Difficulty in organizing thoughts, as evidenced by frequent irrelevancies, disconnectedness or loosening of associations. Agitation or over arousal is clearly evident in episodic outbursts and/or sporadic occurrences. Movements are notably awkward or disjointed. Hallucinations occur frequently and may involve more than one sensory modality, and distort thinking and/or disruptive behaviour.
Thinking is rigid and repetitious thus conversation is limited to only two or three dominant topics. Functions primarily in a concrete mode, exhibiting difficulty with most proverbs and many categories. Conversation lacks free flow and appears uneven repetitive or halting. There is a marked lack of spontaneity and openness, replying to questions with only one or two brief sentences.
Disturbance of volition interferes with thinking and behaviour. Patient shows pronounced indecision that impedes the initiation and continuation of social and motor activities, and which also may be evidenced in halting speech. Affect is generally flat, with only occasional changes in facial expression and a paucity of communicative gestures. Patient is clearly detached emotionally from persons and events in the milieu, resisting all efforts at engagement. Patient appears distant, docile, and purposeless Patient typically is aloof, acts bored, or expresses disinterest. Dis-involvement is obvious and clearly impedes the productivity of the interview. Patient may tend to avoid eye or face contact. Passively participates in only a minority of activities and shows virtually no interest or initiative.
Anxiety is expressed by significant physical and behavioural restlessness. Patients are unable to relax. Anxiety is associated with difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue, waking, dreams, nightmares and/or night terrors. Those with phobias may fear the dark, strangers, being left alone, animals, heights, traffic, and/or crowds
Depressed mood is associated with sadness, pessimism, loss of social interest, psychomotor retardation, and interference in appetite and sleep. Patient is slow in movements, and speech may be characterized by poor productivity, including long response latency, extended pauses, or slow pace. The patient cannot be cheered up. Patient expresses a sense of guilt associated with self- deprecation or the belief that he deserves punishment. The guilt feelings may have a delusional basis, may be volunteered spontaneously, and may be a source of preoccupation. The patient may feel helpless, despaired and suicidal. Loss of appetite / weight and light insomnia are typical. Malfunction in work and activity are present
Mania: Excessive energy, hyperactive at times, restless, decreased need for sleep, elevated mood, inappropriate humorous responses, hypersexuality. Patients with mania have increased rate and amount of speech that is difficult to interrupt. Speech content may be grandiose or reflect paranoid ideas. Patient feels distinctly and unrealistically superior to others and possible delusions about special status or abilities may be present.
Rigid predictable restricted behaviours, childish attitude, immature personality, egocentricity, dependency. Special sensitivity to criticism, need for attention, low impulsive threshold. Patients present an overtly hostile attitude, showing frequent irritability and direct expression of anger or resentment. Patient exhibits repeated impulsive episodes involving verbal abuse, and physical threats.