elderly where the combination of psychomotor retardation, apparent cognitive de \201 cits, and functional decline causes di agnostic confusion with dementia. Pseudo-hallucination A false perception which is perceived as occur- ring as part of one \200\231s internal experience, not as part of the external world. It may be described as ha ving an \200\230as if \200\231 quality or as being seen with the mind \200\231s eye. Addit ionally, hallucinations experienced as true hallucinations during the active phase of a pat ient \200\231s illness may become perceived as pseudo-hallucinations as they recover. They can occur in all modalities of sensation and are described in psychotic, organic, and drug- induced conditions as well as occasionally in normal individuals. (The hallucinations of de ceased spouses commonly described by widows and widowers may have the form of a pseudo-hall ucination.) Pseudologica fantastica The production of convincing false accounts, often with apparent si ncere conviction. There may be a grandiose or over- exaggerated \202 avour to the account s produced. A feature of Munchausen \200\231s disease. 03_Semple_Chap03.indd 102 12/7/2012 6:56:50 PM DICTIONARY OF PSYCHIATRIC SYMPTOMS 103 Psychic anxiety See anxiety. Psychogenic polydipsia Excessive \202 uid intake without organic cause. Psychological dependence See Dependence. Psychological pillow A motor symptom of schizophrenia. The patient holds their head several inches above the bed while lying and can maintain this uncomfortable position for prolonge d periods of time. Psychomotor agitation A combination of psychic anxiety and excess and purposeless motor act ivity. A symptom common to many mental ill- nesses and found in normal individuals in respo nse to stress. Psychomotor retardation Decreased spontaneous movement and slowness in instigating and comp leting voluntary movement. Usually asso- ciated with subjective sense of actions being more of an effort and with subjective retardation of thought. Occurs in moderate to severe depr es- sive illness.