- It may be static (fixed cognitive impairment), the result of a unique global brain injury, progressive (slow or fast depending on aetiology), resulting in long-term decline due to damage or disease in the body, or be secondary to another cause.
- Common types of dementia are Alzheimer’s disease, vascular dementia and Lewy Body dementia.
Hallucination: “is defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space”.
- Hallucinations can occur in any sensory modality —visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive,thermoceptive and chronoceptive.
- Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up
- ‘Charles Bonnet’ syndrome is the name given to visual hallucinations experienced by blind patient
Delusion – paranoid (persecutory and grandiose), nihilistic: “is a fixed belief that is either false, fanciful, or derived from deception, often pathological (in the presence of mental illness) and contrary to the evidence”.
Delusions are categorized into four different groups:
- Bizarre delusion: A delusion that is very strange and completely implausible
- Non-bizarre delusion: A delusion that, though false, is at least possible
- Mood-congruent delusion: Any delusion with content consistent with either a depressive or manic state
- Mood-neutral delusion: A delusion that does not relate to the sufferer’s emotional state
Types of delusion specifically noted for learning..
Paranoid delusions =
- Grandiose delusion: An individual is convinced he has special powers, talents, or abilities. Sometimes, the individual may actually believe he or she is a famous person or character.
- Persecutory delusion: These are the most common type of delusions and involve the theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or obstructed in the pursuit of goals.
- Nihilistic delusion: A person with this type of delusion may have the false belief that the world is ending.
- Delusion of reference: The person falsely believes that insignificant remarks, events, or objects in one’s environment have personal meaning or significance.
Possible causes of delusion may be linked to: genetic, environment, self-esteem issues, frontal lobe injury/damage, somatosensory deficient, bullying, chronic stress.
Obsession & compulsion: as commonly associated to OCD
Obsessions = thoughts that recur and persist despite efforts to ignore them. In pts with OCD, sexual obsessions are common.
Compulsions = some people perform compulsive rituals because they inexplicably feel they have to, others act compulsively so as to mitigate the anxiety that stems from particular obsessive thoughts. Depending on the severity of the compusions, the person may not be able to fulfil daily tasks of work, family/social roles, …
OCD without overt compulsions: (aka “Pure-O”), in 50-60% of OCD cases. Rather than engaging in observable compulsions, the person with this subtype might perform more covert, mental rituals, or might feel driven to avoid the situations in which particular thoughts seem likely to intrude.
Loosening of associations
Flight of ideas: A form of talking where a person continues to switch from subject to subject while talking making it difficult for others to follow the train of thought. This can range from incoherent babbling that does not make sense to the listener to a person that just has mild trouble staying on topic during a conversation.
Thought alienation (insertion, withdrawal, broadcast)
Thought echo– 2 types exist:
“Gedankenlautwerden”, a patient hears thoughts spoken aloud. Thoughts are heard in the form of a voice at the same time as they are thought, not afterwards.
“Écho de la pensée”, thoughts seem to be spoken aloud just after being produced. The patient hears the ‘echo’ of his thoughts in the form of a voice after he has made the thought.
Dissociation/conversion: is a condition in which patients present with neurological symptoms such as numbness, blindness, paralysis, or fits without a physiological cause. It is thought that these problems arise in response to difficulties in the patient’s life, and conversion is considered a psychiatric disorder in ICD-10 and DSM-4.
Catatonia:is a syndrome of psychological and motorological disturbances – either excessive or total loss of activity.
It is not recognized as a separate disorder as such, but is associated with psychiatric conditions such as schizophrenia (catatonic type), bipolar disorder, post-traumatic stress disorder, depression and other mental disorders, as well as drug abuse or overdose (or both).
Tx: benzodiazepines, lorazepam, ECT, memantine/amantadine (NMDA-antagonists).
Psychomotor agitation: is a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual.
This includes pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions. In more severe cases, the motions may become harmful to the individual, such as ripping, tearing or chewing at the skin around one’s fingernails or lips to the point of bleeding.
Psychomotor agitation is a symptom typically found in major depressive disorder or obsessive-compulsive disorder, and sometimes the manic phase in bipolar disorder, although it can also be a result of an excess intake of stimulants.
Poverty of speech
Pressure of speech: is a tendency to speak rapidly and frenziedly, as if motivated by urgency not apparent to the listener.
Pressured speech is difficult to interrupt and may be too fast or too tangential for the listener to understand; it is an example of cluttered speech. It can be unrelenting, loud and without pauses.
The pace of the speech indicates an underlying thought disorder known as “flight of ideas” where the information going through the person’s head is so fast that it is difficult to follow their train of thought
Circumstantiality: “Speech that is highly detailed and very delayed at reaching its goal. Speaking about many concepts related to the point of the conversation before eventually returning to the point and concluding the thought. Excessive long-windedness”.
Echolalia -Echoing of one’s or other people’s speech that may only be committed once, or may be continuous in repetition. This may involve repeating only the last few words or last word of the examiner’s sentences
Baseline mood (euthymic, depressed, elated, irritable, expansive): the normal mood for the individual, it can be slightly elevated or depressed but is relatively consistently.
Euthymic mood =is a word used for indicating a normal non-depressed, reasonably positive mood. It is distinguished from euphoria, which refers to an extreme of happiness, and dysthymia, which refers to a depressed mood.
Expansive mood =Lack of restraint in expressing ones feelings, frequently with an overvaluation of one’s significance or importance. Irritable, easily annoyed and provoked to anger.
Reactivity of mood
Congruence of mood:is the congruence between feeling, or the emotion that a person is experiencing, and affect display, or the manner in which that emotion is “presenting”, or being expressed.In psychology, symptoms are said to be mood-congruent if they are consistent with a patient’s mood or mental disorder. Conversely, they are said to be mood-incongruent if they are inconsistent with their primary mood.Examples:
- Congruent mood – smiling while feeling happy.
- Non-congruent mood – smiling while feeling anxious.
- Inappropriate affect – laughing while describing a loved one’s funeral, for instance.
Intensity of mood
Anhedonia: is an inability to experience pleasurable emotions from normally pleasurable life events such as eating, exercise, social interaction or sexual activities.
Dysphoria, euthymia, euphoria