Key points
- Psychopathology terms are the shared language for describing a patient's mental state: mood and affect, thought, perception, movement, speech and cognition.
- Circumstantiality reaches the point after too much detail; tangentiality never returns to it.
- Flight of ideas keeps recognisable links between topics; loosening of associations weakens them; word salad is the most severe form of thought disorder.
- An illusion misreads a real stimulus; a hallucination has no external stimulus at all.
- Negative symptoms are flat affect, alogia, avolition and social withdrawal, and they are prominent in schizophrenia.
- Pseudodementia is cognitive impairment from severe mood disorder that can mimic dementia and may be reversible with treatment.
Concise definitions for Year 4 Psychiatry (Introduction to Psychopathology). Based on Fish's Clinical Psychopathology and the Oxford Handbook of Psychiatry. Use it with the notes on the mental state examination and on classification.
Mood and affect
| Term | Definition |
|---|---|
| Affect | The observable expression of emotion; described by range, intensity, congruence with thought and appropriateness. |
| Affect, blunted/flat | Marked reduction in emotional expression; voice, facial expression and gestures are diminished. |
| Alexithymia | Difficulty identifying and describing one's emotions, often appearing emotionally "flat" despite internal distress. |
| Ambivalence | Coexistence of opposing feelings or drives toward the same object or person, common in depressive and psychotic states. |
| Anhedonia | Loss of interest or pleasure in previously enjoyable activities; a core feature of major depression and negative symptoms. |
| Anergia | Lack of energy or physical drive; commonly seen in depression and negative symptom clusters. |
| Depression (symptom cluster) | Persistent low mood, slowed thinking and activity, anergia, and negative self-evaluation. |
| Dysphoria | General state of unease, dissatisfaction or restlessness often accompanying mood disorders. |
| Emotional lability | Rapid and exaggerated changes in mood that are disproportionate to external events. |
| Lability of affect (labile affect) | Quick shifts in affective expression that appear unstable or disproportionate. |
| Mania | Sustained period of abnormally elevated, expansive or irritable mood with increased energy and goal-directed activity. |
| Grandiosity | Inflated sense of worth, power, knowledge or identity; often observed in manic episodes. |
| Panic attack | Abrupt surge of intense fear or discomfort accompanied by autonomic symptoms and a sense of imminent danger. |
| Autonomic arousal | Physical signs such as tachycardia, sweating and tremor associated with anxiety or panic responses. |
| Worry | Prolonged, uncontrollable concern about potential future problems; core feature of generalized anxiety disorder. |
| Suicidal ideation | Thoughts about self-harm or ending one's life; range from passive wishes to explicit plans. |
| Empathy impairment | Reduced ability to understand or share the feelings of others, sometimes seen in personality and neurodevelopmental disorders. |
Form of thought and speech
| Term | Definition |
|---|---|
| Formal thought disorder | Collective term for abnormalities in the organization and expression of thought (e.g. derailment, tangentiality). |
| Circumstantiality | Speech with excessive and unnecessary detail that eventually reaches the point, unlike tangentiality. |
| Tangentiality | Replying to a question with oblique or irrelevant information, never returning to the original point. |
| Flight of ideas | Rapid flow of accelerated speech with abrupt changes from topic to topic, but with recognizable links; typical of mania. |
| Loosening (derailment) of associations | Shift in ideas with weakening connections between concepts; the listener may lose the thread of meaning. |
| Incoherence (word salad) | Speech so disorganized that it is largely unintelligible; the most severe form of thought disorder. |
| Word salad | Severe disorganization of language producing an incomprehensible jumble of words and phrases. |
| Clang associations | Speech in which words are linked by sound (rhyme, pun) rather than meaning. |
| Neologism | Newly coined word or expression with idiosyncratic meaning used by the patient. |
| Perseveration | Repetition of words, ideas or actions beyond their usefulness, often reflecting frontal/executive dysfunction. |
| Racing thoughts | Subjective sensation of thoughts moving quickly, often accompanying pressured speech in hypomania/mania. |
| Disorganized speech | Disruption in the form of thought manifesting as incoherent, illogical or derailed speech. |
| Pressured speech | Rapid, urgent speech that is difficult to interrupt, commonly seen in manic states. |
| Logorrhoea | Excessive, often pressured speech that may impede conversational exchange. |
| Poverty of speech | Marked reduction in spontaneous speech output (see alogia). |
| Alogia | Notably reduced fluency and productivity of speech, reflecting impoverished thought. |
| Poverty of content of speech | Speech that is adequate in amount but conveys little information due to vagueness or over-generalization. |
| Echolalia | Automatic repetition of another person's spoken words. |
| Mutism | Lack of voluntary speech despite preserved consciousness; may occur in catatonia or severe anxiety. |
Content of thought
| Term | Definition |
|---|---|
| Delusion | A firmly held false belief resistant to reason or contrary evidence and not shared by cultural or subcultural groups. |
| Cotard's (nihilistic) delusion | Fixed belief that one is dead, dying or that one's organs are missing or rotting. |
| Nihilistic delusion | Belief that the self, parts of the body, or the world do not exist or have been annihilated. |
| Erotomanic delusion | False belief that another (often of higher status) is in love with the patient. |
| Jealous (Othello) delusion | Firmly held false belief that a partner is unfaithful despite lack of evidence. |
| Somatic delusion | False belief concerning the body, its functions or sensations, often bizarre and persistent. |
| Paranoid ideation | Suspicious or mistrustful thoughts, ranging from guardedness to fixed paranoid delusions. |
| Ideas of reference | Mistaken belief that innocuous events or remarks refer directly to oneself. |
| Referential thinking | Interpretation of neutral stimuli as especially significant or directed at the self (similar to ideas of reference). |
| Overvalued idea | An unreasonable and sustained belief held with less than delusional intensity but disproportionately affecting behaviour. |
| Obsession | Persistent, intrusive thought, image or impulse that is ego-dystonic and causes marked anxiety. |
| Compulsion | Repetitive behaviour or mental act performed in response to an obsession or according to rigid rules. |
| Intrusive thoughts | Unwanted, recurrent thoughts or images that cause distress and are difficult to suppress. |
| Ruminations | Repetitive focus on negative themes or worries that are hard to control and maintain distress. |
| Thought broadcasting | Belief that one's private thoughts are accessible to others. |
| Thought insertion | Sensation that thoughts are being put into one's mind by an external source. |
| Thought withdrawal | Belief that thoughts are being taken out of one's mind by an outside force. |
Perception
| Term | Definition |
|---|---|
| Hallucination (general) | Perception-like experience occurring without external stimulus and vivid enough to be mistaken for reality. |
| Auditory hallucination | Perception of sound or voices in the absence of external stimuli; can be conversational, commenting or commanding. |
| Voice (auditory) comments/commands | Auditory hallucinations that comment on behaviour or instruct actions; may carry risk if commanding. |
| Visual hallucination | Seeing people, shapes or scenes that are not present; content and complexity can suggest underlying cause. |
| Tactile hallucination | False perception of touch or movement on the body surface (e.g. formication in stimulant misuse). |
| Olfactory hallucination | Smelling odours that are not present; can be experienced in epilepsy, depression or psychosis. |
| Hallucinosis | Persistent hallucinations with preserved insight into their unreal nature (classically seen in alcohol withdrawal states). |
| Illusion | Misinterpretation of a real external stimulus (e.g. mistaking a coat for a person in dim light). |
| Flashback | Sudden, vivid re-experiencing of a past traumatic event with sensory and emotional detail. |
| Depersonalization | A subjective experience of detachment from oneself, feeling like an outside observer of one's body or thoughts. |
| Derealization | The external world feels unreal, distant or distorted in quality. |
Movement and behaviour
| Term | Definition |
|---|---|
| Catatonia | Cluster of motor signs including stupor, mutism, posturing, rigidity and waxy flexibility; may accompany mood and psychotic disorders. |
| Stupor | Severe reduction in responsiveness and spontaneous activity while consciousness is preserved. |
| Waxy flexibility | Maintenance of limbs placed by another in a fixed position for an extended period (catatonic sign). |
| Echopraxia | Compulsive imitation of another person's movements. |
| Mannerisms | Odd, purposeful-looking behaviours or gestures that are part of a person's habitual repertoire. |
| Stereotypy | Repetitive, ritualistic movements or speech that lack clear purpose and persist across situations. |
| Psychomotor agitation | Increased non-purposeful activity such as pacing or handwringing associated with anxiety or mood disturbance. |
| Psychomotor retardation | Marked slowing of movement, speech and thought; commonly observed in severe depression. |
| Disorganized behaviour | Behaviour that is unpredictable, purposeless or inappropriate to the situation. |
| Avolition | Severe reduction in the initiation of goal-directed behaviour; differs from simple laziness. |
| Withdrawal, social | Active avoidance of interpersonal contact and reduced engagement in social activities. |
| Negative symptoms | Group of deficits including flat affect, alogia, avolition and social withdrawal; prominent in schizophrenia. |
Memory, attention and insight
| Term | Definition |
|---|---|
| Insight | Patient's awareness and understanding of their mental state, symptoms and need for treatment. |
| Anosognosia | Unawareness or denial of illness or deficits; frequently encountered in psychosis and some neurological conditions. |
| Confabulation | Fabricated or distorted memories presented without conscious intent to deceive, commonly after memory loss. |
| Memory impairment | Deficits in acquisition, consolidation or retrieval of information; may point to delirium, dementia or depression. |
| Impaired concentration | Difficulty sustaining attention or focusing, impairing task completion and the clinical interview. |
| Intellectual deterioration | Progressive decline in cognitive function (memory, executive function) suggesting organic or degenerative processes. |
| Pseudodementia | Cognitive impairment due to severe mood disorder that may mimic dementia but can be reversible with treatment. |
Practice questions
1. What is the difference between circumstantiality and tangentiality? Circumstantiality gives excessive and unnecessary detail but eventually reaches the point. Tangentiality replies with oblique or irrelevant information and never returns to the original point.
2. What separates an illusion from a hallucination? An illusion is a misinterpretation of a real external stimulus (for example a coat mistaken for a person in dim light). A hallucination occurs without any external stimulus.
3. Name the negative symptoms. Flat affect, alogia, avolition and social withdrawal. They are prominent in schizophrenia.
4. What is hallucinosis? Persistent hallucinations with preserved insight into their unreal nature, classically seen in alcohol withdrawal states.
5. Define thought insertion, thought withdrawal and thought broadcasting. Insertion: thoughts are being put into one's mind by an external source. Withdrawal: thoughts are being taken out of one's mind by an outside force. Broadcasting: one's private thoughts are accessible to others.
6. What is Cotard's delusion? A fixed belief that one is dead or dying, or that one's organs are missing or rotting.
7. What is pseudodementia? Cognitive impairment due to severe mood disorder that may mimic dementia but can be reversible with treatment.
8. List the signs that make up catatonia. Stupor, mutism, posturing, rigidity and waxy flexibility. It may accompany mood and psychotic disorders.
9. How does flight of ideas differ from loosening of associations? In flight of ideas the speech is rapid and changes topic abruptly but the links are recognisable; it is typical of mania. In loosening of associations the connections between ideas weaken and the listener may lose the thread.
10. What is the difference between an obsession and a compulsion? An obsession is a persistent, intrusive thought, image or impulse that is ego-dystonic and causes marked anxiety. A compulsion is a repetitive behaviour or mental act performed in response to an obsession or according to rigid rules.
Exam-style MCQs with answers and explanations
Try each question before you open the answer.
1. A patient answers every question with a great deal of unnecessary detail but always gets to the point in the end. Which term fits best?
A. Tangentiality
B. Circumstantiality
C. Flight of ideas
D. Perseveration
Answer: B. Circumstantiality is excessive, unnecessary detail that eventually reaches the point. In tangentiality the speaker never returns to the original point.
2. Rapid, accelerated speech with abrupt changes of topic, but with recognisable links between topics, is typical of mania. What is it called?
A. Loosening of associations
B. Word salad
C. Flight of ideas
D. Poverty of content of speech
Answer: C. Flight of ideas keeps recognisable links between topics. Loosening of associations weakens them, and word salad is largely unintelligible.
3. A man says that thoughts are being put into his mind by an outside source. What is this?
A. Thought broadcasting
B. Thought insertion
C. Thought withdrawal
D. Ideas of reference
Answer: B. Thought insertion is the sensation that thoughts are being put into one's mind from outside. Broadcasting means others can access one's thoughts, and withdrawal means thoughts are taken out.
4. In dim light a patient mistakes a coat on a hook for a person. This is best described as:
A. A hallucination
B. A delusion
C. An illusion
D. A flashback
Answer: C. An illusion is a misinterpretation of a real external stimulus. A hallucination occurs without any external stimulus.
5. A patient insists he is dead and that his organs are rotting. Which delusion is this?
A. Jealous (Othello) delusion
B. Erotomanic delusion
C. Cotard's (nihilistic) delusion
D. Grandiose delusion
Answer: C. Cotard's (nihilistic) delusion is a fixed belief that one is dead, dying, or that one's organs are missing or rotting.
6. After a nurse places his arm in a raised position, a patient holds it there for a long time. Which sign is this?
A. Echopraxia
B. Stereotypy
C. Mannerism
D. Waxy flexibility
Answer: D. Waxy flexibility is the maintenance of limbs in a position placed by another person, and it is a catatonic sign.
7. Which of these is a negative symptom?
A. Flight of ideas
B. Avolition
C. Thought broadcasting
D. Pressured speech
Answer: B. Negative symptoms include flat affect, alogia, avolition and social withdrawal.
8. A depressed older patient has marked memory and concentration problems that mimic dementia and improve with treatment of the mood disorder. This is:
A. Confabulation
B. Perseveration
C. Intellectual deterioration
D. Pseudodementia
Answer: D. Pseudodementia is cognitive impairment due to severe mood disorder that may mimic dementia but can be reversible with treatment.
9. Persistent hallucinations with preserved insight, classically in alcohol withdrawal, are called:
A. Hallucinosis
B. Illusion
C. Derealization
D. Flashback
Answer: A. In hallucinosis the patient keeps insight into the unreal nature of the hallucinations.
10. An unwanted, intrusive thought that is ego-dystonic and causes marked anxiety is:
A. A compulsion
B. An overvalued idea
C. An obsession
D. Ruminations
Answer: C. An obsession is a persistent, intrusive thought, image or impulse that is ego-dystonic. A compulsion is the repetitive act performed in response to it.
References
- Fish FJ. Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry. Revised edition (ed. Casey PR, Kelly B). Cambridge University Press; 2019.
- Semple D, Smyth R. Oxford Handbook of Psychiatry. 4th ed. Oxford University Press; 2019.
- Definitions above are concise paraphrases for educational use and drawn from standard clinical psychopathology texts.