GENERAL SYMPTOMATOLOGY OF MENTAL ILLNESS

Symptomatology refers to study of signs and symptoms of a disease.

People suffering from mental disorders present with abnormal behaviors that affect mostly the mood, affect, thought, belief, perception, memory, speech, insight, judgment, and critical thinking. Mental illness can begin suddenly or emerge gradually over a period of time (i.e. months or years). However, the clinical features may indicate that the disease is mild or quite severe. Therefore, some of the mentally ill will present with many of the following signs and symptoms:

DISORDERS OF SPEECH

Speech is the way we talk, gather information or statement, their meaning, appropriate tone and rate

• Mutism:
  Complete loss of speech, commonly seen in severe depression and catatonic schizophrenia.

• Incoherence:
  Patient speaks from one idea to the other without any logical connection.

• Flight of ideas:
  Jumping from one topic to another without completing the former. Commonly seen in manic patients.

• Clang association:
  Patient speaks a word similar in sound but not at all significant, leading to a new thought or word.

• Neologism:
  Patient uses completely new words that have meaning only to him/her.

• Accelerated speech:
  Patient speaks so fast that one may not be able to get meaning out of it. Commonly seen in manic patients.

• Circumstantiality:
  Patient first beats around the bush before reaching the point.

• Tangentiality:
  Patient talks unnecessary details without coming to the point.

• Alogia:
  Poverty of speech or empty response without answering a question.

• Echolalia:
  Repetition of every word said by another person near the patient. Commonly seen in schizophrenic patients.

DISORDERS OF MOOD AND AFFECT

It is a state of one’s feeling or emotion.

Disorders of mood may be elevated, depressed, or inappropriate. Inappropriate mood and affect is when the patient’s response is not appropriate to the stimulus. This is normally called incongruity of mood and affect.

• Apathy/apathetic mood and affect:
  Complete lack of mood and affect. Commonly seen in schizophrenic patients.

• Elation:
  Morbid elevation of mood and affect above the normal. Common in manic patients.

• Euphoria:
  Exaggerated feeling of wellbeing or increased sense of confidence. E.g., in manic patients.

• Incongruity of affect/mood:
  Patient is informed of good news and starts crying, or vice versa.

DISORDERS OF PERCEPTION

Perception refers to the interpretation of sensory impulses or the process of becoming aware of what is presented through the sense organs.

• Hallucination:
  Perception without an external stimulus, affecting the five senses:

  • Auditory hallucination – Hearing (common in schizophrenia)

  • Visual hallucination – Sight (common in schizophrenia)

  • Gustatory hallucination – Taste (common in epileptic patients)

  • Olfactory hallucination – Smell (common in schizophrenia)

  • Tactile hallucination – Touch (common in schizophrenia)

• Illusion:
  Misinterpretation of an external stimulus.

DISORDERS OF MEMORY

• Amnesia:
  Loss of memory, assessed as:

  • Ante-retrograde: Loss of memory about recent events.

  • Retrograde: Loss of memory about past/long-time events. Common in old age–induced dementia.

  • Hyper-amnesia: Excessive retention of memory; events are restated with extraordinary detail.

THOUGHT DISORDERS

Thought Content – Delusion

Delusion is a false belief firmly held by the patient which cannot be corrected by reasoning and is out of keeping with the patient’s social, educational, religious, and cultural background.

Examples:

• Granduers

• Nihilistic: Belief that part of the body is missing.

• Bizarre: Association with supernatural powers.

• Paranoid: Belief that someone is always against them.

• Guilt of sin

• Hypochondriasis: Multiple complaints even in the absence of medical causes.

Thought Process – Thought Alienation

• Thought insertion:
  Belief that external forces insert thoughts into the mind.

• Thought withdrawal:
  Belief that external forces take away/remove thoughts from the mind.

• Thought broadcasting:
  Belief that things said on TV or radio were read from one’s mind.

• Thought block:
  Sudden stop in thinking and talking.

DISORDERS OF ATTENTION AND CONSCIOUSNESS

• Confusion:
  A state of perplexity associated with disturbance in intellectual functions such as judgment and concentration.

• Disorientation:
  Loss of orientation in time, place, person, date, month, and year.

• Stupor:
  A state in which a person has no capacity to respond to stimulation and is mute or emotionless.
  Example: Catatonic stupor, common in schizophrenia.
  Patients are aware of their surroundings but do not participate.

DISORDERS OF INSIGHT

• Patient is not aware of their condition (i.e. mental illness or behavior). Insight is either present or lacking.

DISORDERS OF INTELLIGENCE

• Mental sub-normality (mental retardation):
  May result from:

• Severe infections intrauterine
• HIV
• Severe malnutrition
• Premature births

DISORDERS OF MOTOR BEHAVIOR

Motor function refers to the behavior, facial movement, and posture of the individual.

May include:

• Restlessness
• Overactivity
• Very slow activity

Other features:

• Echopraxia:
  Repetition of every action by the patient.

• Cataplexy:
  Maintaining a particular posture or position for a long time.

• Emotional diarrhea/incontinence:
  Failure to respond to or control emotions.

ASSESSMENT OF MENTALLY ILL PATIENT HISTORY TAKING

• Bio-demographic data (particular) Reasons for referral
• Presenting complaint
• History of presenting complaint Past psychiatric history
• Past medical or surgical history
• Family history (are both parents still alive if so staying together, how many siblings, birth order of the pt, whether there is a positive h/o mental illness, epilepsy and drug abuse.)
• Personal history: from time of conception to birth, upbringing, current life, substance abuse, employment
• Forensic history: has the pt ever been detained in police custody and the reason for detention

MENTAL STATE ASSESSMENT/EXAMINATION

• Appearance and behavior whether clean or shabby, unkempt, dirty and torn clothes, dirty hair, dirty and long finger nails
• Restlessness, mannerisms, grimacing, giggling, aggression, violence, Mood and affect
• Perception (hallucinations and illusions) Speech
• Thought disorders (delusions)
• Cognitive function (sphere) level of consciousness, concentration, attention Memory (long, intermediate and short time memory)
• Orientation ( place, time, day, month, year and person
• Intelligence Abstract thinking Insight Impression

PHYSICAL STATE EXAMINATION

• Head to toe examination

• Four techniques

• Inspection

  Palpation

• Auscultation

• Percussion

• Body systems

• And the vital observation