Abstract thinking:

the ability to deal with concepts, extract common characteristics from groups of objects and interpret information. (Contrast with concrete thinking).

 

Acting out:

inappropriate behaviour that reflects emotional distress, (e.g. cutting wrist rather than expressing sadness).

 

Adjustment disorder:

a disproportionate reaction to an identifiable psychosocial stress, which may include depressed mood, anxiety or volatile mood states/swings, behavioural disturbances and somatic complaints.

 

Affect:

objective assessment of a person’s emotional state. Described in terms of range and reactivity (from flat to blunted to restricted to normal to labile) and appropriateness (appropriate to inappropriate to the content of speech or ideation) and congruence to mood. Descriptors include euphoric, elevated, angry, irritable, and sad.

 

Affective disorder:

disorder of mood (e.g. bipolar disorder, major depressive disorder, dysthymia).

 

Agoraphobia:

avoidance of places which the person associates with severe anxiety. It usually arises as a result of fear that they may have a panic attack and be unable to get help, and so be overwhelmed, humiliated or die.

 

Akathisia:

a severe sense of internal agitation, most commonly in the legs, usually associated with neuroleptic medication. Akathisia may be very distressing with movements such as fidgeting, pacing, or inability to stay still.

 

Alcohol hallucinosis:

auditory hallucinations occurring in a clear sensorium (i.e. not DTs) associated with cessation of alcohol consumption in a heavy drinker.

 

Ambivalence:

simultaneous presence of contradictory emotions, attitudes, ideas, or desires with respect to a particular person object or situation.

 

Amnesia:

loss of memory. Anterograde (inability to lay down new memories); retrograde (loss of memory for events preceding the condition presumed responsible for the amnesia).

 

Anhedonia:

inability to enjoy activities that are usually pleasurable.

 

Anniversary reaction:

emotional responses to a past event occurring at the same time of year as the event (e.g. depression at the anniversary of the death of a loved one).

 

Anorexia nervosa:

eating disorder with weight 15% or more below normal, intense fear of gaining weight, denial of the problem, preoccupation with body image and in females, amenorrhea.

 

Antisocial behaviour:

irresponsible behaviour which demonstrates a lack of respect for the rights of others, e.g. dishonesty, deceitfulness or abuse.

 

Anxiety:

unrealistic worry, tension, or uneasiness resulting from anticipation of danger.

 

Anxiolytics:

medications with a marked antianxiety effect (e.g. benzodiazepines).

 

Attention:

sustained focus on a particular activity.

 

Avolition:

lack of initiative or goals.

 

 

Behaviour therapy:

a variety of techniques that aim to modify behaviour by analysing the factors which increase or decrease the frequency of the behaviour, and altering those factors to reduce the unwanted behaviour.

 

Bereavement:

normal feelings of deprivation, desolation and grief at the loss of a loved one.

 

Binge-eating:

distinct periods of overeating which the person feels unable to control, followed by, depression, guilt, and self-loathing.

 

Bipolar disorder:

mood disorder characterised by at least one manic or hypomanic episode (previously known as manic depressive disorder).

 

Brief psychotherapy:

psychotherapy with a defined end point; usually less than 15 sessions in duration or in terms of specific objectives; usually goal-oriented, circumscribed, active, focused, and directed toward a specific problem or symptom.

 

Bulimia nervosa:

an eating disorder characterised by recurrent episodes of binge eating and by behaviour to

control weight (over-exercise, inducing vomiting, using laxatives, or diuretics).

 

Burnout:

chronic occupational stress resulting in decreased interest and enjoyment in work, reduced work performance, fatigue and irritability and reduced tolerance to stress.

 

 

Case management:

the process of coordinating or providing clinical care, rehabilitation services and support

programs for patients with significant chronic disability.

 

Catatonia:

unusual motor abnormality associated with psychiatric illness. May be associated with reduced activity as in catatonic stupor or immobility; or excessive motor activity as in catatonic excitement; or marked negativism (purposeless resistance to attempts to move the patient’s limbs) or posturing (maintaining bizarre postures or stances); or waxy flexibility (maintaining postures after the person’s limbs have been moved by another person).

 

Catharsis:

a sudden therapeutic release of emotion associated with attaining an insight, or following the release of repressed material.

 

Character:

the sum of a person’s relatively fixed personality traits and habitual modes of response.

 

Circumstantiality:

speech that is long-winded and full of excessive or irrelevant detail, but which eventually gets to the point.

 

Clang associations:

words are strung together according to their sound rather than their meaning (e.g. punning or rhyming which does not make logical sense).

 

Clouding of consciousness:

reduced awareness of environment and capacity to sustain attention.

 

Cognition:

process of thinking, knowing and reasoning.

 

Cognitive:

the mental process of comprehension, judgement, memory, and reasoning, in contrast to emotional and behavioural processes.

 

Cognitive therapy:

aims to alter emotional and behavioural problems by helping people to become aware of their negative or maladaptive thinking style and habits, and modify those cognitions.

 

Command hallucinations:

hallucinations instructing the patient to perform a certain action. The patient may feel compelled to act on these instructions. Command hallucinations instructing the person to self-harm or harm others are indicators of extremely serious risk.

 

Co-morbidity:

co-existence of any two or more illnesses. Commonly used to refer to co-existing mental illness and substance use disorder, but can equally be a mental illness or intellectual disability or a physical illness (see dual diagnosis).

 

Community treatment order (CTO):

an order made under the NSW Mental Health Act 2007 that allows limited compulsory treatment in the community.

 

Compulsions:

repetitive voluntary behaviours (e.g. checking, ordering, hand washing) or mental acts (e.g. counting, praying) coupled with a sense of compulsion, and (at least early on) a desire to resist the behaviour or mental act. They are performed with the intention of reducing distress or preventing some future catastrophe.

 

Concrete thinking:

literal thinking, with limited ability to use metaphors or abstractions.

 

Confusion:

disturbed orientation, inattention and reduced comprehension, often with emotional and behavioural disturbance.

 

Consultation-liaison psychiatry:

subspecialty of psychiatry with expertise in the psychiatric and psychosocial aspects of medical care.

 

Conversion:

abnormality of motor or sensory neurological function for which no physical explanation can be found, unconsciously enacted to solve a strong emotional conflict (note that up to 50% of ‘conversion symptoms’ later turn out to have some organic component).

 

Coping mechanisms:

a person’s usual means of dealing with stress.

 

Counter-transference:

feelings or emotions invoked in the therapist by the patient which arise as a result of the  therapist unconsciously associating events from their own past with the current patient.

 

Crisis intervention:

brief interventions aimed at helping the person deal with acute distress.

 

Cyclothymia:

frequent episodes of switching between hypomania and depressed mood (but which are not as severe as mania or major depressive episodes).

 

 

Defence mechanisms:

a range of unconscious psychological processes, which protect the individual from dealing with distressing emotional conflict or anxiety. May be classified as immature (e.g. denial) or mature (e.g. humour); or as maladaptive or adaptive.

 

Delirium:

an acute cognitive disorder characterised by acute onset of confusion, disorientation, inattention, incoherent speech and fluctuating level of consciousness.

 

Delusion:

a fixed false belief, which is not culturally appropriate, and which is sustained despite evidence that it is false. Delusions are not amenable to rational persuasion. Types of delusion include grandiose, persecutory, religious, jealous, somatic, nihilistic or bizarre.

 

Delusions of control:

the belief that one’s feelings, impulses, thoughts or actions are not one’s own but have

been imposed by some external force.

 

Delusions of reference:

delusion that things, actions or events have a particular significance for the person, or are being staged in order to communicate with them (e.g. the delusion that every car with a number plate with a 6 in it belongs to the devil).

 

Ideas of reference

have a similar theme but do not reach delusional intensity.

 

Dementia:

an acquired decline in memory and cognition (language, judgement, reasoning, information processing, visuospatial skills, orientation, calculating skills) that results in significant impairment of personal, social or occupational function.

 

Denial:

unconscious disavowal of thoughts, feelings, actions or events that are consciously  intolerable.

 

Dependence, substance:

The person has tolerance, withdrawal symptoms when ceases, persists with use despite knowledge of harm, or functioning is adversely affected.

 

Depersonalisation:

altered perception of self such that the person feels they are outside themselves, observing rather than participating, or are otherwise unreal.

 

Depression (common usage):

feelings of sadness, despair, and discouragement, which are part of normal experience.

 

Depression (syndrome):

pathological state lasting at least two weeks with defined somatic, cognitive and emotional symptoms, with one being either depressed mood or loss of interest or pleasure.

 

Disorientation:

impaired awareness of the location of the self in relation to time (time of day, date or season), place (person’s location), or person (who one is).

 

Depot medication:

long-acting intramuscular anti-psychotic drug preparations (usual duration is 2 to 4 weeks).

 

Derealisation:

altered perception such that the external world seems unreal.

 

DSM IV TR:

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision: Published by the American Psychiatric Association and contains a comprehensive classification system of psychiatric disorders, with clear diagnostic criteria.

 

Detachment:

aloofness from interpersonal contact.

 

Devaluing:

attribution of exaggeratedly negative qualities to oneself or others.

 

Disability:

is the restriction of function occasioned by the impairment (e.g. disorganisation affecting work performance).

 

Dissociation:

the splitting of clusters of mental contents from conscious awareness, altering the sense of self of the person. Derealisation and depersonalisation are examples.

 

Dual diagnosis:

co-existence of two disorders commonly psychiatric and substance abuse, also refers to co-existence of psychiatric disorder and intellectual disability.

 

Dystonia:

involuntary muscle contraction resulting in sustained abnormal movement or posture. May be drug-induced, hereditary or idiopathic, and local or generalised.

 

Acute dystonias:

secondary to neuroleptic medication are extremely distressing and potentially fatal. Specific types include laryngospasm, oculogyric crisis (‘look-ups’) and opisthotonos.

 

Dysthymia (dysthymic disorder):

chronic depressed mood over at least 2 years, with some mild symptoms of depression (but not severe enough to be major depression).

 

 

Echolalia:

‘parrot-like’ repetitive echoing of other people’s words or phrases, often with mocking or staccato intonation.

 

Electroconvulsive therapy (ECT):

therapeutic use of electric current to induce convulsive seizures, (a very effective treatment for some psychiatric illnesses, particularly severe depression).

 

Empathy:

insightful and objective understanding and awareness of the feelings and behaviour of another person, combined with concern for the welfare of the person. By contrast sympathy is usually non-objective and non-critical.

 

Entitlement:

an unreasonable expectation of special attention, status or treatment.

 

 

Factitious disorders:

disorders characterised by intentional production or feigning of physical or psychological

symptoms; related to a need to assume the sick role rather than for obvious secondary gains such as financial reward (See malingering).

 

Flight of ideas:

extremely rapid speech with abrupt changes from one topic to another. The person cannot

express ideas as quickly as they come into his or her head.

 

Forensic mental health:

the interaction between mental health, criminal justice and the legal systems.

 

Forensic patients:

patients who are made forensic patients within the meaning of the Mental Health (Forensic

Provisions) Act 1990 (NSW) (three main groups are those ‘not guilty by reason of mental illness’, those ‘not fit to plead’ and prisoners found to have a mental illness and transferred to a psychiatric hospital).

 

Formal thought disorder:

an inexact term referring to a disturbance in the form of thinking rather than to abnormality of content.

 

Formication:

the sensation of something crawling under ones’ skin e.g. ants or insects.

 

Free-floating anxiety:

severe, persistent anxiety not related to a particular object or event.

 

Fugue:

a dissociative disorder marked by sudden apparently random travel away from home, inability to recall their personal history, and often assumption of a new identity.

 

 

Grandiosity:

exaggerated sense or claims of one’s importance.

 

 

Hallucination:

a sensory perception in the absence of an actual external stimulus. Types include auditory (voices, music, other noises); olfactory; somatic (physical sensation within the body); tactile (sensation of something on or under the skin) and visual.

 

Hallucinosis:

hallucinations in which reality testing is not impaired (i.e. the patient realises they are hallucinating).

 

Heightened perception:

extremely vivid perceptions e.g. sounds are unnaturally loud, clear or intense; colours are more brilliant or beautiful).

 

Hypochondriasis:

persisting preoccupation and worry about health despite lack of objective evidence of ill health, and despite appropriate medical reassurance.

 

Hypomania:

elevated mood, unrealistic optimism, pressure of speech and activity, and a decreased need for sleep, which is not quite as extreme as mania.

 

 

Idealisation:

attribution of exaggeratedly positive qualities to the self or others.

 

Ideas of reference:

incorrect interpretation of casual incidents and external events as having direct reference to oneself.

 

Identity:

sense of self and unity of personality over time.

 

Illusion:

misperception of a real external stimulus (e.g. a shadow is seen to be a figure walking toward you). Found in delirium.

 

Impulse control disorders:

inability to resist an impulse, drive, or temptation to perform some act that is harmful to oneself or to others (e.g. pathological gambling, kleptomania, and trichotillomania).

 

Incoherence:

communication is so disorganised and senseless that the main idea cannot be understood.

 

Insight:

the extent of an individual’s awareness of his or her situation and illness. There are varying degrees of insight. For example, an individual may be aware of his or her problem but may believe that someone else is to blame for the problem. Alternatively, the individual may deny that a problem exists at all. The assessment of insight has clinical significance since lack of insight generally means that it will be difficult to encourage the individual to accept treatment.

 

Institutionalisation:

long-term placement of an individual into a hospital, nursing home, or other facility where independent living is restricted. Also refers to the negative effects on an individual of such placement (e.g. physical ill health, relationship difficulties, dependence, reduced independent thinking, reduced flexibility, inability to function independently).

 

Intake:

most mental health services have an ‘intake’ system to triage initial contact between a patient and a mental health service.

 

Introversion:

preoccupation with oneself and inner world.

 

 

La belle indifference:

(‘beautiful indifference’): inappropriate lack of concern about a disability, classically

seen in conversion disorder.

 

Lability:

rapidly shifting or unstable emotions.

 

Limit setting:

providing external containment of a person’s distress by agreeing on the ‘limits’ of acceptable behaviour, and agreeing on the negative consequences if behaviour exceeds those limits. Limit setting is used by experienced therapists as a tool to reduce acting out behaviours.

 

Loosening of associations:

thought disorder in which ideas continually shift from one unrelated subject to another.

 

 

Magical thinking:

belief that thoughts, actions or words may have power to affect events directly.

 

Malingering:

intentional production of symptoms motivated by external incentives, such as gaining financial compensation or avoiding unpleasant duties.

 

Mania:

a mood disorder characterised by excessive elation, inflated self-esteem and grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.

 

Mental status examination:

process of estimating psychological, behavioural and cognitive function by observing and talking with the patient.

 

Mood Disorder:

illness with disturbance of mood as the primary symptom. Includes depressive disorders as well as those with mania and hypomania.

 

Munchausen’s syndrome:

a severe chronic factitious disorder in which the patient attends many different hospitals with fabricated symptoms, often under different names, and often undergoes multiple invasive procedures and operations. It is thought the motivation is to assume the sick role.

 

Munchausen’s by proxy:

seeking treatment for symptoms, which they have fabricated in another (usually a child) (but without intention of seeking external gain).

 

Mutism:

refusal to speak; may be for conscious or unconscious reasons.

 

 

Narcissism:

excessive self-love.

 

Negative symptoms:

symptoms characteristic of schizophrenia that are associated with a loss of functioning of some kind (e.g. alogia, reduced initiative and motivation, social withdrawal, cognitive impairment, blunted affect and anhedonia).

 

Neologism:

an invented new word or expression that has no meaning to anyone other than the individual for example, ‘I have a helopantic under my foot’.

 

Neurosis:

a vague term for chronic emotional disturbances of all kinds apart from psychosis. The term implies excess subjective psychological pain or discomfort.

 

 

Obsessions:

recurrent, intrusive unwanted mental thoughts, ideas, images, fears or impulses that the patient knows are absurd or unreasonable, but recognises as coming from their own mind. They are often of an aggressive, sexual, religious, disgusting or nonsensical nature, and cause distress to the patient.

 

Obsessive compulsive disorder (OCD):

obsessions and/or compulsions which cause marked distress, are time-consuming or significantly interfere with the person’s normal routine, occupational functioning, social activities or relationships.

 

Oppositional defiant disorder:

a pattern of excessive negativistic and hostile behaviour in a child that lasts at least 6 months.

 

Organic mental disorder:

mental illness, or symptom suggestive of mental illness, caused by an underlying physical

or structural abnormality (such as a brain tumour or an endocrine disorder). There is general agreement that it is difficult, if not impossible, to make clear distinctions between ‘organic and non-organic (functional)’.

 

 

Panic disorder:

recurrent, unexpected panic attacks.

 

Paranoia:

an intricate, complex, and elaborate delusion based on misinterpretation of an actual event. Other signs of psychosis are minimal, and the person often functions well.

 

Parkinsonism (drug-induced):

akinesia, tremor and rigidity are common, particularly in the early weeks of neuroleptic use.

 

Perseveration:

excessive repetition of the individual’s own words or ideas in response to different stimuli.

 

Personality traits:

imprecise term to describe aspects of a person’s personality. Often used to describe consistent maladaptive responses, which do not reach full diagnostic criteria (e.g. the patient has antisocial and borderline personality traits).

 

Personality disorder:

characteristic patterns of feeling, behaving and thinking about the environment and oneself that are inflexible and maladaptive, and result in distress or impaired functioning. Three clusters are identified: (a) paranoid, schizoid, schizotypal; (b) antisocial, borderline, histrionic, narcissistic, (c) avoidant, dependent, obsessive-compulsive.

 

Phase of-life problem:

problems in adapting to a developmental phase such as entering school, leaving the family, starting work, marriage, divorce, or retirement.

 

Phobia:

severe anxiety related to a specific object or situation, even though the subject recognises that the fear is excessive or unreasonable. The object or situation is avoided or endured with marked distress.

 

Positive symptoms:

symptoms of psychosis that are thought of as an exaggeration or distortion of normal processes (e.g. hallucinations, delusions or tangentiality).

 

Poverty of speech:

restriction in the amount of speech.

 

Pressured speech:

rapid, accelerated, frenzied speech.

 

Primary gain:

reduction of psychological distress as a result of the use of an unconscious defence mechanism (e.g. somatisation).

 

PRN:

The term PRN refers to medication that is taken as needed. It comes from the Latin term "pro re nata", which means "as the thing is required".

 

Projection:

primitive defence in which one attributes one’s own conflicted feelings and wishes onto another person.

 

Prodrome (Precursor):

an early or premonitory symptom or set of symptoms of a disease or a disorder.

 

Psychomotor retardation:

slowing of physical movements and emotional reactions commonly secondary to depression.

 

Psychosis:

gross impairment in reality testing, typically shown by delusions, hallucinations, or thought disorder, or bizarre or disorganised behaviour.

 

 

Reality testing:

the ability to evaluate the external world objectively and to differentiate adequately between it and the internal world.

 

Regression:

partial or symbolic return to earlier patterns of reacting or thinking.

 

Repression:

unconsciously keeping unacceptable ideas, fantasies, affects, or impulses from consciousness.

 

 

Schizophrenia:

one category from the broader group of psychotic disorders. Diagnosis requires that symptoms be present continuously for at least 6 months, that there be at least one month of active psychotic symptoms, and that there is significant occupational or social dysfunction. Course is variable, with complete remission, episodic relapse and continuous symptoms all described. It is usually not possible to make a definitive diagnosis from a first assessment of someone presenting with psychotic symptoms – diagnosis requires observation over a sustained period. Do not assume that a person with psychotic symptoms has schizophrenia. See DSM-IV-TR for full diagnostic criteria.

 

Schizophreniform disorder:

psychotic symptoms present for between 1 and 6 months. It is preferable to use the more generic and less stigmatising term ‘psychotic disorder’. See DSM-IV-TR for full diagnostic criteria.

 

Schizoaffective disorder:

a disorder in which there are clear affective episodes (major depressive, manic, or mixed episodes) co-exist with symptoms of schizophrenia. See DSM-IV-TR for full diagnostic criteria.

 

Secondary gain:

external gain derived from any illness, such as personal attention and service, monetary gains, disability benefits, and release from unpleasant responsibilities.

 

Social phobia (social anxiety disorder):

persistent fear and avoidance of social situations that might expose one to scrutiny by others and induce one to act in a way or show anxiety symptoms that will be humiliating or embarrassing.

 

Somatisation:

the conversion of mental states or experiences into bodily symptoms, presenting as multiple

physical complaints with no objective evidence of organic impairment.

 

Splitting:

a mental mechanism in which the self or others are reviewed as all good or all bad, with failure to integrate the positive and negative qualities of self and others into cohesive images. Often the person alternately idealises and devalues the same person.

 

Stress reaction:

an acute, maladaptive emotional response to industrial, domestic, and other calamitous life situations.

 

Sundowning:

worsening of symptoms of delirium at night. Also used to refer to the emergence at night of disruptive behaviours in dementia patients.

 

Suppression:

the conscious effort to control and conceal unacceptable impulses, thoughts, feelings, or acts.

 

 

Tangentiality:

replying to a question in an oblique or irrelevant way.

 

Tarasoff decision:

a California court decision that essentially imposes a duty on the therapist to warn the appropriate person or persons when the therapist becomes aware that the patient may present a risk of harm to a specific person or persons. Widely seen as an (untested) standard for Australian therapists.

 

Tardive dyskinesia:

neuroleptic-induced/medication-induced movement disorder consisting of involuntary

choreiform, athetoid, or rhythmic movements of the tongue, jaw, or extremities developing with long-term use (usually a few months or more) of neuroleptic medication. Over a 10-

year period, up to one-third of patients on a long-term antipsychotic medication may develop tardive dyskinesia.

 

Thought-blocking:

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

 

Thought-broadcasting:

delusion that your thoughts can be heard by others.

 

Thought insertion:

delusion that other people are putting thoughts inside the person’s mind.

 

Thought disorder:

disruption in the sequence, order and logic of thought, as reflected in speech and in the execution of actions. Formal thought disorder is a disturbance in the form rather than in the content of thought (e.g. loosening of associations).

 

Transference:

the unconscious assignment to others of feelings and attitudes that were originally associated with important figures (parents, siblings) in one’s early life. Transference may affect the patient/clinician/relationship either positively or negatively.

 

Typical antipsychotics:

older antipsychotics that principally act by dopamine 2 blockade, and are associated

with extrapyramidal side effects and tardive dyskinesia.

 

 

Word salad (verbigeration):

a mixture of words and phrases that lack comprehensive meaning or logical coherence.

 

For a full range of mental health terms see the Glossary section of the Diagnostic and Statistical Manual of Mental Disorders IV TR 4th ed. (DSM IV TR).AMERICAN PSYCHIATRIC ASSOCIATION. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS IV TEXT REVISION 4TH ED. (DSM IV TR). WASHINGTON, DC. AMERICAN PSYCHIATRIC PRESS INC; JULY 2000

 

References:

This information has been reproduced for educational purposes with permission from: Mental Health and Drug and Alcohol Office, Mental Health for Emergency Departments – A Reference Guide. NSW Department of Health, Sydney, 2009. © NSW Health Department 2009