Psychiatric illness Signs and symptoms related to Consciousness, attention, emotion, motor behaviour, thinking, speech, perception, memory.

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Psychiatric Illness: Signs & Symptoms

Sources: Kaplan & Sadock's Synopsis of Psychiatry; Kaplan & Sadock's Comprehensive Textbook of Psychiatry

1. CONSCIOUSNESS

Consciousness refers to awareness of self and environment. Disturbances include:

Term	Definition
Clouding of consciousness	Mild impairment of awareness; reduced clarity of thinking — the earliest sign of delirium
Confusion	Disorientation, bewilderment; reduced ability to think coherently
Delirium	Acute, fluctuating disturbance of consciousness + attention + cognition; associated with perceptual disturbances
Stupor	Markedly reduced responsiveness; patient is aware but mute/immobile
Coma	Complete loss of consciousness; unresponsive to all stimuli
Somnolence	Excessive drowsiness; patient can be aroused but lapses back to sleep
Twilight state	Narrowed field of consciousness with preserved automatic behavior (seen in epilepsy, dissociation)
Fugue state	Dissociative state with amnesia; patient travels away from home, assumes new identity
Depersonalization	Feeling detached from one's own mental processes or body ("I feel unreal, like I'm watching myself")
Derealization	Feeling that the external world is unreal, strange, or dreamlike

2. ATTENTION

Attention is the ability to focus cognitive activity on specific stimuli.

Term	Definition
Distractibility	Inability to concentrate; attention drawn to irrelevant stimuli — cardinal in mania and ADHD
Selective inattention	Blocking out anxiety-provoking stimuli (anxiety disorders)
Hypervigilance	Excessive attention to all stimuli; seen in paranoia, PTSD, stimulant intoxication
Trance	Focused attention with diminished motor activity — seen in dissociative disorders, hypnosis
Concentration difficulty	Impaired sustained attention; seen in depression, anxiety, dementia

3. EMOTION (Affect & Mood)

Mood = sustained internal emotional tone (patient's subjective report).
Affect = observable external expression of emotion (clinician's observation).

Disorders of Mood

Term	Definition
Depression	Pervasive lowering of mood; described as qualitatively different from ordinary sadness — somatic quality, "indescribably painful," worse than severe physical pain
Anhedonia	Inability to experience pleasure; loss of interest in previously enjoyable activities — hallmark of major depression
Dysphoria	Unpleasant mood — irritable, anxious, restless
Elevated mood	Exaggerated feeling of well-being, euphoria — seen in mania
Euphoria	Intense elation with feelings of grandeur
Expansive mood	Lack of restraint in expressing feelings; overvaluation of self-importance
Irritability	Easily provoked anger; seen in mania, depression, personality disorders
Anxiety	Feeling of dread, apprehension without clear cause
Apathy	Absence of feeling; diminished emotional tone without depression
Alexithymia	Inability to describe or recognize one's emotions
Masked depression	Patient denies mood change but presents with somatic complaints (headache, epigastric pain) — depressio sine depressione

Disorders of Affect (Expression)

Term	Definition
Flat affect	Absent or near-absent expression of emotion — voice monotonous, face immobile; characteristic of schizophrenia
Blunted affect	Significantly reduced intensity of emotional expression
Restricted affect	Mildly reduced range and intensity
Inappropriate affect	Incongruence between mood and context (e.g., laughing when discussing death) — seen in schizophrenia
Labile affect	Rapid, unpredictable shifts in emotional expression
Ambivalence	Coexistence of opposing feelings toward same object simultaneously

4. MOTOR BEHAVIOUR (Psychomotor Activity)

Increased Motor Activity

Term	Definition
Psychomotor agitation	Excess motor activity with inner tension — pacing, wringing hands; seen in anxiety, mania, akathisia
Hyperactivity (hyperkinesis)	Increased purposeful movements — ADHD
Tic	Involuntary, repetitive, non-rhythmic motor movement or vocalization
Stereotypy	Repetitive, non-goal-directed movements (e.g., rocking) — autism, schizophrenia
Compulsion	Repetitive behavior driven by obsession (e.g., hand-washing in OCD)
Mannerism	Odd, habitual movements that are goal-directed but appear abnormal
Echopraxia	Pathological imitation of another's movements — seen in schizophrenia

Decreased Motor Activity / Abnormal Motor States

Term	Definition
Psychomotor retardation	Slowed movements, speech, and thinking — cardinal in melancholic depression
Catatonia	State of unresponsiveness with muscular rigidity; patient may be mute and immobile
Catalepsy	Immobile posture maintained for prolonged periods; waxy flexibility (cerea flexibilitas)
Cataplexy	Sudden loss of muscle tone triggered by emotion — narcolepsy
Negativism	Motiveless resistance to all instructions or attempts to be moved
Waxy flexibility (cerea flexibilitas)	Limb maintains the position placed by examiner, like bending warm wax
Posturing	Voluntary maintenance of bizarre posture
Command automatism	Automatic compliance with all commands
Conversion symptoms	Paralysis, tremor, or abnormal gait without neurological cause — conversion disorder

5. THINKING

Thinking is assessed in two domains: form (process) and content.

Disorders of Form (Thought Process)

Term	Definition
Flight of ideas	Rapid, continuous shifting of ideas with loose but traceable connections — hallmark of mania
Loosening of associations (derailment)	Ideas shift with little or no connection; hallmark of schizophrenia
Thought blocking	Sudden interruption in train of thought; patient stops mid-sentence with no explanation
Circumstantiality	Indirect thinking with many unnecessary details but eventually reaching the point
Tangentiality	Replies that are oblique or irrelevant; never returns to original point
Perseveration	Pathological repetition of the same word or idea despite changing stimuli
Clang associations	Connections based on sound rather than meaning (rhyming, punning) — mania
Neologisms	New words created by patient with personal meaning — schizophrenia
Word salad (incoherence)	Incomprehensible mixture of words and phrases; severe disorganization
Poverty of thought	Restricted amount of thinking; vague, overconcrete responses

Disorders of Thought Content

Term	Definition
Delusion	Fixed, false, firmly held belief not shared by cultural group; unresponsive to contradictory evidence
— Persecutory	Belief of being followed, harassed, or conspired against
— Grandiose	Inflated belief of special powers, identity, or importance
— Referential	Belief that ordinary events have special personal significance
— Somatic	False belief about body functioning or appearance
— Nihilistic	Belief that self, others, or world does not exist — Cotard's syndrome
— Erotomanic	Belief that another person is in love with the patient — de Clérambault's syndrome
Overvalued idea	Unreasonable, sustained belief held with less intensity than a delusion; patient can acknowledge doubt
Obsession	Recurrent, intrusive, unwanted thought that causes anxiety; patient recognizes it as ego-dystonic
Phobia	Persistent, irrational fear of specific object or situation leading to avoidance
Suicidal ideation	Thoughts of ending one's life
Magical thinking	Belief that thoughts, words, or actions can cause or prevent events — seen in OCD, schizotypal

6. SPEECH

Speech is the verbal expression of thinking.

Term	Definition
Pressured speech	Rapid, difficult-to-interrupt speech driven by urgency — mania
Poverty of speech (hypophonia)	Reduced quantity of speech; brief replies — depression, schizophrenia
Poverty of content of speech	Speech adequate in amount but conveys little information; vague
Dysarthria	Difficulty articulating words due to neuromuscular disorder
Dysphasia / Aphasia	Impaired production or comprehension of language — neurological
Logorrhea	Copious, incoherent speech — mania, psychosis
Mutism	Absence of speech — catatonia, severe depression, elective mutism
Echolalia	Pathological repetition of another's words — schizophrenia, autism
Verbigeration	Senseless repetition of words or phrases — catatonia
Scanning speech	Staccato speech with words separated by pauses — cerebellar disease
Stuttering	Frequent repetition or prolongation of sounds — fluency disorder

7. PERCEPTION

Perception is the process of organizing and interpreting sensory information.

Hallucinations (Percept without stimulus)

Type	Description	Common Disorders
Auditory	Hearing voices or sounds	Schizophrenia (most common in psychiatry), major depression with psychosis
Visual	Seeing images not present	Delirium, alcohol withdrawal, drugs, dementia
Olfactory	Smelling odors	Temporal lobe epilepsy, depression, schizophrenia
Gustatory	Tasting without stimulus	Schizophrenia, temporal lobe lesions
Tactile (haptic)	Feeling skin crawling, insects (formication)	Alcohol/cocaine withdrawal, delirium
Hypnagogic	Hallucination occurring at sleep onset	Normal phenomenon; narcolepsy
Hypnopompic	Hallucination on awakening	Normal; narcolepsy
Command hallucinations	Auditory hallucinations ordering behavior	Psychosis; associated with violence risk

Illusions (Misperception of real stimulus)

Transformation of an actual stimulus into something else — seen in delirium, anxiety, normal individuals under stress

Other Perceptual Disturbances

Term	Definition
Depersonalization	Feeling detached from one's own body/mental processes
Derealization	World seems unreal or dreamlike
Micropsia	Objects appear smaller than normal
Macropsia	Objects appear larger than normal
Autoscopy	Seeing a projection of oneself ("phantom double")
Hyperesthesia	Increased sensitivity to sensory stimuli

8. MEMORY

Memory is the ability to register, retain, and recall information.

Types of Memory

Type	Description
Immediate (working)	Retention for seconds–minutes (digit span)
Recent memory	Events from the past few days or weeks
Remote memory	Long-term past events
Semantic memory	General knowledge and facts
Episodic memory	Autobiographical events
Implicit memory	Skills, conditioned responses (procedural)

Memory Disorders

Term	Definition
Amnesia	Partial or complete loss of memory
— Anterograde amnesia	Inability to form new memories after insult — Korsakoff's syndrome, head injury
— Retrograde amnesia	Loss of memories before the causative event
Confabulation	Fabrication of memories (without intent to deceive) to fill memory gaps — Korsakoff's syndrome, frontal lobe damage
Paramnesia	Distorted recall; believing a false memory to be true
— Déjà vu	Feeling that a new experience has happened before
— Jamais vu	Feeling of unfamiliarity with a familiar situation
— Fausse reconnaissance	False recognition of unfamiliar persons/situations
Hypermnesia	Exaggerated retention and recall — seen in mania, PTSD
Blackout	Amnesia for periods of alcohol intoxication without loss of consciousness
Dissociative amnesia	Inability to recall important personal information, usually after psychological trauma
Fugue	Dissociative amnesia with purposeful travel; patient may assume new identity

Summary Table: Domain → Key Sign → Disorder Association

Domain	Key Sign	Primary Disorder
Consciousness	Clouding	Delirium
Attention	Distractibility	Mania, ADHD
Emotion	Anhedonia	Major depression
Emotion	Flat affect	Schizophrenia
Motor	Psychomotor retardation	Melancholic depression
Motor	Waxy flexibility	Catatonic schizophrenia
Thinking	Flight of ideas	Mania
Thinking	Loosening of associations	Schizophrenia
Thinking	Persecutory delusion	Schizophrenia, paranoid disorder
Thinking	Obsession	OCD
Speech	Pressured speech	Mania
Speech	Mutism	Catatonia
Perception	Auditory hallucinations	Schizophrenia
Perception	Visual hallucinations	Delirium, substance withdrawal
Memory	Confabulation	Korsakoff's syndrome
Memory	Anterograde amnesia	Korsakoff's, head injury

Sources: Kaplan & Sadock's Synopsis of Psychiatry; Kaplan & Sadock's Comprehensive Textbook of Psychiatry — the authoritative references in clinical psychiatry.

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