Habit and impulse disorder

Repeated acts that have no clear rational motivation, cannot be controlled, and generally harm the individual’s interests and those of other people. The individual reports that the behaviour is associated with impulses to action. Included are pathological gambling, pathological fire-setting, pathological stealing, trichotillomania, and other impulse disorders such as intermittent explosive disorder.

Hallucination

A sensory perception, of any modality, occurring in the absence of the appropriate external stimulus. In addition to the sensory modality in which they occur, hallucinations may be subdivided according to their intensity, complexity, clarity of perception, and the subjective degree of their projection into the external environment. Hallucinations may occur in normal individuals in the half-sleeping (hypnagogic) or half-waking (hypnopompic) state. As morbid phenomena they may be symptomatic of cerebral disease, functional psychoses, and the toxic effects of drugs, each with characteristic features.

Histrionic

Describes exaggerated gesture, expression, and speech associated with acting. When applied to personality, the term denotes an aggregation of morbid traits, including theatrical behaviour, a desire to impress, gain sym­pathy, or be the centre of attention, shallowness of emotion, and intense day­ dreaming.

HIV-associated acute stress reaction

Expressions of despair, anger, guilt, withdrawal, and fear, and frequently the development of somatic symptoms that the individual interprets as evidence of a physical decline due to HIV infection or AIDS. Such reactions are particularly frequent immediately after the discovery of seropositivity and in conjunction with changes in the patient’s clinical state.

Hypnosis

A state of trance, superficially resembling sleep, induced by suggestion of relaxation and concentrated attention on a single object, in which the individual becomes suggestible and responsive to the hypnotist’s influence and may recall forgotten events and obtain relief from psychological symptoms.

Identity disorder

Outlook and attitude of a child or adolescent who is excessively uncertain about personal beliefs and purposes, with consequent impairment of function.

Impulse control

The capacity to resist an impulsive desire or an urge to indulge in self-gratifying behaviour without regard for the consequences.

Incoherence

A severe form of thought and speech disorder in which the prominent features are distortion of grammar, unexplained shifts from topic to topic, and lack of a logical connection between parts of speech.

Insomnia, nonorganic

Unsatisfactory quantity and/or quality of sleep, which persists for a considerable period of time. It includes difficulty .in falling asleep, difficulty in staying asleep, or early final awakening.

Irritability

An undue state of overreaction involving annoyance, impatience, or anger. It may appear in states of fatigue or chronic pain, or be a clinical feature of temperamental anomalies associated with advancing age, cerebral trauma, epileptic states, and manic-depressive disorders.

Jargon aphasia

A form of Wernicke aphasia (receptive, central, or sensory aphasia) characterized by speech in which syntax seems normal but content is meaning­less. Synonym: nonsensical speech

Jealousy, alcoholic

See psychotic disorder, alcohol- or drug-induced.

Juvenile tabes

A form of tabes occurring in children with congenital syphilis or in children who have acquired the disease in infancy or early childhood. The clinical features are those of the adult form of the disease; optic atrophy and mental deterioration are often prominent and the Wasserman reaction may be negative. The untreated course of the disease tends to be one of rapid progression. See also: syphilis, congenital

Juvenile taboparesis

A form of neurosyphilis occurring in childhood in which the clinical features of general paresis are associated with those of tabes dorsalis. See also: syphilis, congenital; general paresis

Kleine-Levin syndrome

A rare syndrome, occurring mostly in young males, characterized by periodic attacks of megaphagia, hypersomnia, and psycho­logical and behavioural disorders. The disorder tends to be self-limiting and may respond to the administration of sympathomimetic amines.

Korsakov psychosis

A syndrome of predominant and lasting reduction of memory span, including striking loss of recent memory, disordered time appreciation, and confabulation, occurring in alcohol-dependent individuals as a sequel to an acute alcoholic psychosis (especially delirium tremens) or, more rarely, in the course of the alcohol dependence syndrome. It is usually accompanied by peripheral neuritis and may be associated with Wernicke encephalopathy. First described in 1889 by Korsakov.

Kuru

A transmissible progressive degenerative disease of the central nervous system, involving primarily the basal ganglia and the cerebellum, and manifest as gross ataxia, athetosis, tremor, dysarthria, and rigidity. Mental changes include emotional lability, psychomotor slowing, and a rapidly progressing dementia. The condition is invariably fatal, death occurring within 6-9 months of onset. The causative agent has been shown by Gajdusek to be an unconventional slow virus with a very long incubation period, closely related to the viral agent suspected in Creutzfeldt-Jakob disease and, possibly, scrapie.

Language disorder, expressive

A specific developmental disorder in which the child’s ability to use expressive spoken language is markedly below the appropriate level for its mental age, but language comprehension is within normal limits. There may or may not be abnormalities in articulation. Synonym: developmental dysphasia or aphasia, expressive type

Life-cycle transitions

Changes that occur as part of passing from one stage to another in the course of maturation and development, and in particular the behaviour and role-function adaptations that an individual is called upon to make in response to age-related changes over which he or she has little if any control.

Life-management difficulty

Problems in dealing effectively with one’s social, occupational, or interpersonal environment.

Limbic epilepsy

A subtype of temporal lobe epilepsy in which pathophysiological changes related to kindling in the mesolimbic system are suspected to lead to the gradual development of personality and behaviour alteration, to severe mood disorders, or to schizophrenia-like psychosis.

Lymphoma, primary CNS

A primary malignant lymphoma of the brain to which individuals with HN infection are susceptible. The lesions, more often unifocal than multifocal, involve proliferation of atypical lymphocytes in a perivascular distribution. In some cases, the lymphoma responds to early aggressive radiation therapy.

Make-believe play

Any of the games or activities of childhood that depend on the child’s imagination or ability to pretend. The ability to use toys and household objects appropriately is one measure of the child’s comprehension and ability to communicate.

Melancholia

A term originating in the Hippocratic tradition (4th century BC), used until the end of the 19th century to denote generally the depressive syndrome. While Kraepelin and others restricted its use to refer only to depression in the elderly, Freud redefined it as a morbid counterpart of normal mourning. Amidst a general decline in its use, DSM-IIF resurrected the term by giving it yet another meaning in which the distinct quality of depressed mood and the exact opposite of normal mourning are the prominent features. In view of this lack of precision, and the contradictory connotations, the continued use of the term is not recommended.

Mental disorder, organic

A range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult, leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively, or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or body systems involved. The term symptomatic mental disorders refers to the latter subgroup.

Migraine

Recurrent paroxysmal attacks of headache that are variable in intensity, frequency, and duration. The attacks are commonly unilateral and are usually accompanied by anorexia, nausea, and vomiting. In some cases they are preceded by, or associated with, neurological disturbances especially affecting the field of vision. In some cases migraine can present with psychiatric symptoms. The condition is ascribed to vasomotor disturbance of the cerebral circulation.

Multiple personality

The apparent existence of two or more distinct or independent personalities within the individual, with only one of them evident at a time.

Negative symptoms

Psychopathological or neurological manifestations of a dimi­nution or loss of normal function resulting from a lesion in the central nervous system. The concept derives from the dissolution theory of Hughlings Jackson (1835-1911), which postulated a dual effect of cerebral lesions: deficits directly due to the lesion, and positive phenomena arising secondarily as ontogenically lower levels are released from the control of the superior centre. This view has had repercussions in psychiatry, notably in the descriptive psychopathol­ogy of schizophrenia. Symptoms usually referred to as negative include poverty of speech, impairment of attention, affective blunting, apathy, and social withdrawal. However, there is no general agreement on the nature and the assessment of the negative symptoms, and little is known about their pathophysiological basis in schizophrenia.

Neurotic disorder

A mental disorder without any demonstrable organic basis, in which the patient may have considerable insight and has unimpaired reality testing, in that he or she usually does not confuse morbid subjective experi­ences and fantasies with external reality. Behaviour may be greatly affected although usually remaining within socially acceptable limits. Personality is not disorganized. The principal manifestations include excessive anxiety, hysterical symptoms, phobias, obsessive and compulsive symptoms, and depression.

nocturnal myoclonus

Periodic episodes of repetitive, stereotyped muscle jerks occurring during sleep and followed by partial arousal or awakening. It is usually associated with insomnia and/or daytime sleepiness, and with the restless legs syndrome. The cause is unknown.

Nonverbal intelligence

Refers to all information-processing and coping skills, such as visual motor coordination and other psychomotor skills, that do not depend primarily on language or verbal responsiveness.

Normality

An ill defined concept with several quite different meanings. Those most relevant to health are: habitual; innocuous; optimal or fittest; average or medium; a metrical variate with a particular probability value.

Panic disorder [episodic paroxysmal anxiety]

The essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable. As with other anxiety disorders, the dominant symptoms vary from person to person but may include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or dereali­ zation). There is often also a secondary fear of dying, losing control or going mad. Panic disorder must be distinguished from panic attacks occurring as part of established phobic anxiety disorders. Panic attacks may also be secondary to depressive disorders.

Paralysis

Loss of motor power attributable to functional or organic disorder of neuromuscular or neural mechanisms.

Paranoia

A rare chronic psychosis in which logically constructed sys­tematized delusions have developed gradually without concomitant hallucin­ations or the schizophrenic type of disordered thinking. The delusions are mostly of grandeur (the paranoiac prophet or inventor), persecution, or somatic abnormality.

Parkinson disease

A neurological disorder, first described by Parkinson (1755-1824), consisting of a degeneration of the basal ganglia, particularly the substantia nigra. The principal clinical features are muscular rigidity, bradykin­ esia, tremor, and postural deformities. The causes may be idiopathic, infectious, or toxic, or the condition may be part of a wide pathological process affecting the central nervous system, e.g. cerebrovascular disease. Parkinsonian symp­ toms (parkinsonism) may also be induced by drugs, e.g. neuroleptics, which produce blockade of dopamine receptors in the basal ganglia.

Personality and behaviour disorder

A variety of conditions and behaviour patterns of clinical significance that tend to be persistent and appear to be the expression of the individual’s lifestyle and mode of relating to self and others. Specific personality disorders, mixed personality disorders, and enduring personality change are deeply ingrained and persisting behaviour patterns, manifested as inflexible responses to a broad range of personal and social situations. They represent extreme or significant deviations from the way in which the average individual in a given culture perceives, thinks, feels, and, particularly, relates to others. Included in this group are: habit and impulse disorders, gender identity disorders, sexual preference disorders, sexual development and orientation disorders, elaboration of physical symptoms for psychological reasons, and intentional production or feigning of symptoms.

Quetelet body mass index

Weight divided by the second power of height multiplied by 100; an anthropometric index proposed in 1835 and still widely used to quantify the relation between height and weight in the diagnostic assessment of eating disorders.

Reactive psychosis

A term employed to designate a group of psychoses causally related to a preceding external event, e.g. personal loss, bereavement, insult, natural disaster. The psychoses are mostly of brief duration, often but not always remitting with the recession of the provoking factor. Their form and content tend to reflect the nature of the precipitant and to fall into three broad clinical categories: disorders of consciousness (confusional), disorders of affect (depression), and delusional disorders (paranoid). This classification of the reactive psychoses, originally delineated by 1’\’immer in 1916 as psychogenic psychoses, is widely but not universally accepted.

Reading disorder, specific

A specific and significant impairment in the development of reading skills that is not solely accounted for by mental age, visual acuity problems, or inadequate schooling. Reading comprehension skill, reading word recognition, oral reading skill, and performance of tasks requiring reading may all be affected. Spelling difficulties are frequently associated with specific reading disorder and often continue into adolescence even after some progress has been made in reading. Specific developmental disorders of reading are commonly preceded by a history of disorders in speech or language development. Associated emotional and/or behavioural disturbances are com­ mon during the school-age period.

Rehabilitation

As applied to disability, the combined and coordinated use of medical, social, educational, and vocational measures for training or retraining the individual to the highest possible level of functional ability.

REM sleep

Periods of sleep lasting an average of 5 minutes, which recur in the adult about every 90 minutes and during which rapid eye movements can be recorded by electrooculography. REM (or paradoxical) sleep periods are almost entirely occupied by vivid dreaming, and accompanied by a variety of physiological changes in the pulse rate, respiration, muscle tone, and cerebral blood flow.

Restless legs syndrome

Deep, ill-defined paraesthesias of the legs which are experienced principally during prolonged muscular rest, states of drowsiness, and the pre-dormal period. The symptoms are relieved by moving the legs or by walking. The condition may be familial and is often associated with nocturnal myoclonus.

Schizoaffective disorder

An episodic disorder in which both affective and schizophrenic symptoms are prominent, so that the episode of illness does not justify a diagnosis of either schizophrenia or a depressive or manic episode. Manic, depressive, and mixed types can be distinguished, depending on the preponderant features of the affective ingredient.

Schizophrenia

A disorder characterized in general by fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained, although certain cognitive deficits may evolve in the course of time. The disturbance involves the most basic functions that give the normal person a feeling of individuality, uniqueness, and self-direction. The most intimate thoughts, feelings, and acts are often felt to be known or shared by others, and explanatory delusions may develop, to the effect that natural or supernatural forces are at work to influence the afflicted individual’s thoughts and actions in ways that are often bizarre. Although no strictly pathognomonic symptoms can be identified, the most important psychopathological phe­nomena include thought echo, thought insertion or withdrawal, thought broadcasting, delusional perception, and delusions of control, influence or passivity, hallucinatory voices commenting on or discussing the patient in the third person, disorders in the train of thought, catatonia, and negative symptoms. The course of schizophrenia can be continuous, or episodic with progressive or stable deficit following the episodes, or consist of one or more episodes with complete remissions.

Sedative

Any substance that diminishes the activity of an organ or tissue; more specifically, the class of pharmacological substances that moderate excitement and induce a state of calm by their depressing action on the central nervous system. In higher doses they can induce sleep and general anaesthesia.

Social anxiety disorder

A wariness of strangers and social apprehension or anxiety when encountering new, strange, or socially threatening situations. Such fears arise during early childhood, but are severe enough to cause problems in social functioning.

Stress reaction, acute

A transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and/or mental stress and that usually subsides within hours or days. Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions. The symptoms show a typically mixed and changing picture and include an initial state of “daze”, with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, and disorientation. This state may be followed either by further withdrawal from the surrounding situation (to the extent of a dissociative stupor), or by agitation and over-activity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are commonly present. The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within 2-3 days (often within hours). Partial or complete amnesia for the episode may be present.

Tension headache

A sensation of tightness, pressure, or dull pain that may be generalized or, more typicaliy, have a band-like quality. As a transient disturbance, it is commonly associated with the stresses of everyday life but, when persistent, may be a presenting feature of an anxiety state or a depressive illness.

Thought echo

The experience of one’s own thoughts being repeated or echoed (but not spoken aloud) within one’s head. The interval between the original thought and its echo is usually only a few seconds. The repeated thought, though identical in content, may be felt as slightly altered in quality.

Thyroid hormone

Thyroxine or any of the other active agents secreted by the thyroid gland, including triiodothyronine and thyrocalcitonin. Excessive secre­tion in hyperthyroidism is characterized by accelerated basal metabolic rate, weakness, weight loss, nervousness, and, particularly in middle-aged or older individuals, cardiac arrhythmia or congestive heart failure.

Tolerance

Decrease in response to a drug dose that occurs with continued use of the drug. In the frequent or heavy drinker, for example, higher doses of alcohol are needed to achieve the effects originally produced by lower doses. Both physiological and psychosocial factors may be involved in the production of tolerance.

Tunnel vision

A restriction of peripheral vision, with unimpaired central visual acuity, occurring in retinitis pigmentosa and advanced chronic glaucoma. The term is also used as a synonym for tubular vision, a dissociative symptom of hysteria, in which the area of the visual field is the same regardless of the distance of the eye from the focal point.

Unconscious motivation

Any intrinsic force of which the individual is not fully aware that serves to initiate, maintain, or direct behaviour towards a goal. Many systems of psychology assume the presence of an unconscious portion of the mental apparatus containing memories, wishes, impulses, etc. that are not within the immediate field of awareness but that none the less have significant effects on behaviour.

Victimology

The study of the victims of malteatment, including not only the immediate reaction to the traumatic event but also such issues as how they came to be the objects of attack the kind of physical or psychological assault they were forced to endure, the type of support they might need to return to their usual level of functioning, the long-term consequences of their experience, and the type of restitution or compensation they might merit.

Visual processing

The manipulation of visual data within the central nervous system: an object is perceived and then coded into a form that can be stored and, ultimately, retrieved. Among the elements included in visual processing are discrimination of visual stimuli, visual sequencing, directionality, and visual association.

Vitamin B12 deficiency

Inadequate vitamin B12, often a nutritional deficiency secondary to insufficient absorption of the vitamin from the ileum in individuals with long-standing gastrointestinal disease. A frequent result is subacute degeneration of the spinal cord, optic nerves, cerebral white matter, and peripheral nerves. Spinal cord involvement is manifested as combined system disease, characterized by symmetrical progressive paraesthesias of the feet or hands (numbness, tingling, burning, etc.), followed by unsteadiness of gait and finally spasticity, ataxia, and paraplegia. Psychological symptoms include apathy, irritability, suspiciousness, and, with progression, confusion and dementia.

Vocalization

The act of giving utterance, of making sounds or words, used most often to refer to the panicky scream that typically signals the onset of an episode of sleep terror, or to the involuntary repetition of a vowel, word, or phrase that occurs as a characteristic element in some types of focal epilepsy. Vocalization is also used to refer to the sounds made by infants before they acquire regular speech.

Volatile solvent use disorder

Any mental or behavioural disorder due to the use of volatile solvents. When inhaled, volatile solvents (also called inhalants) such as glue, aerosol paints, industrial solvents, lacquer thinners, gasoline, and cleaning fluids produce altered states of consciousness. In addition, some solvents are directly toxic to the liver, kidney, or heart, and some produce peripheral neuropathy or progressive brain degeneration. The user typically soaks a rag with inhalant and places it over the mouth and nose, or puts the inhalant in a paper or plastic bag which is then put over the face (inducing anoxia as well as intoxication). Signs of intoxication include belligerence, assaultiveness, lethargy, psychomotor retardation, euphoria, im­paired judgement, dizziness, nystagmus, blurred vision or diplopia, slurred speech, tremors, unsteady gait, hyperreflexia, muscle weakness, stupor, or coma.

Wernicke aphasia

An inability to comprehend spoken or written language, and in particular to understand or report spoken language and to name objects or qualities. Reading and writing are secondarily impaired. The lesion, generally vascular, is usually in the association cortex of the first temporal convolution of the dominant hemisphere. In children, this impairment may occur as a specific developmental disorder

Wernicke encephalopathy

An acute, life-threatening, neurological syndrome (de­scribed as polioencephalitis haemorrhagica superior in 1881) consisting of confusion, apathy, dullness, a dreamy delirium, palsies of the ocular muscles and of gaze (due to lesions in the nuclei of cranial nerves Ill and VI), nystagmus and · disturbances in equilibrium (due to lesions in the vestibular nuclei), and ataxia (due to lesions in the cerebellar cortex). Its most common cause in industrialized countries is thiamine deficiency associated with alcoholism. If not treated immediately with replacement therapy, the patient is likely to progress into Korsakov psychosis (also known as Wernicke-Korsakov psychosis or syndrome, and as alcohol amnestic disorder}: severe anterograde amnesia, retrograde amnesia, and sometimes confabulation.

Withdrawal state

A group of symptoms of variable clustering and degree of severity occurring on absolute or relative withdrawal of a substance after persistent use of that substance. The onset and course are time-limited and are related to the type of substance and dose being used immediately before cessation or reduction of use. The withdrawal state may be complicated by convulsions or delirium.

Word deafness

An impaired ability to appreciate spoken language, usually attributable to damage to the cerebral receptive area for hearing in the first temporal gyrus of the dominant hemisphere. In its pure form the condition is rare.

Word fluency and output

The ready and easy flow of words in speaking. In expressive language disorder, impairment of word fluency and output may be manifested in speech that is halting and hesitant, with a restricted vocabulary and excessive use of generalizations; sentences may be abnormally short or telegrammatic because of omission of conjunctions and prepositions.