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Terminologies in psychiatric nursing

Terminologies in Psychiatric Nursing

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Terminologies in psychiatric nursing

  1. 1.  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 impaired functioning.
  2. 2.  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 )
  3. 3.  Perception is the meaningful organization of sensory data and their interpretation in the light of one’s past experience.  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 .
  4. 4.  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, Psychiatric disorders)  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
  5. 5. Types of auditory hallucination:  Second-person hallucinations: voice speaking to the person addressing him as “you”.  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 the head.
  6. 6.  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
  7. 7.  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.
  8. 8.  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 wonderland syndrome.
  9. 9.  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.
  10. 10.  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.
  11. 11.  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 personalities, hysteria.  Derealisation: A subjective sense that the environment is strange and unreal.  Depersonalization: a person’s subjective sense of being unreal, strange and unfamiliar.
  12. 12.  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)
  13. 13.  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, doubts/checking/counting, aggressive impulses/inappropriate acts, Ruminations: internal debates in which arguments for and against even the simplest everyday actions.
  14. 14.  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.
  15. 15.  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 passive  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)
  16. 16.  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.
  17. 17.  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 dementia.
  18. 18.  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 information requested. 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.“
  19. 19.  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 states.  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.
  20. 20.  Overvalued Ideas: abnormal beliefs ,unique to the individual which dominates his life .  Worry- subjective sense of tension or uneasiness.  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 pathology  Religious preoccupation- seen in OCD
  21. 21.  Excessive day dreaming- Schizotypal personality (odd and eccentric people with less relationship)  Homicidal ideas-F-20, ASP (Anti social personality)  Philosophical and Magical ideas  Depressive cognition- ideas of worthlessness, helplessness, hopelessness  Suicidal ideas DSH (Deliberate self harm)  Inflated self esteem- mania, narcissistic personality (excessive self admiration, disregard for others' feelings etc.)
  22. 22.  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 Schizophrenia.  Secondary Delusions: Derived from preceding morbid experience.
  23. 23.  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 familiar situations.  Grandiose delusion: Delusion of exaggerated self-importance, power or identity.  Persecutory (paranoid) delusion: Delusion of being persecuted (cheated, mistreated, etc.)
  24. 24.  Delusion of Control/influence: The thoughts, feelings of the patient is controlled by external forces.  Delusion of jealousy/infidelity: Delusion that a loved person (wife/husband) is unfaithful (infidelity delusion)  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 melting.
  25. 25.  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 oneself.  Delusions of love (‘fantasy lover’, ‘erotomania’): Delusion that someone, (usually inaccessible, high social class person) is deeply in love with the patient.
  26. 26.  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 hallucination.  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.
  27. 27.  Systematized Delusion – Delusion united by a single event or theme e.g. delusion of jealousy/thematically well connected with each other.  Bizarre Delusion - Totally odd and strange delusional belief, e.g. delusion that person’s acts are controlled by stars.
  28. 28.  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 …
  29. 29.  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 inner experience.  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!”
  30. 30.  Feeling: A positive or negative reaction to some experience  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 causative event.  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 nor manic.  Perplexity: A state of puzzled bewilderment.
  31. 31.  Anxiety: Feeling of apprehension accompanied by autonomic symptoms (such as muscles tension, perspiration and tachycardia), caused by anticipation of danger.  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 symptoms.
  32. 32.  Phobia: irrational exaggerated fear and avoidance of a specific object, situation or activity.  Agoraphobia: patients rigidly avoids situations in which it would be difficult to obtain help.  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
  33. 33.  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.
  34. 34.  Agitation: severe feeling of inner tension associated with motor restlessness.  Irritable mood: easily annoyed and provoked to anger.  Dysphoria: mixture feelings of sadness and apprehension.  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.
  35. 35.  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 relative)  Guilt: unpleasant emotion secondary to doing what is perceived as wrong.  Shame: unpleasant emotion secondary to failure to live up to self-expectations.
  36. 36.  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;
  37. 37. Elevated Mood:  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 mania .
  38. 38.  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 external stimuli.
  39. 39.  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 conversion disorder.  Inappropriate Affect: disharmony between emotions and the idea, thought, or speech, accompanying it.  Cyclothymia: There is cyclical mood variation to a lesser degree than in bipolar disorder.  Dysthymia: Mild chronic depression.
  40. 40.  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 stimuli.  Pressure of Speech: rapid, uninterrupted speech that is increased in amount. Tendency to speak rapidly and frenziedly
  41. 41.  Mutism: inability to speak.  Elective Mutism: refusal to speak in certain circumstances.  Poverty of Speech: restricted amount of speech.  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 on me.)
  42. 42.  Word Salad: incoherent mixture of words and phrases.  Dysphasia: impairment in producing or understanding speech.  Dysarthria: difficulty in articulation (production of appropriate sound) and speech production.  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 comprehension).
  43. 43.  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 processing).  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.
  44. 44.  Psychomotor Retardation: Slowed mental and motor activities.  Stupor: A state in which a person does not react to the surroundings: (mute, immobile and unresponsive).  Catatonic Stupor: Stupor with rigid posturing.  Psychomotor Agitation: Restlessness with psychological tension. (Patient is not fully aware of restlessness.)
  45. 45.  Catatonic Excitement: Marked agitation, impulsivity and aggression without external provocation.  Chorea: sudden involuntary movement of several muscle groups with the resultant action appearing like part of voluntary movement.  Aggression: Verbal or physical hostile behavior, with rage and anger.  Akathisia: Inability to keep sitting still, due to a compelling subjective feeling of restlessness.  Dyskinesia: Restless movement of group of muscles (face, neck, hands).
  46. 46.  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 somebody.  Stereotypies: Purposeless repetitive involuntary movements. e.g. Foot tapping, thigh rocking.  Mannerism: Odd goal-directed movements. e.g. repeated hand movement resembling a military salute.
  47. 47.  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 catatonic schizophrenia.
  48. 48.  Automatic obedience: the patient carries out every instruction regardless of the consequences.  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.
  49. 49.  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 instant gratification.
  50. 50.  Dipsomania: uncontrollable craving for alcohol or compulsive drinking of alcohol.  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.