Terminologies in

Mental Health
Nursing
Mr. Johny Kutty Joseph,
Asstt. Professor
SMVDCoN
 Mental Health & Illness
 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.
 Definition
 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 )
 Disorders of Perception
 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 .
 Disorders of Perception
 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
 Disorders of Perception
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.
 Disorders of Perception
 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
 Disorders of Perception
 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.
 Disorders of Perception
 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.
 Disorders of Perception
 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.
 Disorders of Perception
 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.
 Disorders of Perception
 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.
 Disorders of Thought
 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)
 Abnormalities of Possession of
thought
 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.
 Abnormalities of Possession of
thought
 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.
 Abnormalities of Possession of
thought
 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)
 Abnormalities in the stream of thought.
 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.
 Abnormalities in the stream of thought.
 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.
 Abnormalities in the stream of thought.
 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.“
 Abnormalities in the stream of thought.
 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.
 Abnormalities in the content of
thought.
 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
 Abnormalities in the content of
thought.
 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.)
 Abnormalities in the content of
thought.
 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.
 Abnormalities in the content of

thought.
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.)
 Abnormalities in the content of
thought.
 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.
 Abnormalities in the content of
thought.
 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.
 Abnormalities in the content of
 thought.
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.
 Abnormalities in the content of
thought.
 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.
 Abnormalities of Form of
thought.
 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 …
 Abnormalities of Form of

thought.
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!”
 ABNORMALITIES OF MOOD /
 EMOTION
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.
 ABNORMALITIES OF MOOD
/EMOTION
 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.
 ABNORMALITIES OF MOOD
/EMOTION
 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
 ABNORMALITIES OF MOOD
/EMOTION
 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.
 ABNORMALITIES OF MOOD
/EMOTION
 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.
 ABNORMALITIES OF MOOD
/EMOTION
 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.
 ABNORMALITIES OF MOOD
/EMOTION
 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;
 ABNORMALITIES OF MOOD
/EMOTION
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 .
 ABNORMALITIES OF MOOD
/EMOTION
 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.
 ABNORMALITIES OF MOOD
/EMOTION
 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.
 ABNORMALITIES OF SPEECH
 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
 ABNORMALITIES OF SPEECH
 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.)
 ABNORMALITIES OF SPEECH
 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).
 ABNORMALITIES OF SPEECH
 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.
 ABNORMALITIES OF MOTOR
BEHAVIOUR
 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.)
 ABNORMALITIES OF MOTOR
BEHAVIOUR
 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).
 ABNORMALITIES OF MOTOR
BEHAVIOUR
 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.
 ABNORMALITIES OF MOTOR
BEHAVIOUR
 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.
 ABNORMALITIES OF MOTOR
BEHAVIOUR
 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.
 ABNORMALITIES OF MOTOR
BEHAVIOUR
 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.
 ABNORMALITIES OF MOTOR
BEHAVIOUR
 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.