locus coeruleus A small area in the brain stem containing norepinephrine neurons that is considered to be a key brain center for anxiety and fear.

long-term memory The final phase of memory in which information storage may last from hours to a lifetime.

loosening of associations A disturbance of thinking shown by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first. Statements that lack a meaningful relationship may be juxtaposed, or speech may shift suddenly from one frame of reference to another. The speaker gives no indication of being aware of the disconnectedness, contradictions, or illogicality of speech.

M 

macropsia The visual perception that objects are larger than they actually are.

magical thinking A conviction that thinking equates with doing. Occurs in dreams in children, in primitive peoples, and in patients under a variety of conditions. Characterized by lack of realistic relationship between cause and effect.

manifest content The remembered content of a dream or fantasy, as contrasted with latent content, which is concealed and distorted.

masochism Pleasure derived from physical or psychological pain inflicted on oneself either by oneself or by others. It is called sexual masochism and classified as a paraphilia when it is consciously sought as a part of the sexual act or as a prerequisite to sexual gratification. It is the converse of sadism, although the two tend to coexist in the same person.

memory consolidation The physical and psychological changes that take place as the brain organizes and restructures information that may become a permanent part of memory.

mental retardation A major group of disorders of infancy, childhood, or adolescence characterized by intellectual functioning that is significantly below average (IQ of 70 or below), manifested before the age of 18 by impaired adaptive functioning (below expected performance for age in such areas as social or daily living skills, communication, and self-sufficiency). Different levels of severity are recognized: an IQ level of 50/55 to 70 is Mild; an IQ level of 35/40 to 50/55 is Moderate; an IQ level of 20/25 to 35/40 is Severe; an IQ level below 20/25 is Profound.

MHPG (3-methoxy-4-hydroxyphenylglycol) A major metabolite of brain norepinephrine excreted in urine.

magical thinking The erroneous belief that one's thoughts, words, or actions will cause or prevent a specific outcome in some way that defies commonly understood laws of cause and effect. Magical thinking may be a part of normal child development.

micropsia The visual perception that objects are smaller than they actually are.

middle insomnia Awakening in the middle of the night followed by eventually falling back to sleep, but with difficulty.

mirroring 1) The empathic responsiveness of the parent to the developing child's grandiose-exhibitionistic needs. Parental expressions of delight in the child's activities signal that the child's wishes and experiences are accepted as legitimate. This teaches the child which of his or her potential qualities are most highly esteemed and valued. Mirroring validates the child as to who he or she is and affirms his or her worth. The process transforms archaic aims to realizable aims, and it determines in part the content of the self-assessing, self-monitoring functions and their relationships to the rest of the personality. The content of the superego is the residue of the mirroring experience. 2) A technique in psychodrama in which another person in the group plays the role of the patient, who watches the enactment as if gazing into a mirror. The first person may exaggerate one or more aspects of the patient's behavior. Following the portrayal, the patient is usually encouraged to comment on what he or she has observed.

mood A pervasive and sustained emotion that colors the perception of the world. Common examples of mood include depression, elation, anger, and anxiety. In contrast to affect, which refers to more fluctuating changes in emotional "weather," mood refers to a more pervasive and sustained emotional "climate."  Types of mood include: dysphoric, elevated, euthymic, expansive, irritable.

mood-congruent psychotic features Delusions or hallucinations whose content is entirely consistent with the typical themes of a depressed or manic mood. If the mood is depressed, the content of the delusions or hallucinations would involve themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. The content of the delusion may include themes of persecution if these are based on self-derogatory~ concepts such as deserved punishment. If the mood is manic, the content of the delusions or hallucinations would involve themes of inflated worth, power, knowledge, or identity, or a special relationship to a deity or a famous person. The content of the delusion may include themes of persecution if these are based on concepts such as inflated worth or deserved punishment.

mood-incongruent psychotic features Delusions or hallucinations whose content is not consistent with the typical themes of a depressed or manic mood. In the case of depression, the delusions or hallucinations would not involve themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. In the case of mania, the delusions or hallucinations would not involve themes of inflated worth, power, knowledge, or identity, or a special relationship to a deity or a famous person. Examples of mood-incongruent psychotic features include persecutory delusions (without self-derogatory~ or grandiose content), thought insertion, thought broadcasting, and delusions of being controlled whose content has no apparent relationship to any of the themes listed above.

N

negative symptoms Most commonly refers to a group of symptoms characteristic of schizophrenia that include loss of fluency and spontaneity of verbal expression, impaired ability to focus or sustain attention on a particular task, difficulty in initiating or following through on tasks, impaired ability to experience pleasure to form emotional attachment to others, and blunted affect.

negativism Opposition or resistance, either covert or overt, to outside suggestions or advice. May be seen in schizophrenia.

neologism In psychiatry, a new word or condensed combination of several words coined by a person to express a highly complex idea not readily understood by others; seen in schizophrenia and organic mental disorders.

neurotic disorder A mental disorder in which the predominant disturbance is a distressing symptom or group of symptoms that one considers unacceptable and alien to one's personality. There is no marked loss of reality testing ; behavior does not actively violate gross social norms, although it may be quite disabling. The disturbance is relatively enduring or recurrent without treatment and is not limited to a mild transitory reaction to stress. There is no demonstrable organic etiology.

nihilistic delusion The delusion of nonexistence of the self or part of the self, or of some object in external reality.

nystagmus Involuntary rhythmic movements of the eyes that consist of small-amplitude~ rapid tremors in one direction and a larger, slower, recurrent sweep in the opposite direction. Nystagmus may be horizontal, vertical, or rotary.

O

object relations The emotional bonds between one person and another, as contrasted with interest in and love for the self; usually described in terms of capacity for loving and reacting appropriately to others. Melanie Klein is generally credited with founding the British object-relations school.

obsession Recurrent and persistent thought, impulse, or image experienced as intrusive and distressing. Recognized as being excessive and unreasonable even though it is the product of one's mind. This thought, impulse, or image cannot be expunged by logic or reasoning.

oedipal stage Overlapping some with the phallic stage, this phase (ages 4 to 6) represents a time of inevitable conflict between the child and parents. The child must desexualize the relationship to both parents in order to retain affectionate kinship with both of them. The process is accomplished by the internalization of the images of both parents, thereby giving more definite shape to the child's personality. With this internalization largely completed, the regulation of self-esteem and moral behavior comes from within.

Oedipus complex Attachment of the child to the parent of the opposite sex, accompanied by envious and aggressive feelings toward the parent of the same sex. These feelings are largely repressed (i.e., made unconscious) because of the fear of displeasure or punishment by the parent of the same sex. In its original use, the term applied only to the boy or man.

olfactory hallucination A hallucination involving the perception of odor, such as of burning rubber or decaying fish.

ontogenetic Pertaining to the development of the individual.

operant conditioning (instrumental conditioning) A process by which the results of the person's behavior determine whether the behavior is more or less likely to occur in the future.

oral stage The earliest of the stages of infantile psychosexual development, lasting from birth to 12 months or longer. Usually subdivided into two stages: the oral erotic, relating to the pleasurable experience of sucking; and the oral sadistic, associated with aggressive biting. Both oral eroticism and sadism continue into adult life in disguised and sublimated forms, such as the character traits of demandingness or pessimism. Oral conflict, as a general and pervasive influence, might underlie the psychological determinants of addictive disorders, depression, and some functional psychotic disorders.

orientation Awareness of one's self in relation to time, place, and person.

overcompensation A conscious or unconscious process in which a real or imagined physical or psychological deficit generates exaggerated correction. Concept introduced by Adler.

overdetermination The concept of multiple unconscious causes of an emotional reaction or symptom.

overvalued idea An unreasonable and sustained belief that is maintained with less than delusional intensity (i.e., the person is able to acknowledge the possibility that the belief may not be true). The belief is not one that is ordinarily accepted by other members of the person's culture or subculture

P 

panic attacks Discrete periods of sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks there are symptoms such as shortness of breath or smothering sensations; palpitations, pounding heart, or accelerated heart rate; chest pain or discomfort; choking; and fear of going crazy or losing control. Panic attacks may be unexpected (uncued), in which the onset of the attack is not associated with a situational trigger and instead occurs "out of the blue"; situationally bound, in which the panic attack almost invariably occurs immediately on exposure to, or in anticipation of, a situational trigger ("cue"); and situationally predisposed, in which the panic attack is more likely to occur on exposure to a situational trigger but is not invariably associated with it.

paranoid ideation Ideation, of less than delusional proportions, involving suspiciousness or the belief that one is being harassed, persecuted, or unfairly treated.

parasomnia Abnormal behavior or physiological events occurring during sleep or sleep-wake transitions.

persecutory delusion  A delusion in which the central theme is that one (or someone to whom one is close) is being attacked, harassed, cheated, persecuted, or conspired against.

perseveration Tendency to emit the same verbal or motor response again and again to varied stimuli.

personality Enduring patterns of perceiving, relating to, and thinking about the environment and oneself. Personality traits are prominent aspects of personality that are exhibited in a wide range of important social and personal contexts. Only when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress do they constitute a Personality Disorder.

phallic stage The period, from about 21/2 to 6 years, during which sexual interest, curiosity, and pleasurable experience in boys center on the penis, and in girls, to a lesser extent, the clitoris.

phobia A persistent, irrational fear of a specific object, activity, or situation (the phobic stimulus) that results in a compelling desire to avoid it. This often leads either to avoidance of the phobic stimulus or to enduring it with dread.

piblokto  A culture specific syndrome of Eskimos involving attacks of screaming, crying, and running naked through the snow

preconscious Thoughts that are not in immediate awareness but that can be recalled by conscious effort.

pregenital In psychoanalysis, refers to the period of early childhood before the genitals have begun to exert the predominant influence in the organization or patterning of sexual behavior. Oral and anal influences predominate during this period.

pressured speech Speech that is increased in amount, accelerated, and difficult or impossible to interrupt. Usually it is also loud and emphatic. Frequently the person talks without any social stimulation and may continue to talk even though no one is listening.

prevalence Frequency of a disorder, used particularly in epidemiology to denote the total number of cases existing within a unit of population at a given time or over a specified period.

primary gain The relief from emotional conflict and the freedom from anxiety achieved by a defense mechanism. Contrast with secondary gain.

primary process In psychoanalytic theory, the generally unorganized mental activity characteristic of the unconscious. This activity is marked by the free discharge of energy and excitation without regard to the demands of environment, reality, or logic.

prodrome An early or premonitory sign or symptom of a disorder

projection A defense mechanism, operating unconsciously, in which what is emotionally unacceptable in the self is unconsciously rejected and attributed (projected) to others.

projective identification A term introduced by Melanie Klein to refer to the unconscious process of projection of one or more parts of the self or of the internal object into another person (such as the mother). What is projected may be an intolerable, painful, or dangerous part of the self or object (the bad object). It may also be a valued aspect of the self or object (the good object) that is projected into the other person for safekeeping. The other person is changed by the projection and is dealt with as though he or she is in fact characterized by the aspects of the self that have been projected.

projective tests Psychological diagnostic tests in which the test material is unstructured so that any response will reflect a projection of some aspect of the subject's underlying personality and psychopathology

prosopagnosiaInability to recognize familiar faces that is not explained by defective visual acuity or reduced consciousness or alertness.

pseudocyesis Included in DSM-IV as one of the somatoform disorders. It is characterized by a false belief of being pregnant and by the occurrence of signs of being pregnant, such as abdominal enlargement, breast engorgement, and labor pains.

pseudodementia A syndrome in which dementia is mimicked or caricatured by a functional psychiatric illness. Symptoms and response of mental status examination questions are similar to those found in verified cases of dementia. In pseudodementia, the chief diagnosis to be considered in the differential is depression in an older person vs. cognitive deterioration on the basis of organic brain disease.

psychomotor agitation Excessive motor activity associated with a feeling of inner tension. When severe, agitation may involve shouting and loud complaining. The activity is usually nonproductive and repetitious, and consists of such behavior as pacing, wringing of hands, and inability to sit still.

psychomotor retardation Visible generalized slowing of movements and speech.

psychosexual development A series of stages from infancy to adulthood, relatively fixed in time, determined by the interaction between a person's biological drives and the environment. With resolution of this interaction, a balanced, reality-oriented development takes place; with disturbance, fixation and conflict ensue. This disturbance may remain latent or give rise to characterological or behavioral disorders.

psychotic This term has historically received a number of different definitions, none of which has achieved universal acceptance. The narrowest definition of psychotic is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A slightly less restrictive definition would also include prominent hallucinations that the individual realizes are hallucinatory experiences. Broader still is a definition that also includes other positive symptoms of Schizophrenia (i.e., disorganized speech, grossly disorganized or catatonic behavior). Unlike these definitions based on symptoms, the definition used in DSM-II and ICD-9 was probably far too inclusive and focused on the severity of functional impairment, so that a mental disorder was termed psychotic if it resulted in "impairment that grossly interferes with the capacity to meet ordinary demands of life." Finally, the term has been defined conceptually as a loss of ego boundaries or a gross impairment in reality testing. Based on their characteristic features, the different disorders in DSM-IV emphasize different aspects of the various definitions of psychotic.

psychotropic medication Medication that affects thought processes or feeling states.

R 

rationalization A defense mechanism, operating unconsciously, in which an individual attempts to justify or make consciously tolerable by plausible means, feelings or behavior that otherwise would be intolerable. Not to be confused with conscious evasion or dissimulation. See also projection.

reaction formation A defense mechanism, operating unconsciously, in which a person adopts affects, ideas, and behaviors that are the opposites of impulses harbored either consciously or unconsciously. For example, excessive moral zeal may be a reaction to strong but repressed asocial impulses.

reality principle In psychoanalytic theory, the concept that the pleasure principle, which represents the claims of instinctual wishes, is normally modified by the demands and requirements of the external world. In fact, the reality principle may still work on behalf of the pleasure principle but reflects compromises and allows for the postponement of gratification to a more appropriate time. The reality principle usually becomes more prominent in the course of development but may be weak in certain psychiatric illnesses and undergo strengthening during treatment. reality testing The ability to evaluate the external world objectively and to differentiate adequately between it and the internal world. Falsification of reality, as with massive denial or projection, indicates a severe disturbance of ego functioning and/or of the perceptual and memory processes upon which it is partly based.

reciprocal inhibition In behavior therapy, the hypothesis that if anxiety-provoking stimuli occur simultaneously with the inhibition of anxiety (e.g., relaxation), the bond between those stimuli and the anxiety will be weakened.

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