TIPS IN PSYCHIATRY

AUTISM:

* associated with congenital rubella, PKU, tuberous sclerosis, Rett's disorder.

*show more evidence of perinatal complications

*have significantly more minor congenital physical anomalies than siblings & controls

*4-32% - Grand Mal seizures

*20-25% - ventricular enlargement on CT

*10-83% - various non-specific EEG abnormalities with some indication of failed cerebral lateralisation

*recently one MRI study showed hypoplasia of cerebellar vermal lobules 6 & 7

*another MRI study showed cortical abnormalities particularly polymicrogyria. May reflect abnormal cell migration in first 6 months of gestation

*Autopsy study showed decreased Purkinje cell counts, increased total brain volume, greates avg percentage increase in Occipital, parietal & temporal lobe. No difference in frontal lobes

*PET scan increased diffuse cortical metabolism

* 1/3 patients increased plasma serotonin.

*withdrawl & stereotypies showed increased CSF homovalinic acid. some evidences indicate that symptom severity decreases as ratio of CSF 5-HIAA to CSF HVA increases
ADHD:

*most children do not show evidence of gross structural damage in CNS

*some evidence suggestive that September is the peak month for births of ADHD children with or without co-morbid learning disorders

*Non-focal (soft) neurological signs are frequently seen

*PET scans show decreased cerebral blood flow & metabolic rates in frontal lobes of ADHD children
_________________

ANOREXIA NERVOSA:

*Anorexia nervosa has a negative impact on the immune system and the central nervous system (CNS).

*It is also thought to be linked to serotonin and dopamine abnormalities.

*Many anorectics are diagnosed with obsessive-compulsive behavior at some point in their lives.

*Some have an eating-disordered parent, demonstrating a possible genetic link with the disorder.

*In a long-term set of studies on fifty-one adolescents with anorexia nervosa, eighteen percent of subjects were consistently diagnosed with some type of autism-like disorder at onset and at five- and ten-year follow-ups.

*Researchers have noted that a "small but important minority" of young women with anorexia nervosa may be suffering from undetected and underlying autistic disorders.

*There is increasing speculation that the onset of anorexia has a genetic component. It has been shown that mutations in a certain gene linked to abnormalities with the neurotransmitter chemical serotonin is more common amongst sufferers of anorexia than in the general population.

*Victims of mercury, lead, beryllium and arsenic poisoning have been known to develop anorexia as a symptom thereof.

*Some psychological traits associated with anorexia are consistent with deficiencies in important vitamins and minerals, such as magnesium and the B vitamins.

*Zinc deficiency is common among anorexics, thereby resulting in heightened levels of copper which is associated with depression and nervousness.

*That these deficiencies (or untoward exposure to heavy metals) can produce powerful psychological effects, such as depression, anxiety, and loss of appetite, is not widely known.

*Anorexia is also associated with general anemia.


BULIMIA NERVOSA:

*Research done in 2003, shows a link to the development of bulimia nervosa with an area on the 10p chromosome.

*Familial links include a history of obesity, substance abuse, and depressive disorder.

*Twin studies also strongly support this genetic factor. While both genetics and unique environments contributed to the development of the disorder, twin studies indicate a slightly stronger effect from the genetic predisposition than from environmental circumstances.

*The protein leptin decreases hunger levels in a person, and is more often blocked in patients with bulimia causing abnormal hunger levels in comparison with the norm.

*Due to the binging and purging cycle the stomach is stretched to an enlarged state, and over the progression of time becomes more permanently enlarged, making it necessary for more food to be in the person’s stomach to reach a level of satiety. This is a primary cause of the need for a bulimic to gradually increase the caloric size of their binges, as the original quantities no longer satisfy their enlarged stomach.


Obsessive Compulsive Disorders

*Some research has discovered a type of size abnormality in different brain structures.

*The majority of researchers believe that there is some type of abnormality in the neurotransmitter serotonin

*Recent research has revealed a possible genetic mutation that could be the cause of OCD. Researchers have found a mutation in the human serotonin transporter gene, hSERT, in unrelated families with OCD.

*Using tools like positron emission tomography (PET scans), it has been shown that those with OCD tend to have brain activity that differs from those who do not have this disorder

*It has been theorized that a miscommunication between the orbital-frontal cortex, the caudate nucleus, and the thalamus may be a factor in the explanation of OCD.

*People with OCD may be diagnosed with other conditions, such as Tourette syndrome, compulsive skin picking, body dysmorphic disorder and trichotillomania.

*It is also interesting to note that there is some research demonstrating a link between drug addiction and obsessive compulsive disorder as well. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among obsessive compulsive patients may serve as a type of compulsive behavior and not just as a coping mechanism.

*Depression is also extremely prevalent among sufferers of OCD.

*Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed P.A.N.D.A.S. (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections).

*OCD in men at least may be partially caused by low oestrogen levels

*OCD primarily involves the brain regions of the striatum and the cingulate cortex, especially the striatum.

*OCD involves several different receptors, mostly H2, M4, nk1, NMDA, and non-NMDA glutamate receptors. The receptors 5-HT1D, 5-HT2C, and the mu opioid receptor exert a secondary effect. The H2, M4, nk1, and non-NMDA glutamate receptors are active in the striatum, whereas the NMDA receptors are active in the cingulate cortex.

*The activity of certain receptors is positively correlated to the severity of OCD, whereas the activity of certain other receptors is negatively correlated to the severity of OCD. Those correlations are as follows:

*Activity positively correlated to severity:

H2
M4
nk1
non-NMDA glutamate receptors

*Activity negatively correlated to severity:

NMDA
mu opioid
5-HT1D
5-HT2C

*The central dysfunction of OCD involves the receptors nk1, non-NMDA glutamate receptors, and NMDA, whereas the other receptors exert secondary modulatory effects.

*Pharmaceuticals that act directly on those core mechanisms are aprepitant (nk1 antagonist), riluzole (glutamate release inhibitor), and tautomycin (NMDA receptor sensitizer). The drugs that are popularly used to fight OCD lack efficacy because they do not act upon the core mechanisms.

BIPOLAR DISORDER:

*Bipolar disorders research Bipolar disorder runs in families. More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a genetic component.

*Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes.
*The monozygotic concordance rate for the disorder is 70%. This means that if a person has the disorder, an identical twin has a 70% likelihood of having the disorder as well. Dizygotic twins have a 23% concordance rate. These concordance rates are not universally replicated in the literature, recent studies have shown rates of around 40% for monozygotic and <10% for dizygotic twins.

In 2003, a group of American and Canadian researchers published a paper that used gene linkage techniques to identify a mutation in the GRK3 gene as a possible cause of up to 10% of cases of bipolar disorder. This gene is associated with a kinase enzyme called G protein receptor kinase 3, which appears to be involved in dopamine metabolism, and may provide a possible target for new drugs for bipolar disorder

*PET & MRI studies have found anatomical differences in areas such as the prefrontal cortex and hippocampus
_________________


Evidence that a single nucleotide polymorphism in the promoter of the G protein receptor kinase 3 gene is associated with bipolar disorder.


In a genome-wide linkage survey, evidence suggesting that the chromosome 22q12 region contains a susceptibility locus for bipolar disorder (BPD).

Two independent family sets yielded lod scores suggestive of linkage at markers in this region near the gene G protein receptor kinase 3 (GRK3).

GRK3 is an excellent candidate risk gene for BPD since GRK3 is expressed widely in the brain, and since GRKs play key roles in the homologous desensitization of G protein-coupled receptor signaling.

It was also shown GRK3 expression to be induced by amphetamine in an animal model of mania using microarray-based expression profiling.

To identify possible functional mutations in GRK3, the putative promoter region, all 21 exons, and intronic sequence flanking each exon, in 14-22 individuals with BPD were sequenced.

Six sequence variants in the 5'-UTR/promoter region, but no coding or obvious splice variants were found.

Transmission disequilibrium analyses of one set of 153 families indicated that two of the 5'-UTR/promoter variants are associated with BPD in families of northern European Caucasian ancestry.

A supportive trend towards association to one of these two variants (P-5) was then subsequently obtained in an independent sample of 237 families.

In the combined sample, the P-5 variant had an estimated allele frequency of 3% in bipolar subjects, and displayed a transmission to non-transmission ratio of 26 : 7.7 (2=9.6, one-sided P value=0.0019).

Altogether, these data support the hypothesis that a dysregulation in GRK3 expression alters signaling desensitization, and thereby predisposes to the development of BPD.


02/03/2007 9:55:01 AM | Add a comment | Send a message | Permalink | View trackbacks (0) | Blog itAsperger's syndrome
Asperger described his patients as "little professors".Asperger's disorder or Asperger's syndrome (AS) is a pervasive developmental disorder most closely related to autism, and commonly referred to as a form of "high-functioning" autism. The term "Asperger's Syndrome" was coined by Lorna Wing in a 1981 medical paper; she named it after Hans Asperger, an Austrian psychiatrist and pediatrician whose work was not internationally recognized until the 1990s. "Aspie" is an affectionate term used by some with Asperger's syndrome to describe themselves; others prefer "Aspergian", or no name at all. Asperger's also has an especially significant part in the controversies surrounding the autism spectrum.

Non-autistics (neurotypicals) possess a comparatively sophisticated sense of other people's mental states. Most people are able to gather a whole host of information about other people's cognitive and emotional states based on clues gleaned from the environment and the other person's body language. Autists (or autistic persons) do not have this ability, and the individual with Asperger's can be every bit as "mind-blind" as the person with profound classical autism. For those who are severely affected by "mind-blindness", they may, at best, see a smile but not know what it means (is it an understanding, a condescending, or a malicious smile?) and at worst they will not even see the smile, frown, smirk, or any other nuance of interpersonal communication. They generally find it difficult or impossible to "read between the lines," that is, figure out those things a person is implying but is not saying directly. It is worth noting, however, that since it is a spectrum disorder, a few with Asperger's are nearly normal in their ability to read facial expressions and intentions of others. Those with Asperger's often have difficulty with eye contact. Many make very little eye contact, finding it overwhelming, while others have unmodulated, staring eye contact that can be "off-putting" to everyday people.

Asperger's Syndrome involves an intense level of focus on things of interest and is often characterized by special (and possibly peculiar) gifts; one person might be obsessed with 1950s professional wrestling, another with national anthems of African dictatorships, another with building models out of matchsticks. Particularly common interests are means of transportation (for example trains) and computers. In general, things with order have appeal. When these special interests coincide with a materially or socially useful task, the individual with Asperger's can often lead a profitable life — the child obsessed with naval architecture may grow up to be an accomplished shipwright, for instance. In pursuit of these interests, the individual with Asperger's often manifests extremely sophisticated reasoning, an almost obsessive focus, and eidetic memory. Hans Asperger called his young patients "little professors", based on the fact that his thirteen-year-old patients had as comprehensive and nuanced an understanding, within their area of expertise, as university professors. It is because of this that individuals with Asperger's are considered to have a higher intellectual capacity while suffering from a lower social capacity.

Autists have emotional responses as strong as, or perhaps stronger than, most "neurotypicals", though what generates an emotional response might not always be the same. What they lack is the inborn ability to express their emotional state via body language, facial expression, and nuance in the way that most neurotypicals do. Many people with Asperger's report a feeling of being unwillingly divorced from the world around them; they lack the natural ability to see the subtexts of social interaction, and equally lack the ability to broadcast their own emotional state to the world accurately.

This leads to no end of troubles both in childhood and adulthood. When a teacher asks a child with Asperger's, "And did the dog eat your homework?", the child with Asperger's will remain silent if they don't understand the expression, trying to figure out if they need to explain to the teacher that they don't have a dog and besides dogs don't generally like paper. The child doesn't understand what the teacher is asking, cannot infer the teacher's meaning or the fact that there is a non-literal meaning from the tone of voice, posture or facial expression, and is faced with a question which made as much sense to him as "did the glacier in the library bounce today?" The teacher walks away from the experience frustrated and thinking the child is arrogant, spiteful and insubordinate. The child sits there mutely, feeling frustrated and wronged.


Social interaction and cognitive patterns

Asperger's can also lead to problems with normal social interaction between peers. In childhood and teenage years, this can cause severe problems as a child or teen with Asperger's can have difficulty interpreting subtle social cues and as such be ostracized by his/her peers, leading to social cruelty. The child or teen with Asperger's is frequently puzzled as to the source of this cruelty, unaware of what he is doing "wrong". Recent efforts in the field of special education have worked to correct this problem, meeting with only minor to moderate success.

In adulthood, the person with Asperger's may find it difficult to differentiate between the smiles of a waitress waiting on his table and the woman at the next table who's interested in him. He may well wind up asking the waitress out for a cup of coffee and ignoring the woman at the next table.

The social alienation of people with asperger's syndrome is so intense from childhood that many of them have imaginary friends as companionship.

Asperger's Syndrome is hardly a guarantee of a miserable life, however — far from it. Often their intense focus and tendency to work things out logically will grant them a high level of ability in their fields of interest. Despite their difficulty with social interaction, many possess a rare gift for humor (especially puns, wordplay, doggerel, and satire) and written expression. In fact, sometimes their fluency with language is such that a number of them also qualify as hyperlexic. While their lives will probably not be considered a social success by the common standards, and there are a large number who will remain alone their entire lives, it is possible for them to find understanding people (sometimes also on the autistic spectrum, sometimes not) with whom they can have close relationships. While they face enormous obstacles, some overcome them and prosper in society. Many autists are married and have children; their children may be neurotypical or have an autism spectrum disorder. Many autists don't know they have autism and neither do their friends and family members, because milder forms of autism are widely undiagnosed and misdiagnosed by professionals and widely misunderstood.


DSM definition

Asperger's is defined in section 299.80 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:

Qualitative impairment in social interaction, as manifested by at least two of the following:
Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
Failure to develop peer relationships appropriate to developmental level
A lack of spontaneous seeking to share enjoyment, interest or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
A lack of social or emotional reciprocity
Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
Apparently inflexible adherence to specific, nonfunctional routines or rituals
Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
Persistent preoccupation with parts of objects.
The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
There is no clinically significant general delay in language (e.g., single words used by age two years, communicative phrases used by age three years)
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills or adaptive behavior (other than in social interaction) and curiosity about the environment in childhood
Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
The Diagnostic and Statistical Manual's diagnostic criteria have been roundly criticized for being far too vague and subjective: what one psychologist calls a "significant impairment" another psychologist may call insignificant.

A series of studies have supported the thesis that there are in fact no or only very few cases that strictly meet the above DSM-IV definition of Asperger's: patients typically show communication impairment, which then qualifies them for a diagnosis of autistic disorder and not Asperger's. See [1].


Relationship to autism

Asperger's syndrome is named after Hans Asperger.Experts today generally agree that there is no single mental condition called autism. Rather, there is a spectrum of autistic disorders, with different forms of autism taking different positions on this spectrum. But within certain circles of the autism/AS community, this concept of a "spectrum" is being severely questioned. If differences in development are purely a function of differential acquisition of skills, then attempting to distinguish between "degrees of severity" may be dangerously misleading. A person may be subjected to unrealistic expectations, or even denied life-saving services, solely on the basis of very superficial observations made by others in the community.

In the 1940s, Leo Kanner and Hans Asperger, working independently in the United States and Europe, identified essentially the same population, Asperger's group being perhaps more "socially functional" than Kanners as a whole. Some of Kanner's originally identified autistic children, might today get an Asperger's syndrome diagnosis, and vice versa. It is a mistake to say that a "Kanner autistic" is a child who sits and rocks and does not communicate. Kanner's study subjects were all along the spectrum.

Researchers are grappling with the problem of how to divide up the spectrum. There is no easy way to do this. It would appear that one can divide the population of autistics in any particular way and define the group accordingly. Autistics who speak, those who don't. Autistics with seizures, those without. Autistics with more "stereotypical behaviors", those with less, and so forth. Some are trying to identify genes associated with these traits as a way to make logical groupings. Eventually, one may hear about autistics with or without the HOXA 1 gene, with or without changes to chromosome 15, etc.

Kanner's syndrome is described in the article autism.

According to Dr. Peter Szatmari, and others in the field of autism research, if one strictly applies the DSM-IV guidelines, then, in fact, there are almost NO people with "Asperger's syndrome" pointing to the flawed nature of the DSM-IV description.


Leo Kanner discovered another form of autism around the same time as Hans Asperger.Dr. Sally Ozonoff, of the University of California at Davis's MIND institute, argues that there should be no dividing line between "high-functioning" autism and Asperger's, and that the fact that some don't start to produce speech until a later age is no reason to divide the two groups, as they are identical in the way they need to be treated.

Asperger's Syndrome and other forms of autism are often grouped together in a Pervasive Developmental Disorder family.


Probable causes and origins

The causes and origins of autism and Asperger's syndrome is a source of continuing conjecture and debate. Amongst several competing theories are the underconnectivity theory developed by cognitive scientists at Carnegie Mellon University and the University of Pittsburgh, the Neanderthal theory, the extreme male brain theory by simon baron cohen, the lack of theory of mind, and the Preoperational-autism theory, which states that autistic people are those who get neurologically stuck at the pre-operational stage of cognitive development, where much of information processing is at a wholistic-visual level and largely non verbal and musical. This also addresses the issue of the theory of mind where children at the pre-operational stage of cognitive development have not attained decentralisation from egocentrism.

The underconnectivity theory holds that autism is a system-wide brain disorder that limits the coordination and integration among brain areas. Since the brain is known to be modular, researchers examined white matter (which connects various areas of the brain like cables) with the aid of fMRI and found abnormalities in people with autism. Observation thus supports the idea that Asperger's syndrome is a deficiency in coordination among brain areas. This theory is parsimonious, in that it explains why autistic people are matured on certain dimensions eg: visual information processing and logical analysis, and yet are socially and sometimes neuro-physiologically, significantly younger to their chronological age.

Other probable theories, addresses the rise of autism in recent times. They suggests the rise of visual media and thereby the increasing central role of visual information processing in the breakdown of language and the rise of autism.


Effect on relationships

The significant others of people with Asperger's are more prone to major depression than the general population because Asperger's people often have trouble showing affection or understanding the need to show affection, and are very literal and hard to communicate with in an emotional way. It is very helpful for the spouses to read as much as they can about Asperger's syndrome, OCD, hyperlexia and other "comorbid disorders". It also helps to visit the support groups' websites online and talk with other spouses of people with Asperger's Syndrome. A spouse will often be much less angry or depressed if they understand that the Asperger's symptoms are not intentionally directed at them, but that they are part of a neurological condition. That someone does not spontaneously show affection does not necessarily mean that they do not feel it. Thus the spouse will feel a lot less rejected and be a lot more understanding. Light will be shed on the nature of the misunderstandings. They may figure out ways to work around the problems, for example being more explicit about their needs.


A gift and a curse

Recently, some researchers have speculated that many well-known people including Glenn Gould, Nikola Tesla, Albert Einstein and Isaac Newton had AS, as they showed some Asperger's related tendencies (such as intense interest in one subject and social problems); such diagnoses remain controversial, however (cf. BBC News, Einstein and Newton "had autism" (http://news.bbc.co.uk/1/hi/health/2988647.stm), 30 April 2003). The obvious social contributions of such individuals has led to a shift in the perception of Asperger's and autism away from the simple view of a disease just needing to be cured towards a more complex view of a syndrome with both advantages and disadvantages. There is a semi-jocular theory within science fiction fandom, for example, which argues that many of the distinctive traits of that subculture may be explained by the speculation that a significant portion thereof is composed of people with Asperger's. A Wired Magazine article called The Geek Syndrome (http://www.wired.com/wired/archive/9.12/aspergers_pr.html) suggested that Asperger's syndrome is more common in the Silicon Valley, a haven for computer scientists and mathematicians. It created an enduring myth popularized in the media and self-help books that "Geek Syndrome" equals Asperger's syndrome, and precipitated a rash of self-diagnoses. Though these conditions do share overlap, there is a consensus that most geeks are arguably "variant normal" and do not exhibit autistic spectrum behaviors.


Asperger's in the media

Detective Robert Goren from the television series Law & Order: Criminal Intent, has a touch of Asperger's Syndrome. The series has also dealt with a suspect who has a much more pronounced form. Detective Adrian Monk of the television series Monk may very well also have the syndrome.

Detective Vic Mackey from the television series The Shield has a son, Matthew, diagnosed with Asperger's Syndrome.

Georgia Lass from Dead Like Me, with her dead-pan facial expressions, blunt communication style and (earlier in the series) her awkward social skills, may have Asperger's Syndrome.

In production in 2004, the film Mozart and the Whale is a love story between two people with Asperger's Syndrome.

In The Curious Incident of the Dog in the Night-Time, a novel by Mark Haddon, the narrator is a 15 year old boy with Asperger's Syndrome.

Luke Jackson and his family starred in the British TV program, My Family and Autism (http://www.bbc.co.uk/ouch/tvradio/autism/). Luke is about 14 and has Asperger's Syndrome. He has a brother with dyslexia, a brother with ADHD and a brother with profound autism. He also has three neurotypical sisters. He has written a book called "Freaks, Geeks and Asperger Syndrome" (ISBN 1843100983) which focuses on Asperger's and how it affects teenagers.


Criticisms

Some people, including people diagnosed with Asperger Syndrome argue that asperger's syndrome is a social construct. Professor Simon Baron-Cohen of the Autism Research Centre has written a book arguing that Asperger Syndrome is an extreme version of the way in which men's brains differ to women's. He says that in general men are better at systemizing than women, and that women are better at empathizing than men. Hans Asperger himself is quoted as saying that his patients have 'an extreme version of the male form of intelligence'.


References

[1] Mayes SD, Calhoun SL, Crites DL: Does DSM-IV Asperger's disorder exist?, Journal of Abnormal Child Psychology 2001 June; 29(3), pages 263–271, online version (http://www.findarticles.com/cf_0/m0902/3_29/76558499/p1/article.jhtml)

The ADHD-Autism Connection: A Step toward more accurate diagnosis and effective treatment, by Diane M. Kennedy, ISBN 1578564980 (The aim of this book is to explore the similarities that attention deficit hyperactivity disorder (ADHD) shares with a spectrum of disorders currently known as pervasive developmental disorders.)

Asperger's Syndrome — A Guide for Parents and Professionals by Tony Atwood. This book is considered to be the Bible as far as general AS books go.

Martian in the Playground by Claire Sainsbury. This book is all about the schoolchild with Asperger's Syndrome.

Freaks, Geeks and Asperger's Syndrome by Luke Jackson. This book won the National Association of Special Educational Needs Children's book award. It is written by someone who has gone though all the experiences he is writing about.

Men, Women and the Extreme Male Brain by Simon Baron-Cohen. The author proposes the theory that autism and Asperger Syndrome can be explained as extreme examples of the male type of mind.

02/03/2007 9:43:10 AM | Add a comment | Send a message | Permalink | View trackbacks (0) | Blog itSuicide - Commonest cause of death among Psychiatric Patients
I. Suicide
Commonest cause of death among Psychiatric Patients

Suicide – deliberate self harm (DSH) – Human act of self – intentioned and self-inflicted cessation (death) – attempted suicide.

Suicidal Gesture – Attempted Suicide – Action never intends to die – Attempted suicide – women – completed suicide – 2-4 times commoner in men.

Some Common Themes in Suicide

1. It is a crisis that causes intense suffering and feelings of hopelessness and helplessness.
2. There is a conflict between survival and unbearable stress.
3. There is a narrowing of the person’s perceived options
4. There is a wish to escape (it is an escape rather than a going-towards).
5. There is often a wish to punish self and / or punish significant others with guilt.

Epidemiology

Top 10 causes of death – 9.9 / lakh population / year (1994 figures) – 10-15 / lakh population – the world ranges – 5-30 / lakh population – attempted suicide to completed – 10:! India – Highest Suicide - 18-30 years – highest – Pondicherry, West Bengal, Madras & Bangalore.

Etiology:
Common causes of suicide are
1.Psychiatric Disorders

1.Depression

1-Major depression
2-Depression secondary to serious physical illness.
3-Reactive depression

2. Alcoholism and drug dependence

3. Schizophrenia

and biochemical factors{low levels of 5-HIAA]

II. Physical Disorders

- incurable or painful physical disorders, AIDS, often commit suicide- 13.5% of all

III. Psychosocial Factors

Examination, Failure in Love, Dowry Difficulties, Marital Difficulties, Illegitimate Pregnancy, Family Dispute, Psychopathology, Loss of a loved object, Occupational and Financial Difficulties.

Methods Used

Ingestion of Poisons (about 35%) followed by Hanging (about 23%), Drowning (about 9%), Jumping in front of a train (4 %), Burning (12%)

Men often – Violent Methods

Medico – Legal Aspects

Section 309 of IPC states that – Attempts to Commit Suicide and does any towards the commission of such offence – Punishable with simple imprisonment – which may extend to one year – also be liable to fine.

Section 309 of IPC was repealed by the Court of India in 1994, 1996, Attempt to Suicide - Punishable Offence. So the Section 309 IPC continues.

Major Risk Factors For Suicide

The presence of the following factors increases the risk of completed suicide:

1. Age > 40 years
2. Male Sex
3. Staying Single
4. Previous suicidal attempt(s)
5. Depression (risk about 25 times more than normal)
i. Presence of guilt, self-accusation, agitation, nihilistic ideation, worth-lessness, Hypochondriacal delusions and / or severe insomnia.
ii. More at the beginning or towards the end of a depressive episode
6. Suicidal preoccupation (e.g. a ‘suicide note’ is written or detailed plans are made for committing suicide)
7. Alcohol or drug dependence
8. Severe, disabling, painful or untreatable physical illness
9. Recent serious loss or major stressful life event
10. Social Isolation

Common Misconceptions about suicide
(Modified about Shneidman and Farberow, 1961)

Misconceptions Facts
1. People who talk about suicide, don’t commit suicide-- Nearly 80 % of persons who commit suicide,
2. Suicide happens without warning--give definite warnings and / or clues about their suicidal intentions

3. Suicidal persons are fully intent on dying-- Most suicidal persons are undecided about dying or living.
4. Once a person is suicidal, he is suicidal forever.-- Suicidal person is suicidal only for a limited period of time
5. All suicidal persons are mentally ill or psychotic-- Although the suicidal person is often extremely unhappy, he is not necessarily mentally ill

Management

No longer treatable.

Prevention Centres – Emergency Services – Welfare Centres (of the Patient)

1. All suicidal Threats, Gestures
2. Seriousness of the situation and take remedial
i. Physical Surroundings, Sharp Objects, Ropes, Drugs, Firearms etc.
ii. Surveillance

3. Acute Psychiatric Emergency
4. Counseling and Guidance
i. The Desire
ii. Ongoing life stressors, Teaching coping skills, Interpersonal skills

5. Medication or ECT
02/03/2007 9:38:02 AM | Add a comment | Send a message | Permalink | View trackbacks (0) | Blog itElectroconvulsive Therapy (ECT)
1.1 It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/ or when the condition is considered to be potentially life-threatening, in individuals with:

° severe depressive illness
° catatonia
° a prolonged or severe manic episode

1.2 The decision as to whether ECT is clinically indicated should be based on a documented assessment of the risks and potential benefits to the individual, including: the risks associated with the anaesthetic; current co-morbidities;
anticipated adverse events, particularly cognitive impairment; and the risks of not having treatment.


1.3 The risks associated with ECT may be enhanced during pregnancy, in older people, and in children and young people, and therefore clinicians should exercise particular caution when considering ECT treatment in these groups.

1.4 Valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. The decision to use ECT should be made jointly by the individual and the clinician( s) responsible for treatment, on the basis of an informed discussion. This discussion should be enabled by the provision of full and appropriate information about the general risks associated with ECT (see Section 1.9) and about the risks and potential benefits specific to that individual. Consent should be obtained without pressure or coercion, which may occur as a result of the circumstances and clinical setting, and the individual should be reminded of their right to withdraw consent at any point. There should be strict adherence to recognised guidelines about consent and the involvement of patient advocates and/ or carers to facilitate informed discussion is strongly encouraged.

1.5 In all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/ or carer should be consulted.

1.6 Clinical status should be assessed following each ECT session and treatment should be stopped when a response has been achieved, or sooner if there is evidence of adverse effects. Cognitive function should be monitored on an ongoing basis, and at a minimum at the end of each course of treatment.

1.7 It is recommended that a repeat course of ECT should be considered under the circumstances indicated in 1.1 only for individuals who have severe depressive illness, catatonia or mania and who have previously responded well to ECT. In patients who are experiencing an acute episode but have not previously responded, a repeat trial of ECT should be undertaken only after all other options have been considered and following discussion of the risks and benefits with the individual and/ or where appropriate their carer/ advocate.

1.8 As the longer-term benefits and risks of ECT have not been clearly established, it is not recommended as a maintenance therapy in depressive illness.

1.9 The current state of the evidence does not allow the general use of ECT in the management of schizophrenia to be recommended.

1.10 National information leaflets should be developed through consultation with appropriate professional and user organisations to enable individuals and their carers/ advocates to make an informed decision regarding the appropriateness of ECT for their circumstances. The leaflets should be evidence based, include information about the risks of ECT and availability of alternative treatments, and be produced in formats and languages that make them accessible to a wide range of service users


01/03/2007 5:03:29 PM | Add a comment | Read comments (1) | Send a message | Permalink | View trackbacks (0) | Blog itPsychiatric Defence mechanisms
Level 1 Defense Mechanisms - Almost always pathological; for the user these three defenses permit someone to rearrange external reality (and therefore not have to cope with reality); for the beholder, the users of these mechanisms frequently appear crazy or insane. These are the "psychotic" defenses, common in overt psychosis, in dreams, and throughout childhood.

Denial - a refusal to accept external reality because it is too threatening. There are examples of denial being adaptive (for example, it might be adaptive for a person who is dying to have some denial)

Distortion - a gross reshaping of external reality to meet internal needs

Delusional Projection - frank delusions about external reality, usually of a persecutory nature

Level 2 Defense Mechanisms are seen frequently in adults and are common in adolescents. For the user these mechanism alter distress and anxiety caused by reality or other people; while for the beholder, people who use such defenses are seen as socially undesirable, immature, difficult and out of touch. They are considered "immature" defenses and almost always lead to serious problems in a person's ability to cope with the world. These defenses are seen in severe depression, personality disorders, and adolescence. They include:

Fantasy - tendency to retreat into fantasy in order to resolve inner and outer conflicts

Projection - attributing one's own unacknowledged feelings to others; includes severe prejudice, severe jealousy, hypervigilance to external danger, and "injustice collecting". (remember that projection is a primitive form of paranoia, so it is common in today's world)

Hypochondriasis - the transformation of negative feelings towards others into negative feelings toward self, pain, illness and anxiety

Passive Agressive Behavior - aggression towards others expressed indirectly or passively

Acting Out Behavior - direct expression of an unconscious wish or impulse to avoid being conscious of the emotion that accompanies it


Level 3 Defense Mechanisms are often considered "neurotic" but are fairly common in adults. They can have short-term advantages in coping, but they often cause long-term problems in relationships, work, and enjoyment of life for people who primarily use them as their basic style of coping with the world. They include:

Intellectualization - separation of emotion from ideas; thinking about wishes in formal, affectively bland terms and not acting on them

Repression - seemingly inexplicable naivete, memory lapse, or lack of awareness of physical status; the emotion is conscious, but the idea behind it is absent

Reaction Formation - behavior that is completely the opposite of what one really wants or feels (e.g, taking care of someone when what one really wants is to be taken care of; studying to be a pilot to cover-up being afraid to fly). Note - this can work in the short term as an effective strategy to cope, but will eventually break down.

Displacement - separation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to avoid dealing directly with what is frightening or threatening

Dissociation - temporary and drastic modification of one's personal identity or character to avoid emotional distress

Rationalization :is the process of constructing a logical justification for a decision that was originally arrived at through a different mental process.


Level 4 Defense Mechanisms are common among most "healthy" adults and are considered the most "mature". Many of them have their origins in the "immature" level, but have been honed by the individual to optimize his/her success in life and relationships. Use of these defenses gives the user pleasure and feelings of mastery. For the user, these defenses help them to integrate many conflicting emotions and thoughts and still be effective; and for the beholder their use by someone is viewed as a virtue. They include:

Sublimation - transformation of negative emotions or instincts into positive actions, behavior, or emotion

Altruism - constructive service to others that brings pleasure and personal satisfaction

Suppression - the conscious decision to delay paying attention to an emotion or need in order to cope with the present reality; able to later access the emotion and accept it.

Anticipation - realistic planning for future discomfort

Humor - overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about) that gives pleasure to others; (humor lets you call a spade a spade, while "wit" is actually a form of displacement.

01/03/2007 4:57:28 PM | Add a comment | Send a message | Permalink | View trackbacks (0) | Blog itSyndromes in Psychiatry
Wernicke’s encephalopathy
An acute reaction to severe thiamine deficiency mostly d/t chronic alcohol use.
C/b ocular signs (nystagmus & external ophthalmoplagia)
Higher mental function disturbance(disorientation, confusion, recent memory disturbances)
Apathy & ataxia.
Peripheral neuropathy & malnutrition may be co-existent.

Korsakoff’s psychosis
Also d/t severe thiamine deficiency d/t chronic alcohol use.
C/b amnestic syndrome with gross memory disturbances
Confabulation
Insight often impaired.

Marchiafava-Bignami syndrome
A rare disorder most probably d/t alcohol-related nutritional deficiency.
C/b disorientation, personality & intellectual deterioration, hallucinations, epilepsy, dysarthria, ataxia & spastic limb paralysis.

Holiday Heart
Atrial or ventricular arrhythmias, especially paroxysmal tachycardia, after drinking a binge of alcohol in individuals showing no other evidence of heart disease.

Hemp insanity (cannabis psychosis)
Asso with cannabis.
Acute schizophreniform disorder with disorientation & confusion
Good prognosis.

Amotivational syndrome
Lethargy, apathy, loss of interest, anergia, reduced drive & lack of ambition d/t chronic cannabis use.
Van Gogh syndrome
Dramatic self-mutilation occurring in schizophrenia.

Pfropf schizophrenia
A syndrome of schizophrenia occurring in presence of mental retardation.

Oneiroid schizophrenia
A subtype of schizophrenia with acute onset, clouding of consciousness, disorientation, dream-like states & perceptual disturbances with rapid shifting.

Alice in Wonderland syndrome
Perceptual distortion of shape, size, colour& reciprocal position of objects. seen with schizophrenia, migraine

PAD syndrome
Phobic-Anxiety-Depersonalization syndrome.
Commoner in women 20-40 years.
C/b diffuse anxiety, multiple phobias, panic attacks, depersonalization, derealization & depressive features.

Othello syndrome (conjugal paranoia)
A psychosis in which the content of delusions is predominantly jealousy (infidelity) involving spouse.

Clerambault’s syndrome (erotomania)
A psychosis in which the content of delusions is erotic.
Most often in women with erotic conviction that a person with higher status is in love with the patient.

Kadinsky-Clerambault’s syndrome
A syndrome of mental automatism

Folie a deux
Induced delusional disorder c/b sharing of delusions b/w 2 persons.
So is folie a trios, folie a quatre, folie a famille…

Capgras’ syndrome (delusion of doubles)
C/b delusional conviction that other persons in environment are not their real selves but are their own doubles.
There are 4 types
1. Typical Capgras’ syndrome(illusion des sosies)- pt sees a familiar person as a stranger who is imposing as the familiar person.
2. Illusion de Fregoli pt falsely identifies strangers as familiar persons.
3. Syndrome of subjective doubles pt’s own self is perceived as being replaced by a double.
4. Intermetamorphosis pt’s misidentification is complete including both external appearance & personality.

Fregoli’s phenomenon
Delusion that a persecutor is taking on a variety of faces like an actor.

Cotard’s syndrome
Delusion that one has lost everything- possessions, strength & even bodily organs such as heart.
Seen in severe depression where pt has extreme nihilistic delusion (e.g. may think that his bowels are rotting and he will never pass stools again)

Ganser’s syndrome (hysterical pseudodementia)
Commonly found in prison inmates.
C/b vorbeireden- approximate answers- person understands nature of questions but answers wrong.

La-Belle-Indifference
Lack of concern towards symptoms despite apparent severity of disability produces.
Seen in pts with conversion & dissociation disorder(hysteria).

Briquet’s syndrome (Somatisation disorder)
A chronic or recurrent illness with either a dramatic or complicated medical history.
A pt with at least 25 unexplained medical symptoms for a diagnosis or with 20-25 unexplained symptoms for a probable diagnosis.

Munchausen syndrome (Factitious disorder, Polysurgis, Professional patients, Hospital hoboes, Hospital addiction)
Pt repeatedly simulates or fakes diseases for sole purpose of obtaining medical attention.

Munchausen syndrome by proxy
Pt intentionally produces physical signs & symptoms in another person who is under pt’s care.

Ekbom syndrome (Restless Legs syndrome)
Pt experiences extremely uncomfortable feeling in leg muscles during walking.
Asso with insomnia.

Gelineu’s syndrome
Narcolepsy.
Asso with hypersomnia.

Pickwickian syndrome
Sleep apnea commoner in elderly & obese persons, asso with hypersomnia.

Kleine-Levin syndrome
C/b hypersomnia
Hyperphagia
Hypersexuality

Clumsy Child syndrome (Motor dyspraxia, Motor skills disorder, Developmental coordination disorder)
C/b poor coordination in daily activities of life.

Idiot Savant syndrome
Pervasive impairment of functions but certain islets of precocity or splinter functions may remain.

Heller’s syndrome (Disintegrative psychosis)
A type of childhood psychosis with age of onset 3-5 years.
C/b rapid downhill course leading to deterioration & development of neurological deficits.

Asperger’s syndrome
Predominantly in boys.
Less severe form of pervasive developmental disorder
Autism without significant delay in language & cognitive development.
schizoid personality
pedantic speech
preoccupation with obscure facts

Rett’s syndrome
Occurs in girls.
After an apparently normal early development & normal head circumference at birth, there is deceleration of head growth b/w age of 5-30 months.
Loss of purposive hand movements & acquired fine motor manipulative skills with subsequent development of stereotyped hand movements.

Strauss syndrome
Attention deficit hyperkinetic disorder, Minimal brain dysfunction, Organic drivenness.

Gilles de la Tourette’s syndrome
C/b multiple motor tics
Multiple vocal tics
Duration of >1 year

Kanner syndrome
Failure to develop attachment with a parenteral figure & pre-occupation with inanimate objects.

Syndromes associated with dementia
Alzheimer’s disease
Pick’s disease
Parkinson’s disease
Shy-Drager syndrome (Multisystem degeneration)
Huntington’s chorea
Steel-Richardson syndrome (progressive Supranuclear palsy)
Binswanger’s disease (subcortical arteriosclerotic encephalopathy)
Wilson’s disease
Leigh’s disease
Creutzfeldt-Jacob disease
Gerstmann-Straussler-Scheinker disease
ALS-Parkinson’s-Dementia complex of Gaum

Syndromes associated with mental retardation
Down’s syndrome
Turner’s syndrome
Kleinfelter’s syndrome
Cri du chat syndrome
Fragile X syndrome
Hartnup’s disease
Tay-Sachs disease
Gaucher’s disease
Niemann-Pick disease
Lesch Nyhan syndrome
Hurler’s disease
Hunter’s disease
Sanfillipo’s disease
Renpenning’s syndrome
Sturge-Weber syndrome
Crouzon’s syndrome
Apert’s syndrome
De Lange syndrome (Amsterdam dwarfism)

Some Culture-Bound Syndromes are as follows

Dhat syndrome
A culture-bound syndrome prevalent in Indian subcontinent.
C/b complaint of passage of ‘dhat’ in urine.
Multiple somatic symptoms.
Asthenia
May be anxiety, depression or sexual dysfunction associated.

Koro
Prevalent in Asia including India.
Affected male pt believes that his penis is shrinking & may disappear into his abdominal wall & he may die.
Females affected infrequently, believing that their breasts & vulva are shrinking.

Amok
Prevalent in South-East Asia.
C/b sudden, unprovoked episode of rage in which affected person runs about & indiscriminately injures or kills any person who in encountered on the way.

Latah (Startle reaction)
Prevalent in South-East Asia & Japan.
More in women, c/b automatic obedience, echolalia & echopraxia.

Windigo (Wihtigo)
Prevalent in native American Indians.
Pt believes that he has been transformed into a wihtigo, a cannibal monster, occurring especially during times of starvation.

Shinkeishitsu
A defense syndrome, mainly of anxiety but with obsessive features occurring in young Japanese thrown into a modern industrial society for which they are not equipped. They feel inadequate, lost & unloved.

Susto
Occurs in Latin America.
Pt believes that his body is entered by a magical substance & that he is altered. It takes on a delusional quality.

Piblokto (Arctic Hysteria)
Occurs in Askimos.
Often female, who screams & tears off her clothes, throw herself on ice in extremely cold conditions.
She may imitate the cry of a bird or an animal.
The episode lasting for 1-2 hours, f/b amnesia of events.

Psychiatric Glossary

A
abreaction An emotional release or discharge after recalling a painful experience that has been repressed because it was not consciously tolerable. Often the release is surprising to the individual experiencing it because of it's intensity and the circumstances surrounding its onset. A therapeutic effect sometimes occurs through partial or repeated discharge of the painful affect.

abstract attitude (categorical attitude) This is a type of thinking that includes voluntarily shifting one's mind set from a specific aspect of a situation to the general aspect; It involves keeping in mind different simultaneous aspects of a situation while grasping the essentials of the situation. It can involve breaking a situation down into its parts and isolating them voluntarily; planning ahead ideationally; and/or thinking or performing symbolically. A characteristic of many psychiatric disorders is the person's inability to assume the abstract attitude or to shift readily from the concrete to the abstract and back again as demanded by circumstances.
abulia A lack of will or motivation which is often expressed as inability to make decisions or set goals. Often, the reduction in impulse to action and thought is coupled with an indifference or lack of concern about the consequences of action.
acalculia The loss of a previously possessed ability to engage in arithmetic calculation.
acculturation difficulty A problem stemming from an inability to appropriately adapt to a different culture or environment. The problem is not based on any coexisting mental disorder.
acetylcholine A neurotransmitter in the brain, which helps to regulate memory, and in the peripheral nervous system, where it affects the actions of skeletal and smooth muscle.

acting out This is the process of expressing unconscious emotional conflicts or feelings via actions rather than words. The person is not consciously aware of the meaning or etiology of such acts. Acting out may be harmful or, in controlled situations, therapeutic (e.g., children's play therapy).

actualization The realization of one's full potential - intellectual, psychological, physical, etc.

adiadochokinesia The inability to perform rapid alternating movements of one or more of the extremities. This task is sometimes requested by physicians of patients during physical examinations to determine if there exists neurological problems.

adrenergic This refers to neuronal or neurologic activity caused by neurotransmitters such as epinephrine, norepinephrine, and dopamine.

affect This word is used to described observable behavior that represents the expression of a subjectively experienced feeling state (emotion). Common examples of affect are sadness, fear, joy, and anger. The normal range of expressed affect varies considerably between different cultures and even within the same culture. Types of affect include: euthymic, irritable, constricted; blunted; flat; inappropriate, and labile.

affective disorders Refers to disorders of mood. Examples would include Major Depressive Disorder, Dysthymia, Depressive Disorder, N.O.S., Adjustment Disorder with Depressed Mood, Bipolar Disorder...

age-associated memory impairment (AAMI) The mild disturbance in memory function that occurs normally with aging; benign senescent forgetfulness. Such lapses in memory are lately humorously referred to as representing "a senior moment".

agitation (psychomotor agitation) Excessive motor activity that accompanies and is associated with a feeling of inner tension. The activity is usually nonproductive and repetitious and consists of such behavior as pacing, fidgeting, wringing of the hands, pulling of clothes, and inability to sit still.

agnosia Failure to recognize or identify objects despite intact sensory function; This may be seen in dementia of various types. An example would be the failure of someone to recognize a paper clip placed in their hand while keeping their eyes closed.

agonist medication A chemical entity that is not naturally occuring within the body which acts upon a receptor and is capable of producing the maximal effect that can be produced by stimulating that receptor. A partial agonist is capable only of producing less than the maximal effect even when given in a concentration sufficient to bind with all available receptors.

agonist/antagonist medication A chemical entity that is not naturally occuring within the body which acts on a family of receptors (such as mu, delta, and kappa opiate receptors) in such a fashion that it is an agonist or partial agonist on one type of receptor while at the same time it is also an antagonist on another different receptor.

agoraphobia Anxiety about being in places or situations in which escape might be difficut or embarrassing or in which help may not be available should a panic attack occur. The fears typically relate to venturing into the open, of leaving the familiar setting of one's home, or of being in a crowd, standing in line, or traveling in a car or train. Although agoraphobia usually occurs as a part of panic disorder, agoraphobia without a history of panic disorder has been described as also occuring without other disorders.

agraphia The loss of a pre-existing ability to express one's self through the act of writing.

akathisia Complaints of restlessness accompanied by movements such as fidgeting of the legs, rocking from foot to foot, pacing, or inability to sit or stand. Symptoms can develop within a few weeks of starting or raising the dose of traditional neuroleptic medications or of reducing the dose of medication used to treat extrapyramidal symptoms. akathisia is a state of motor restlessness ranging from a feeling of inner disquiet to inability to sit still or lie quietly.

akinesia A state of motor inhibition or reduced voluntary movement.

akinetic mutism A state of apparent alertness with following eye movements but no speech or voluntary motor responses.

alexia Loss of a previously intact ability to grasp the meaning of written or printed words and sentences.

alexithymia A disturbance in affective and cognitive function that can be present in an assortment of diagnostic entities. Is common in psychosomatic disorders, addictive disorders, and posttraumatic stress disorder. The chief manifestations are difficulty in describing or recognizing one's own emotions, a limited fantasy life, and general constriction in affective life.

algophobia Fear of pain.

alienation The estrangement felt in a setting one views as foreign, unpredictable, or unacceptable. For example, in depersonalization phenomena, feelings of unreality or strangeness produce a sense of alienation from one's self or environment.

alloplastic Referring to adaptation by means of altering the external environment. This can be contrasted to autoplastic, which refers to the alteration of one's own behavior and responses.

alogia An impoverishment in thinking that is inferred from observing speech and language behavior. There may be brief and concrete replies to questions and restriction in the amount of spontaneous speech (poverty of speech). Sometimes the speech is adequate in amount but conveys little information because it is overconcrete, overabstract, repetitive, or stereotyped (poverty of content).

ambivalence The coexistence of contradictory emotions, attitudes, ideas, or desires with respect to a particular person, object, or situation. Ordinarily, the ambivalence is not fully conscious and suggests psychopathology only when present in an extreme form.

amentia Subnormal development of the mind, with particular reference to intellectual capacities; a type of severe mental retardation.

amimia A disorder of language characterized by an inability to make gestures or to understand the significance of gestures.

amines Organic compounds containing the amino group. Amines such as epinephrine and norepinephrine are significant because they function as neurotransmitters.

amnesia Loss of memory. Types of amnesia include: anterograde Loss of memory of events that occur after the onset of the etiological condition or agent. retrograde Loss of memory of events that occurred before the onset of the etiological condition or agent.

amok A culture specific syndrome from Malay involving acute indiscriminate homicidal mania .

amygdala This is a structure of the brain which is part of the basal ganglia located on the roof of the temporal horn of the lateral ventricle at the inferior end of the caudate nucleus. It is a structure in the forebrain that is an important component of the limbic system.

amyloid Any one of various complex proteins that are deposited in tissues in different disease processes. These proteins have an affinity for Congo red dye. In neuropsychiatry, of particular interest are the beta-amyloid (A4) protein, which is the major component of the characteristic senile plaques of Alzheimer's disease, and the amyloid precursor protein (APP).

anaclitic In psychoanalytic terminology, dependence of the infant on the mother or mother substitute for a sense of well-being. This is considered normal behavior in childhood, but pathologic in later years.

anal stage The period of pregenital psychosexual development, usually from 1 to 3 years, in which the child has particular interest and concern with the process of defecation and the sensations connected with the anus. The pleasurable part of the experience is termed anal eroticism.

anamnesis The developmental history of a patient and of his or her illness, especially recollections.

anankastic personality Synonym for obsessive-compulsive personality.

androgyny A combination of male and female characteristics in one person.

anhedonia Inability to experience pleasure from activities that usually produce pleasurable feelings. Contrast with hedonism.

anima In Jungian psychology, a person's inner being as opposed to the character or persona presented to the world. Further, the anima may be the more feminine "soul" or inner self of a man, and the animus the more masculine soul of a woman.

anomie Apathy, alienation, and personal distress resulting from the loss of goals previously valued. Emile Durkheim popularized this term when he listed it as a principal reason for suicide.

anosognosia The apparent unawareness of or failure to recognize one's own functional defect (e.g., hemiplegia, hemianopsia).

antagonist medication A chemical entity that is not naturally occuring within the body which occupies a receptor, produces no physiologic effects, and prevents endogenous and exogenous chemicals from producing an effect on that receptor.

anxiety The apprehensive anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic symptoms of tension. The focus of anticipated danger may be internal or external. Anxiety is often distinguished from fear in that fear is a more appropriate word to use when there exists threat or danger in the real world. Anxiety is reflective more of a threat that is not apparent or imminent in the real world, at least not to the experienced degree.

apathy Lack of feeling, emotion, interest, or concern.

aphasia An impairment in the understanding or transmission of ideas by language in any of its forms--reading, writing, or speaking--that is due to injury or disease of the brain centers involved in language.

anomic or amnestic aphasia Loss of the ability to name objects.

aphonia An inability to produce speech sounds that require the use of the larynx that is not due to a lesion in the central nervous system.

apperception Perception as modified and enhanced by one's own emotions, memories, and biases.

apraxia Inability to carry out previously learned skilled motor activities despite intact comprehension and motor function; this may be seen in dementia.

assimilation A Piagetian term describing a person's ability to comprehend and integrate new experiences.

astereognosis Inability to recognize familiar objects by touch that cannot be explained by a defect of elementary tactile sensation.

ataxia Partial or complete loss of coordination of voluntary muscular movement.

attention The ability to focus in a sustained manner on a particular stimulus or activity. A disturbance in attention may be manifested by easy distractibility or difficulty in finishing tasks or in concentrating on work

auditory hallucination A hallucination involving the perception of sound, most commonly of voices. Some clinicians and investigators would not include those experiences perceived as coming from inside the head and would instead limit the concept of true auditory hallucinations to those sounds whose source is perceived as being external.

aura A premonitory, subjective brief sensation (e.g., a flash of light) that warns of an impending headache or convulsion. The nature of the sensation depends on the brain area in which the attack begins. Seen in migraine and epilepsy.

autoeroticism Sensual self-gratification. Characteristic of, but not limited to, an early stage of emotional development. Includes satisfactions derived from genital play, masturbation, fantasy, and oral, anal, and visual sources.

automatism Automatic and apparently undirected nonpurposeful behavior that is not consciously controlled. Seen in psychomotor epilepsy.

autoplastic Referring to adaptation by changing the self.

autotopagnosia Inability to localize and name the parts of one's own body. finger agnosia would be autotopagnosia restricted to the fingers.

avolition An inability to initiate and persist in goal-directed activities. When severe enough to be considered pathological, avolition is pervasive and prevents the person from completing many different types of activities (e.g., work, intellectual pursuits, self-care).

B
basal gangliaClusters of neurons located deep in the brain; they include the caudate nucleus and the putamen (corpus striatum), the globus pallidus, the subthalamic nucleus, and the substantia nigra. The basal ganglia appear to be involved in higher-order aspects of motor control, such as planning and execution of complex motor activity and the speed of movements. Lesions of the basal ganglia produce various types of involuntary movements such as athetosis, chorea, dystonia, and tremor. The basal ganglia are involved also in the pathophysiology of Parkinson's disease, Huntington's disease, and tardive dyskinesia. The internal capsule, containing all the fibers that ascend to or descend from the cortex, runs through the basal ganglia and separates them from the thalamus.
bestiality Zoophilia; sexual relations between a human being and an animal. See also paraphilia.

beta-blocker An agent that inhibits the action of beta-adrenergic receptors, which modulate cardiac functions, respiratory functions, and the dilation of blood vessels. Beta-blockers are of value in the treatment of hypertension, cardiac arrhythmias, and migraine. In psychiatry, they have been used in the treatment of aggression and violence, anxiety-related tremors and lithium-induced tremors, neuroleptic-induced akathisia, social phobias, panic states, and alcohol withdrawal.

bizarre delusion A delusion that involves a phenomenon that the person's culture would regard as totally implausible.

blind spot Visual scotoma, a circumscribed area of blindness or impaired vision in the visual field; by extension, an area of the personality of which the subject is unaware, typically because recognition of this area would cause painful emotions.

blocking A sudden obstruction or interruption in spontaneous flow of thinking or speaking, perceived as an absence or deprivation of thought.

blunted affect An affect type that represents significant reduction in the intensity of emotional expression

body image One's sense of the self and one's body.

bradykinesia Neurologic condition characterized by a generalized slowness of motor activity.

Broca's aphasia Loss of the ability to comprehend language coupled with production of inappropriate language.

bruxism Grinding of the teeth, occurs unconsciously while awake or during stage 2 sleep. May be secondary to anxiety, tension, or dental problems.

C

Capgras' syndrome The delusion that others, or the self, have been replaced by imposters. It typically follows the development of negative feelings toward the other person that the subject cannot accept and attributes, instead, to the imposter. The syndrome has been reported in paranoid schizophrenia and, even more frequently, in organic brain disease.

catalepsy Waxy flexibility--rigid maintenance of a body position over an extended period of time.

cataplexy Episodes of sudden bilateral loss of muscle tone resulting in the individual collapsing, often in association with intense emotions such as laughter, anger, fear, or surprise.

catatonic behavior Marked motor abnormalities including motoric immobility (i.e., catalepsy or stupor), certain types of excessive motor activity (apparently purposeless agitation not influenced by external stimuli), extreme negativism (apparent motiveless resistance to instructions or attempts to be moved) or mutism, posturing or stereotyped movements, and echolalia or echopraxia

catharsis The healthful (therapeutic) release of ideas through "talking out" conscious material accompanied by an appropriate emotional reaction. Also, the release into awareness of repressed ("forgotten") material from the unconscious. See also repression.

cathexis Attachment, conscious or unconscious, of emotional feeling and significance to an idea, an object, or, most commonly, a person.

causalgia A sensation of intense pain of either organic or psychological origin.

cerea flexibilitas The "waxy flexibility" often present in catatonic schizophrenia in which the patient's arm or leg remains in the position in which it is placed.

circumstantiality Pattern of speech that is indirect and delayed in reaching its goal because of excessive or irrelevant detail or parenthetical remarks. The speaker does not lose the point, as is characteristic of loosening of associations, and clauses remain logically connected, but to the listener it seems that the end will never be reached.

clanging A type of thinking in which the sound of a word, rather than its meaning, gives the direction to subsequent associations.

climacteric Menopausal period in women. Sometimes used to refer to the corresponding age period in men. Also called involutional period.

cognitive Pertaining to thoughts or thinking. Cognitive disorders are disorders of thinking, for example, schizophrenia.

comorbidity The simultaneous appearance of two or more illnesses, such as the co-occurrence of schizophrenia and substance abuse or of alcohol dependence and depression. The association may reflect a causal relationship between one disorder and another or an underlying vulnerability to both disorders. Also, the appearance of the illnesses may be unrelated to any common etiology or vulnerability.

compensation A defense mechanism, operating unconsciously, by which one attempts to make up for real or fancied deficiencies. Also a conscious process in which one strives to make up for real or imagined defects of physique, performance skills, or psychological attributes. The two types frequently merge. See also overcompensation.

compulsion Repetitive ritualistic behavior such as hand washing or ordering or a mental act such as praying or repeating words silently that aims to prevent or reduce distress or prevent some dreaded event or situation. The person feels driven to perform such actions in response to an obsession or according to rules that must be applied rigidly, even though the behaviors are recognized to be excessive or unreasonable.

conative Pertains to one's basic strivings as expressed in behavior and actions

concrete thinking Thinking characterized by immediate experience, rather than abstractions. It may occur as a primary, developmental defect, or it may develop secondary to organic brain disease or schizophrenia.

condensation A psychological process, often present in dreams, in which two or more concepts are fused so that a single symbol represents the multiple components.

confabulation Fabrication of stories in response to questions about situations or events that are not recalled.

confrontation A communication that deliberately pressures or invites another to self-examine some aspect of behavior in which there is a discrepancy between self-reported and observed behavior.

constricted affect Affect type that represents mild reduction in the range and intensity of emotional expression.

constructional apraxia An acquired difficulty in drawing two-dimensional objects or forms, or in producing or copying three-dimensional arrangements of forms or shapes.

contingency reinforcement In operant or instrumental conditioning, ensuring that desired behavior is followed by positive consequences and that undesired behavior is not rewarded.

conversion A defense mechanism, operating unconsciously, by which intrapsychic conflicts that would otherwise give rise to anxiety are instead given symbolic external expression. The repressed ideas or impulses, and the psychological defenses against them, are converted into a variety of somatic symptoms. These may include such symptoms as paralysis, pain, or loss of sensory function.

coping mechanisms Ways of adjusting to environmental stress without altering one's goals or purposes; includes both conscious and unconscious mechanisms.

coprophagia Eating of filth or feces.

counterphobia Deliberately seeking out and exposing onself to, rather than avoiding, the object or situation that is consciously or unconsciously feared.

countertransference The therapist's emotional reactions to the patient that are based on the therapist's unconscious needs and conflicts, as distinguished from his or her conscious responses to the patient's behavior. Countertransference may interfere with the therapist's ability to understand the patient and may adversely affect the therapeutic technique. Currently, there is emphasis on the positive aspects of countertransference and its use as a guide to a more empathic understanding of the patient.

cretinism A type of mental retardation and bodily malformation caused by severe, uncorrected thyroid deficiency in infancy and early childhood.

cri du chat A type of mental retardation. The name is derived from a catlike cry emitted by children with this disorder, which is caused by partial deletion of chromosome 5.

conversion symptom A loss of, or alteration in, voluntary motor or sensory functioning suggesting a neurological or general medical condition. Psychological factors are judged to be associated with the development of the symptom, and the symptom is not fully explained by a neurological or general medical condition or the direct effects of a substance. The symptom is not intentionally produced or feigned and is not culturally sanctioned.

culture-specific syndromes Forms of disturbed behavior specific to certain cultural systems that do not conform to western nosologic entities. Some commonly cited syndromes are the following: amok; koro; latah; piblokto, and windigo.

D

Da Costa's syndrome Neurocirculatory asthenia; "soldier's heart"; a functional disorder of the circulatory system that is usually a part of an anxiety state or secondary to hyperventilation.

decompensation The deterioration of existing defenses, leading to an exacerbation of pathological behavior.

defense mechanism Automatic psychological process that protects the individual against anxiety and from awareness of internal or external stressors or dangers. Defense mechanisms mediate the individual's reaction to emotional conflicts and to external stressors. Some defense mechanisms (e.g., projection, splitting, and acting out) are almost invariably maladaptive. Others, such as suppression and denial, may be either maladaptive or adaptive, depending on their severity, their inflexibility, and the context in which they occur.

déjà vu A paramnesia consisting of the sensation or illusion that one is seeing what one has seen before

delusion A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone 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). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. Delusional conviction occurs on a continuum and can sometimes be inferred from an individual's behavior. It is often difficult to distinguish between a delusion and an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion). Delusions are subdivided according to their content. Some of the more common types are: bizarre; delusional jealousy; grandiose; delusion of reference; persecutory; somatic; thought broadcasting; thought insertion.

delusional jealousy The delusion that one's sexual partner is unfaithful. erotomanic A delusion that another person, usually of higher status, is in love with the individual.

delusion of reference A delusion whose theme is that events, objects, or other persons in one's immediate environment have a particular and unusual significance. These delusions are usually of a negative or pejorative nature, but also may be grandiose in content. This differs from an idea of reference, in which the false belief is not as firmly held nor as fully organized into a true belief.

denial A defense mechanism where certain information is not accessed by the conscious mind. Denial is related to repression, a similar defense mechanism, but denial is more pronounced or intense. Denial involves some impairment of reality. Denial would be operating (as an example) if a cardiac patient who has been warned about the potential fatal outcome of engaging in heavy work, decides to start building a wall of heavy stones.

depersonalization An alteration in the perception or experience of the self so that one feels detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream).

derailment ("loosening of associations") A pattern of speech in which a person's ideas slip off one track onto another that is completely unrelated or only obliquely related. In moving from one sentence or clause to another, the person shifts the topic idiosyncratically from one frame of reference to another and things may be said in juxtaposition that lack a meaningful relationship. This disturbance occurs between clauses, in contrast to incoherence, in which the disturbance is within clauses. An occasional change of topic without warning or obvious connection does not constitute derailment.

derealization An alteration in the perception or experience of the external world so that it seems strange or unreal (e.g., people may seem unfamiliar or mechanical).

dereistic Mental activity that is not in accordance with reality, logic, or experience.

detachment A behavior pattern characterized by general aloofness in interpersonal contact; may include intellectualization, denial, and superficiality.

diplopia Double vision due to paralysis of the ocular muscles; seen in inhalant intoxication and other conditions affecting the oculomotor nerve.

disconnection syndrome Term coined by Norman Geschwind (1926¾1984) to describe the interruption of information transferred from one brain region to another.

disinhibition Freedom to act according to one's inner drives or feelings, with less regard for restraints imposed by cultural norms or one's superego; removal of an inhibitory, constraining, or limiting influence, as in the escape from higher cortical control in neurologic injury, or in uncontrolled firing of impulses, as when a drug interferes with the usual limiting or inhibiting action of GABA within the central nervous system.

disorientation Confusion about the time of day, date, or season (time), where one is (place), or who one is (person).

dysphoric mood An unpleasant mood, such as sadness, anxiety, or irritability.

displacement A defense mechanism, operating unconsciously, in which emotions, ideas, or wishes are transferred from their original object to a more acceptable substitute; often used to allay anxiety.

dissociation A disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic.

distractibility The inability to maintain attention, that is, the shifting from one area or topic to another with minimal provocation, or attention being drawn too frequently to unimportant or irrelevant external stimuli.

double bind Interaction in which one person demands a response to a message containing mutually contradictory signals, while the other person is unable either to comment on the incongruity or to escape from the situation.

drive Basic urge, instinct, motivation; a term used to avoid confusion with the more purely biological concept of instinct.

dyad A two-person relationship, such as the therapeutic relationship between doctor and patient in individual psychotherapy.

dysarthria Imperfect articulation of speech due to disturbances of muscular control or incoordination.

dysgeusia Perversion of the sense of taste.

dyskinesia Distortion of voluntary movements with involuntary muscular activity.

dyslexia Inability or difficulty in reading, including word-blindness and a tendency to reverse letters and words in reading and writing.

dyssomnia Primary disorders of sleep or wakefulness characterized by insomnia or hypersomnia as the major presenting symptom. Dyssomnias are disorders of the amount, quality, or timing of sleep.

dystonia Disordered tonicity of muscles.

E

echolalia The pathological, parrotlike, and apparently senseless repetition (echoing) of a word or phrase just spoken by another person. echolalia Parrot-like repetition of overheard words or fragments of speech.

echopraxia Repetition by imitation of the movements of another. The action is not a willed or voluntary one and has a semiautomatic and uncontrollable quality.

ego In psychoanalytic theory, one of the three major divisions in the model of the psychic apparatus, the others being the id and the superego. The ego represents the sum of certain mental mechanisms, such as perception and memory, and specific defense mechanisms. It serves to mediate between the demands of primitive instinctual drives (the id), of internalized parental and social prohibitions (the superego), and of reality. The compromises between these forces achieved by the ego tend to resolve intrapsychic conflict and serve an adaptive and executive function. Psychiatric usage of the term should not be confused with common usage, which connotes self-love or selfishness.

ego ideal The part of the personality that comprises the aims and goals for the self; usually refers to the conscious or unconscious emulation of significant figures with whom one has identified. The ego ideal emphasizes what one should be or do in contrast to what one should not be or not do.

ego-dystonic Referring to aspects of a person's behavior, thoughts, and attitudes that are viewed by the self as repugnant or inconsistent with the total personality.

eidetic image Unusually vivid and apparently exact mental image; may be a memory, fantasy, or dream.

elaboration An unconscious process consisting of expansion and embellishment of detail, especially with reference to a symbol or representation in a dream.

elevated mood An exaggerated feeling of well-being, or euphoria or elation. A person with elevated mood may describe feeling "high," "ecstatic," "on top of the world," or "up in the clouds."

engram A memory trace; a neurophysiological process that accounts for persistence of memory

epigenesis Originally from the Greek "epi" (on, upon, on top of) and "genesis" (origin); the theory that the embryo is not preformed in the ovum or the sperm, but that it develops gradually by the successive formation of new parts. The concept has been extended to other areas of medicine, with different shades of meaning. Some of the other meanings are as follows: 1. Any change in an organism that is due to outside influences rather than to genetically determined ones. 2. The occurrence of secondary symptoms as a result of disease. 3. Developmental factors, and specifically the gene-environment interactions, that contribute to development. 4. The appearance of new functions that are not predictable on the basis of knowledge of the part-processes that have been combined. 5. The appearance of specific features at each stage of development, such as the different goals and risks that Erikson described for the eight stages of human life (trust vs. mistrust, autonomy vs. doubt, etc.). The life cycle theory adheres to the epigenetic principle in that each stage of development is characterized by crises or challenges that must be satisfactorily resolved if development is to proceed normally.

ethnology A science that concerns itself with the division of human beings into races and their origin, distribution, relations, and characteristics.

euthymic Mood in the "normal" range, which implies the absence of depressed or elevated mood.

expansive mood Lack of restraint in expressing one's feelings, frequently with an overvaluation of one's significance or importance. irritable Easily annoyed and provoked to anger.

extinction The weakening of a reinforced operant response as a result of ceasing reinforcement. See also operant conditioning. Also, the elimination of a conditioned response by repeated presentations of a conditioned stimulus without the unconditioned stimulus. See also respondent conditioning.

extraversion A state in which attention and energies are largely directed outward from the self as opposed to inward toward the self, as in introversion.

F

fantasy An imagined sequence of events or mental images (e.g., daydreams) that serves to express unconscious conflicts, to gratify unconscious wishes, or to prepare for anticipated future events.

flashback A recurrence of a memory, feeling, or perceptual experience from the past.

flat affect An affect type that indicates the absence of signs of affective expression.

flight of ideas A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may be disorganized and incoherent.

flooding (implosion) A behavior therapy procedure for phobias and other problems involving maladaptive anxiety, in which anxiety producers are presented in intense forms, either in imagination or in real life. The presentations, which act as desensitizers, are continued until the stimuli no longer produce disabling anxiety.

folie à deux A shared psychotic disorder between 2 people, usually people who are mutually dependent upon each other.

formal thought disorder An inexact term referring to a disturbance in the form of thinking rather than to abnormality of content. See blocking; loosening of associations; poverty of speech.

formication The tactile hallucination or illusion that insects are crawling on the body or under the skin.

fragmentation Separation into different parts, or preventing their integration, or detaching one or more parts from the rest. A fear of fragmentation of the personality, also known as disintegration anxiety, is often observed in patients whenever they are exposed to repetitions of earlier experiences that interfered with development of the self. This fear may be expressed as feelings of falling apart, as a loss of identity, or as a fear of impending loss of one's vitality and of psychological depletion.

free association In psychoanalytic therapy, spontaneous, uncensored verbalization by the patient of whatever comes to mind.

frotteurism One of the paraphilias, consisting of recurrent, intense sexual urges involving touching and rubbing against a nonconsenting person; common sites in which such activities take place are crowded trains, buses, and elevators. Fondling the victim may be part of the condition and is called toucherism.

fusion The union and integration of the instincts and drives so that they complement each other and help the organism to deal effectively with both internal needs and external demands.
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Gegenhalten "Active" resistance to passive movement of the extremities that does not appear to be under voluntary control.

globus hystericus The disturbing sensation of a lump in the throat.

glossolalia Gibberish-like speech or "speaking in tongues."

gender dysphoria A persistent aversion toward some or all of those physical characteristics or social roles that connote one's own biological sex.

gender identity A person's inner conviction of being male or female.

gender role Attitudes, patterns of behavior, and personality attributes defined by the culture in which the person lives as stereotypically "masculine" or "feminine" social roles.

grandiosity An inflated appraisal of one's worth, power, knowledge, importance, or identity. When extreme, grandiosity may be of delusional proportions.

grandiose delusion A delusion of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.

gustatory hallucination A hallucination involving the perception of taste (usually unpleasant).

H

hallucination A sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Hallucinations should be distinguished from illusions, in which an actual external stimulus is misperceived or misinterpreted. The person may or may not have insight into the fact that he or she is having a hallucination. One person with auditory hallucinations may recognize that he or she is having a false sensory experience, whereas another may be convinced that the source of the sensory experience has an independent physical reality. The term hallucination is not ordinarily applied to the false perceptions that occur during dreaming, while falling asleep (hypnagogic), or when awakening (hypnopompic). Transient hallucinatory experiences may occur in people without a mental disorder.

hedonism Pleasure-seeking behavior. Contrast with anhedonia.

5-HIAA (5-hydroxyindoleacetic acid) A major metabolite of serotonin, a biogenic amine found in the brain and other organs. Functional deficits of serotonin in the central nervous system have been implicated in certain types of major mood disorders, and particularly in suicide and impulsivity.

hippocampus Olfactory brain; a sea-horse¾shaped structure located within the brain that is an important part of the limbic system. The hippocampus is involved in some aspects of memory, in the control of the autonomic functions, and in emotional expression.

hyperacusis Inordinate sensitivity to sounds; it may be on an emotional or an organic basis.

hypersomnia Excessive sleepiness, as evidenced by prolonged nocturnal sleep, difficulty maintaining an alert awake state during the day, or undesired daytime sleep episodes. ideas of reference The feeling that casual incidents and external events have a particular and unusual meaning that is specific to the person. This is to be distinguished from a delusion of reference, in which there is a belief that is held with delusional conviction

hypnagogic Referring to the semiconscious state immediately preceding sleep; may include hallucinations that are of no pathological significance.

hypnopompic Referring to the state immediately preceding awakening; may include hallucinations that are of no pathological significance.

I

id In Freudian theory, the part of the personality that is the unconscious source of unstructured desires and drives. See also ego; superego.

idealization A mental mechanism in which the person attributes exaggeratedly positive qualities to the self or others.

ideas of reference Incorrect interpretations of casual incidents and external events as having direct reference to oneself. May reach sufficient intensity to constitute delusions.

identification A defense mechanism, operating unconsciously, by which one patterns oneself after some other person. Identification plays a major role in the development of one's personality and specifically of the superego. To be differentiated from imitation or role modeling, which is a conscious process.

idiot savant A person with gross mental retardation who nonetheless is capable of performing certain remarkable feats in sharply circumscribed intellectual areas, such as calendar calculation or puzzle solving.

illusion A misperception or misinterpretation of a real external stimulus, such as hearing the rustling of leaves as the sound of voices. See also hallucination.

imprinting A term in ethology referring to a process similar to rapid learning or behavioral patterning that occurs at critical points in very early stages of animal development. The extent to which imprinting occurs in human development has not been established.

inappropriate affect An affect type that represents an unusual affective expression that does not match with the content of what is being said or thought.

incoherence Speech or thinking that is essentially incomprehensible to others because words or phrases are joined together without a logical or meaningful connection. This disturbance occurs within clauses, in contrast to derailment, in which the disturbance is between clauses. This has sometimes been referred to as "word salad" to convey the degree of linguistic disorganization. Mildly ungrammatical constructions or idiomatic usages characteristic of particular regional or cultural backgrounds, lack of education, or low intelligence should not be considered incoherence. The term is generally not applied when there is evidence that the disturbance in speech is due to an aphasia.

incorporation A primitive defense mechanism, operating unconsciously, in which the psychic representation of a person, or parts of the person, is figuratively ingested.

individuation A process of differentiation, the end result of which is development of the individual personality that is separate and distinct from all others.

indoleamine One of a group of biogenic amines (e.g., serotonin) that contains a five-membered, nitrogen-containing indole ring and an amine group within its chemical structure. inhibition Behavioral evidence of an unconscious defense against forbidden instinctual drives; may interfere with or restrict specific activities.

insomnia A subjective complaint of difficulty falling or staying asleep or poor sleep quality. Types of insomnia include:

initial insomnia Difficulty in falling asleep.

instinct An inborn drive. The primary human instincts include self-preservation, sexuality, and according to some proponents the death instinct, of which aggression is one manifestation.

integration The useful organization and incorporation of both new and old data, experience, and emotional capacities into the personality. Also refers to the organization and amalgamation of functions at various levels of psychosexual development.

intellectualization A mental mechanism in which the person engages in excessive abstract thinking to avoid confrontation with conflicts or disturbing feelings.

intersex condition A condition in which an individual shows intermingling, in various degrees, of the characteristics of each sex, including physical form, reproductive organs, and sexual behavior.

introspection Self-observation; examination of one's feelings, often as a result of psychotherapy.

introversion Preoccupation with oneself and accompanying reduction of interest in the outside world. Contrast to extraversion.

isolation A defense mechanism operating unconsciously central to obsessive-compulsive phenomena in which the affect is detached from an idea and rendered unconscious, leaving the conscious idea colorless and emotionally neutral.

K

Klinefelter's syndrome Chromosomal defect in males in which there is an extra X chromosome; manifestations may include underdeveloped testes, physical feminization, sterility, and mental retardation.

koro A culture specific syndrome of China involving fear of retraction of penis into abdomen with the belief that this will lead to death.

L

la belle indifférence Literally, "beautiful indifference." Seen in certain patients with conversion disorders who show an inappropriate lack of concern about their disabilities. labile Rapidly shifting (as applied to emotions); unstable.

labile affect An affect type that indicates abnormal sudden rapid shifts in affect.

latah A culture specific syndrome of Southeast Asia involving startle-induced disorganization, hypersuggestibility, automatic obedience, and echopraxia.

latent content The hidden (i.e., unconscious) meaning of thoughts or actions, especially in dreams or fantasies. In dreams, it is expressed in distorted, disguised, condensed, and symbolic form.

learned helplessness A condition in which a person attempts to establish and maintain contact with another by adopting a helpless, powerless stance.

lethologica Temporary inability to remember a proper noun or name.

libido The psychic drive or energy usually associated with the sexual instinct. (Sexual is used here in the broad sense to include pleasure and love-object seeking.)

locus coeruleus A small area in the brain stem containing norepinephrine neurons that is considered to be a key brain center for anxiety and fear.

long-term memory The final phase of memory in which information storage may last from hours to a lifetime.

loosening of associations A disturbance of thinking shown by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first. Statements that lack a meaningful relationship may be juxtaposed, or speech may shift suddenly from one frame of reference to another. The speaker gives no indication of being aware of the disconnectedness, contradictions, or illogicality of speech.

M

macropsia The visual perception that objects are larger than they actually are.

magical thinking A conviction that thinking equates with doing. Occurs in dreams in children, in primitive peoples, and in patients under a variety of conditions. Characterized by lack of realistic relationship between cause and effect.

manifest content The remembered content of a dream or fantasy, as contrasted with latent content, which is concealed and distorted.

masochism Pleasure derived from physical or psychological pain inflicted on oneself either by oneself or by others. It is called sexual masochism and classified as a paraphilia when it is consciously sought as a part of the sexual act or as a prerequisite to sexual gratification. It is the converse of sadism, although the two tend to coexist in the same person.

memory consolidation The physical and psychological changes that take place as the brain organizes and restructures information that may become a permanent part of memory.

mental retardation A major group of disorders of infancy, childhood, or adolescence characterized by intellectual functioning that is significantly below average (IQ of 70 or below), manifested before the age of 18 by impaired adaptive functioning (below expected performance for age in such areas as social or daily living skills, communication, and self-sufficiency). Different levels of severity are recognized: an IQ level of 50/55 to 70 is Mild; an IQ level of 35/40 to 50/55 is Moderate; an IQ level of 20/25 to 35/40 is Severe; an IQ level below 20/25 is Profound.

MHPG (3-methoxy-4-hydroxyphenylglycol) A major metabolite of brain norepinephrine excreted in urine.

magical thinking The erroneous belief that one's thoughts, words, or actions will cause or prevent a specific outcome in some way that defies commonly understood laws of cause and effect. Magical thinking may be a part of normal child development.

micropsia The visual perception that objects are smaller than they actually are.

middle insomnia Awakening in the middle of the night followed by eventually falling back to sleep, but with difficulty.

mirroring 1) The empathic responsiveness of the parent to the developing child's grandiose-exhibitionistic needs. Parental expressions of delight in the child's activities signal that the child's wishes and experiences are accepted as legitimate. This teaches the child which of his or her potential qualities are most highly esteemed and valued. Mirroring validates the child as to who he or she is and affirms his or her worth. The process transforms archaic aims to realizable aims, and it determines in part the content of the self-assessing, self-monitoring functions and their relationships to the rest of the personality. The content of the superego is the residue of the mirroring experience. 2) A technique in psychodrama in which another person in the group plays the role of the patient, who watches the enactment as if gazing into a mirror. The first person may exaggerate one or more aspects of the patient's behavior. Following the portrayal, the patient is usually encouraged to comment on what he or she has observed.

mood A pervasive and sustained emotion that colors the perception of the world. Common examples of mood include depression, elation, anger, and anxiety. In contrast to affect, which refers to more fluctuating changes in emotional "weather," mood refers to a more pervasive and sustained emotional "climate." Types of mood include: dysphoric, elevated, euthymic, expansive, irritable.

mood-congruent psychotic features Delusions or hallucinations whose content is entirely consistent with the typical themes of a depressed or manic mood. If the mood is depressed, the content of the delusions or hallucinations would involve themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. The content of the delusion may include themes of persecution if these are based on self-derogatory~ concepts such as deserved punishment. If the mood is manic, the content of the delusions or hallucinations would involve themes of inflated worth, power, knowledge, or identity, or a special relationship to a deity or a famous person. The content of the delusion may include themes of persecution if these are based on concepts such as inflated worth or deserved punishment.

mood-incongruent psychotic features Delusions or hallucinations whose content is not consistent with the typical themes of a depressed or manic mood. In the case of depression, the delusions or hallucinations would not involve themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. In the case of mania, the delusions or hallucinations would not involve themes of inflated worth, power, knowledge, or identity, or a special relationship to a deity or a famous person. Examples of mood-incongruent psychotic features include persecutory delusions (without self-derogatory~ or grandiose content), thought insertion, thought broadcasting, and delusions of being controlled whose content has no apparent relationship to any of the themes listed above.

N

negative symptoms Most commonly refers to a group of symptoms characteristic of schizophrenia that include loss of fluency and spontaneity of verbal expression, impaired ability to focus or sustain attention on a particular task, difficulty in initiating or following through on tasks, impaired ability to experience pleasure to form emotional attachment to others, and blunted affect.

negativism Opposition or resistance, either covert or overt, to outside suggestions or advice. May be seen in schizophrenia.

neologism In psychiatry, a new word or condensed combination of several words coined by a person to express a highly complex idea not readily understood by others; seen in schizophrenia and organic mental disorders.

neurotic disorder A mental disorder in which the predominant disturbance is a distressing symptom or group of symptoms that one considers unacceptable and alien to one's personality. There is no marked loss of reality testing ; behavior does not actively violate gross social norms, although it may be quite disabling. The disturbance is relatively enduring or recurrent without treatment and is not limited to a mild transitory reaction to stress. There is no demonstrable organic etiology.

nihilistic delusion The delusion of nonexistence of the self or part of the self, or of some object in external reality.

nystagmus Involuntary rhythmic movements of the eyes that consist of small-amplitude~ rapid tremors in one direction and a larger, slower, recurrent sweep in the opposite direction. Nystagmus may be horizontal, vertical, or rotary.

O

object relations The emotional bonds between one person and another, as contrasted with interest in and love for the self; usually described in terms of capacity for loving and reacting appropriately to others. Melanie Klein is generally credited with founding the British object-relations school.

obsession Recurrent and persistent thought, impulse, or image experienced as intrusive and distressing. Recognized as being excessive and unreasonable even though it is the product of one's mind. This thought, impulse, or image cannot be expunged by logic or reasoning.

oedipal stage Overlapping some with the phallic stage, this phase (ages 4 to 6) represents a time of inevitable conflict between the child and parents. The child must desexualize the relationship to both parents in order to retain affectionate kinship with both of them. The process is accomplished by the internalization of the images of both parents, thereby giving more definite shape to the child's personality. With this internalization largely completed, the regulation of self-esteem and moral behavior comes from within.

Oedipus complex Attachment of the child to the parent of the opposite sex, accompanied by envious and aggressive feelings toward the parent of the same sex. These feelings are largely repressed (i.e., made unconscious) because of the fear of displeasure or punishment by the parent of the same sex. In its original use, the term applied only to the boy or man.

olfactory hallucination A hallucination involving the perception of odor, such as of burning rubber or decaying fish.

ontogenetic Pertaining to the development of the individual.

operant conditioning (instrumental conditioning) A process by which the results of the person's behavior determine whether the behavior is more or less likely to occur in the future.

oral stage The earliest of the stages of infantile psychosexual development, lasting from birth to 12 months or longer. Usually subdivided into two stages: the oral erotic, relating to the pleasurable experience of sucking; and the oral sadistic, associated with aggressive biting. Both oral eroticism and sadism continue into adult life in disguised and sublimated forms, such as the character traits of demandingness or pessimism. Oral conflict, as a general and pervasive influence, might underlie the psychological determinants of addictive disorders, depression, and some functional psychotic disorders.

orientation Awareness of one's self in relation to time, place, and person.

overcompensation A conscious or unconscious process in which a real or imagined physical or psychological deficit generates exaggerated correction. Concept introduced by Adler.

overdetermination The concept of multiple unconscious causes of an emotional reaction or symptom.

overvalued idea An unreasonable and sustained belief that is maintained with less than delusional intensity (i.e., the person is able to acknowledge the possibility that the belief may not be true). The belief is not one that is ordinarily accepted by other members of the person's culture or subculture

P

panic attacks Discrete periods of sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks there are symptoms such as shortness of breath or smothering sensations; palpitations, pounding heart, or accelerated heart rate; chest pain or discomfort; choking; and fear of going crazy or losing control. Panic attacks may be unexpected (uncued), in which the onset of the attack is not associated with a situational trigger and instead occurs "out of the blue"; situationally bound, in which the panic attack almost invariably occurs immediately on exposure to, or in anticipation of, a situational trigger ("cue"); and situationally predisposed, in which the panic attack is more likely to occur on exposure to a situational trigger but is not invariably associated with it.

paranoid ideation Ideation, of less than delusional proportions, involving suspiciousness or the belief that one is being harassed, persecuted, or unfairly treated.

parasomnia Abnormal behavior or physiological events occurring during sleep or sleep-wake transitions.

persecutory delusion A delusion in which the central theme is that one (or someone to whom one is close) is being attacked, harassed, cheated, persecuted, or conspired against.

perseveration Tendency to emit the same verbal or motor response again and again to varied stimuli.

personality Enduring patterns of perceiving, relating to, and thinking about the environment and oneself. Personality traits are prominent aspects of personality that are exhibited in a wide range of important social and personal contexts. Only when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress do they constitute a Personality Disorder.

phallic stage The period, from about 21/2 to 6 years, during which sexual interest, curiosity, and pleasurable experience in boys center on the penis, and in girls, to a lesser extent, the clitoris.

phobia A persistent, irrational fear of a specific object, activity, or situation (the phobic stimulus) that results in a compelling desire to avoid it. This often leads either to avoidance of the phobic stimulus or to enduring it with dread.

piblokto A culture specific syndrome of Eskimos involving attacks of screaming, crying, and running naked through the snow

preconscious Thoughts that are not in immediate awareness but that can be recalled by conscious effort.

pregenital In psychoanalysis, refers to the period of early childhood before the genitals have begun to exert the predominant influence in the organization or patterning of sexual behavior. Oral and anal influences predominate during this period.

pressured speech Speech that is increased in amount, accelerated, and difficult or impossible to interrupt. Usually it is also loud and emphatic. Frequently the person talks without any social stimulation and may continue to talk even though no one is listening.

prevalence Frequency of a disorder, used particularly in epidemiology to denote the total number of cases existing within a unit of population at a given time or over a specified period.

primary gain The relief from emotional conflict and the freedom from anxiety achieved by a defense mechanism. Contrast with secondary gain.

primary process In psychoanalytic theory, the generally unorganized mental activity characteristic of the unconscious. This activity is marked by the free discharge of energy and excitation without regard to the demands of environment, reality, or logic.

prodrome An early or premonitory sign or symptom of a disorder

projection A defense mechanism, operating unconsciously, in which what is emotionally unacceptable in the self is unconsciously rejected and attributed (projected) to others.

projective identification A term introduced by Melanie Klein to refer to the unconscious process of projection of one or more parts of the self or of the internal object into another person (such as the mother). What is projected may be an intolerable, painful, or dangerous part of the self or object (the bad object). It may also be a valued aspect of the self or object (the good object) that is projected into the other person for safekeeping. The other person is changed by the projection and is dealt with as though he or she is in fact characterized by the aspects of the self that have been projected.

projective tests Psychological diagnostic tests in which the test material is unstructured so that any response will reflect a projection of some aspect of the subject's underlying personality and psychopathology

prosopagnosia Inability to recognize familiar faces that is not explained by defective visual acuity or reduced consciousness or alertness.

pseudocyesis Included in DSM-IV as one of the somatoform disorders. It is characterized by a false belief of being pregnant and by the occurrence of signs of being pregnant, such as abdominal enlargement, breast engorgement, and labor pains.

pseudodementia A syndrome in which dementia is mimicked or caricatured by a functional psychiatric illness. Symptoms and response of mental status examination questions are similar to those found in verified cases of dementia. In pseudodementia, the chief diagnosis to be considered in the differential is depression in an older person vs. cognitive deterioration on the basis of organic brain disease.

psychomotor agitation Excessive motor activity associated with a feeling of inner tension. When severe, agitation may involve shouting and loud complaining. The activity is usually nonproductive and repetitious, and consists of such behavior as pacing, wringing of hands, and inability to sit still.

psychomotor retardation Visible generalized slowing of movements and speech.

psychosexual development A series of stages from infancy to adulthood, relatively fixed in time, determined by the interaction between a person's biological drives and the environment. With resolution of this interaction, a balanced, reality-oriented development takes place; with disturbance, fixation and conflict ensue. This disturbance may remain latent or give rise to characterological or behavioral disorders.

psychotic This term has historically received a number of different definitions, none of which has achieved universal acceptance. The narrowest definition of psychotic is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A slightly less restrictive definition would also include prominent hallucinations that the individual realizes are hallucinatory experiences. Broader still is a definition that also includes other positive symptoms of Schizophrenia (i.e., disorganized speech, grossly disorganized or catatonic behavior). Unlike these definitions based on symptoms, the definition used in DSM-II and ICD-9 was probably far too inclusive and focused on the severity of functional impairment, so that a mental disorder was termed psychotic if it resulted in "impairment that grossly interferes with the capacity to meet ordinary demands of life." Finally, the term has been defined conceptually as a loss of ego boundaries or a gross impairment in reality testing. Based on their characteristic features, the different disorders in DSM-IV emphasize different aspects of the various definitions of psychotic.

psychotropic medication Medication that affects thought processes or feeling states
R

rationalization A defense mechanism, operating unconsciously, in which an individual attempts to justify or make consciously tolerable by plausible means, feelings or behavior that otherwise would be intolerable. Not to be confused with conscious evasion or dissimulation. See also projection.

reaction formation A defense mechanism, operating unconsciously, in which a person adopts affects, ideas, and behaviors that are the opposites of impulses harbored either consciously or unconsciously. For example, excessive moral zeal may be a reaction to strong but repressed asocial impulses.

reality principle In psychoanalytic theory, the concept that the pleasure principle, which represents the claims of instinctual wishes, is normally modified by the demands and requirements of the external world. In fact, the reality principle may still work on behalf of the pleasure principle but reflects compromises and allows for the postponement of gratification to a more appropriate time. The reality principle usually becomes more prominent in the course of development but may be weak in certain psychiatric illnesses and undergo strengthening during treatment. reality testing The ability to evaluate the external world objectively and to differentiate adequately between it and the internal world. Falsification of reality, as with massive denial or projection, indicates a severe disturbance of ego functioning and/or of the perceptual and memory processes upon which it is partly based.

reciprocal inhibition In behavior therapy, the hypothesis that if anxiety-provoking stimuli occur simultaneously with the inhibition of anxiety (e.g., relaxation), the bond between those stimuli and the anxiety will be weakened.

regression Partial or symbolic return to earlier patterns of reacting or thinking. Manifested in a wide variety of circumstances such as normal sleep, play, physical illness, and in many mental disorders.

reinforcement The strengthening of a response by reward or avoidance of punishment. This process is central in operant conditioning.

repetition compulsion In psychoanalytic theory, the impulse to reenact earlier emotional experiences. Considered by Freud to be more fundamental than the pleasure principle. Defined by Jones in the following way: "The blind impulse to repeat earlier experiences and situations quite irrespective of any advantage that doing so might bring from a pleasure-pain point of view."

repression A defense mechanism, operating unconsciously, that banishes unacceptable ideas, fantasies, affects, or impulses from consciousness or that keeps out of consciousness what has never been conscious. Although not subject to voluntary recall, the repressed material may emerge in disguised form. Often confused with the conscious mechanism of suppression. resistance One's conscious or unconscious psychological defense against bringing repressed (unconscious) thoughts into conscious awareness.

respondent conditioning (classical conditioning, Pavlovian conditioning) Elicitation of a response by a stimulus that normally does not elicit that response. The response is one that is mediated primarily by the autonomic nervous system (such as salivation or a change in heart rate). A previously neutral stimulus is repeatedly presented just before an unconditioned stimulus that normally elicits that response. When the response subsequently occurs in the presence of the previously neutral stimulus, it is called a conditioned response, and the previously neutral stimulus, a conditioned stimulus.

residual phase The phase of an illness that occurs after remission of the florid symptoms or the full syndrome.

S

screen memory A consciously tolerable memory that serves as a cover for an associated memory that would be emotionally painful if recalled.

secondary gain The external gain derived from any illness, such as personal attention and service, monetary gains, disability benefits, and release from unpleasant responsibilities. See also primary gain.

secondary process In psychoanalytic theory, mental activity and thinking characteristic of the ego and influenced by the demands of the environment. Characterized by organization, systematization, intellectualization, and similar processes leading to logical thought and action in adult life. See also primary process; reality principle.

sensory extinction Failure to report sensory stimuli from one region if another region is stimulated simultaneously, even though when the region in question is stimulated by itself, the stimulus is correctly reported.

separation anxiety disorder A disorder with onset before the age of 18 consisting of inappropriate anxiety concerning separation from home or from persons to whom the child is attached. Among the symptoms that may be seen are unrealistic concern about harm befalling or loss of major attachment figures; refusal to go to school (school phobia) in order to stay at home and maintain contact with this figure; refusal to go to sleep unless close to this person; clinging; nightmares about the theme of separation; and development of physical symptoms or mood changes (apathy, depression) when separation occurs or is anticipated.

separation-individuation Psychological awareness of one's separateness, described by Margaret Mahler as a phase in the mother-child relationship that follows the symbiotic stage. In the separation-individuation stage, the child begins to perceive himself or herself as distinct from the mother and develops a sense of individual identity and an image of the self as object. Mahler described four subphases of the process: differentiation, practicing, rapprochement (i.e., active approach toward the mother, replacing the relative obliviousness to her that prevailed during the practicing period), and separation-individuation proper (i.e., awareness of discrete identity, separateness, and individuality).

sex A person's biological status as male, female, or uncertain. Depending on the circumstances, this determination may be based on the appearance of the external genitalia or on karyotyping.

sign An objective manifestation of a pathological condition. Signs are observed by the examiner rather than reported by the affected individual.

shaping Reinforcement of responses in the patient's repertoire that increasingly approximate sought-after behavior.

sick role An identity adopted by an individual as a "patient" that specifies a set of expected behaviors, usually dependent.

signal anxiety An ego mechanism that results in activation of defensive operations to protect the ego from being overwhelmed by an excess of excitement. The anxiety reaction that was originally experienced in a traumatic situation is reproduced in an attenuated form, allowing defenses to be mobilized before the current threat does, in fact, become overwhelming.

simultanagnosia Inability to comprehend more than one element of a visual scene at the same time or to integrate the parts into a whole

sleep terror disorder One of the parasomnias, characterized by panic and confusion when abruptly awakening from sleep. This usually begins with a scream and is accompanied by intense anxiety. The person is often confused and disoriented after awakening. No detailed dream is recalled, and there is amnesia for the episode. Sleep terrors typically occur during the first third of the major sleep episode.

social adaptation The ability to live and express oneself according to society's restrictions and cultural demands.

somatic delusion A delusion whose main content pertains to the appearance or functioning of one's body.

somatic hallucination A hallucination involving the perception of a physical experience localized within the body (such as a feeling of electricity). A somatic hallucination is to be distinguished from physical sensations arising from an as-yet undiagnosed general medical condition, from hypochondriacal preoccupation with normal physical sensations, and from a tactile hallucination.

spatial agnosia Inability to recognize spatial relations; disordered spatial orientation.

splitting A mental mechanism in which the self or others are reviewed as all good or all bad, with failure to integrate the positive and negative qualities of self and others into cohesive images. Often the person alternately idealizes and devalues the same person.

stereotyped movements Repetitive, seemingly driven, and nonfunctional motor behavior (e.g., hand shaking or waving, body rocking, head banging, mouthing of objects, self-biting, picking at skin or body orifices, hitting one's own body).

Stockholm syndrome A kidnapping or terrorist hostage identifies with and has sympathy for his or her captors on whom he or she is dependent for survival.

stressor Any life event or life change that may be associated temporally (and perhaps causally) with the onset, occurrence, or exacerbation of a mental disorder.

structural theory Freud's model of the mental apparatus composed of id, ego, and superego.

stupor A state of unresponsiveness with immobility and mutism

sublimation A defense mechanism, operating unconsciously, by which instinctual drives, consciously unacceptable, are diverted into personally and socially acceptable channels.

substitution A defense mechanism, operating unconsciously, by which an unattainable or unacceptable goal, emotion, or object is replaced by one that is more attainable or acceptable.

suggestibility Uncritical compliance or acceptance of an idea, belief, or attribute.

suggestion The process of influencing a patient to accept an idea, belief, or attitude suggested by the therapist.

superego In psychoanalytic theory, that part of the personality structure associated with ethics, standards, and self-criticism. It is formed by identification with important and esteemed persons in early life, particularly parents. The supposed or actual wishes of these significant persons are taken over as part of the child's own standards to help form the conscience.

suppression The conscious effort to control and conceal unacceptable impulses, thoughts, feelings, or acts.

symbiosis A mutually reinforcing relationship between two persons who are dependent on each other; a normal characteristic of the relationship between the mother and infant child. See separation-individuation

symbolization A general mechanism in all human thinking by which some mental representation comes to stand for some other thing, class of things, or attribute of something. This mechanism underlies dream formation and some symptoms, such as conversion reactions, obsessions, and compulsions. The link between the latent meaning of the symptom and the symbol is usually

symptom A subjective manifestation of a pathological condition. Symptoms are reported by the affected individual rather than observed by the examiner.

syndrome A grouping of signs and symptoms, based on their frequent co-occurrence, that may suggest a common underlying pathogenesis, course, familial pattern, or treatment selection.

synesthesia A condition in which a sensory experience associated with one modality occurs when another modality is stimulated, for example, a sound produces the sensation of a particular color.

syntaxic mode The mode of perception that forms whole, logical, coherent pictures of reality that can be validated by others.

systematic desensitization A behavior therapy procedure widely used to modify behaviors associated with phobias. The procedure involves the construction of a hierarchy of anxiety-producing stimuli by the subject, and gradual presentation of the stimuli until they no longer produce anxiety.

T

tactile hallucination A hallucination involving the perception of being touched or of something being under one's skin. The most common tactile hallucinations are the sensation of electric shocks and formication (the sensation of something creeping or crawling on or under the skin).

tangentiality Replying to a question in an oblique or irrelevant way. Compare with circumstantiality.

temperament Constitutional predisposition to react in a particular way to stimuli.

terminal insomnia Awakening before one's usual waking time and being unable to return to sleep.

termination The act of ending or concluding. In psychotherapy, termination refers to the mutual agreement between patient and therapist to bring therapy to an end. The idea of termination often occurs to both, but usually it is the therapist who introduces the subject into the session as a possibility to be considered. In psychoanalytic treatment, the patient's reactions are worked through to completion before the treatment ends. The early termination that is characteristic of focal psychotherapy and other forms of brief psychotherapy often requires more extensive work with the feelings of loss and separation.

therapeutic community A term of British origin, now widely used, for a specially structured mental hospital milieu that encourages patients to function within the range of social norms.

therapeutic window A well-defined range of blood levels associated with optimal clinical response to antidepressant drugs, such as nortriptyline. Levels above or below that range are associated with a poor response.

thought broadcasting The delusion that one's thoughts are being broadcast out loud so that they can be perceived by others.

thought insertion The delusion that certain of one's thoughts are not one's own, but rather are inserted into one's mind.

tic An involuntary, sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.

token economy A system involving the application of the principles and procedures of operant conditioning to the management of a social setting such as a ward, classroom, or halfway house. Tokens are given contingent on completion of specified activities and are exchangeable for goods or privileges desired by the patient.

tolerance A characteristic of substance dependence that may be shown by the need for markedly increased amounts of the substance to achieve intoxication or the desired effect, by markedly diminished effect with continued use of the same amount of the substance, or by adequate functioning despite doses or blood levels of the substance that would be expected to produce significant impairment in a casual user.

transference The unconscious assignment to others of feelings and attitudes that were originally associated with important figures (parents, siblings, etc.) in one's early life. The transference relationship follows the pattern of its prototype. The psychiatrist utilizes this phenomenon as a therapeutic tool to help the patient understand emotional problems and their origins. In the patient-physician relationship, the transference may be negative (hostile) or positive (affectionate). See also countertransference.

transitional object An object, other than the mother, selected by an infant between 4 and 18 months of age for self-soothing and anxiety-reduction. Examples are a "security blanket" or a toy that helps the infant go to sleep. The transitional object provides an opportunity to master external objects and promotes the differentiation of self from outer world.

transsexualism Severe gender dysphoria, coupled with a persistent desire for the physical characteristics and social roles that connote the opposite biological sex.

transvestism Sexual pleasure derived from dressing or masquerading in the clothing of the opposite sex, with the strong wish to appear as a member of the opposite sex. The sexual origins of transvestism may be unconscious.

trichotillomania The pulling out of one's own hair to the point that it is noticeable and causing significant distress or impairment.

U

unconscious That part of the mind or mental functioning of which the content is only rarely subject to awareness. It is a repository for data that have never been conscious (primary repression) or that may have been conscious and are later repressed (secondary repression).

undoing A mental mechanism consisting of behavior that symbolically atones for, makes amends for, or reverses previous thoughts, feelings, or actions.

urophilia One of the paraphilias, characterized by marked distress over, or acting on, sexual urges that involve urine.

V

verbigeration Stereotyped and seemingly meaningless repetition of words or sentences.

visual hallucination A hallucination involving sight, which may consist of formed images, such as of people, or of unformed images, such as flashes of light. Visual hallucinations should be distinguished from illusions, which are misperceptions of real external stimuli.

voyeurism Peeping; one of the paraphilias, characterized by marked distress over, or acting on, urges to observe unsuspecting people, usually strangers, who are naked or in the process of disrobing, or who are engaging in sexual activity.

W

Wernicke's aphasia Loss of the ability to comprehend language coupled with production of inappropriate language.

windigo A culture specific syndrome of Canadians involving delusions of being possessed by a cannibal-istic monster (windigo), attacks of agitated depression, oral sadistic fears and impulses.

word salad A mixture of words and phrases that lack comprehensive meaning or logical coherence; commonly seen in schizophrenic states.

Z

zeitgeist The general intellectual and cultural climate of taste characteristic of an era.

zoophilia One of the paraphilias, characterized by marked distress over, or acting on, urges to indulge in sexual activity that involves animals.



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