Affect:

A person's observed moment to moment emotional expression expressed in posture, face, body movements, and tone of voice. Compare to definition of mood.

Anhedonia:

Loss of interest in and withdrawal from all regular and pleasurable activities. In evaluating anhedonia, inquiring whether the person has lost the sense of pleasure is not enough. The clinician must document that the patient has actually given up previously enjoyed pastimes. When mild, anhedonia evidences with a decreased interest in life. Later, patients complain that they have lost all interest in things.

Apathy / apathetic:

Dulled emotional tone associated with detachment or indifference; seen in certain types of schizophrenia and depression.

Appearance:

Appearance refers to the physical characteristics of the person. It includes:

• bodily habits
• physical disabilities
• dress
• stature
• grooming, and
• cleanliness.

Attitude towards clinician:

Attitude toward clinician refers to the person's approach to the interview and interaction with the clinician, if the person is willing or unwilling to engage, is responsive to questions, etc. The person's attitude toward the interview and interaction with the clinician will affect the information elicited. Attitude may change during the course of the interview as anxiety reduces (or increases). The development of rapport is an important factor in attitude.

Auditory hallucination:

The perception of sound or voice, ranging from an indistinct buzzing to a conversation loud enough to preclude attention to real sounds/conversations. Three types of auditory hallucinations are:

1. audible thoughts described as hallucinated voices that speak aloud what the person is thinking;
2. voices that give a running commentary on the person's actions; and
3. hearing two or more voices arguing with each other often about the person, who is referred to in the third person.

Behaviour:

Behaviour and activity refers to the level and quality of the person's physical movement. Noting the activity level and the type of movement the individual displays are useful indicators of concurrent mood states or of physical problems.

Some individuals cannot sit still, whereas others barely move, and others move in abnormal ways. Abnormal activity and movements can be indicative of a neurologic problem, as well as, mood states. Some individuals, for example, may also be behaving in unusual ways because they are responding to hallucinations and delusions.

Bizarre:

Conspicuously or grossly unconventional or unusual.

Capacity:

Capacity is the ability to make one's own decisions.

An adult over the age of 18 has the right to make their own decisions and choices e.g. what to wear, what to eat, where to live, how to act. Adults have the right to make a decision, think it through and act. This is regardless of what others may think of their decision making process or outcomes. Adults are presumed to have capacity to make their own decisions.

Chronological age:

The person's actual age.

Clang association:

Statements are connected by sound not by meaning. A type of thinking in which the sound of a word, rather than its meaning, gives the direction to subsequent associations.

Punning and rhyming may substitute for logic, and language may become increasingly a senseless compulsion to associate and decreasingly a vehicle for communication. Documented in thought form and flow section of MSE.

For example, in response to the statement 'That will probably remain a mystery,' a person said, 'History is one of my strong points'.

Cognitive Assessment:

The process of systematically gathering test scores and related data in order to make judgements about an individual's ability to perform various mental activities involved in the processing, acquisition, retention, conceptualization, and organisation of sensory, perceptual, verbal, spatial, and psychomotor information.

Concentration:

The act or process of concentrating, especially the fixing of close, undivided attention.

Also see Attention and concentration.

Congruent mood and affect:

Where the emotions observed correspond to contents of speech and thought.

Delusion:

Fixed false belief based on incorrect inference about external reality. The delusions are not consistent with patient's intelligence and cultural background and cannot be corrected by reasoning. Occurs in some psychotic states and firmly sustained despite clear evidence to the contrary. The belief is not part of a cultural tradition such as an article of religious faith. Can range from being quite bizarre and fragmented to being plausible and organised.

Types of delusions include: bizarre, jealous, erotomanic, grandiose, control, reference, persecution, somatic, thought broadcasting and thought insertion.

Systematised delusions are a stable set of delusions in which various psychotic features tend to interrelate, and the person is able to discuss most things in terms of his/her delusional system. Documented in thought content section of MSE.

Non-systematised delusions are those that change rapidly in content; their organisation is difficult to elucidate and the psychotic elements are not particularly interrelated. Non-systematised delusions usually extend into many areas of life, and new data - new people and situations - are constantly incorporated to further support the presence of the delusion. The patient usually has concurrent mental confusion, hallucinations, and some affective lability.

Dimensions of Delusions:

• Conviction - How convinced person is of belief.
• Extent - Do delusions involve many areas of person's life?
• Bizarreness - A delusion that involves a phenomenon that the person's culture would regard as physically impossible. Bizarre delusions suggest schizophrenia.
• Disorganization - Are beliefs internally consistent, logical, and systematised?
• Pressure - How preoccupied person is with belief.

Types of delusions:

• Passivity experiences/delusions of control - False belief that a person's will, thoughts, or feelings are being controlled by external forces. These include thought broadcasting, thought insertion or thought withdrawal.
• Grandiose/ delusions of grandeur - False belief that the behaviour of others refers to oneself or that events, objects, or other people have a particular and unusual significance, usually of a negative nature. Derived from idea of reference in which persons falsely feel that others are talking about them. For example, a belief that a television program or newspaper article has special meaning for him/her or that a person on the television or radio are talking about/or to them.

Depersonalisation:

Sensation of unreality concerning oneself, parts of oneself, or ones environment that occurs under extreme stress or fatigue. Seen in schizophrenia, depersonalisation disorder and schizotypal personality disorder.

Despondent:

Feeling dejected. Without or almost without hope.

Dissociation:

Unconscious defence mechanism involving the segregation of any group of mental or behavioural processes from the rest of the person's psychic activity. May entail the separation of an idea form its accompanying emotional tone.

Distractibility:

Inability to maintain attention; shifting from one area or topic to another with minimal stimulus.

Dysphoria / dysphoric:

Feeling of unpleasantness or discomfort; a mood of general dissatisfaction and restlessness.

Echolalia:

Mechanical and meaningless repetition of the words of another person (as in schizophrenia). Involuntary parrotlike repetition of a word or sentence just spoken by another person.

Egocentric interpretation:

The individual references themself when interpreting a proverb.

Euphoria / euphoric:

An exaggerated feeling of physical and emotional well-being, that is inappropriate to real events. Also seen in organic mental disorders, toxic and drug-induced states and bipolar disorders.

Executive functioning:

Cognitive abilities such as planning, organising, sequencing, and abstracting. Diminished in dementia and can be impaired in schizophrenia.

Eye contact:

Visual contact with another person's eyes

Fear:

Unpleasant emotional and physiological response to recognised sources of danger, to be distinguished from anxiety. See also phobia.

Flight of ideas:

A nearly continuous flow of accelerated speech with abrupt changes from one topic to another, usually based on understandable associations, distracting stimuli, or plays on words. When severe this may lead to disorganised and incoherent speech.

Flight of ideas is characteristic of manic episodes, but it may occur also in organic mental disorders, schizophrenia, other psychoses, and, rarely, acute reactions to stress.

Gait:

Refers to the persons manner of walking.

Generalised anxiety disorder:

The essential feature of an anxiety disorder is the presence of excessive anxiety and worry. An individual with an anxiety disorder will find it difficult to control this tendency to worry, and their anxiety will be accompanied by symptoms such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension and disturbed sleep among others.

Grandiosity:

Exaggerated belief or claims of one's importance or identity, often manifested by delusions of great wealth, power, or fame.

Gustatory hallucination:

A hallucination involving the perception of taste (usually unpleasant).

Hallucination:

Unprovoked perceptual experiences that occur in a person's mind through any sense (sight, hearing, smell, taste, touch) in the absence of external stimulation.

Hallucinations may involve any of the senses (sight, hearing, smell, taste, touch).

Hyperactivity:

Excessive motor activity that may be purposeful or aimless; movements and utterances are usually more rapid than normal. Hyperactivity is a prominent feature of attention-deficit disorder and hypo / hypermania.

Hypomania:

Mood abnormality with the qualitative characteristics of mania but somewhat less intense. It is characterised by unrealistic optimism, pressure of speech and activity, and a decreased need for sleep. Some people show increased creativity during hypomanic states, whereas others show poor judgement, or irritability.

Ideas of reference:

Misinterpretation of incidents and events in the outside world as having direct personal reference to oneself; frequently seen in paranoid patients. For example, remarks that one overhears, or people that one encounters seem to be concerned with and usually hostile to self. If present with sufficient frequency or intensity or if organised and systematised, they constitute delusions of reference. Documented in the thought content section of MSE.

Illusion:

A misperception of a real external stimulus. Example: the rustling of leaves is heard as the sound of voices. Contrast with hallucination.

Impulsivity:

Displaying behaviour characterised by little or no forethought, reflection, or consideration of the consequences. Rapid, unplanned responses to stimuli. Is of clinical interest because of the danger the person's actions may present to self and others. Should be considered in a risk assessment, especially if the person is also prone to violence, or is currently angry or hostile.

Incoherence:

Lacking in unity or consistency; often applied to speech or thinking that is not understandable owing to any of the following: lack of logical connection between words or phrases, excessive use of incomplete sentences; many irrelevancies or abrupt changes in subject matter; idiosyncratic word usage; or distorted grammar. See also loosening of associations.

Judgement:

Mental act of comparing choices between a given set of values in order to select a course of action.

Labile affect:

Abnormal variability, with repeated, rapid, and abrupt shifts in affective expression. Fluctuating rapidly between extremes, unrelated to external stimuli. For instance, shifting rapidly from laughing to tearful.

Long term memory:

The part of the mind that retains information permanently or nearly so; a system in the brain that can store and retrieve vast amounts of information on a relatively enduring basis.

Lugubrious:

Mournful, dismal, or gloomy, especially in an affected, exaggerated, or unrelieved manner.

Magical thinking:

A conviction that thinking equates with doing. Occurs in dreams in children, in primitive peoples, and in individuals under a variety of conditions. Many superstitions are examples of culturally validated magical thinking. Characterised by lack of realistic relationship between cause and effect.

Mania:

A mental state of elevated, expansive or irritable mood and persistently increased level of activity or energy. Can also be characterized by such symptoms as severe insomnia, grandiose notions, increased speed and/or volume of speech, flight of ideas increased sexual desire, markedly increased energy and activity level, poor judgement, and inappropriate social behaviour.

Mini Mental State Examination (MMSE):

The Mini-Mental Status Exam is a five-minute screening test that is designed to evaluate basic mental function in a number of different areas. Some of the areas tested involve a person's ability to recall facts, to write and to calculate numbers.

The test provides a quick way to determine if more in-depth neurological testing is needed. Anyone suspected of mental decline or potential dementia is a candidate for this test although the test is best suited for people older than 60.

Read more about the MMSE

View the mini MSE

Motor coordination:

The harmonious functioning of body parts that involve movement, including gross motor movement, fine motor movement, and motor planning.

Negative symptoms:

Most commonly refers to a group of symptoms characteristic of schizophrenia that include diminished emotional expression and avolition, alogia, anhedonia and asociality.

Nihilistic delusion:

A conviction of non-existence of the self, part of the self, or others, or of the world. 'I no longer have a brain' is an example.

Cotard's Syndrome is a nihilistic delusion in which one believes that one's body, or parts of it, is disintegrating, or that one is bereft of all resources, or one's family has been exterminated, and so forth. It has been reported in depressive disorders, schizophrenia, and lesions of the non-dominant lobe.

Obsession:

Recurrent and persistent thought, impulse, or image experienced as intrusive and distressing.

Recognised as being excessive and unreasonable even though it is the product of one's mind. This thought, impulse, or image cannot be expunged by logic or reasoning. Associated with anxiety.

Orientation:

Awareness of one's self in relation to time, place, and person.

Panic:

Sudden, overwhelming anxiety of such intensity that it produces terror and physiological changes.

Paranoid delusions:

A condition characterised by an intricate, complex, and elaborate system of thinking based on (and often proceeding logically from) misinterpretation of an actual event. Belief that a person or persons is/are persecuting them. Despite its chronic course, this condition does not seem to interfere with thinking and personality. Includes persecutory delusions and delusions of reference, control and grandeur

Positive symptoms:

In psychosis and schizophrenia: hallucinations, delusions, and thought disorder.

Poverty of thought:

Marked reduction in the amount of thought. Thinking is vague, concrete, over-abstract, repetitive, or stereotyped. Also known as poverty of ideas and poverty of content of thought.

Preoccupation:

Centring of thought on a particular idea, associated with strong emotional reactions in the individual.

Problem solving:

A specific form of intellectual activity used when a person faces a situation that cannot be handled in terms of past learning. Problem solving strategies are considered crucial in any psychotherapeutic endeavour.

Psychomotor agitation:

Excessive motor activity associated with a feeling of inner tension. When severe, agitation may involve shouting and loud complaining. The activity is usually non-productive and repetitious, and consists of such behaviour as pacing, wringing of hands, and inability to sit still.

Psychosis:

A group of symptoms that reflects a change in a person's sense of reality and may lead to changes in their mood, thoughts, perceptions and beliefs. It may be characterised by hallucinations, delusions and illusions.

Racing thoughts:

The subjective experience of thoughts moving very quickly from topic to topic. Racing thoughts are reported most often by people with mania, hypomania, anxiety and drug intoxication. As the person becomes increasingly unwell will potentially become flight of ideas.

Recall:

The process of bringing a memory into consciousness (see conscious). Recall is often used to refer to the recollection of facts, events, and feelings that occurred in the immediate past.

Short-term memory:

The recognition, recall, and reproduction of perceived material 10 seconds or longer after initial presentation.

Somatoform disorder:

These disorders are characterised by physical complaints that appear to be medical in origin but that cannot be explained in terms of a physical disease, the results of substance abuse, or by another mental disorder.

Speech:

The faculty or act of expressing or describing thoughts, feelings, or perceptions by the articulation of words.

Staccato:

Abnormal speech in which the person pauses between words, breaking the rhythm of the phrase or sentence.

Strengths perspective:

A strengths perspective or practice model rests on the assumption that there are strengths and resources present for all people, in all situations and forms of distress.

A strengths based approach to mental health work relies on awareness, utilisation and enhancement of existing strengths (personal) and resources (environmental).

Suicidal ideation:

Thoughts about killing oneself. Can range from specific plans to passive feelings or ideation, such as 'I wish I was dead'.

Suicide plan:

Individual strategy inclusive of time frame and means to kill oneself.

Taciturn:

Habitually silent, reserved, or uncommunicative; not inclined to conversation.

Tangentiality:

Replying to a question in an oblique or irrelevant way. The person does not get around to answering the question.

Documented in thought form/flow section of MSE.

Thought blocking:

A sudden obstruction or interruption in spontaneous flow of thinking or speaking, perceived as an absence or deprivation of thought.

Thought content:

Refers to what the person is talking about, rather than how the person is thinking. Preoccupations, obsessions, phobias, rituals and delusions are examples of disturbance in thought content.

Thought form/flow:

Form means the "arrangement of parts". Disturbances in the form of thought are disturbances in the logical process of thought - more simply, disturbances in the logical connections between ideas. Circumstantial speech, flight of ideas, loosening of associations, perseverance and blocking are examples of disturbances in thought form.

Thought latency:

Delay or hesitancy preceding the production of a verbal response or statement.

Thought process: Individuals pattern of thoughts, not specific content. Refer to 'thought form/flow'.

Tic:

An involuntary, sudden, rapid, recurrent, nonrhythmic stereotyped motor movement or vocalization. A tic may be an expression of an emotional conflict, the result of neurologic disease, or an effect of a drug (especially a stimulant or other dopamine agonist).

Visual hallucination:

Perception of an image such as people (formed) or a flash of light (unformed). Previously thought to have been uncommon in schizophrenia, but now found to be prevalent in high numbers in subjects with chronic schizophrenia. Also occur in people with visual system disease (eg, macular degeneration) unrelated to primary psychiatric disorder. Common with substance induced psychosis.

Word salad:

Speech is an incoherent, essentially incomprehensible jumble of words and phrases recounted with normal intonation. A mixture of words and phrases that lack comprehensive meaning or logical coherence; commonly seen in schizophrenic states. Documented in thought form and flow section of MSE.