Term
posture
is erect, and position is relaxed |
|
Definition
sitting on edge of chair or curled in bed, tense muscles, frowning, darting watchful eyes, restless pacing occur with anxiety and with hyperthyroidism
sitting slumped in chair, slow walk, dragging feet occur with depression and some organic brain diseases |
|
|
Term
Body Movements.
Body movements
are voluntary, deliberate, coordinated, and smooth and even. |
|
Definition
Restless, fidgety movements or hyperkinetic appearance occurs with anxiety.
Apathy and psychomotor slowing occur with depression and dementia.
Abnormal posturing and bizarre gestures occur with schizophrenia.
Facial grimaces. |
|
|
Term
Dress.
Dress
is appropriate for setting, season, age, gender, and social group. Clothing fits and is put on appropriately. |
|
Definition
Inappropriate dress can occur with organic brain syndrome.
Eccentric dress combination and bizarre makeup occur with schizophrenia or manic syndrome. |
|
|
Term
Grooming and Hygiene.
The person is clean and well groomed; hair is neat and clean; women have moderate or no makeup; men are shaved, or beard or mustache is well groomed. Nails are clean (although some jobs leave nails chronically dirty). Note: A disheveled appearance in a previously well-groomed person is significant. Use care in interpreting clothing that is disheveled, bizarre, or in poor repair, piercings, and tattoos, because these sometimes reflect the person's economic status or a deliberate fashion trend (especially among adolescents). |
|
Definition
Unilateral neglect (total inattention to one side of body) occurs following some cerebrovascular accidents.
Inappropriate dress, poor hygiene, and lack of concern with appearance occur with depression and severe Alzheimer disease. Meticulously dressed and groomed appearance and fastidious manner may occur with obsessive-compulsive disorders. |
|
|
Term
Level of Consciousness.
The person is awake, alert, aware of stimuli from the environment and within the self, and responds appropriately and reasonably soon to stimuli. |
|
Definition
Loses track of conversation, falls asleep.
Lethargic (drowsy), obtunded (confused) (see Table 5-3, Levels of Consciousness, p. 83). |
|
|
Term
Facial Expression.
The look is appropriate to the situation and changes appropriately with the topic. There is comfortable eye contact unless precluded by cultural norm (e.g., American Indian). |
|
Definition
| Flat, masklike expression occurs with parkinsonism and with depression. |
|
|
Term
Speech.
Judge the quality of speech by noting that the person makes laryngeal sounds effortlessly and shares conversation appropriately. |
|
Definition
Dysphonia is abnormal volume, pitch (see Table 5-4, Speech Disorders, p. 84).
Monopolizes interview. Silent, secretive, or uncommunicative. |
|
|
Term
| The pace of the conversation is moderate, and stream of talking is fluent. |
|
Definition
| Slow, monotonous speech with parkinsonism, depression. Rapid-fire, pressured, and loud talking occurs with manic syndrome. |
|
|
Term
| Articulation (ability to form words) is clear and understandable. |
|
Definition
| Dysarthria is distorted speech (see Table 5-4). Misuses words; omits letters, syllables, or words; transposes words; occurs with aphasia. Circumlocution, or repetitious abnormal patterns: neologism, echolalia (see Table 5-6, p. 86). |
|
|
Term
| Word choice is effortless and appropriate to educational level. The person completes sentences, occasionally pausing to think. |
|
Definition
| Unduly long word-finding or failure in word search occurs with aphasia. |
|
|
Term
Mood and Affect.
Judge this by body language and facial expression and by asking directly, “How do you feel today,” or “How do you usually feel?” The mood should be appropriate to the person's place and condition and change appropriately with topics. The person is willing to cooperate with you. |
|
Definition
| See Table 5-5, Abnormalities of Mood and Affect. Wide mood swings occur with manic syndrome. Bizarre mood is apparent in schizophrenia. |
|
|
Term
Orientation.
You can discern orientation through the course of the interview by asking about the person's address, phone number, health history. Or ask for it directly, using tact, “Some people have trouble keeping up with the dates while in the hospital. Do you know today's date?” Assess: |
|
Definition
|
|
Term
Time: Day of week, date, year, season
Place: Where person lives, present location, type of building, name of city and state
Person: Own name, age, who examiner is, type of worker
Many hospitalized people normally have trouble with the exact date but are fully oriented on the remaining items. |
|
Definition
| Disorientation occurs with delirium and dementia. Orientation is usually lost in this order—first to time, then to place, and rarely to person. |
|
|
Term
Attention Span.
Check the person's ability to concentrate by noting whether he or she completes a thought without wandering. Note any distractibility or difficulty attending to you. Or give a series of directions to follow and note the correct sequence of behaviors, such as “Please take this glass of water with your left hand, drink from it, shift it to your right hand, and set it on the table.” Note that attention span commonly is impaired in people who are anxious, fatigued, or drug intoxicated. |
|
Definition
Digression from initial thought. Irrelevant replies to questions. Easily distracted; “stimulus bound” (i.e., any new stimulus quickly draws attention).
Confusion, negativism. |
|
|
Term
Recent Memory.
Assess recent memory in the context of the interview by the 24-hour diet recall or by asking the time the person arrived at the agency. Ask questions you can corroborate. This screens for the occasional person who confabulates or makes up answers to fill in the gaps of memory loss. |
|
Definition
| Recent memory deficit occurs with delirium, dementia, amnestic syndrome, or Korsakoff's syndrome in chronic alcoholism. |
|
|
Term
Remote Memory.
In the context of the interview, ask the person verifiable past events; for example, ask to describe past health, the first job, birthday and anniversary dates, and historical events that are relevant for that person. |
|
Definition
| Remote memory is lost when cortical storage area for that memory is damaged (e.g., Alzheimer dementia or any disease that damages the cerebral cortex). |
|
|
Term
New Learning—The Four Unrelated Words Test.
This tests the person's ability to lay down new memories. It is a highly sensitive and valid memory test. It requires more effort than does the recall of personal or historic events. It also avoids the danger of unverifiable material.
To the person, say, “I am going to say four words. I want you to remember them. In a few minutes I will ask you to recall them.” To be sure the person has understood, have the words repeated. Pick four words with semantic and phonetic diversity:
1 brown1.fun
2 honesty2.carrot
3 tulip3.ankle
4 eyedropper4.loyalty |
|
Definition
After 5 minutes, ask for the recall of the four words. To test the duration of memory, ask for a recall at 10 minutes and at 30 minutes. The normal response for persons younger than 60 years is an accurate three- or four-word recall after a 5-, 10-, and 30-minute delay.33
People with Alzheimer dementia score a zero- or one-word recall. Impaired new learning ability also occurs with anxiety (due to inattention and distractibility) and depression (due to lack of effort mobilized to remember).
|
|
|
Term
Additional Testing for Persons with Aphasia
Word Comprehension.
Point to articles in the room, parts of the body, articles from pockets, and ask the person to name them.
Reading.
Ask the person to read available print. Be aware that reading is related to educational level. Use caution that you are not just testing literacy. |
|
Definition
| Aphasia is the loss of the ability to speak or write coherently or to understand speech or writing, due to a brain attack (see Table 5-4, Speech Disorders) |
|
|
Term
Writing.
Ask the person to make up and write a sentence. Note coherence, spelling, and parts of speech (the sentence should have a subject and a verb). |
|
Definition
| Reading and writing are important in planning health teaching and rehabilitation. |
|
|
Term
Higher Intellectual Function
These tests measure problem-solving and reasoning abilities. Results are closely related to the person's general intelligence and must be assessed considering educational and cultural background. Tests of higher intellectual functioning have been used to discriminate between organic brain disease and psychiatric disorders; errors on the tests indicate organic dysfunction.
Although they have been widely used, there is little evidence that most of these tests are valid in detecting organic brain disease. Furthermore, most of these tests have little relevance for daily clinical care. Thus many time-honored, standard tests of higher intellectual function are not discussed here, such as fund of general knowledge, digit span repetition, calculation, proverb interpretation and similarities to test abstract reasoning, or hypothetical situations to test judgment. |
|
Definition
|
|
Term
Judgment
A person exercises judgment when he or she can compare and evaluate the alternatives in a situation and reach an appropriate course of action. Rather than testing the person's response to a hypothetical situation (e.g., “What would you do if you found a stamped, addressed envelope lying on the sidewalk?”), you should be more interested in the person's judgment about daily or long-term life goals, the likelihood of acting in response to delusions or hallucinations, and the capacity for violent or suicidal behavior. |
|
Definition
|
|
Term
| To assess judgment in the context of the interview, note what the person says about job plans, social or family obligations, and plans for the future. Job and future plans should be realistic, considering the person's health situation. Also, ask the person to describe the rationale for personal health care and how he or she decided about whether or not to comply with prescribed health regimens. The person's actions and decisions should be realistic. |
|
Definition
Impaired judgment (unrealistic or impulsive decisions, wish fulfillment) occurs with mental retardation, emotional dysfunction, schizophrenia, and organic brain disease.
|
|
|
Term
THOUGHT PROCESSES AND PERCEPTIONS
Thought Processes.
Ask yourself, “Does this person make sense? Can I follow what the person is saying?” The way a person thinks should be logical, goal directed, coherent, and relevant. The person should complete a thought. |
|
Definition
Illogical, unrealistic thought processes. Digression from initial thought. Ideas run together. Evidence of blocking (person stops in middle of thought) (see Table 5-6, Abnormalities of Thought Process).
|
|
|
Term
Thought Content.
What
the person says should be consistent and logical.
|
|
Definition
| Obsessions, compulsions (see Table 5-7, Abnormalities of Thought Content). |
|
|
Term
Perceptions.
The person should be consistently aware of reality. The perceptions should be congruent with yours. Ask the following questions:
_ How do people treat you?
_ Do other people talk about you?
_ Do you feel like you are being watched, followed, or controlled?
_ Is your imagination very active?
_ Have you heard your name when alone? |
|
Definition
| Illusions, hallucinations (see Table 5-8, Abnormalities of Perception). Auditory and visual hallucinations occur with psychiatric and organic brain disease and with psychedelic drugs. Tactile hallucinations occur with alcohol withdrawal. |
|
|
Term
Screen for Anxiety Disorders.
Anxiety and depression are the two most common mental health problems seen in people seeking general medical care. Anxiety disorders are common, disabling, and often untreated. However, you can screen for core anxiety symptoms by asking the first two questions from the 7-item GAD scale listed in Fig. 5-1.22 Scores on this GAD subscale range from 0 to 6; a score of 0 suggests no anxiety disorder is present. |
|
Definition
| The four most common anxiety disorders: generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, posttraumatic stress disorder (PTSD) (see Table 5-12, Anxiety Disorders). |
|
|
Term
If these first 2 items yield positive results, Kroenke et al.22 suggest following with the other 5 items. The full scale identifies probable presentations of GAD and also is a severity measure in that increasing scores are associated with increasing impairment and disability.
31
|
|
Definition
| A score of 10 on the GAD-7 identifies GAD; scores of 5, 10, and 15 represent mild, moderate, and severe levels of anxiety. |
|
|
Term
Screen for Depression.
There are many formal screening tools available. However, a shorter method, simply asking two simple questions about depressed mood and anhedonia (little interest or pleasure in doing things) will detect a majority of depressed patients.35 Thus you can ask: “Over the past 2 weeks, have you felt down, depressed, or hopeless? And “Over the past 2 weeks, have you felt little interest or pleasure in doing things?” |
|
Definition
| Finding positive answers to these questions then requires further diagnostic interviews that use criteria such as the DSM-IV-TR to assess specific depressive disorders (see Table 5-11, Mood Disorders, p. 89). |
|
|
Term
Screen for Suicidal Thoughts.
When the person expresses feelings of sadness, hopelessness, despair, or grief, it is important to assess any possible risk of physical harm to himself or herself. Begin with more general questions. If you hear affirmative answers, continue with more specific questions: |
|
Definition
Suicide is a preventable health problem; it is the 11th leading cause of death in the United States and the third leading cause of death in young people ages 10 to 24 years.
28
|
|
|
Term
_ Have you ever felt so blue you thought of hurting yourself?
_ Do you feel like hurting yourself now?
_ Do you have a plan to hurt yourself?
_ How would you do it?
_ What would happen if you were dead?
_ How would other people react if you were dead?
It is very difficult to question people about possible suicidal wishes, especially for beginning examiners. Examiners fear invading privacy and may have their own normal denial of death and suicide. However, the risk is far greater if you skip these questions when you have the slightest clue that they are appropriate. You may be the only health professional to pick up clues of suicide risk. You are responsible for encouraging the person to talk about suicidal thoughts.
Depression is painful and debilitating, and sometimes a depressed person really wishes to kill himself or herself. However, the majority of suicidal people are ambivalent, and for them, you can buy time so they can be helped to find an alternate route to the stressful situation. Promptly share any concerns you have about a person's suicide ideation with a mental health professional.
|
|
Definition
A precise suicide plan to take place in the next 24 to 48 hours using a lethal method constitutes high risk. Important clues and warning signs of suicide:
Prior suicide attempts
Depression, hopelessness
Firearms in the home
Family history of suicide
Incarceration
Family violence including physical or sexual abuse
Self-mutilation
Anorexia
Verbal suicide messages (defeat, failure, worthlessness, loss, giving up, desire to kill self)
Death themes in art, jokes, writing, behaviors
Saying goodbye (giving away prized possessions)
Additional content on mental disorders is listed in Table 5-9, Schizophrenia; Table 5-10, Delirium, Dementia, and Amnestic Disorders; Table 5-11, Mood Disorders; and Table 5-12, Anxiety Disorders. |
|
|
Term
The Mini-Mental State is a simplified scored form of the cognitive functions of the mental status examination (memory, orientation to time and place, naming, reading, copying or visuospatial orientation, writing, and the ability to follow a three-stage command)10,13 (Table 5-1).
The Mini-Mental State Examination (MMSE) quick and easy, includes a standard set of only 11 questions, and requires only 5 to 10 minutes to administer. It is useful for both initial and serial measurement, so you can demonstrate
The maximum score on the test is 30; people with normal mental status average 27. Scores between 24 and 30 indicate no cognitive impairment. |
|
Definition
| Scores that occur with dementia and delirium are classified as follows: 18-23 = mild cognitive impairment; 0-7 = severe cognitive impairment. |
|
|
Term
|
Definition
Awake or readily aroused, oriented, fully aware of external and internal stimuli and responds appropriately, conducts meaningful interpersonal interactions
> |
|
|
Term
| (2) Lethargic (or Somnolent) |
|
Definition
| Not fully alert, drifts off to sleep when not stimulated, can be aroused to name when called in normal voice but looks drowsy, responds appropriately to questions or commands but thinking seems slow and fuzzy, inattentive, loses train of thought, spontaneous movements are decreased. |
|
|
Term
|
Definition
(Transitional state between lethargy and stupor; some sources omit this level.)
Sleeps most of time, difficult to arouse—needs loud shout or vigorous shake, acts confused when is aroused, converses in monosyllables, speech may be mumbled and incoherent, requires constant stimulation for even marginal cooperation |
|
|
Term
|
Definition
| Spontaneously unconscious, responds only to persistent and vigorous shake or pain; has appropriate motor response (i.e., withdraws hand to avoid pain); otherwise can only groan, mumble, or move restlessly; reflex activity persists. |
|
|
Term
|
Definition
| Completely unconscious, no response to pain or to any external or internal stimuli (e.g., when suctioned, does not try to push the catheter away), light coma has some reflex activity but no purposeful movement, deep coma has no motor response. |
|
|
Term
Acute Confusional State (Delirium)
|
|
Definition
| Clouding of consciousness (dulled cognition, impaired alertness); inattentive; incoherent conversation; impaired recent memory and confabulatory for recent events; often agitated and having visual hallucinations; disoriented, with confusion worse at night when environmental stimuli are decreased. |
|
|
Term
|
Definition
| Difficulty or discomfort in talking, with abnormal pitch or volume, due to laryngeal disease. Voice sounds hoarse or whispered, but articulation and language are intact. |
|
|
Term
|
Definition
| Distorted speech sounds; speech may sound unintelligible; basic language (word choice, grammar, comprehension) intact. |
|
|
Term
Aphasia
Language comprehension and production secondary to brain damage
|
|
Definition
True language disturbance, defect in word choice and grammar or defect in comprehension; defect is in higher integrative language processing.
|
|
|
Term
|
Definition
| An earlier dichotomy classified aphasias as expressive (difficulty producing language) or receptive (difficulty understanding language). Because all people with aphasia have some difficulty with expression, beginning examiners tend to classify them all as expressive. The following system is more descriptive. |
|
|
Term
|
Definition
| The most common and severe form. Spontaneous speech is absent or reduced to a few stereotyped words or sounds. Comprehension is absent or reduced to only the person's own name and a few select words. Repetition, reading, and writing are severely impaired. Prognosis for language recovery is poor. Caused by a large lesion that damages most of combined anterior and posterior language areas. |
|
|
Term
|
Definition
| Expressive aphasia. The person can understand language but cannot express himself or herself using language. This is characterized by nonfluent, dysarthric, and effortful speech. The speech is mostly nouns and verbs (high-content words) with few grammatic fillers, termed “agrammatic” or “telegraphic” speech. Repetition and reading aloud are severely impaired. Auditory and reading comprehensions are surprisingly intact. Lesion is in anterior language area called the motor speech cortex or Broca's area. |
|
|
Term
|
Definition
| Receptive aphasia. The linguistic opposite of Broca's aphasia. The person can hear sounds and words but cannot relate them to previous experiences. Speech is fluent, effortless, and well articulated but has many paraphasias (word substitutions that are malformed or wrong) and neologisms (made-up words) and often lacks substantive words. Speech can be totally incomprehensible. Often there is a great urge to speak. Repetition, reading, and writing also are impaired. Lesion is in posterior language area called the association auditory cortex or Wernicke's area. |
|
|
Term
| Flat affect (blunted affect) |
|
Definition
Lack of emotional response; no expression of feelings; voice monotonous and face immobile
Topic varies, expression does not |
|
|
Term
|
Definition
Sad, gloomy, dejected; symptoms may occur with rainy weather, after a holiday, or with an illness; if the situation is temporary, symptoms fade quickly
“I've got the blues.”
|
|
|
Term
Depersonalization (lack of ego boundaries)
|
|
Definition
Loss of identity, feels estranged, perplexed about own identity and meaning of existence
“I don't feel real.” “I feel like I'm not really here.”
|
|
|
Term
|
Definition
Joy and optimism, overconfidence, increased motor activity, not necessarily pathologic
“I'm feeling very happy.”
|
|
|
Term
|
Definition
Excessive well-being, unusually cheerful or elated, which is inappropriate considering physical and mental condition, implies a pathologic mood
“I am high.” “I feel like I'm flying.” “I feel on top of the world.”
` |
|
|
Term
|
Definition
Worried, uneasy, apprehensive from the anticipation of a danger whose source is unknown
“I feel nervous and high strung.” “I worry all the time.” “I can't seem to make up my mind.”
|
|
|
Term
|
Definition
Worried, uneasy, apprehensive; external danger is known and identified
Fear of flying in airplanes
(` |
|
|
Term
|
Definition
Annoyed, easily provoked, impatient
Person internalizes a feeling of tension, and a seemingly mild stimulus “sets him (or her) off”
` |
|
|
Term
|
Definition
Furious, loss of control
Person has expressed violent behavior toward self or others
` |
|
|
Term
|
Definition
The existence of opposing emotions toward an idea, object, person
A person feels love and hate toward another at the same time
` |
|
|
Term
|
Definition
Rapid shift of emotions
Person expresses euphoric, tearful, angry feelings in rapid succession
(` |
|
|
Term
|
Definition
Affect clearly discordant with the content of the person's speech
Laughs while discussing admission for liver biopsy
` |
|
|
Term
|
Definition
Sudden interruption in train of thought, unable to complete sentence, seems related to strong emotion
“Forgot what I was going to say.”
(` |
|
|
Term
|
Definition
Fabricates events to fill in memory gaps
Gives detailed description of his long walk around the hospital although you know Mr. J. remained in his room all afternoon.
` |
|
|
Term
|
Definition
Coining a new word; invented word has no real meaning except for the person; may condense several words
“I'll have to turn on my thinkilator.”
` |
|
|
Term
|
Definition
Round-about expression, substituting a phrase when cannot think of name of object
Says “the thing you open the door with” instead of “key.”
(` |
|
|
Term
|
Definition
Talks with excessive and unnecessary detail, delays reaching point; sentences have a meaningful connection but are irrelevant (this occurs normally in some people)
“When was my surgery? Well I was 28, I was living with my aunt, she's the one with psoriasis, she had it bad that year because of the heat, the heat was worse then than it was the summer of ‘92, …”
` |
|
|
Term
|
Definition
Shifting from one topic to an unrelated topic; person seems unaware that topics are unconnected
“My boss is angry with me and it wasn't even my fault. (pause) I saw that movie too, Lassie. I felt really bad about it. But she kept trying to land the airplane and she never knew what was going on.”
` |
|
|
Term
|
Definition
Abrupt change, rapid skipping from topic to topic, practically continuous flow of accelerated speech; topics usually have recognizable associations or are plays on words
“Take this pill? The pill is blue. I feel blue. (sings) She wore blue velvet.”
` |
|
|
Term
|
Definition
Incoherent mixture of words, phrases, and sentences; illogical, disconnected, includes neologisms
“Beauty, red-based five, pigeon, the street corner, sort of.”
` |
|
|
Term
|
Definition
Persistent repeating of verbal or motor response, even with varied stimuli
“I'm going to lock the door, lock the door. I walk every day and I lock the door. I usually take the dog and I lock the door.”
` |
|
|
Term
|
Definition
Imitation, repeats others’ words or phrases, often with a mumbling, mocking, or mechanical tone
Nurse: “I want you to take your pill.”
Patient (mocking): “Take your pill. Take your pill.”
` |
|
|
Term
|
Definition
Word choice based on sound, not meaning, includes nonsense rhymes and puns
“My feet are cold. Cold, bold, told. The bell tolled for me.”
` |
|
|
Term
|
Definition
Strong, persistent, irrational fear of an object or situation; feels driven to avoid it
Cats, dogs, heights, enclosed spaces
` |
|
|
Term
|
Definition
Morbid worrying about his or her own health, feels sick with no actual basis for that assumption
Preoccupied with the fear of having cancer; any symptom or physical sign means cancer
` |
|
|
Term
|
Definition
Unwanted, persistent thoughts or impulses; logic will not purge them from consciousness; experienced as intrusive and senseless
Violence (parent having repeated impulse to kill a loved child); contamination (becoming infected by shaking hands)
` |
|
|
Term
|
Definition
Unwanted repetitive, purposeful act; driven to do it; behavior thought to neutralize or prevent discomfort or some dreaded event
Handwashing, counting, checking and rechecking, touching
` |
|
|
Term
|
Definition
Firm, fixed, false beliefs; irrational; person clings to delusion despite objective evidence to contrary
Grandiose—person believes he or she is God; famous, historical, or sports figure; or other well-known person
Persecution—“They are out to get me.”
` |
|
|
Term
|
Definition
Sensory perceptions for which there are no external stimuli; may strike any sense: visual, auditory, tactile, olfactory, gustatory
Visual: seeing an image (ghost) of a person who is not there; auditory: hearing voices or music
` |
|
|
Term
|
Definition
Mis
perception of an actual existing stimulus, by any sense
Folds of bed sheets appear to be animated
` |
|
|
Term
Schizophrenia
*
Characteristic Symptoms
`
|
|
Definition
Two (or more) of the following, each present for a significant part of a 1-month period:
1 Delusions (i.e., involving a phenomenon that the person's culture would regard as totally implausible, such as thought broadcasting, being controlled by a dead person)
2 Hallucinations (auditory are more common) (e.g., voices speaking directly to the person or commenting on his or her ongoing behavior)
3 Disorganized speech (e.g., frequent derailment or incoherence)
4 Grossly disorganized or catatonic behavior
5 Negative symptoms (i.e., affective flattening, alogia [inability to speak], or avolition)
` |
|
|
Term
Schizophrenia
B. Social/Occupational Dysfunctio
` |
|
Definition
One or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to onset of the disturbance
` |
|
|
Term
Schizophrenia
C. Duration
` |
|
Definition
. Duration
Continuous signs persist for at least 6 months, including at least 1 month of symptoms from criterion A (i.e., active phase) and may include periods of prodromal or residual symptoms
Adapted from the American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: The Association. Reprinted with permission from the American Psychiatric Association.
` |
|
|
Term
|
Definition
A Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
B A change in cognition (e.g., memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance.
C The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
Delirium may be due to a general medical condition: systemic infections, metabolic disorders (e.g., hypoxia, hypercarbia, hypoglycemia), fluid or electrolyte imbalances, liver or kidney disease, thiamine deficiency, postoperative states, hypertensive encephalopathy, or following seizures or head trauma.
Delirium also may be substance-induced (i.e., due to a drug of abuse, a medication, or toxin exposure).
` |
|
|
Term
|
Definition
A The development of multiple cognitive deficits manifested by both:
1 Memory impairment (impaired ability to learn new information or to recall previously learned information), and
2 One (or more) of the following cognitive disturbances:
a Aphasia (language disturbance)
b Apraxia (impaired ability to carry out motor activities despite intact motor function)
c Agnosia (failure to recognize or identify objects despite intact sensory function)
d Disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
B The cognitive deficits must be sufficiently severe to cause impairment in occupational or social functioning and must represent a decline from a previously higher level of functioning.
Dementias have a common symptom presentation but are differentiated based on etiology, which include senile dementia of the Alzheimer's type or SDAT (course is characterized by gradual onset and continuing cognitive decline); dementia due to cerebrovascular disease (characterized by focal neurologic signs and symptoms [e.g., exaggeration of deep tendon reflexes, extensor plantar response, gait abnormalities, weakness of an extremity]); human immunodeficiency virus disease; head trauma; Parkinson disease; and others.
` |
|
|
Term
|
Definition
A The development of memory impairment (inability to learn new information or to recall previously learned information) in the absence of other significant cognitive impairments.
B The memory disturbance causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning.
This may be due to pathology (closed head trauma, penetrating missile wounds, surgical intervention, hypoxia, infarction of the posterior cerebral artery, herpes simplex encephalitis), or it may be substance induced (e.g., alcohol-induced amnestic disorder due to thiamine deficiency associated with prolonged, heavy ingestion of alcohol).
` |
|
|
Term
Major Depressive Episode
(`` |
|
Definition
A Five (or more) of the following symptoms present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood, or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly caused by a general medical condition or delusions or hallucinations.
1 Depressed mood most of the day nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or by observation by others (e.g., appears tearful)
Note: In children and adolescents, can be irritable mood.
2 Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day
3 Significant weight loss when not dieting, weight gain (e.g., a change of >5% body weight in a month), or decrease or increase in appetite nearly every day
Note: In children, consider failure to make expected weight gains.
4 Insomnia or hypersomnia nearly every day
5 Psychomotor agitation or retardation nearly every day
6 Fatigue or loss of energy nearly every day
7 Feelings of worthlessness or excessive or inappropriate guilt nearly every day
8 Diminished ability to think or concentrate or indecisiveness nearly every day
9 Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C The symptoms are not due to the direct physiologic effects of a substance (e.g., drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism) and are not better accounted for by bereavement, as with loss of a loved one (unless persist for longer than 2 months or are characterized by functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).
` |
|
|
Term
|
Definition
A A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
B During this period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable):
1 Inflated self-esteem or grandiosity
2 Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3 More talkative than usual or pressure to keep talking
4 Flight of ideas or subjective experience that thoughts are racing
5 Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6 Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7 Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
C The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D The symptoms are not due to the direct physiologic effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
` |
|
|
Term
Major depressive disorde
` |
|
Definition
is characterized by one or more major depressive episodes (i.e., at least 2 weeks of depressed mood or loss of interest accompanied by at least four additional symptoms of depression); dysthymic disorder is characterized by at least 2 years of depressed mood for more days than not, accompanied by additional depressive symptoms; bipolar disorder is characterized by one or more manic episodes usually accompanied by major depressive episodes.
` |
|
|
Term
|
Definition
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:
1 Palpitations, pounding heart, or accelerated heart rate
2 Sweating
3 Trembling or shaking
4 Sensations of shortness of breath or smothering
5 Feeling of choking
6 Chest pain or discomfort
7 Nausea or abdominal distress
8 Feeling dizzy, unsteady, light-headed, or faint
9 Derealization (feelings of unreality) or depersonalization (being detached from oneself)
10 Fear of losing control or going crazy
11 Fear of dying
12 Paresthesias (numbness or tingling sensations)
13 Chills or hot flashes
` |
|
|
Term
|
Definition
A Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a panic attack or panic-like symptoms—agoraphobic fears typically involve being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.
B The situations are avoided (e.g., travel is restricted), are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.
` |
|
|
Term
|
Definition
A Both 1 and 2 occur:
1 Recurrent unexpected panic attacks (see above)
2 At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
a Persistent concern about having additional attacks
b Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
c A significant change in behavior related to the attacks
B Agoraphobia may be present or absent.
` |
|
|
Term
|
Definition
A Marked and persistent fear that is excessive or unreasonable, cued by a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
B Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may be a panic attack.
Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.
C The person recognizes that the fear is excessive or unreasonable.
D The phobic situation is avoided or is endured with intense anxiety or distress.
E This interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships.
` |
|
|
Term
|
Definition
A A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others; the individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.
B.–E.: The same as in specific phobia.
` |
|
|
Term
Obsessive-Compulsive Disorder
` |
|
Definition
A Person has either obsessions:
1 Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress
2 The thoughts, impulses, or images are not simply excessive worries about real-life problems
3 The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action
4 The person recognizes that the obsessional thoughts are a product of his or her own mind (not imposed from without)
Or compulsions:
1 Repetitive behaviors (e.g., handwashing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2 The behaviors or mental acts are aimed at preventing or reducing distress or at preventing some dreaded event or situation
B At some point, the person has recognized that the obsessions or compulsions are excessive or unreasonable.
C The obsessions or compulsions cause marked distress; are time consuming; or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.
` |
|
|
Term
Posttraumatic Stress Disorder
` |
|
Definition
A The person has been exposed to a traumatic event in which:
1 The person experienced, witnessed, or was confronted with the actual or threatened death or serious injury of self or others
2 The person's response involved intense fear, helplessness, or horror
B The traumatic event is persistently reexperienced by:
1 Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions
2 Recurrent distressing dreams of the event
3 Acting or feeling as if the traumatic event were recurring
C Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (e.g., feeling of detachment or estrangement from others, unable to have loving feelings, sense of a foreshortened future).
D Persistent symptoms of increased arousal:
1 Difficulty falling or staying asleep
2 Irritability or outbursts of anger
3 Difficulty concentrating
4 Hypervigilance
5 Exaggerated startle response
` |
|
|
Term
Generalized Anxiety Disorder
` |
|
Definition
A Excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities (e.g., work or school performance).
B The person finds it difficult to control the worry.
C The anxiety and worry are associated with three (or more) of the following:
1 Restlessness or feeling keyed up or on edge
2 Being easily fatigued
3 Difficulty concentrating or mind going blank
4 Irritability
5 Muscle tension
6 Sleep disturbance
` |
|
|
