9-symptoms and signs

8/2/2019 9-Symptoms and Signs

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Symptoms and Signs in

Psychiatry

Dr. Wendel Abel


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Objectives

Basic understanding of signs andsymptoms in psychiatry


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Classification

DSM Diagnostic and Statistical

Manual

ICD International


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Classification Diagnostic and

StatisticalManual

InternationalClassification(ICD)


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Definition

Signs: Objective findings elicited byclinician.

Symptoms: Subjective experiencesreported by the patient.

Syndrome: Group of symptoms andsigns


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Major Disorders

Psychotic Disorder - Schizophrenia

Mood Disorders Depression andBipolar Disorder

Anxiety Disorders


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Emotion

Emotion: Complex feeling state andinvolves affect and mood.


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Affect

Observed expression of emotion

Warm affect: Expressed emotion isappropriate

Blunted affect: Expressed emotion is

reduced.


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Mood

Pervasive emotion. Subjectivelyexperienced and reported by thepatient.

Euthymic mood: Normal

Depressed mood: Depression

Elated mood: Mania


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Expression of Mood

I Message Techniques I Feel .

Because..

What I want/prefer..


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Perception

Process by which sensory stimulibrought to awareness.


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Disorders in Perception

Hallucination

Illusion


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Hallucination

Hallucination= Perception+ No

stimulus

False sensory perception occurring inthe absence of specific stimulus.


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Hallucinations

Sensemodality

Hallucination

HearingAuditory most commonVoices threatening, obscene, accusatory, insultingVoices- conversing, commenting

Sight Visual - Common

Touch Tactile, Somatic

Smell Olfactory

Taste Gustatory


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Hallucinations

Hypnogogic Occurring while falling

asleep. Not pathological.

Hypnopompic- Occurring while

awakening. Not pathological.

Hallucinations occur in psychotic


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Illusion

Perception: Misperception of stimulus


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Disorders in Thought

Thought form

Thought content - Delusions


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Thought form

Neologism: New words

Word salad: Incoherent mixture ofwords

Loosening of association: Ideas shiftfrom one subject o another


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Delusion

Fixed, False Belief, inappropriate to

socio-cultural background.

Fixed not amenable to reasoning


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Delusions

Delusions of persecution

Delusions of Jealousy

Delusions of Guilt Delusions of grandeur

Religious delusions

Somatic delusions

Delusions of reference

Delusions of being controlled


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Psychotic Disorder

Hallucinations

Delusions

Disorder in thought Form


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Depression

Mood Depressed


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Bipolar Disorder

Mood elated


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Mood Disorders Symptoms

Depression Mania (Bipolar)

Mood Depressed Elevated/ elated

Interest/pleasure Decreased Increasedinvolvement inpleasurable activities

Sleep insomnia Decreased need

Psychomotor Decreased (typical) Increased goaldirectedactivity/agitation

Energy Decreased (easily fatigued) Increased

Feelings Worthlesness/excessive

guilt/may be delusional

Grandiose

Thinking Decreased (difficultyconcentrating)

Racing thoughts,flight of ideas

Ideation Thoughts of death/ suicidal Grandiose


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Major Depression

Depressed Mood (sad mood ortearfulness)

Loss of interest/pleasure in all activities

Weight loss or weight gain Sleep disturbances ( insomnia or

hypersomnia)

Fatigue or loss of energy

Feelings of worthlessness/ excessive,inappropriate guilt

Difficulty concentrating/ indecisiveness

Thou hts of death or suicide


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MAJOR DEPRESSION

5symptoms

2weeks


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Anxiety Disorders


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ANXIETY DISORDERS

Disorders characterized by anxietysymptoms:

- Panic Disorder

- Phobias

- OCD

- PTSD

- Generalized Anxiety Disorder

-


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Anxiety Symptoms

SKIN: sweating, hot flushes, chills, paresthesias, tingling sensation

CNS: dizziness, unsteady, lightheadedness

PSYCHOLOGICAL: fear of going crazy, fear of losing control, fear of dying,

depersonalization, derealization

RESP: choking sensation, chest pain/discomfort, SOB

CVS: palpitations, pounding heart

GIT: nausea, abdominal distress


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ANXIETY DISORDERS

PANIC DISORDER sudden onset,sporadic (recurrent), short lived

PHOBIA associated with a stimulus(object, situation)

OCD Obsessions and compulsions

GENERALISED ANXIETY DISORDER PTSD ASSOCIATED WITH TRAUMA


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PANIC DISORDER

Sudden onset

Spontaneous (no stimulus)

Short lived - minutes Sporadic (recurrent)

Persistent worry/concern

Agoraphobia

Substance abuse


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OCD

Obsessions thoughts (recurrent,intrusive)

Compulsions- behavior

Obsessions Anxiety

Compulsions Anxiety


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PTSD

Trauma Exposure: (disaster, MVA,rape etc)

Witness it, Experience it, Told about it

Re-experience trauma- (recollections,flashbacks, nightmares, bad dreams)

Avoidance (thoughts, people, places,things)

Memory activated


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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.

Washington, DC: American Psychiatric Association; 1994.

GAD

Excessive anxietyand worry, for

more days than not for 6 months,

about a number of events or

activities

Worry is difficult to control


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32 year old male, presents with suddenonset of

chest pain 2 weeks ago. Since then hehas been

having frequent episodes of SOB &palpitations.

During these episodes he feels he is

going to die.He has difficulty sleeping at nights.

He cannot leave his house alone and he

has to be


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Cognitive Disorders

Delirium

Dementia

Amnestic Disorders


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Cognitive Disorders

Delirium

Dementia

Vascular Alzheimer's Disease


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Delirium

Changes in consciousness

Changes in cognition ( memory,

orientation, language) Perceptual disturbance

Acute onset, fluctuating course


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Dementia

Memory impairment (short term first)

Aphasia (language disturbance)

Apraxia (inability to carry out motoractivity despite intact motorfunction)

Agnosia (failure to recognize objectsdespite intact sensory function)

Executive function impaired (SOAP)


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32 year old male, presents with sudden

onset of

chest pain 2 weeks ago. Since then hehas been

having frequent episodes of SOB &palpitations.

During these episodes he feels he isgoing to die.

He has difficulty sleeping at nights.

He cannot leave his house alone and he

Case 1

Case 2


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Case 2

52 yo female. Presents to GP for the

first time. She states that she is alwayskeyed up and on edge and hasbeen having nightmares about an

accident that she was involved in someyears ago. She states that her closefriend died in the accident and she hasbeen experiencing what she describesas movies of it all happening overagain while awake. She reports that shehas difficulty discussing these events as

they are very distressing. She has

Case 3


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Case 3

59 yo female, teacher, retires nextschool year

Presents with sad mood, difficulty

sleeping at nights with early morningwakening, heaviness in head, crawlingsensation on top of head X 6/12.

Difficulty concentrating in class She was extremely tearful in office

What is the diagnosis?

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