Like any field, psychiatry has its own collection of terminology. Some of it is self-explanatory, but some of it isn’t. I believe that knowing the jargon helps to narrow the power gap between health care providers and patients, so I wanted to talk about some of the terminology that’s commonly used. Some of these terms are a follow-up to yesterday’s post on psychiatric assessment and the mental status exam.
- Alexithymia: inability to identify and describe one’s emotions
- Alogia: This refers to an impoverishment of thinking that is inferred from speech. This can involve a decreased amount of speech (may be referred to as poverty of speech) or a lack of content (may be referred to as poverty of thought).
- Anhedonia: an inability to experience pleasure
- Avolition: an inability to initiate and persist in goal-directed activities
- Catatonia: markedly decreased physical reactivity to the environment. Think One Flew Over the Cuckoo’s Nest.
- Confabulation: This is the unconscious filling in of memory gaps by imagined events; it does not involve intentional lying. Traumatic brain injury is a good example of a condition that may involve confabulation.
- Echolalia: imitation of words/sounds
- Echopraxia: imitation of movements
- Ego-dystonic: thoughts that are inconsistent with what someone normally believes when they are well (the opposite of this is ego-syntonic)
- Floridly psychotic: psychosis that is overtly obvious
- Neologisms: making up new words
- Overvalued ideas: a belief that someone is quite fixed on but not to the extent of a delusion
- Pressured speech: speech that is rapid and very difficult to interrupt
- Responding to internal stimuli: obviously responding to hallucinations, such as when a person seems to be talking back to auditory hallucinations
Types of delusions:
- Capgras: believing that people have been replaced by imposters
- Erotomanic: an example would be believing that one is in a romantic relationship with a famous person
- Grandiose: an example might be a person believing they are a key advisor to a major political figure
- Ideas of reference: interpreting messages as being particularly directed at oneself, including things on billboards, tv, or radio
- Paranoid/persecutory: This is probably what first comes to mind when many people think of delusions. These delusions that one is or will be harmed may be further described as non-bizarre (within the realm of possibility, like being monitored by the government) or bizarre (aliens trying to enter their home via the cat door to steal their right foot).
- Somatic: false beliefs about things that are happening in one’s body, ranging from something like cancer to something bizarre like believing one’s stomach is filled with dancing turtles
- Delusions of control: belief that one’s thoughts are controlled by outside forces
- Thought broadcasting: believing that one’s thoughts can be heard by other people
- Thought insertion/thought withdrawal: believing that thoughts are being put into or taken out of one’s head
- “Delusional proportions”: things like guilt or obsessions may become so intense they’re considered to have become delusional in nature, aka reached delusional proportions
Thought form/thought process descriptors:
- circumstantiality: wandering away from the original idea, but eventually returning to it
- clanging: grouping unrelated words based on sound (such as rhyming)
- concrete: interpreting things very literally, often tested by asking a patient to interpret proverbs; eg “it ain’t over til the fat lady sings” might be interpreted as an obese woman would have to sing a song before something could be finished
- loose associations: connecting ideas that seem to be totally unrelated
- overinclusive: including excessive amounts of detail
- perseveration: repeatedly returning to the same topic
- poverty of thought: an easy way to describe this might be that the lights are on but nobody’s home
- tangentiality: going off on a tangent, and losing the original idea
Descriptors of affect (facial expression of emotion):
- euthymic: neutral, “normal”
- expansive: unrestrained expression of feelings
- incongruent: does not match the reported mood
- labile: rapidly changing
- restricted/blunted/flat: These all refer to decreased facial expressiveness. Restricted is the mildest term, and flat refers to almost no emotional expression.
Some of these terms may sound rather judge-y, but like jargon in any field, when terms are used routinely they start to lose the connotations they might have outside that particular field. Having a set of relatively standardized terms is useful in helping health care providers understand what is being referred to in a patient’s chart, but it’s easy to forget that these terms may mean something very different to the patient who ends up reading their own chart.
Have you ever had psychiatric jargon applied to you in some way that felt wrong or judgmental?