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Mental Health is a state of balance
between the individual and the
surrounding world, a state of harmony
between oneself and others, and a co-
existence between the reality of the self
and that of the others.
Mental Illness are clinically significant
conditions characterized by alterations in
thinking, mood (emotions), behaviour
associated with personal distress and
Psychiatry: It is a branch of medicine that
deals with the diagnosis, treatment and
prevention of mental illness .
Psychiatric Nursing: It is a specialized
area of nursing practice, employing
theories of human behaviour as it is a
science , and the purposeful use of self
as it is an art , in the diagnosis and
treatment of human responses to actual
or potential mental health problems .
( ANA1994 )
Perception is the meaningful organization of sensory
data and their interpretation in the light of one’s past
Hyper aesthesia: Increased intensity of sensations,
seen in intense emotions and hypochondriacal (chronic
anxiety) personalities. In hyper aesthesia sounds appear
louder, colours brighter, and pain unbearable.
Illusions: Misperceptions or misinterpretations of real
external sensory stimuli: e.g. Shadows may be
misperceived as frightening figures., In a fading light rope
is misperceived as a snake .
Hallucinations: Perception in the absence of real
external stimuli; experienced as true perception coming
from the external world (not within the mind). e.g.
Hearing a voice of someone when actually nobody is
speaking within the hearing distance. (Causes: Intense
emotions, Suggestion, Disorders of sense organs,
Sensory deprivation, Disorders of CNS - epilepsy,
Auditory hallucinations ( Voice, sound, noise). is a
form of hallucination that involves perceiving sounds
without auditory stimulus. Seen in Psychosis. Three
types: Elementary – noises, bells or undifferentiated
whispers ; in organic states: Partly organized- music
and Completely organized- hallucinatory voices
schizophrenia- persecutory in nature
Types of auditory hallucination:
Second-person hallucinations: voice
speaking to the person addressing him
Third-person hallucinations: voice talking
about the person as “he” or “she”:
Thought echo : hearing one’s own
thoughts being spoken aloud; the
voice may come from inside or outside
Visual hallucination: is the seeing of things
that are not there. (Elementary- flashes of
light: Partly organized- patterns: Completely
organized- people, animals, objects.)
Olfactory hallucinations is the phenomenon
of smelling odours that are not really
present. The most common odours are
unpleasant smells such as rotting flesh
,vomit, urine, faeces, smoke, etc.
Gustatory hallucination is the perception of
taste without a stimulus. Seen in depression
Tactile hallucinations: Hallucination of touch
or surface sensation. Three types:
superficial, kinaesthetic (movement of body
parts) and visceral (severe pain of
separation of internal organ, twitching etc.).
Formication, ( type of tactile hallucination) is
the sensation of insects crawling
underneath the skin and is frequently
associated with prolonged cocaine use.
Somatic Hallucination: False sensation of
things occurring / moving in or to the body,
most often visceral in origin.
Imperative hallucination: Voices giving
instructions to patients, who may or may not feel
obliged to carry them out.
Command / commentary hallucinations: The
subject hears voices that comment on, command,
or describe the subject's actions or behaviour. The
person feels obliged to obey.
Lilliputian hallucinations: A type of visual
hallucination. Commonly seen in certain
neurological diseases. Here the object appear
either smaller or larger than they actually are. (
micropsia, macropsia). It is seen in Alice in
Scenic hallucinations: hallucinations in which
whole scenes are hallucinated like a cinema film;
more common in psychiatric disorders associated
with epilepsy. Type of visual hallucination.
Autoscopy (phantom mirror image): The person
sees himself and knows that it is he. Sometimes
seen in normal subjects when they are depressed
or emotionally disturbed. Commonly seen in
borderline disorders and psychosis. ‘Negative
Autoscopy’: the patient looks in the mirror and
sees no image; in organic states. Although the
sufferer's image may be seen by others, he or she
claims not to see it. Internal Autoscopy: the
subject sees his own internal organs.
Extracampine hallucinations: a hallucination
which is outside the limits of the sensory
field. They are hallucinations beyond the
possible sensory field. e.g., 'seeing'
somebody standing behind you.
Hypnagogic hallucinations: hallucinations
when falling asleep. Hypnopompic
hallucinations: hallucinations when waking
from sleep. It can be any type such as
auditory, visual etc.
Mood congruent hallucination: Hallucination in
which content is consistent with either a
depressed or manic mood.
Mood incongruent hallucination: Hallucination
in which content is not consistent with either a
depressed or manic mood.
Eg. Depressed voices in depression, self
inflated worth or power in mania.
Pseudo hallucination seen in Attention seeking
Derealisation: A subjective sense that the
environment is strange and unreal.
Depersonalization: a person’s subjective sense
of being unreal, strange and unfamiliar.
Abnormalities of Possession of thought
(source of water)
Abnormalities in the stream of thought.
( flow of river)
Abnormalities in the content of thought.
( water, mud etc..)
Abnormalities of Form of thought.
(liquid form of water)
Obsessions: Repetitive ideas, images, feelings
or urges insistently entering person’s mind
despite resistance. They are unwanted,
distressful and recognized as senseless and
irrational. Obsessions are frequently followed by
compelling actions (compulsions).
Common obsessional Contents: dirt/
contamination / cleaning, orderliness,
impulses/inappropriate acts, Ruminations:
internal debates in which arguments for and
against even the simplest everyday actions.
Thought alienation: Thoughts are under the
control of outside forces and are participating in
it. The types of alienation are;
Thought Insertion: Delusion that some of
person’s thoughts being put into the mind by an
external force (other people, certain agency)
and these thoughts are recognized as foreign.
Thought Withdrawal: Delusion that some of
person’s thoughts being taken out of the mind
against his will by outside forces. Usually
associated with thought blocking. The
experience is passive.
Thought Broadcasting: Delusion that others
can read or hear the person’s thoughts, as
they are broadcast over the air, radio or
some other unusual way. The experience is
Dysmorphophobia: A type of overvalued
idea where the patient believes one aspect
of his body is abnormal/deformed or
imperfect. It is also called as Body
dysmorphic disorder (BDD)
Volubility- abundant or pressured talking.
Seen in mania ( tachylogia (excessive
speech), verbomania (use of more words)
Flight of ideas: The thoughts follow each
other rapidly and there is no general
direction of thinking, seen in mania /excited
schizophrenics. Flight of ideas describes
excessive speech at a rapid rate that
involves fragmented or unrelated ideas. It is
common in mania. It has also been
described in schizophrenia and ADHD.
Pressure of thoughts: Rapid abundant varying
thoughts associated with pressure of speech
and flight of ideas.
Poverty of thoughts: Few, slow, unvaried
thoughts associated with poverty of speech.
Thought block: Sudden cessation of thought
flow with complete emptying of the mind not
caused by an external influence.
Circumstantiality: A pattern of thinking and
communication that is demonstrated by the
speaker’s inclusion of many irrelevant and
unnecessary details in his speech before he is
able to come to the point. Seen in epileptic
personality, obsessional personality and
Derailment: Direction of thought is lost and the
thought goes away from the intended theme .
Tangentiality- It is a form of derailment.
Replying to a question in a oblique, tangential
or even irrelevant manner. Wandering from the
topic and never returning to it or providing the
e.g. In answer to the question "Where are you
from?", a response "My dog is from England.
They have good fish and chips there. Fish
breathe through gills.“
Thought blocking ( thought derivation,
snapping off ) - sudden arrest of train of
thoughts leaving a “blank” . A new thought
may begin after the pause. With no recall of
what was being said or going to be said.
Seen in F-20, also in anxious or exhausted
Preservation- It is the repetition of a
particular response (such as a word, phrase,
or gesture) regardless of the absence or
cessation of a stimulus. It is usually caused
by a brain injury or other organic disorder.
Overvalued Ideas: abnormal beliefs ,unique
to the individual which dominates his life .
Worry- subjective sense of tension or
Phobias- persistent, pathological, unrealistic
fear of an object, situation
Somatic symptoms- bodily complains which
are varied in anatomical location and are
usually are not associated with any
Religious preoccupation- seen in OCD
Excessive day dreaming- Schizotypal
personality (odd and eccentric people with
Homicidal ideas-F-20, ASP (Anti social
Philosophical and Magical ideas
Depressive cognition- ideas of worthlessness,
Suicidal ideas DSH (Deliberate self harm)
Inflated self esteem- mania, narcissistic
personality (excessive self admiration,
disregard for others' feelings etc.)
Delusions: Fixed false beliefs which are not
shared by others ,are out of keeping with
one’s educational ,social and cultural
background and are unshakable in the face
of evidence to the contrary.
Primary Delusion: (Autochthonous
Delusion): That whic appear suddenly and
with full conviction, but without any
previous events leading up to it. Seen in
Secondary Delusions: Derived from
preceding morbid experience.
Delusional Mood: The experience of change
of mood often with anxiety prior to delusion.
Delusional Perception: in the initial stage of
delusion the person make new perceptions
with familiar stimuli such as doubting
Grandiose delusion: Delusion of
exaggerated self-importance, power or
Persecutory (paranoid) delusion: Delusion
of being persecuted (cheated, mistreated,
Delusion of Control/influence: The thoughts,
feelings of the patient is controlled by
Delusion of jealousy/infidelity: Delusion that
a loved person (wife/husband) is unfaithful
Delusion of Guilt/self accusation: belief that
one is sinner and responsible for the ruin of
family of someone else.
Somatic Delusion: Belief involving
functioning of the body. Eg. My brain is
Nihilistic delusion: Delusion of nonexistence
of self, part of the body, belongings, others
or the world. Seen in major depression.
Delusion of reference: Delusion that some
events and others behaviour refer to
Delusions of love (‘fantasy lover’,
‘erotomania’): Delusion that someone,
(usually inaccessible, high social class
person) is deeply in love with the patient.
Somatic Passivity: Passive recipient of bodily
sensations imposed from outside forces. Passivity
phenomena also may occur as part of delusions such as
our impulses, actions and feelings are controlled by
some external force. Connected with somatic
Delusions of Replacement (Capgras Syndrome): a
belief that important people in one's life have been
replaced by impostors.
Mood-Congruent Delusion – Delusional content has
association to mood: - in depressed mood: delusion of
self - accusation.
Mood-Incongruent Delusions – Delusional content has
no association to mood, e.g. patient with elevated mood
has delusion of thought insertion.
Systematized Delusion – Delusion united by
a single event or theme e.g. delusion of
jealousy/thematically well connected with
Bizarre Delusion - Totally odd and strange
delusional belief, e.g. delusion that person’s
acts are controlled by stars.
Loosening of Association: (Loose
Association) A thought disorder in which
series of ideas are presented with loosely
connected. A manifestation of a thought
disorder whereby the patient's responses to
the interviewer's questions are not logically
connected to those that occur before or after.
Example: I sang out for my mother …… for this
to hell I went…how long is road …
Neologism: Use of newly coined term, word, or
phrase that has not yet been accepted into
mainstream language. Eg. What do you know about
him? Answer: 404.
Autistic thinking: Thinking not in accordance with
consensus reality and emphasizes preoccupation with
Verbigeration: senseless repetition of some words or
phrases over and over again. Peter paid plenty for
piping. Plenty for piping paid Peter.”
Word Salad: Meaningless and incoherent mixture of
words of phrases. Eg. “It was shockingly not of the
best quality I have known all such evildoers coming
out of doors with the best of intentions!”
Feeling: A positive or negative reaction to some
Emotion: A stirred up state due to physiological
changes which occurs as a response to some event
and which tends to maintain or abolish the
Mood: The pervasive feeling tone which is sustained
(lasts for a length of time) and colours the total
experience of the person.
Affect: The outward objective expression of the
immediate cross sectional emotion at a given time.
Euthymia: A normal mood state, neither depressed
Perplexity: A state of puzzled bewilderment.
Anxiety: Feeling of apprehension
accompanied by autonomic symptoms
(such as muscles tension, perspiration and
tachycardia), caused by anticipation of
Free-floating anxiety: Diffuse, unfocused
anxiety, not attached to a specific danger.
Fear: Anxiety caused by realistic
consciously recognized danger.
Panic: Acute, self-limiting, episodic intense
attack of anxiety associated with
overwhelming dread and autonomic
Phobia: irrational exaggerated fear and
avoidance of a specific object, situation
Agoraphobia: patients rigidly avoids
situations in which it would be difficult to
Social phobia - Intense and excessive
fear of being observed by other people
Eg: eating or drinking in public or talking
to the other member of sex
Specific phobia: irrational fear of a specific
object or stimulus.
Acrophobia : fear of heights
Arachnophobia : fear of spiders
Claustrophobia : fear of closed spaces
Gamophobia : fear of marriage
Hemophobia / Haematophobia : fear of blood
Zoophobia : fear of animals
Insectophobia: Fear of insects
Hydrophobia: fear of water
Astraphobia: fear of thunderstorms.
Agitation: severe feeling of inner tension
associated with motor restlessness.
Irritable mood: easily annoyed and provoked
Dysphoria: mixture feelings of sadness and
Depressed mood: feeling of sadness,
pessimism and a sense of loneliness.
Anhedonia: lack of pleasure in acts which
are normally pleasurable. Eg. Games,
watching movies etc.
Diurnal variation: a variation in the
severity of symptoms (mood) depending
on the time of the day
Grief: Subjective feeling of loss. sadness
appropriate to a real loss (e.g. death of a
Guilt: unpleasant emotion secondary to
doing what is perceived as wrong.
Shame: unpleasant emotion secondary to
failure to live up to self-expectations.
Ambivalent Mood: coexistence of two
opposing emotional tones towards the same
object in the same person at the same time.
Alexithymia: inability to, or difficulty in,
expressing one’s own emotions.
Elevated Mood: a mood more cheerful than
usual . The types are as follows;
Euphoria (Stage I): mild elevation in which feeling of
elevated mood with optimism and self satisfaction not
keeping with ongoing events. Usually seen in hypomania.
Elation (stage II): (Moderate elevation) – a feeling of
confidence and enjoyment, along with increased Positive
mental attitude(PMA). –a feature of manic illness
Exaltation (stage III): (severe elevation): intense elation
with delusions of grandeur, seen in severe mania.
Ecstasy (Stage IV): (very severe elevation): a sense of
extreme well-being associated with a feeling of rapture,
bliss and grace. typically seen in delirious and stuporous
Expansive Mood: expression of euphoria with
an overestimation of self-importance.
Grandiosity: feeling and thinking of great
importance (in identity or ability).
Constricted Affect: significant reduction in the
normal emotional responses.
Flat affect: absence of emotional expression.
Apathy: lack of emotion, interest or concern,
associated with detachment.
Labile Affect: rapid, abrupt changes in
emotions in the same setting, unrelated to
La Belle Indifference: A condition in which the
person is unconcerned with symptoms caused
by a conversion disorder. Lack of emotion or
concern for the perceptions by others of one's
disability, usually seen in persons with
Inappropriate Affect: disharmony between
emotions and the idea, thought, or speech,
Cyclothymia: There is cyclical mood variation to
a lesser degree than in bipolar disorder.
Dysthymia: Mild chronic depression.
Echolalia: Meaningless imitation of words
or phrases made by others.
Verbigeration : Repetition of words of
phases while unable to articulate the next
word in the sentence. Similar to
preservation but no significance of
Pressure of Speech: rapid, uninterrupted
speech that is increased in amount.
Tendency to speak rapidly and frenziedly
Mutism: inability to speak.
Elective Mutism: refusal to speak in certain
Poverty of Speech: restricted amount of
Stuttering (Stammering): frequent repetition or
prolongation of a sound or syllable, leading to
markedly impaired speech fluency.
Cluttering: dysrhythmic rapid and jerky speech.
Clang Associations (Rhyming): association of
word similar in sound but not in meaning (e.g.
That boat hope floats” or “The train brain rained
Word Salad: incoherent mixture of words
Dysphasia: impairment in producing or
Dysarthria: difficulty in articulation
(production of appropriate sound) and
Sensory Aphasia: nonsensical fluent speech
due to damage to Wernicke’s area (a part of
cerebral cortex that deals with sensory
speech processing such as
Motor Aphasia: impairment in the ability to
formulate fluent speech due to lesion
affecting Broca’s areaarea (a part of cerebral
cortex that deals with motor speech
Coprolalia: forced vocalization/repetition of
obscene words or phrases,
Palilalia: is characterized by the repetition of
a word or phrase; i.e., the subject continues
to repeat a word or phrase after once having
said. It is a perseveratory phenomenon.
Alogia: lack of speech output.
Psychomotor Retardation: Slowed mental
and motor activities.
Stupor: A state in which a person does not
react to the surroundings: (mute, immobile and
Catatonic Stupor: Stupor with rigid
Psychomotor Agitation: Restlessness with
psychological tension. (Patient is not fully aware
Catatonic Excitement: Marked agitation,
impulsivity and aggression without external
Chorea: sudden involuntary movement of
several muscle groups with the resultant
action appearing like part of voluntary
Aggression: Verbal or physical hostile
behavior, with rage and anger.
Akathisia: Inability to keep sitting still, due
to a compelling subjective feeling of
Dyskinesia: Restless movement of group of
muscles (face, neck, hands).
Dystonia: Painful severe muscle spasm.
Torticollis: Contraction of neck muscles.
Tics: Sudden repeated involuntary muscle
twisting. e.g. repeated blinking, grimacing.
Compulsions: Compelling repeated irrational
action associated with obsessions. e.g.
repeated hand washing.
Echopraxia: Imitative repetition of movement of
Stereotypies: Purposeless repetitive involuntary
movements. e.g. Foot tapping, thigh rocking.
Mannerism: Odd goal-directed movements. e.g.
repeated hand movement resembling a military
Waxy Flexibility: Patient’s limbs may be
moved like wax, holding position for long
period of time before returning to
previous position. People allowing
themselves to be placed in postures by
others, and then maintaining those
postures for long periods even if they are
obviously uncomfortable. This occurs in
Automatic obedience: the patient carries
out every instruction regardless of the
Perseveration: is a senseless repetition
of a goal-directed action, a particular
response, such as a word, phrase, or
gesture which has already served its
purpose (beyond their relevance).
Dyspraxia; inability to carryout complex
motor tasks, although the component
motor movements are preserved.
Ambitendency: a motor symptom of
schizophrenia in which there is an
alternating mixture of automatic
obedience and negativism.
Trichotillomania: a condition
characterized by an overwhelming urge
to pluck out specific hairs.
Pyromania: is an impulse control
disorder in which individuals repeatedly
fail to resist impulses to deliberately start
fires, in order to relieve tension or for
Dipsomania: uncontrollable craving for
alcohol or compulsive drinking of
Kleptomania: a disorder in which the
individual impulsively steals things other
than personal use or financial gain.
Negativism: an apparently motiveless
resistance to all commands and attempts
to be moved or doing just the opposite.