# 06 - 3 Symptoms of psychiatric illness

# 01 - 3 Symptoms of psychiatric illness

# 3 Symptoms of psychiatric illness

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Symptoms of psychiatric 
illness
Symptoms of psychiatric illness  100
Dictionary of psychiatric symptoms  102
Chapter 3

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Chapter 3  Symptoms of psychiatric illness
Symptoms of psychiatric illness
In general medicine, symptom refers to an abnormality reported by the pa­
tient, while sign refers to an abnormality detected by the doctor by observa­
tion or clinical examination. In psychiatry, the terms symptom and sign tend 
to be used synonymously because abnormalities of mental state can only be 
elicited by exploring, with the patient, their internal experiences.
Psychopathology is the study of abnormalities in mental state and is one 
of the core sciences in clinical psychiatry. Descriptive psychopathology is one 
method for describing the subjective experience and behaviour of patients 
and is the basis for our current clinical descriptions of mental disorder. It is 
atheoretical and does not rest on any particular explanation for the cause of 
the abnormal mental state. In this, it contrasts with dynamic (Freudian) psy­
chopathology, which attempts to describe, and then to explain, these states.
Descriptive psychopathology includes close observation of the patient’s 
behaviour and empathic exploration of their subjective experience. The 
latter is called phenomenology. The following general terms are used as quali­
fiers for symptoms described in the following pages:
 • Subjective vs objective—​objective signs are those noted by an external 
observer; subjective signs are those reported by the patient.
 • Form vs content—​a distinction is drawn between the form and content of 
abnormal internal experiences. For example, a patient may believe that 
he is continually under surveillance by agents of MI5 who are plotting to 
frame him for another’s crimes. Here, the content of the symptom is the 
belief about the name and methods of the persecutor; the form is that 
of a persecutory delusion. Content is culture-​ and experience-​related, 
whereas form is attributable to the type of underlying mental illness.
 • Primary vs secondary—​primary symptoms are considered as arising 
directly from the pathology of the mental illness; secondary symptoms 
arise as an understandable response to some aspect of the disordered 
mental state (e.g. a patient with severe depression developing a 
secondary delusion of being wicked and deserving punishment). 
Secondary symptoms can be understood in the light of knowledge of 
the patient’s symptoms; primary symptoms can be empathized with, but 
not fully understood.
 • Endogenous vs reactive—​these terms have been largely made redundant 
by developments in understanding of mental disorders but are still 
seen occasionally. It was formerly thought that some conditions arose 
in response to external events (e.g. depression arising after job loss) 
(reactive), while others arose spontaneously from within (endogenous).
 • Psychotic vs neurotic—​in present classifications, these terms are used 
purely descriptively to describe two common types of symptoms that 
may occur in a variety of mental disorders. Previously, they were used 
to distinguish those disorders characterized by impairment of insight, 
abnormal beliefs, and abnormal perceptual experiences from those 
where there was preserved insight but abnormal affect.

Symptoms of psychiatric illness
 • Congruent vs incongruent—​this is an observation made regarding the 
apparent appropriateness of a patient’s affect towards their symptoms 
or their symptoms to their mood. A patient with apparent cheerfulness 
despite persecutory beliefs is described as having incongruent affect; a 
patient with profoundly depressed mood developing a delusion that 
they were mortally ill is described as possessing a mood-​congruent 
delusion.
 • Structural vs functional—​a distinction formerly made between those brain 
disorders with observable structural abnormalities on post-​mortem (e.g. 
Alzheimer’s disease) and those without (e.g. schizophrenia). This usage 
has diminished since the discovery of definite observable brain changes 
in those disorders formerly called functional psychoses. Nowadays, the 
term is more often used in neurology/​neuropsychiatry to distinguish 
syndromes which generally have abnormal investigation findings (e.g. 
multiple sclerosis) from those without (e.g. dissociative paralysis).

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Chapter 3  Symptoms of psychiatric illness
Dictionary of psychiatric symptoms
Abnormal beliefs A category of disturbance which includes delusions and 
overvalued ideas.
Abnormal perceptions A category of disturbance which includes sensory 
distortions and false perceptions.
Acute confusional state See Delirium.
Affect The emotional state prevailing in a patient at a particular moment 
and in response to a particular event or situation. Contrasted with mood 
which is the prevailing emotional state over a longer period of time.
Affect illusion See Illusion.
Agitated depression A  combination of depressed mood and psycho­
motor agitation, contrasting with the more usual association of depressed 
mood with psychomotor retardation. A common presentation of depres­
sive illness in the elderly.
Agitation See Psychomotor agitation.
Agoraphobia A generalized phobia in which there is a fear of open spaces, 
social situations, crowds, etc. Associated with avoidance of these stimuli.
Akathisia A subjective sense of uncomfortable desire to move, relieved 
by repeated movement of the affected part (usually the legs). A side effect 
of treatment with neuroleptic drugs.
Alexithymia Inability to describe one’s subjective emotional experiences 
verbally. May be a personality characteristic but is also associated with 
somatization.
Alogia Poverty of thoughts, as observed by absence of spontaneous 
speech. A negative symptom of schizophrenia and a symptom of depres­
sive illness.
Ambitendency A motor symptom of schizophrenia in which there is an 
alternating mixture of automatic obedience and negativism.
Amnesia Loss of ability to recall memories for a period of time. May 
be global (complete memory loss for the time period) or partial (patchy 
memory loss with ‘islands’ of preserved memory).
Anergia The subjective feeling of lack of energy and a sense of i effort 
required to carry out tasks. Associated with depressive illness.
Anhedonia The feeling of absent or significantly diminished enjoyment of 
previously pleasurable activities. A core symptom of depressive illness, also 
a negative symptom of schizophrenia.
Anorexia Loss of appetite for food. Seen in depressive illness and many 
general medical conditions. Interestingly, patients with anorexia nervosa 
often do not have anorexia as so defined. They commonly describe them­
selves as very hungry—​controlling their desire for food by supreme effort 
in order to control their weight.
Anterograde amnesia The period of amnesia between an event (e.g. 
head injury) and the resumption of continuous memory. The length of an­
terograde amnesia is correlated with the extent of brain injury.
Anxiety A normal and adaptive response to stress and danger which is 
pathological if prolonged, severe, or out of keeping with the real threat of 
the external situation. Anxiety has two components: psychic anxiety, which 
is an affect characterized by i arousal, apprehension, a sense of vulner­
ability, and dysphoria; and somatic anxiety in which there are bodily sensa­
tions of palpitations, sweating, dyspnoea, pallor, and abdominal discomfort.

Dictionary of psychiatric symptoms
Aphonia Loss of the ability to vocalize. May occur with structural dis­
ease affecting the vocal cords directly, the ninth cranial nerve, or higher 
centres. May also occur in functional illness where the underlying vocal 
cord function is normal. This can be demonstrated by asking the patient 
to cough—​a normal cough demonstrates the ability of the vocal cords to 
oppose normally.
Asyndesis Synonym for loosening of associations.
Ataxia Loss of coordination of voluntary movement. Seen in drug and 
alcohol intoxication and organic disorders, particularly cerebellar.
Athetosis Sinuous, writhing involuntary movements.
Aura Episode of disturbed sensation occurring before an epileptic event. 
Wide range of manifestations, although usually stereotyped for each 
individual.
Autistic thinking An abnormal absorption with the self, distinguished by 
interpersonal communication difficulties, a short attention span, and an in­
ability to relate to others as people.
Autochthonous delusion A primary delusion which appears to arise fully 
formed in the patient’s mind without explanation (e.g. a patient suddenly 
becomes aware that he has inherited a large estate in the Scottish Highlands 
and will thus have the funds to settle scores with all those who have ever 
wronged him).
Automatic obedience A motor symptom of schizophrenia in which the 
patient obeys the examiner’s instructions unquestioningly. This cooperation 
may be ‘excessive’, with the patient going beyond what is asked (e.g. raising 
both arms and both legs when asked to raise an arm).
Automatism Behaviour which is apparently conscious in nature, occurring 
in the absence of full consciousness (e.g. during a temporal lobe seizure).
Autoscopy The experience of seeing a visual hallucination or pseudo-​
hallucination of oneself. Also known as ‘phantom mirror image’. Uncommon 
symptom reported in schizophrenia and temporal lobe epilepsy.
Autotopagnosia Condition where one cannot identify or describe their 
own body parts. Individuals can dress and move appropriately but cannot 
talk about their bodies.
Avoidance The action of not exposing oneself to situations which gen­
erate anxiety, e.g. a patient with agoraphobia remaining at home or a pa­
tient with post-​traumatic stress disorder (PTSD), following a road traffic 
accident, refusing to drive. Can be understood in terms of an operant 
conditioning model where actions with reward—​in this case, reduction of 
anxiety—​are repeated.
Belle indifférence A surprising lack of concern for, or denial of, apparently 
severe functional disability. It is part of classical descriptions of hysteria and 
continues to be associated with operational descriptions of conversion dis­
order. It is also seen in medical illnesses (e.g. following a cerebrovascular 
accident) and is a rare and non-​specific symptom of no diagnostic value.
Biological features of depression Symptoms of moderate to severe de­
pressive illness which reflect disturbance of core vegetative function. They 
are depressive sleep disturbance, anorexia, loss of libido, anergia, and sub­
jective impression of deterioration in memory and concentration.
Blunting of affect Loss of the normal degree of emotional sensitivity and 
sense of appropriate emotional response to events. A negative symptom 
of schizophrenia.

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Chapter 3  Symptoms of psychiatric illness
Broca’s dysphasia A type of expressive dysphasia due to damage to the 
posterior part of the inferior frontal gyrus of the dominant hemisphere 
(Broca’s language area).
Bulimia i appetite and desire for food and/​or excessive, impulsive eating 
of large quantities of usually high-​calorie food. Core symptom of bulimia 
nervosa and may also be seen in mania and in some types of learning 
disability.
Capgras syndrome A type of delusional misidentification in which the pa­
tient believes that a person known to them has been replaced by a ‘double’ 
who is to all external appearances identical, but is not the ‘real person’.
Catalepsy A rare motor symptom of schizophrenia. Describes a situation 
in which the patient’s limbs can be passively moved to any posture, which 
will then be held for a prolonged period of time. Also known as waxy flexi­
bility or flexibilitas cerea. See also Psychological pillow.
Cataplexy Symptom of narcolepsy in which there is sudden loss of 
muscle tone, leading to collapse. Usually occurs following emotional stress.
Catastrophic reaction Response occasionally seen in patients with de­
mentia who are asked to perform tasks beyond their, now impaired, per­
formance level. There is sudden agitation, anger, and occasionally violence.
Catatonia i resting muscle tone which is not present on active or passive 
movement (in contrast to the rigidity associated with Parkinson’s disease 
and extra-​pyramidal side effects). A motor symptom of schizophrenia.
Chorea Sudden and involuntary movement of several muscle groups, 
with the resultant action appearing like part of a voluntary movement.
Circumstantial thinking A disorder of the form of thought where irrele­
vant details and digressions overwhelm the direction of the thought pro­
cess. This abnormality may be reflected in the resultant speech. It is seen in 
mania and in anankastic personality disorder.
Clang association An abnormality of speech where the connection be­
tween words is their sound, rather than their meaning. May occur during 
manic flight of ideas.
Clouding of consciousness Conscious level between full consciousness 
and coma. Covers a range of increasingly severe loss of function with drow­
siness and impairment of concentration and perception.
Command hallucination An auditory hallucination of a commanding 
voice, instructing the patient towards a particular action. Also known as 
teleological hallucination.
Completion illusion See Illusion.
Compulsion A behaviour or action which is recognized by the patient 
as unnecessary and purposeless, but which he cannot resist performing 
repeatedly (e.g. hand washing). The drive to perform the action is recog­
nized by the patient as his own (i.e. there is no sense of ‘possession’ or 
passivity), but it is associated with a subjective sense of need to perform 
the act, often in order to avoid the occurrence of an adverse event. The 
patient may resist carrying out the action for a time, at the expense of 
mounting anxiety.
Concrete thinking The loss of the ability to understand abstract con­
cepts and metaphorical ideas, leading to a strictly literal form of speech and 
the inability to comprehend allusive language. Seen in schizophrenia and 
dementing illnesses.

Dictionary of psychiatric symptoms
Confabulation The process of describing plausibly false memories for a 
period for which the patient has amnesia. Occurs in Korsakoff’s syndrome, 
in dementing illnesses, and following alcoholic palimpsest.
Confusion The core symptom of delirium or acute confusional state. 
There is disorientation, clouding of consciousness, and deterioration in 
the ability to think rationally, lay down new memories, and understand 
sensory input.
Conversion Development of features suggestive of physical illness but 
which are attributed to psychiatric illness or emotional disturbance, rather 
than organic pathology. Originally described in terms of psychoanalytic 
theory where the presumed mechanism was ‘conversion’ of unconscious 
distress to physical symptoms, rather than allowing its expression in con­
scious thought.
Coprolalia A  ‘forced’ vocalization of obscene words or phrases. The 
symptom is largely involuntary but can be resisted for a time, at the expense 
of mounting anxiety. Seen in Gilles de la Tourette’s syndrome.
Cotard syndrome A presentation of psychotic depressive illness seen par­
ticularly in elderly people. There is a combination of severely depressed mood 
with nihilistic delusions and/​or hypochondriacal delusions. The patient may 
state that he is already dead and should be buried, that his insides have stopped 
working and are rotting away, or that he has stopped existing altogether.
Couvade syndrome A  conversion symptom seen in partners of ex­
pectant mothers during their pregnancy. The symptoms vary but mimic 
pregnancy symptoms and so include nausea, vomiting, abdominal pain, and 
food cravings. It is not delusional in nature; the affected individual does not 
believe they are pregnant (cf. pseudocyesis). This behaviour is a cultural 
norm in some societies.
Craving A subjective sense of the need to consume a particular substance 
(e.g. drugs or alcohol) for which there may be dependence.
Cyclothymia A personality characteristic in which there is cyclical mood 
variation, to a lesser degree than in bipolar disorder.
De Clérambault syndrome A form of delusion of love. The patient, usu­
ally ♀, believes that another, higher-​status individual is in love with them. 
There may be an additional persecutory delusional component where the 
affected individual comes to believe that individuals are conspiring to keep 
them apart. The object may be an employer or a doctor or, in some cases, 
a prominent public figure or celebrity.
Déjà vu A sense that events being experienced for the first time have 
been experienced before. An everyday experience, but also a non-​specific 
symptom of a number of disorders, including temporal lobe epilepsy, 
schizophrenia, and anxiety disorders.
Delirium A clinical syndrome of confusion, variable degree of clouding 
of consciousness, visual illusions, and/​or visual hallucinations, lability of af­
fect, and disorientation. The clinical features can vary markedly in severity, 
hour by hour. Delirium is a stereotyped response by the brain to a variety of 
insults and is similar in presentation, whatever the primary cause.
Delirium tremens The clinical picture of acute confusional state sec­
ondary to alcohol withdrawal. Comprises confusion, withdrawals, visual 
hallucinations, and occasionally persecutory delusions and Lilliputian 
hallucinations.

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Chapter 3  Symptoms of psychiatric illness
Delusion An abnormal belief which is held with absolute subjective cer­
tainty, which requires no external proof, which may be held in the face of 
contradictory evidence, and which has personal significance and import­
ance to the individual concerned. Excluded are those beliefs which can be 
understood as part of the subject’s cultural or religious background. While 
the content is usually demonstrably false and bizarre in nature, this is not 
invariably so.
Primary delusions are the direct result of psychopathology, while sec­
ondary delusions can be understood as having arisen in response to other 
primary psychiatric conditions (e.g. a patient with severely depressed mood 
developing delusions of poverty or a patient with progressive memory 
impairment developing a delusion that people are entering his house and 
stealing or moving items). Primary delusions can be subdivided by the 
method by which they are perceived as having arisen or into broad classes 
based on their content.
If the patient is asked to recall the point when they became aware of 
the delusion and its significance to them, they may report that the belief 
arose: ‘out of the blue’ (autochthonous delusion), on seeing a normal per­
cept (delusional perception), on recalling a memory (delusional memory), 
or on a background of anticipation, odd experiences, and i awareness 
(delusional mood).
Based on their content, 12 types of primary delusion are commonly 
recognized: persecutory, grandiose, delusions of control, of thought inter­
ference, of reference, of guilt, and of love, delusional misidentification, 
jealousy, hypochondriacal delusions, nihilistic delusions, and delusions of 
infestation.
Delusional atmosphere Synonym for delusional mood.
Delusional elaboration Secondary delusions which arise in a manner 
which is understandable as the patient attempting to find explanations for 
primary psychopathological processes (e.g. a patient with persistent audi­
tory hallucinations developing a belief that a transmitter has been placed 
in their ear).
Delusional jealousy A delusional belief that one’s partner is being un­
faithful. This can occur as part of a wider psychotic illness, secondary to 
organic brain damage (e.g. following the ‘punch drunk syndrome’ in boxers), 
associated with alcohol dependence, or as a monosymptomatic delusional 
disorder (‘Othello syndrome’). Whatever the primary cause, there is a 
strong association with violence, usually towards the supposedly unfaithful 
partner. For this type of delusion, the content is not bizarre or inconceiv­
able and the central belief may even be true.
Delusional memory A primary delusion which is recalled as arising as a 
result of a memory (e.g. a patient who remembers his parents taking him 
to hospital for an operation as a child becoming convinced that he had been 
implanted with control and monitoring devices which have become active 
in his adult life).
Delusional misidentification A delusional belief that certain individuals 
are not who they externally appear to be. The delusion may be that familiar 
people have been replaced with outwardly identical strangers (Capgras syn­
drome) or that strangers are ‘really’ familiar people (Frégoli syndrome). 
A rare symptom of schizophrenia or of other psychotic illnesses.

Dictionary of psychiatric symptoms
Delusional mood A primary delusion which is recalled as arising following 
a period when there is an abnormal mood state characterized by anticipa­
tory anxiety, a sense of ‘something about to happen’, and an i sense of the 
significance of minor events. The development of the formed delusion may 
come as a relief to the patient in this situation.
Delusional perception A  primary delusion which is recalled as having 
arisen as a result of a perception (e.g. a patient who, on seeing two white 
cars pull up in front of his house, became convinced that he was therefore 
about to be wrongly accused of being a paedophile). The percept is a real 
external object, not a hallucinatory experience.
Delusions of control A group of delusions which are also known as pas­
sivity phenomena or delusions of bodily passivity. They are considered 
first-​rank symptoms of schizophrenia. The core feature is the delusional 
belief that one is no longer in sole control of one’s own body. The individual 
delusions are that one is being forced by some external agent to feel emo­
tions, to desire to do things, to perform actions, or to experience bodily 
sensations. Respectively, these delusions are called: passivity of affect, pas­
sivity of impulse, passivity of volition, and somatic passivity.
Delusions of guilt A delusional belief that one has committed a crime or 
other reprehensible act. A feature of psychotic depressive illness (e.g. an 
elderly woman with severe depressive illness who becomes convinced that 
her child, who died by cot death many years before, was in fact murdered 
by her).
Delusions of infestation A delusional belief that one’s skin is infested with 
multiple tiny, mite-​like animals. As a monosymptomatic delusional disorder, 
this is called Ekbom syndrome. It is also seen in acute confusional states 
(particularly secondary to drug or alcohol withdrawal), in schizophrenia, in 
dementing illnesses, and as delusional elaboration of tactile hallucinatory 
experiences.
Delusions of love A delusion where the patient believes another indi­
vidual is in love with them and that they are destined to be together. A rare 
symptom of schizophrenia and other psychotic illnesses—​one particular 
subtype of this delusion is de Clérambault syndrome.
Delusions of reference A delusional belief that external events or situ­
ations have been arranged in such a way as to have particular significance 
for, or to convey a message to, the affected individual. The patient may 
believe that television news items are referring to them or that parts of the 
Bible are about them directly.
Delusions of thought interference A group of delusions which are con­
sidered first-​rank symptoms of schizophrenia. They are thought insertion, 
thought withdrawal, and thought broadcasting.
Dementia Chronic brain failure—​in contrast with delirium (which is acute 
brain failure). In dementia, there is progressive and global loss of brain 
function. It is usually irreversible. Different dementing illnesses will show 
different patterns and rate of functional loss, but in general, there is impair­
ment of memory, loss of higher cognitive function, perceptual abnormal­
ities, dyspraxia, and disintegration of the personality.
Dependence The inability to control the intake of a substance to which 
one is addicted. The dependence syndrome (E The dependence syn­
drome, p. 574) is characterized by primacy of drug-​seeking behaviour, the

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Chapter 3  Symptoms of psychiatric illness
inability to control the intake of a substance once consumption has started, 
use of the substance to avoid withdrawals, i tolerance to the intoxicating 
effects of the substance, and re-​instigation of the pattern of use after a 
period of abstinence. Dependence has two components: psychological de­
pendence, which is the subjective feeling of loss of control, cravings, and 
preoccupation with obtaining the substance; and physiological dependence, 
which is the physical consequences of withdrawal and is specific to each 
drug. For some drugs (e.g. alcohol), both psychological and physiological 
dependence occur; for others (e.g. LSD), there are no marked features of 
physiological dependence.
Depersonalization An unpleasant subjective experience where the 
patient feels as if they have become ‘unreal’. A  non-​specific symptom 
occurring in many psychiatric disorders, as well as in normal people.
Depressed mood The core feature of depressive illness. Milder forms 
of depressed mood are part of the human experience, but in its patho­
logical form, it is a subjective experience. Patients describe variously: an un­
remitting and pervasive unhappiness; a loss of the ability to experience the 
normal range of positive emotions (‘feeling of a lack of feeling’); a sense of 
hopelessness and negative thoughts about themselves, their situation, and 
the future; somatic sensations of ‘a weight’ pressing down on the head and 
body; and a sort of ‘psychic pain’ or wound.
Depressive sleep disturbance Characteristic pattern of sleep disturb­
ance seen in depressive illness. It includes initial insomnia and early morning 
waking. In addition, sleep is described as more shallow, broken, and less 
refreshing. There is i rapid eye movement (REM) latency where the patient 
enters REM sleep more rapidly than normal, and REM sleep is concentrated 
in the beginning, rather than the end, of the sleep period.
Derailment A  symptom of schizophrenic thought disorder in which 
there is a total break in the chain of association between the meaning of 
thoughts. The connection between two sequential ideas is apparent neither 
to the patient nor to the examiner.
Derealization An unpleasant subjective experience where the patient 
feels as if the world has become unreal. Like depersonalization, it is a non-​
specific symptom of a number of disorders.
Diogenes syndrome Hoarding of objects, usually of no practical use, and 
neglect of one’s home or environment. May be a behavioural manifestation 
of an organic disorder, schizophrenia, a depressive disorder, or OCD; or 
may reflect a reaction late in life to stress in a certain type of personality.
Disinhibition Loss of the normal sense of which behaviours are appro­
priate in the current social setting. Symptom of manic illnesses and occurs 
in the later stages of dementing illnesses and during intoxication with drugs 
or alcohol.
Disorientation Loss of the ability to recall and accurately update informa­
tion as to the current time, place, and personal identity. Occurs in delirium 
and dementia. With increasing severity of illness, orientation for time is lost 
first, then orientation for place, with orientation for person usually pre­
served until dysfunction becomes very severe.
Dissociation The separation of unpleasant emotions and memories from 
consciousness awareness, with subsequent disruption to the normal inte­
grated function of consciousness and memory. Conversion and dissociation

Dictionary of psychiatric symptoms
are related concepts. In conversion, the emotional abnormality produces 
physical symptoms, while in dissociation, there is impairment of mental 
functioning (e.g. in dissociative fugue and dissociative amnesia).
Distractibility Inability to maintain attention or loss of vigilance on min­
imal distracting stimulation.
Diurnal variation Variation in the severity of a symptom, depending on 
the time of day (e.g. depressed mood experienced as most severe in the 
morning and improving later in the day).
Double depression A combination of dysthymia and depressive illness.
Dysarthria Impairment in the ability to properly articulate speech. Caused 
by lesions in the brainstem, cranial nerves, or pharynx. Distinguished from 
dysphasia in that there is no impairment of comprehension, writing, or 
higher language function.
Dyskinesia Impairment of voluntary motor activity by superimposed in­
voluntary motor activity.
Dyslexia Inability to read at a level normal for one’s age or intelligence 
level.
Dysmorphophobia A type of over-​valued idea where the patient believes 
one aspect of his body is abnormal or conspicuously deformed.
Dysphasia Impairment in producing or understanding speech (expressive 
dysphasia and receptive dysphasia, respectively) related to cortical abnor­
mality, in contrast with dysarthria where the abnormality is in the organs of 
speech production.
Dysphoria An emotional state experienced as unpleasant. Secondary to a 
number of symptoms (e.g. depressed mood, withdrawals).
Dyspraxia Inability to carry out complex motor tasks (e.g. dressing, 
eating), although the component motor movements are preserved.
Dysthymia Chronic, mildly depressed mood and diminished enjoyment, 
not severe enough to be considered depressive illness.
Early morning wakening (EMW) Feature of depressive sleep disturb­
ance. The patient wakes in the very early morning and is unable to return 
to sleep.
Echo de la pensée Synonym for thought echo.
Echolalia The repetition of phrases or sentences spoken by the examiner. 
Occurs in schizophrenia and mental retardation.
Echopraxia Motor symptom of schizophrenia in which the patient mir­
rors the doctor’s body movements. This continues after being told to stop.
Eidetic imagery Particular type of exceptionally vivid visual memory. Not 
a hallucination. More common in children than adults (cf. flashbacks).
Ekbom syndrome A monosymptomatic delusional disorder where the 
core delusion is a delusion of infestation.
Elation Severe and prolonged elevation of mood. A feature of manic 
illnesses.
Elemental hallucination A  type of hallucination where the false per­
ceptions are of very simple form (e.g. flashes of light or clicks and bangs). 
Associated with organic illness.
Elevation of mood The core feature of manic illnesses. The mood is pre­
ternaturally cheerful; the patient may describe feeling ‘high’, and there is 
subjectively i speed and ease of thinking.
Entgleisen Synonym for derailment.

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Chapter 3  Symptoms of psychiatric illness
Entgleiten Synonym for thought blocking or snapping off.
Erotomania Synonym for delusions of love.
Euphoria Sustained and unwarranted cheerfulness. Associated with 
manic states and organic impairment.
Euthymia A ‘normal’ mood state, neither depressed nor manic.
Expressive dysphasia Dysphasia affecting the production of speech. 
There is impairment of word-​finding, sentence construction, and articula­
tion. Speech is slow and ‘telegraphic’, with substitutions, null words, and 
perseveration. The patient characteristically exhibits considerable frus­
tration at his deficits. Writing is similarly affected. Basic comprehension is 
largely intact, and emotional utterances and rote-​learnt material may also 
be surprisingly preserved.
Extracampine hallucination A hallucination where the percept appears 
to come from beyond the area usually covered by the senses (e.g. a patient 
in Edinburgh ‘hearing’ voices seeming to come from a house in Glasgow).
Extra-​pyramidal side effects (EPSEs) Side effects of rigidity, tremor, 
and dyskinesia caused by the anti-​dopaminergic effects of psychotropic 
drugs, particularly neuroleptics. Unlike in idiopathic Parkinson’s disease, 
bradykinesia is not prominent.
Ey syndrome Synonym for Othello syndrome.
False perceptions Internal perceptions which do not have a corres­
ponding object in the external or ‘real’ world. Includes hallucinations and 
pseudo-​hallucinations.
Faseln Synonym for muddling.
First-​rank symptoms (of schizophrenia) A group of symptoms, originally 
described by Schneider, which are useful in the diagnosis of schizophrenia. 
They are neither pathognomonic for, nor specific to, schizophrenia and are 
also seen in organic and affective psychoses. There are 11 symptoms in four 
categories:
 • Auditory hallucinations
 •
​ ‘Voices heard arguing’.
 •
​ Thought echo.
 •
​ ‘Running commentary’.
 • Delusions of thought interference
 •
​ Thought insertion.
 •
​ Thought withdrawal.
 •
​ Thought broadcasting.
 • Delusions of control
 •
​ Passivity of affect.
 •
​ Passivity of impulse.
 •
​ Passivity of volitions.
 •
​ Somatic passivity.
 • Delusional perception
 •
​ A primary delusion of any content that is reported by the patient as 
having arisen following the experience of a normal perception.
Flashbacks Exceptionally vivid and affect-​laden re-​experiencing of remem­
bered experiences. Flashbacks of the initial traumatic event occur in PTSD, 
and flashbacks of abnormal perceptual experiences initially experienced 
during LSD intoxication can occur many years after the event.

Dictionary of psychiatric symptoms
Flattening of affect Diminution of the normal range of emotional experi­
ence. A negative symptom of schizophrenia.
Flexibilitas cerea Synonym for catalepsy.
Flight of ideas Subjective experience of one’s thoughts being more 
rapid than normal, with each thought having a greater range of conse­
quent thoughts than normal. Meaningful connections between thoughts are 
maintained.
Folie à deux Describes a situation where two people with a close rela­
tionship share a delusional belief. This arises as a result of a psychotic illness 
in one individual with the development of a delusional belief, which comes 
to be shared by the second. The delusion resolves in the second person on 
separation; the first should be assessed and treated in the usual way.
Formal thought disorder A term which is confusingly used for three dif­
ferent groups of psychiatric symptoms:
 • To refer to all pathological disturbances in the form of thought.
 • As a synonym for schizophrenic thought disorder.
 • To mean the group of first-​rank symptoms which are delusions 
regarding thought interference (i.e. thought insertion, thought 
withdrawal, and thought broadcasting).
The first of these uses is to be preferred.
Formication A form of tactile hallucination in which there is the sensa­
tion of numerous insects crawling over the surface of the body. Occurs in 
alcohol or drug withdrawal, particularly from cocaine.
Free-​floating anxiety Anxiety occurring without any identifiable external 
stimulus or threat (cf. Phobia).
Frégoli syndrome A type of delusional misidentification, in which the pa­
tient believes that strangers have been replaced with familiar people.
Fugue A dissociative reaction to unbearable stress. Following a severe 
external stressor (e.g. marital break-​up), the affected individual develops 
global amnesia and may wander to a distant location. Consciousness is un­
impaired. Following resolution, there is amnesia for the events which oc­
curred during the fugue.
Functional hallucination A hallucination experienced only when experi­
encing a normal percept in that modality (e.g. hearing voices when the noise 
of an air conditioner is heard).
Fusion A symptom of schizophrenic thought disorder, in which two or 
more unrelated concepts are brought together to form one compound idea.
Ganser symptom The production of ‘approximate answers’. Here the 
patient gives repeated wrong answers to questions, which are nonethe­
less ‘in the right ballpark’ (e.g. ‘what is the capital of Scotland?’—​‘Paris’). 
Occasionally associated with organic brain illness, it is much more com­
monly seen as a form of malingering in those attempting to feign mental 
illness (e.g. in prisoners awaiting trial).
Gedankenlautwerden Synonym for thought echo.
Globus hystericus The sensation of a ‘lump in the throat’ occurring 
without an oesophageal structural abnormality or motility problems. 
A symptom of anxiety and somatization disorders.
Glossolalia ‘Speaking in tongues’. Production of non-​speech sounds as 
a substitute for speech. Seen in dissociative and neurotic disorders and ac­
cepted as a subcultural phenomenon in some religious groups.

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Chapter 3  Symptoms of psychiatric illness
Grandiose delusion A delusional belief that one has special powers or 
is unusually rich or powerful, or that one has an exceptional destiny (e.g. 
a man who requested admission to hospital because he had become con­
vinced that God had granted him ‘the greatest possible sort of mind’ and 
that coming into contact with him would cure others of mental illnesses). 
Can occur in all psychotic illnesses, but particularly in manic illnesses.
Grandiosity An exaggerated sense of one’s own importance or abilities. 
Seen in manic illnesses.
Hallucination An internal percept without a corresponding external 
object. The subjective experience of hallucination is that of experiencing 
a normal percept in that modality of sensation. A true hallucination will 
be perceived as in external space, distinct from imagined images, outside 
conscious control, and as possessing relative permanence. A  pseudo­
hallucination will lack one or all of these characteristics.
Hallucinations are subdivided, according to their modality of sensation, 
and may be auditory, visual, gustatory, tactile, olfactory, or kinaesthetic. 
Auditory hallucinations, particularly of voices, are characteristic of schizo­
phrenic illness, while visual hallucinations are characteristic of organic states.
Hemiballismus Involuntary, large-​scale ‘throwing’ movements of one limb 
or one body side.
Hypersomnia Excessive sleepiness with i length of nocturnal sleep and 
daytime napping. Occurs as a core feature of narcolepsy and in atypical 
depressive states.
Hypnagogic hallucination A transient false perception experienced while 
on the verge of falling asleep (e.g. hearing a voice calling one’s name which 
then startles you back to wakefulness to find no one there). The same 
phenomenon experienced while waking up is called hypnopompic hallu­
cination. Frequently experienced by healthy people, and so not a symptom 
of mental illness.
Hypnopompic hallucination See Hypnagogic hallucination.
Hypochondriacal delusion A  delusional belief that one has a serious 
physical illness [e.g. cancer, acquired immune deficiency syndrome (AIDS)]. 
Most common in psychotic depressive illnesses.
Hypochondriasis The belief that one has a particular illness despite 
evidence to the contrary. Its form may be that of a primary delusion, an 
over-​valued idea, a rumination, or a mood-​congruent feature of depres­
sive illness.
Hypomania Describes a mild degree of mania where there is ele­
vated mood, but no significant impairment of the patient’s day-​to-​day 
functioning.
Illusion A type of false perception in which the perception of a real-​world 
object is combined with internal imagery to produce a false internal per­
cept. Three types are recognized: affect, completion, and pareidolic illu­
sions. In affect illusion, there is a combination of heightened emotion and 
misperception (e.g. while walking across a lonely park at night, briefly seeing 
a tree moving in the wind as an attacker). Completion illusions rely on our 
brain’s tendency to ‘fill in’ presumed missing parts of an object to produce a 
meaningful percept and are the basis for many types of optical illusion. Both 
these types of illusions resolve on closer attention. Pareidolic illusions are

Dictionary of psychiatric symptoms
meaningful percepts produced when experiencing a poorly defined stimulus 
(e.g. seeing faces in a fire or clouds).
Imperative hallucination A form of command hallucination in which the 
hallucinatory instruction is experienced as irresistible, a combination of 
command hallucination and passivity of action.
Impotence Loss of the ability to consummate sexual relationships. Refers 
to the inability to achieve penile erection in men and a lack of genital pre­
paredness in women. It may have a primary medical cause, may be related 
to psychological factors, or can be a side effect of many psychotropic 
medications.
Incongruity of affect Refers to the objective impression that the displayed 
affect is not consistent with the current thoughts or actions (e.g. laughing 
while discussing traumatic experiences). Occurs in schizophrenia.
Initial insomnia Difficulty getting off to sleep. Seen as a symptom of pri­
mary insomnia, as well as in depressive sleep disturbance.
Insightlessness See Lack of insight.
Irritability Diminution in the stressor required to provoke anger or verbal 
or physical violence. Seen in manic illnesses, organic cognitive impairment, 
psychotic illnesses, and drug and alcohol intoxication. Can also be a feature 
of normal personality types and of personality disorder.
Jamais vu The sensation that events or situations are unfamiliar, although 
they have been experienced before. An everyday experience, but also a 
non-​specific symptom of a number of disorders, including temporal lobe 
epilepsy, schizophrenia, and anxiety disorders.
Knight’s move thinking Synonym for derailment.
Lability of mood Marked variability in the prevailing affect.
Lack of insight Loss of the ability to recognize that one’s abnormal 
experiences are symptoms of psychiatric illness and that they require 
treatment.
Lilliputian hallucination A type of visual hallucination in which the subject 
sees miniature people or animals. Associated with organic states, particu­
larly delirium tremens.
Logoclonia Symptom of Parkinson’s disease where the patient gets 
‘stuck’ on a particular word of a sentence and repeats it.
Logorrhoea Excess speech or ‘verbal diarrhoea’. Symptom of mania.
Loosening of associations A symptom of formal thought disorder, in 
which there is a lack of meaningful connection between sequential ideas.
Loss of libido Loss of the desire for sexual activity. Common in depres­
sive illness and should be inquired about directly, as it is usually not men­
tioned spontaneously. Should be distinguished from impotence.
Magical thinking A  belief that certain actions and outcomes are con­
nected, although there is no rational basis for establishing a connection (e.g. 
‘if you step on a crack, your mother will break her back’). Magical thinking is 
common in normal children and is the basis for most superstitions. A similar 
type of thinking is seen in psychotic patients.
Malingering Deliberately falsifying the symptoms of illness for a sec­
ondary gain (e.g. for compensation, to avoid military service, or to obtain 
an opiate prescription).

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Chapter 3  Symptoms of psychiatric illness
Mania A form of mood disorder initially characterized by elevated mood, 
insomnia, loss of appetite, i libido, and grandiosity. More severe forms de­
velop elation and grandiose delusions.
Mannerism Abnormal and occasionally bizarre performance of a vol­
untary, goal-​directed activity (e.g. a conspicuously dramatic manner of 
walking. Imagine John Cleese’s ‘minister of silly walks’).
Mental retardation Diminished intelligence below the second standard 
deviation (IQ <70). Increasing severity of retardation is associated with 
d ability to learn, to solve problems, and to understand abstract con­
cepts. Subdivided as:  mild:  50–​69; moderate 35–​49; severe 20–​34; and 
profound 0–​19.
Micrographia Small, ‘spidery’ handwriting seen in patients with Parkinson’s 
disease; a consequence of being unable to control fine movements. This is 
most easily recognized by comparing their current signature with one from 
a number of years previously.
Middle insomnia Wakefulness and inability to return to sleep occurring in 
the middle part of the night.
Mirror sign Lack of recognition of one’s own mirror reflection, with the 
perception that the reflection is another individual who is mimicking your 
actions. Seen in dementia.
Mitgehen An extreme form of mitmachen where the patient’s limbs can 
be moved to any position by very slight or fingertip pressure (‘angle-​poise 
lamp sign’).
Mitmachen A motor symptom of schizophrenia where the patient’s limbs 
can be moved without resistance to any position (cf. mitgehen). The limbs 
return to their resting state once the examiner lets go, in contrast with cata­
lepsy where the limbs remain in their set positions for prolonged periods.
Mood The subjective emotional state over a period of time, in contrast 
to affect which describes the emotional response to a particular situation 
or event.
Mood-​congruent A  secondary symptom which is understandable in 
the light of an abnormal mood state (e.g. a severely depressed patient 
developing a delusion that they are in severe debt, or a manic patient 
developing a delusion that they are exceptionally wealthy).
Morbid jealousy Synonym for delusional jealousy.
Motor symptoms of schizophrenia Schizophrenic illness is associated 
with a variety of soft neurological signs and motor abnormalities. In the 
modern era, many motor abnormalities will be attributed to the side effects 
of neuroleptic drugs, but all were described in schizophrenic patients prior 
to the introduction of these drugs in 1952.
Recognized motor symptoms in schizophrenia include:  catatonia, 
catalepsy, automatic obedience, negativism, ambitendency, mitgehen, 
mitmachen, mannerism, stereotypy, echopraxia, and psychological pillow.
Muddling A feature of schizophrenic thought disorder caused by sim­
ultaneous derailment and fusion. The speech so produced may be very 
bizarre.
Multiple personality The finding of two or more distinct ‘personalities’ 
in one individual. These personalities may answer to different names, ex­
hibit markedly different behaviours, and describe amnesia for periods 
when other personalities were active. This symptom is most probably an

Dictionary of psychiatric symptoms
iatrogenic condition produced during exploratory psychotherapy in suggest­
ible individuals.
Mutism Absence of speech without impairment of consciousness.
Negative symptoms (of schizophrenia) Symptoms of schizophrenia 
which reflect impairment of normal function. They are:  lack of volition, 
lack of drive, apathy, anhedonia, flattening of affect, blunting of affect, and 
alogia. Believed to be related to cortical cell loss.
Negativism A motor symptom of schizophrenia where the patient resists 
carrying out the examiner’s instructions and his attempts to move or direct 
the limbs.
Neologism A made-​up word or normal word used in an idiosyncratic 
way. Neologisms are found in schizophrenic speech.
Nihilistic delusion A  delusional belief that the patient has died or no 
longer exists or that the world has ended or is no longer real. Nothing 
matters any longer, and continued effort is pointless. A feature of psychotic 
depressive illness.
Nystagmus Involuntary oscillating eye movements.
Obsession An idea, image, or impulse which is recognized by the pa­
tient as their own but which is experienced as repetitive, intrusive, and 
distressing. The return of the obsession can be resisted for a time, at the 
expense of mounting anxiety. In some situations, the anxiety accompanying 
the obsessional thoughts can be relieved by associated compulsions (e.g. 
a patient with an obsession that his wife may have come to harm feeling 
compelled to phone her constantly during the day to check she is still alive).
Othello syndrome A monosymptomatic delusional disorder where the 
core delusion has the content of delusional jealousy.
Over-​valued ideas A form of abnormal belief. These are ideas which are 
reasonable and understandable in themselves but which come to unreason­
ably dominate the patient’s life.
Palimpsest Episode of discrete amnesia related to alcohol or drug intoxi­
cation. The individual has no recall for a period when, although intoxicated, 
he appeared to be functioning normally. This is also commonly known as 
‘blackout’, but the term palimpsest is preferable as it avoids confusion with 
episodes of loss of consciousness.
Panic attack Paroxysmal, severe anxiety. May occur in response to a par­
ticular stimulus or occur without apparent stimulus.
Paranoid delusion Strictly speaking, this describes self-​referential delu­
sions (i.e. grandiose delusions and persecutory delusions). It is, however, 
more commonly used as a synonym for persecutory delusion.
Paraphasia The substitution of a non-​verbal sound in place of a word. 
Occurs in organic lesions affecting speech.
Passivity phenomena Synonym for delusions of control.
Persecutory delusion A delusional belief that one’s life is being interfered 
with in a harmful way.
Perseveration Continuing with a verbal response or action which was 
initially appropriate after it ceases to be apposite (e.g. ‘Do you know where 
you are?’—​‘In the hospital’; ‘Do you know what day it is?’—​‘In the hos­
pital’). Associated with organic brain disease and is occasionally seen in 
schizophrenia.
Phantom mirror image Synonym for autoscopy.

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Chapter 3  Symptoms of psychiatric illness
Phobia A particular stimulus, event, or situation which arouses anxiety 
in an individual and is therefore associated with avoidance. The concept 
of ‘biological preparedness’ is that some fears (e.g. of snakes, fire, heights) 
had evolutionary advantage, and so it is easier to develop phobias for these 
stimuli than other more evolutionarily recent threats (e.g. of guns or elec­
tric shock).
Physiological dependence See Dependence.
Pica The eating of things which are not food or of food items in abnormal 
quantities.
Positive symptoms (of schizophrenia) The symptoms of schizophrenia 
which are qualitatively different from normal experience (i.e. delusions, 
hallucinations, schizophrenic thought disorder). Believed to be related to 
neuro-​chemical abnormalities.
Posturing The maintenance of bizarre and uncomfortable limb and body 
positions. Associated with psychotic illnesses and may have delusional sig­
nificance to the patient.
Pressure of speech The speech pattern consequent upon pressure of 
thought. The speech is rapid and difficult to interrupt, and, with increasing 
severity of illness, the connection between sequential ideas may become 
increasingly hard to follow. Occurs in manic illness.
Pressure of thought The subjective experience of one’s thoughts 
occurring rapidly, each thought being associated with a wider range of con­
sequent ideas than normal and with the inability to remain on one idea for 
any length of time. Occurs in manic illness.
Priapism A  sustained and painful penile erection, not associated with 
sexual arousal. A rare side effect of antidepressant medication. If not re­
lieved, can cause permanent penile damage.
Pseudocyesis A false pregnancy. May be hysterical or delusional in nature 
and can occur in both sexes, although more commonly in women. The be­
lief in the false pregnancy may be accompanied by abdominal distension, 
lumbar lordosis, and amenorrhoea.
Pseudodementia A  presentation of severe depression in the elderly 
where the combination of psychomotor retardation, apparent cognitive 
deficits, and functional decline causes diagnostic confusion with dementia.
Pseudo-​hallucination A false perception which is perceived as occurring 
as part of one’s internal experience, not as part of the external world. It 
may be described as having an ‘as if’ quality or as being seen with the mind’s 
eye. Additionally, hallucinations experienced as true hallucinations during 
the active phase of a patient’s illness may become perceived as pseudo-​
hallucinations as they recover. They can occur in all modalities of sensation 
and are described in psychotic, organic, and drug-​induced conditions, as 
well as occasionally in normal individuals. (The hallucinations of deceased 
spouses commonly described by widows and widowers may have a form of 
a pseudo-​hallucination.)
Pseudologica fantastica The production of convincing false accounts, 
often with apparent sincere conviction. There may be a grandiose or 
an over-​exaggerated flavour to the accounts produced. A  feature of 
Munchausen’s disease.
Psychic anxiety See Anxiety.
Psychogenic polydipsia Excessive fluid intake without organic cause.
Psychological dependence See Dependence.

Dictionary of psychiatric symptoms
Psychological pillow A motor symptom of schizophrenia. The patient 
holds their head several inches above the bed, while lying, and can maintain 
this uncomfortable position for prolonged periods of time.
Psychomotor agitation A combination of psychic anxiety and excess and 
purposeless motor activity. A symptom common to many mental illnesses 
and found in normal individuals in response to stress.
Psychomotor retardation d spontaneous movement and slowness in 
instigating and completing voluntary movement. Usually associated with a 
subjective sense of actions being more of an effort and with subjective re­
tardation of thought. Occurs in moderate to severe depressive illness.
Punding A form of stereotyped motor behaviour in which there is an 
apparent fascination with repetitive mechanical tasks such as arranging 
items or dismantling and reassembling mechanical objects. It is seen as a 
side effect of anti-​Parkinsonian medication and in some individuals taking 
methamfetamine. It bears some similarity to behaviours seen in individuals 
with autism.
Receptive dysphasia Dysphasia affecting the understanding of speech. 
There is impairment in understanding spoken commands and repeating 
back speech. There are also significant abnormalities in spontaneous speech 
with word substitutions, defects in grammar and syntax, and neologisms. 
The abnormal speech so produced is, however, fluent (cf. expressive dys­
phasia), and the patient may be unconcerned by his deficits.
Reflex hallucination The experience of a real stimulus in one sensory 
modality triggering a hallucination in another.
Retrograde amnesia The period of amnesia between an event (e.g. head 
injury) and the last continuous memory before the event.
Rumination A compulsion to engage in repetitive and pointless consider­
ation of phrases or ideas, usually of a pseudo-​philosophical nature. May be 
resisted for a period, with consequent mounting anxiety.
‘Running commentary’ A type of third-​person auditory hallucination, 
which is a first-​rank symptom of schizophrenia. The patient hears one or 
more voices providing a narrative of their current actions—​‘he’s getting 
up . . . now he’s going towards the window’.
Russell sign Skin abrasions, small lacerations, and calluses on the dorsum 
of the hand overlying the metacarpophalangeal and interphalangeal joints 
found in patients with symptoms of bulimia. Caused by repeated contact 
between the incisors and the skin of the hand, which occurs during self-​
induced vomiting.
Schizophasia Synonym for word salad.
Schizophrenic speech disorder This includes abnormalities in the form 
of speech consequent upon a schizophrenic thought disorder and those 
abnormalities in the use of language characteristic of schizophrenia such as 
use of neologisms and stock words/​phrases.
Schizophrenic thought disorder A group of abnormalities in the sub­
jective description of the form of thought which occurs in schizophrenia. 
The abnormalities include: loosening of associations, derailment, thought 
blocking, fusion, and muddling.
Sensory distortions Changes in the perceived intensity or quality of a 
real external stimulus. Associated with organic conditions and with drug 
ingestion or withdrawals. Examples include: hyperacusis (hearing sounds as

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Chapter 3  Symptoms of psychiatric illness
abnormally loud), micropsia (‘wrong end of the telescope’ effect, perceiving 
objects which are close as small and far away).
Snapping off Synonym for thought blocking.
Somatic anxiety See Anxiety.
Somatization The experience of bodily symptoms with no, or no suffi­
cient, physical cause for them, with presumed psychological causation.
Splitting of perception Loss of the ability to simultaneously process com­
plementary information in two modalities of sensation (e.g. sound and pic­
tures on television). Rare symptom of schizophrenia.
Stereotypy A repetitive and bizarre movement which is not goal-​directed 
(in contrast to mannerism). The action may have delusional significance to 
the patient. Seen in schizophrenia.
Stock phrases/​stock words Feature of schizophrenic speech disorder. 
Use of particular words and phrases more frequently than in normal speech 
and with a wider variety of meanings than normal.
Stupor Absence of movement and mutism where there is no impair­
ment of consciousness. Functional stupor occurs in a variety of psychiatric 
illnesses. Organic stupor is caused by lesions in the midbrain (the ‘locked-​in’ 
syndrome).
Synaesthesia A stimulus in one sensory modality is perceived in a fashion 
characteristic of an experience in another sensory modality (e.g. ‘tasting’ 
sounds or ‘hearing’ colours). Occurs in hallucinogenic drug intoxication and 
in epileptic states.
Tangentiality Producing answers which are only very indirectly related to 
the question asked by the examiner.
Tardive dyskinesia A  movement disorder associated with long-​term 
treatment with neuroleptic drugs (although it was described in psychotic pa­
tients before the use of these drugs in clinical practice). There is continuous 
involuntary movement of the tongue and lower face. More severe cases 
involve the upper face and have choreoathetoid movements of the limbs.
Teleological hallucination Synonym for command hallucination.
Terminal insomnia Synonym for early morning wakening.
Third-​person auditory hallucinations Auditory hallucinations character­
istic of schizophrenia where voices are heard referring to the patient as 
‘he’ or ‘she’, rather than ‘you’. The first-​rank symptoms of ‘voices heard 
arguing’ and ‘running commentary’ are of this type.
Thought blocking A symptom of schizophrenic thought disorder. The 
patient experiences a sudden break in the chain of thought. It may be ex­
plained as due to thought withdrawal. In the absence of such delusional 
elaboration, it is not a first-​rank symptom.
Thought broadcasting The delusional belief that one’s thoughts are ac­
cessible directly to others. A first-​rank symptom of schizophrenia.
Thought disorder See Formal thought disorder.
Thought echo The experience of an auditory hallucination in which the 
content is the individual’s current thoughts. A first-​rank symptom of schizo­
phrenia. Also known as gedankenlautwerden or echo de la pensée.
Thought insertion The delusional belief that thoughts are being placed 
in the patient’s head from outside. A first-​rank symptom of schizophrenia.
Tic Sudden twitches of a single muscle or muscle group.
Trichotillomania The compulsion to pull one’s hair out.

Dictionary of psychiatric symptoms
Verbigeration Repetition of words or phrase while unable to articulate 
the ‘next’ word in the sentence. Seen in expressive dysphasia.
Verschmelzung Synonym for fusion.
‘Voices heard arguing’ A type of auditory hallucination which is a first-​
rank symptom of schizophrenia. The patient hears two or more voices 
debating with one another, sometimes about a matter over which the pa­
tient is agonizing (e.g. ‘he should take the medication, it’s worked before’, 
‘no, not again, he’ll not take it this time’).
Vorbeigehen Synonym for Ganser symptom.
Vorbeireden Synonym for Ganser symptom.
Waxy flexibility Synonym for catalepsy.
Wernicke’s dysphasia A type of receptive dysphasia due to cortical le­
sions in or near the posterior portion of the left first temporal convolution 
(superior temporal gyrus)—​known as the Wernicke area.
Withdrawals The physical sequelae of abstinence from a drug to which 
one is dependent. These are individual to the drug concerned (e.g. sweating, 
tachycardia, and tremor for alcohol; dilated pupils, piloerection, abdominal 
pain, and diarrhoea for opiates).
Word salad The most severe degree of schizophrenic thought disorder, 
in which no connection of any kind is understandable between sequential 
words and phrases the patient uses. Also called schizophasia.