GENERAL SIGNS AND SYMPTOMS OF MENTAL ILLNESS

People suffering from mental disorders commonly present with abnormal behaviors affecting key areas such as Mood, Thinking, Belief, Perception, Memory, and Speech.

Mental illness can begin suddenly or emerge gradually over months or years. Clinical features can range from very mild to quite severe; therefore, some patients may present with many of the following signs and symptoms, while others may only have one or two.

1. DISORDERS OF SPEECH

Speech is how we talk, gather information/statements, and includes the meaning, appropriateness, tone, rate, and quantity of verbal output.

• Mutism: Complete loss of speech, common in severe depression and catatonic stupor.

• Incoherence: The patient speaks from one idea to another without a logical connection, making the speech unintelligible.

• Flight of ideas: Jumping from one topic to another without completing the former thought.

• Clang association: A word similar in sound (rhyming) but not significant to the topic leads to a new thought and word.

• Neologism: A patient uses completely new words that have a meaning only to them.

• Accelerated speech: Speech that is too fast, making it difficult to understand.

2. DISORDERS OF MOOD/AFFECT

Mood is an individual’s emotional inner feeling. Affect refers to the facial expression of one’s emotion and state. Emotion is a strong feeling accompanied by physiological change.

• Apathy: Complete lack of emotional response to stimuli.

• Elation: Morbid elevation of mood above the normal range; the patient is abnormally cheerful and optimistic given the circumstances.

• Euphoria: Morbid increased sense of well-being and confidence.

• Incongruity of affect: A peculiar mood in which the person responds to an event in a way entirely different from the normal (e.g., laughing when told of a death).

3. PERCEPTION DISORDERS

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

• Illusion: Misinterpretation of a real stimulus (e.g., mistaking a rope in the darkness for a snake). This occurs majorly in delirium and during intoxication.

• Hallucination: A false perception that occurs without an external stimulus (e.g., hearing voices when no one is around). Hallucinations can affect the five senses:

  • Auditory hallucinations: Hearing voices when nobody is around (most common). Occurs in Schizophrenia (Paranoid disorders), epilepsy, and alcohol withdrawal states.

  • Visual hallucinations: Seeing features, objects, shadows, or ghosts when there is actually nothing. Occasionally occurs in Schizophrenia (S/Z) and often a sign of Organic Brain Syndrome (OBS).

  • Olfactory hallucination: Smelling a pleasant or unpleasant odor (common in epilepsy).

  • Gustatory hallucination: A peculiar taste in the mouth.

  • Tactile hallucinations: Hallucination of touch, such as feeling insects crawling over the body (seen in cocaine intoxication).

4. DISORDERS OF MEMORY

• Amnesia: Loss of memory for events.

• Anterograde amnesia: Loss of memory for recent events.

• Retrograde amnesia: Loss of memory for past events, often occurring in old age.

• Hyperamnesia: Excessive retention of memory in which events are restated with extraordinary details.

5. THOUGHT DISORDERS

A. Delusions (Disorders of Thought Content)

A delusion is a false and fixed belief firmly held by a patient, not in keeping with the patient’s educational, cultural, and religious background, and cannot be changed by logical reasoning.

• Delusion of grandeur/grandiose delusion: An individual overvalues themselves as a great, important, or remarkable person (e.g., believing they are a religious savior, great economist, president, or God). Common in manic patients.

• Delusions of reference: A belief that people are talking about you or that articles in newspapers or television refer specifically to you.

• Delusions of unworthiness: The patient feels they are not worthy of anything.

• Hypochondriacal delusions: A belief that an individual is suffering from a chronic or horrible disease, despite laboratory investigations and medical examinations revealing nothing.

• Nihilistic delusions: An individual believes that some of their body parts are missing or may insist that they are living in a shadow.

• Delusions of love (Erotomania): Belief that one is being loved by another person where actually no relationship exists, or they have never met. Common in manic patients.

• Infidelity delusion (Jealousy): Belief that one’s spouse is cheating on them or engaging in extramarital sex. Common in alcoholics.

• Paranoid/Persecutory delusion: The patient thinks they are suspicious, hated, or bewitched.

B. Disorders of Thought Process

• Poverty of thinking: Initiation and progression of thought are very slow; the patient has difficulty thinking and speaks slowly.

• Thought insertion: An individual experiences thoughts being pushed into their mind from outside by an external force.

• Thought broadcast: The patient feels and believes that their thoughts are known to other people before they tell them.

• Thought withdrawal: The patient feels that their thoughts are being taken away from the mind by an external force.

• Thought block: The patient suddenly stops thinking or speaking.

6. DISORDERS OF ATTENTION AND CONSCIOUSNESS

• Confusion: A state of perplexity associated with disturbance in intellectual functions like judgment and memory.

• Disorientation: The process by which a person understands and locates themselves in the environment. A person can be disoriented in time, place, and person.

• Stupor: A situation where a person does not have any response to stimulation and is mute or motionless (e.g., catatonic stupor in S/Z). Patients in stupor are aware of what is taking place but do not participate.

7. DISORDERS OF INSIGHT

• Lack of Insight: The patient is not aware of their illness or abnormal behaviors.

8. DISORDERS OF INTELLIGENCE

• The most common is mental subnormality (intellectual disability).

9. MOTOR ACTIVITIES

Motor function includes the behavior, facial expression, movement, and posture of the individual; these can include restlessness, overactivity, or slowness.

• Echopraxia: The imitation of the actions or repetition of actions by the patient.

• Catalepsy: When the patient maintains/gains a certain position for a long time, depending on the position selected.

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