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• Professor of Medicine
• Director, Lipid and Prevention Clinics
• Division of Cardiology
• University of North Carolina School of Medicine
• Chapel Hill, North Carolina

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Reaction time General appearance Social manner and non-verbal behaviour the important points to be noted are: Physique and body habitus (build) and physical ap Increased, decreased, or inappropriate behaviour pearance (approximate height, weight, and appear Eye contact (gaze aversion, staring vacantly, staring ance), at the examiner, hesitant eye contact, or normal eye Looks comfortable/uncomfortable, contact). Physical health, Rapport Grooming, Hygiene, Self-care, Dressing (adequate, appropriate, any peculiarities), Whether a working and empathic relationship Facies (non-verbal expression of mood), can be established with the patient, should be men Effeminate/masculine tioned. Mood is described as general warmth, euphoria, Odd gesturing in response to auditory or visual elation, exaltation and/or ecstasy (seen in severe hallucinations. Anhedonia may occur in both schizophrenia and Rate and quantity of speech depression. Whether speech is present or absent (mutism), Thought If present, whether it is spontaneous, whether produc tivity is increased or decreased, Normal thinking is a goal directed ow of ideas, Rate is rapid or slow (its appropriateness), Pressure symbols and associations initiated by a problem or a of speech or poverty of speech. Therefore, thought Increased/decreased (its appropriateness), process that is not goal-directed, or not logical, or does Low/high/normal pitch not lead to a realistic solution to the problem at hand, is not considered normal. Flow and rhythm of speech Traditionally, in the clinical examination, thought Smooth/hesitant, Blocking (sudden), is assessed (by the content of speech) under the four Dysprosody, Stuttering/Stammering/Cluttering, Any headings of stream, form, content and possession of accent, thought. Affect, on the other hand, is tivity, ight of ideas, prolixity, poverty of content of the outward objective expression of the immediate, speech, and thought block should be mentioned here. The circumstantiality, illogical thinking, perseveration, or other components are stability of mood (over a period verbigeration is noted. Any preoccupations; the affect is similarly described under quality of Obsessions (recurrent, irrational, intrusive, ego affect, range of affect (of emotional changes displayed dystonic, ego-alien ideas); Psychiatric History and Examination 13 Contents of phobias (irrational fears);. The presence of neolo Whether visual, auditory, or in other sensory elds; gisms should be recorded here. Perception is the process of being aware of a sensory Depersonalisation/derealisation experience and being able to recognize it by compar ing it with previous experiences. Hallucinations Somatic passivity phenomenon the presence of hallucinations should be noted. A hallucination is a perception experienced in the Somatic passivity is the presence of strange sensa absence of an external stimulus. Others It is really important to clarify whether they are elementary (only sounds are heard) or complex (voices Autoscopy, abnormal vestibular sensations, sense of heard). The hallucination is experienced much like a true Cognition (Neuropsychiatric) Assessment perception and it seems to come from an external objective space (for example, from outside the ears in Assessment of the cognitive or higher mental func the case of an auditory hallucination). A signi cant tion does not either appear to be a true perception or disturbance of cognitive functions commonly points comes from a subjective internal space (for example, to the presence of an organic psychiatric disorder. Recent Memory Grade the level of consciousness: conscious/ con Ask how did the patient come to the room/hospital; fusion/somnolence/clouding/delirium/stupor/coma. Give an address to be memorised ideally be rated on Glasgow Coma Scale, where a and ask it to be recalled 15 minutes later or at the end numeric value is given to the best response in each of the interview. Note any amnesia (anterograde/ asking the time, date, day, month, year, season, and retrograde), or confabulation, if present. Disorientation in time usually precedes Ask questions about general information, keeping disorientation in place and person. Start with two Abstract thinking digit numbers increasing gradually up to eight digit numbers or till failure occurs on three consecutive Abstract thinking is characterised by the ability to: occasions. Proverb Testing: the meaning of simple proverbs Memory (usually three) should be asked. Similarities (and also the differences) between Use the digit span test to assess the immediate familiar objects should be asked, such as: table/ memory; digit forwards and digit backwards subtests chair; banana/orange; dog/lion; eye/ear. Awareness of being sick, due to something unknown that the patient has regarding his illness. Intellectual Insight: Awareness of being ill and that whether there is an illness or not; if yes, which kind of the symptoms/failures in social adjustment are due illness (physical, psychiatric or both); is any treatment to own particular irrational feelings/thoughts; yet needed; is there hope for recovery; what is the cause of does not apply this knowledge to the current/future illness. True Emotional Insight: It is different from intellec tual insight in that the awareness leads to signi cant Judgement basic changes in the future behaviour. Judgement is the ability to assess a situation correctly and act appropriately within that situation. Social judgement is observed during the hospital stay and during the interview session. Test judgement is assessed by asking the patient Some of the following tests may be useful in screen ing for the medical disorders causing the psychiatric what he would do in certain test situations, such symptoms. Judgement is rated as Good/Intact/Normal or Poor/ Total and differential leucocyte counts: Routine screen, Impaired/Abnormal. After a detailed history and examination, investi Urinalysis: Routine screen; Drug screening. Thyroid function tests: Refractory depression, rapid Brain Imaging Tests (Cranial) cycling mood disorder. Genetic Tests Polysomnography/Sleep studies: Sleep disorders, sei Cytogenetic work-up is useful in some cases of mental zures (occurring in sleep). Serum testosterone: Sexual desire disorders, Male erectile used projective tests of personality are Rorschach inkblot disorder. Psychological Investigations Several rating scales are used in psychiatry to quantify the Objective Tests psychopathology observed. Precipitating the diagnostic formulation focuses on aetiological factors based on the biopsychosocial model (Table 2. Similarly, it is useful to devise the manage Protective ment plan based on the biopsychosocial model (Table 2. Short-term Thus, psychiatric assessment is an initial step Medium-term towards diagnosis and management of psychiatric Long-term disorders. Organic (Including Symptomatic) Mental Disorders 3 It is assumed that all psychological and behavioural evaluating a patient with any psychological or behav processes, whether normal or abnormal, are a result of ioural clinical syndrome. A rational corol features requires a high index of suspicion for an lary would be that all psychiatric disorders are due to organic mental disorder (or what is loosely called as abnormal brain functioning and are therefore organic. Presence of confusion, disorientation, memory disorders are behavioural or psychological disorders impairment or soft neurological signs. Delirium is the commonest organic mental disorder Since organic brain illness can mimic any psychi seen in clinical practice. Five to fteen percent of atric disorder, especially in the initial stages, organic all patients in medical and surgical inpatient units mental disorder should be the rst consideration in are estimated to develop delirium at some time in 20 A Short Textbook of Psychiatry their lives. It is important to recognize delirium at the Clinical Features earliest possible as delirium often has an underlying Delirium is characterised by the following features: aetiology which may be correctable. Clouding of consciousness, characterised by permanent de cits which can be irreversible. No decreased ability to respond to environmental ancillary laboratory test is diagnostic, although tests stimuli, and may help in nding the aetiology. These Marked perceptual disturbances such as illu include impairment of consciousness and attention (on sions, misinterpretations, and hallucinations also a continuum from clouding to coma; reduced ability occur. These are most commonly visual though to direct, focus, sustain, and shift attention), global other perceptual domains can also be involved. Diurnal variation is marked, usually with the onset is usually rapid, the course diurnally worsening of symptoms in the evening and night uctuating, and the total duration of the condition (called sun downing). Generalised autonomic dysfunction, speech and A history of underlying physical or brain disease, thought disturbances (such as slurring of speech, and/or evidence of cerebral dysfunction. Carphologia or occillation (picking movements Presence of certain predisposing factors lowers the at cover-sheets and clothes), threshold for the development of delirium (Table 3. Occupational delirium (elaborate pantomimes as Aetiology if continuing their usual occupation in the hospital bed), and the list of possible causes of delirium is virtually 5. Any factor which disturbs the metabolism of Organic (Including Symptomatic) Mental Disorders 21 brain suf ciently can cause delirium. The aetiology of One of the important causes of delirium, namely delirium demonstrates a threshold phenomenon, with post-cardiac surgery delirium, is discussed in Chapter a combination of factors adding up to cross a threshold 12. In cases where a cause is not obvious (or other contributory causes are suspected), a battery of Table 3. Pre-existing brain damage or dementia complete blood count, urinalysis, blood glucose, 2. Extremes of age (very old or very young) blood urea, serum electrolytes, liver and renal 3. Previous history of delirium function tests, thyroid function tests, serum B and 12 4. Stroke (acute phase), Hypertensive encephalo Drugs (Both ingestion and withdrawal can cause pathy delirium) and Poisons vi. There is impairment of agitated, emergency psychiatric treatment may judgement and impulse control, and also impairment be needed. There is however usually no im zepam or diazepam) or antipsychotics (haloperi pairment of consciousness (unlike in delirium; Table dol or risperidone) may be given either orally or 3. Maintenance treatment can continue though some forms of dementia can be reversible. These There is an increased risk of stroke in elderly include: patients with dementia with prescription of 1. Emotional lability (marked variation in emotional atypical antipsychotics such as olanzapine and expression). Disorientation in time; disorientation in place and memory, especially in early stages), person may also develop in later stages. Course Usually recover in 1 week; Usually protracted, although may be reversible may take up to 1 month in some cases 3. Memory Immediate retention and Immediate retention and recall normal recall disturbed Recent memory disturbed Recent memory disturbed Remote memory disturbed only in late stages d. Perception Visual illusions and Hallucinations may occur hallucinations very common i. Other features Asterixis; multifocal myoclonus Catastrophic reaction; perseveration Organic (Including Symptomatic) Mental Disorders 23 Diagnosis 3. Depressive pseudodementia: Depression in the elderly patients may mimic dementia clinically. It Like delirium, the diagnosis of dementia is clinical is called as depressive pseudodementia (Table 3. In personal activities of daily living, memory impairment contrast, patients with dementia do not often complain (typically affecting registration, storage, and retrieval of these disturbances. In fact, when confronted with of new information though previously learned material evidence of memory impairment, they often con may also be lost particularly in later stages, impaired fabulate. As depression may often be superimposed thinking, presence of clear consciousness (conscious on dementia, it is at times necessary to undertake a ness can be impaired if delirium is also present), and therapeutic trial with antidepressants, if the clinical a duration of at least 6 months. The following conditions must be kept in mind in It is useful to differentiate dementia into cortical the differential diagnosis of dementia. Normal aging process: Although impairment of Aetiology memory and intellect are commoner in elderly, their mere presence does not justify a diagnosis A large number of conditions can cause dementia of dementia. Some clinically important severity to interfere with social and/or occupational types of dementia are brie y discussed here. Delirium: the syndromes of delirium and demen this is the commonest cause of dementia, seen in tia may overlap. Patient rarely complains of cognitive impairment Patient usually always complains about memory impairment 2. Recent memory impairment found on examination Recent memory impairment rarely found on examination 7. Consistently poor performance on similar tests Marked variability in performance on similar tests 9.

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On physical examination the young boy has significant muscle weakness of his hip flexors, knee extensors, deltoids, and biceps muscles. His examination is significant for proximal muscle weakness, toe walking, and calf enlargement. Diagnostic studies are significant for a pri mary muscle disorder with myopathic changes on electrodiagnostic testing and significantly elevated levels of a muscle enzyme, creatinine kinase. Know the clinical presentation of the most common child hood onset muscular dystrophy. Considerations the regression of motor milestones in a previously healthy male toddler is sug gestive of a neuromuscular disorder in the absence of delays in other develop mental milestones. The toddler has proximal muscle weakness resulting in gait instability (toe walking) and inability to rise from a sitting position or from a fall; often requir ing the child to push on his knees to upright himself. Thus, the clinical con sideration is of a primary myopathy, either acquired or inherited. In this case, the toddler presents with regression of motor milestones, enlarged calves, and an elevated creatinine kinase, and no family history. It is caused by the absence of dystrophin, a protein involved in maintaining the integrity of muscle. In the absence of a family history, a patient is unlikely to be diagnosed younger than the age of 2 or 3 years. Parents usually worry something unusual in the way the child walks, due to frequent falling or difficulty rising from the ground or going up steps. Creatinine kinase: An enzyme found primarily in the heart and skeletal muscles, and to a lesser extent in the brain. Muscular dystrophy: Inherited disease characterized by progressive weakness and degeneration of the skeletal muscles that control movement. X-linked inheritance: Inherited disease passed from mother to son because of a genetic abnormality on the X chromosome. Dystrophin protein: Rod-shaped protein, and a vital part of a protein com plex that connects the cytoskeleton of a muscle fiber to the surrounding extracellular matrix through the cell membrane. Patients present with progressive muscle weakness of the legs and pelvis, which is asso ciated with a loss of muscle mass or muscle atrophy. Calf muscles initially grow larger because of replacement of muscle tissue with fat and connective tissue, a condi tion called pseudohypertrophy. With progressive weakness, muscle contractures occur in the hips, knees, and ankles. Thus, the muscles are unusable because the muscle fibers shorten and fibrosis (scarring) occurs in connective tissue. By age 10 years, braces might be required for walking, and by age 12 years, most patients are confined to a wheelchair. Bones develop abnormally, causing skele tal deformities of the spine (scoliosis) and other areas. Muscular weakness and skeletal deformities contribute to respiratory or breathing problems, leading to frequent infections and often requiring assisted ventilation. Cardiac muscle is also commonly affected, leading to car diomyopathy and in almost all cases leading to congestive heart failure and arrhythmias. Intellectual impairment can occur, but it is not inevitable and does not worsen as the disorder progresses. Death usually occurs by 25 years of age, typically from respiratory (lung) disorders. Symptoms usually appear in males at approximately age 12 years, but can sometimes begin later. Muscle weakness is slowly progressive, causing difficulty with running, hopping, jumping, and eventually, walking. Patients may be able to walk well into adulthood, but it is associated with instability and frequent falls. Dystrophin is considered a key structural element in the muscle fiber, and the stabilization of the muscle plasma membrane, and possibly has a role of signaling (Fig. Mechanically induced damage through muscle contrac tions puts a high stress on fragile membranes that could eventually lead to loss of regulatory processes leading to cell death. Altered regeneration, inflamma tion, impaired vessel response, and fibrosis are probably later events that take part in the muscular dystrophy. Diagnostic tests include measurement of a muscle enzyme, creatinine kinase, in the blood. In addition, electrodiagnostic studies of nerve and muscle func tion (electromyography and nerve conduction studies) will confirm abnormal muscle function (myopathy) and the pattern or distribution of muscle dys function, in the absence of a peripheral nerve disorder. Muscle biopsy is often diagnostic of the disease with confirmation of muscle pathology and a loss or decrease of the dystrophin protein. Treatment and Management Treatment is aimed at control of symptoms to maximize the quality of life. Modalities can include physical therapy, respiratory therapy, speech therapy, orthopedic appliances used for support, and corrective orthopedic surgery. Drug therapy includes corticosteroids to slow muscle degeneration, anticon vulsants to control seizures and some muscle activity, immunosuppressants to delay some damage to dying muscle cells, and antibiotics to fight respiratory infections. Some individuals can benefit from occupational therapy and assis tive technology. Some patients might need assisted ventilation to treat respira tory muscle weakness and a pacemaker for cardiac abnormalities. Therefore, patients require multispecialty care from neurologists, rehabilitative services, pulmonologists, and cardiologists. The neurologist is contemplating a diagnosis between Becker and Duchenne muscular dystrophies. Which of the following statements is most accurate regarding these two conditions Because males have only one X chromosome, a male carrying a copy with a dystrophin gene mutation will have the condition. Thus a mother who is a carrier has a 50% chance passing the mutation to her sons or daughters. Of those children, 50% of the boys will have the disease, and 50% of the girls will be carriers. Because it is a primary skeletal muscle disorder, the other mentioned tests are of limited value. When the woman is a carrier for the dystrophin mutation, half of her sons will have the disease, and half of her daughters will be carriers. His parents complain that their son is constantly clearing his throat and coughing, repetitive jerking hand movement and dystonic neck pos turing. The child has a socially disturbing habit of constantly touching his genital region and recently has been having difficulty paying attention at school. He suffered from night terrors when he was 4 years old and still occasionally exhibits sleepwalking. He admits to the stated behavior and reports that he has an over whelming desire to clear his throat, which he is unable to suppress. When reminded of this behavior, he started to manifest it despite an obvious attempt to control it. He exhibits multiple repetitive stereotyped jerking movements of his hand and shoulder as well as twisting movement of his neck. He states that he is aware of these movements and can control them for a short period of time with mounting tension, which results in an inevitable release with more exag gerated behavior. The child manifested an unusual insight into his behavior and appeared to be highly intelligent and motivated. He is embarrassed by his habit of touching his genitals but cannot resist an urge and instead attempts to cover it up by adjusting his clothing. He has obsessive-compulsive tendencies and is having performance issues in school. Tics are brief and episodic movements or sounds induced by internal stimuli that are only temporarily suppressible. Of note, the tics associated with Tourette syndrome are often suggestible; discussing the tics leads to an irrepressible manifesta tion despite attempts to control them. A full evaluation including physical examination, assessment for illicit drugs, mental status examination, and neu rologic examination are important. The most important aspect of therapy is education, as it can be very distressing for both child and parents. Autistic spectrum disorders: Impaired social interactions, poorly devel oped language, and frequent cognitive impairment. Clinical Approach Although Tourette syndrome is the most common cause of childhood-onset tics, there are many other neurologic and psychiatric disorders that exhibit tics as part of its presentation. Autistic spectrum disorders usually manifest by impaired social interactions, poorly developed language, and frequent cognitive impairment. There is usually no cognitive or intellectual deficits associated with Tourette syndrome. Such progressive neurodegenerative disor ders as neuroacanthocytosis and Huntington disease can often present with tics but rapidly develop other hyperkinetic movements that differentiate them from Tourette syndrome. Tics are brief and episodic move ments or sounds induced by internal stimuli that are only temporarily sup pressible. It is often difficult to differentiate tics from compulsive movements, which are also semivoluntary, but instead induced by unwanted feeling or compulsion. For example, in our patient touching of genitalia is probably not a tic, but a compulsion, but throat clearing, coughing, and hand jerking are simple phonic and motor tics. Simple motor tics involve single groups of muscles, causing jerk-like movement in cases of clonic tics, or briefly sustained posture in cases of dystonic or tonic tics. Simple dystonic tics include oculogyric deviation, bruxism, blepharospasm, and torticollis-like posturing. Simple phonic tics include coughing, sniffing, throat clearing, and grunting among others. Complex motor tics include coordinated movements, which involve multiple muscles and often resemble normal movements. Complex tics should be considered a compulsion if it is preceded by obsessive thought, anxiety, or fear. Complex tics are often camou flaged by incorporating them into seemingly planned and purposeful movement. Although rare, but notoriously associated with Tourette syndrome, is shouting obscenities or profanities called coprolalia. In contrast to most other hyperkinetic movement disorders, tics are episodic, repetitive and often stereotypic, being mistaken for mannerisms. Most patients report an ability to suppress tics with mental effort at the expense of mounting inner tension with eventual explosive release in the more appropriate environment. Also in contrast to other hyperkinetic movements, motor and phonic tics can persist during all stages of sleep (Jankovic 1984). Both, like Tourette syndrome, are clinically diagnosed, and no tests or imaging is required. Those comorbidities often interfere with learning and social activities more than tics. Obsessions are intense and often intrusive thoughts, which compel patients to perform mostly meaningless, time-consuming, and sometimes embarrassing rituals or compulsions. One of the most distressing symptoms of Tourette syndrome is a self-injurious behavior, which varies from minor skin damage by biting or scratching, to life threatening injuries. These irresistible urges are not tics, but obsessions fol lowed by a compulsive injurious behavior. Treatment the first and most important step in the management of Tourette syndrome is education of the patient and caregivers, which in their turn should educate teachers, coaches, and principals. Most Tourette syndrome patients do not need medications, but require reassurance and help in arranging the most pro ductive environment for the child at school and at home. Tics should be treated if they interfere with school or work, cause embarrassment, and disturb oth ers to a degree that patient avoids social interactions. The most effective pharmacologic agents for tic suppression are dopamine receptor blocking agents. Typical neuroleptics such as Haldol, despite being effective, are rarely used as first-line therapy because of the side effects. Most feared side effects of the long-term neuroleptic therapy are tardive dyskinesia and hepatotoxicity. That is why most specialists use so-called atypical neuroleptics such as fluphenazine (Prolixin) and pimozide as the first-line pharmacotherapy because they reportedly have lower incidence of tardive dyskinesia as well as less sedation. In addition to dopamine receptor blockers, dopamine depleter, tetra benazine, was found to be effective in treatment of tics. The second line of tic therapy includes clon azepam, naltrexone, and even botulinum toxin injections for the specific, well defined tic. Botulinum toxin injections were found to be beneficial also in the treatment of phonic tics including coprolalia (Jankovic, 1994).

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Positive symptoms in schizo during different activities such as the absorp phrenia include hallucinations (a sensory tion of the radioactive sugar, fuorine-18 perception in the absence of any external labeled 2-deoxyglucose, which is taken up stimulus, for example, hearing voices) and by brain cells in proportion to their activity delusions (fxed false beliefs). Postmodern psy reasoning, characterized by a reliance on chologists (including social constructionists, autonomous moral principles. Two stages discursive psychologists, and relational theo compose this level of moral reasoning. In rists) are infuenced by postmodernist trends stage 5, social contract orientation, indi in literary criticism, philosophy, and socio viduals base their moral judgments on the cultural theory, as well as by the rise of global degree to which actions promote commonly capitalism and rapid advances in communi agreed upon laws and rules. Rules units of analysis, redirecting the focus of are seen as fexible, depending on their con inquiry to the relational or discursive feld. In stage 6, ethical principle They also dispute the assumption that psy orientation, moral reasoning is based on self chological concepts correspond to empirical chosen ethical principles which are abstract, realities, by demonstrating that psychological universal, and context free. It criticize the claim that psychology functions has been argued that the postconventional in society to help foster greater individual level of morality can only be found in com freedom, arguing instead that psychologists plex urban societies (both Western and non often unwittingly reinforce inequality and Western). A period beginning shortly after the birth quency of an event inferred from empirical of a child in which a woman begins to have a evidence after its occurrence, which can then depressed mood every day or almost every day, be used to predict future events. These symptoms hold the knowledge necessary for becoming a usually disappear within a few weeks. A test of the equality of two or more means cent to the axonic membrane of another neu in an analysis of variance or multiple regres ron, which has chemical receptor sites for sion analysis that is decided upon after the neurotransmitters released from the axon of data has been collected and examined. Postmodernism refers to a family of late postsynaptic neuron 20th-century intellectual and cultural move n. A nerve cell which receives input from a ments that envision personhood, social life, particular other nerve cell in the form of 393 postsynaptic potential poverty of speech neurotransmitters which are released by the physical assaults, natural or human-caused other nerve cell and foat across a synaptic disasters, and severe motor vehicle acci gap. Reexperiencing symptoms may include intru post-traumatic amnesia sive thoughts or nightmares about the event, n. Inability to store new information and/or psychological or physiological reactivity retrieve previous information as a result of when reminded of the event, and in its most traumatic head injury. Head injury can be severe form fashbacks in which the person associated with coma, and post-traumatic feels as if he/she is reliving the event in the amnesia becomes evident only when the moment. Post-traumatic amne ing symptoms by reenacting the trauma dur sia is associated with a diversity of cognitive ing play. Avoidance symptoms may include impairments, including attention, percep trying to avoid things that remind the person tion, problem solving, and memory. After of the trauma and failing to remember parts the head injury and once the patient can of the trauma. Avoidance symptoms can also respond to questions, usually it is evident be marked by a lack of interest in activities, that he/she has not only signifcant antero detachment from others, restricted emo grade amnesia (defect in acquiring new tions, and a sense of a foreshortened future. As the ing or concentrating, irritability, hypervigi patient improves, the duration of the retro lance in which the person is always on guard grade amnesia shrinks to within a few hours, against future dangers, and an exaggerated minutes, or seconds before the brain injury, startle response. The dura ing, three avoidance, and two arousal symp tion of the post-traumatic amnesia has been toms, and the symptoms must last for at least used as a criterion of the head injury severity a month, causing signifcant personal dis and in monitoring the course of traumatic tress or functional impairment. Severe traumatic brain injury poverty of speech is associated with amnesia for more than n. Patients with this symptom post-traumatic stress disorder respond to open-ended questions. Examples alogia and is a common negative symptom of causal events include, but are not limited of schizophrenia. These short responses are to , combat, childhood abuse, rape, other not thought to be motivated by a resistance 394 power preconscious to respond to open-ended questions. The capacity to control, decide, or infu tion with eating, obesity, light and soft skin, ence. Social power is usually exercised by con pain insensitivity, and stubby fngers and toes. In statistics, the likelihood of fnding a positive result when pragmatics there is actually a result there to fnd. In linguistics, the social and behavioral mathematics, the number of times a number functioning of language communication is multiplied by itself. The degree of social acceptance of unequal distribution of capacity to control social Pragnanz events, groups, organizations, and societies as n. Cultures differ considerably in this ceptual systems to form the best and simplest dimension, as do smaller social groups. A learning procedure in which practice precocious development is spread over time with nonpractice inter n. Abnormally early appearance of skills or vals between practice periods rather than in abilities usually not developed until later in massed practice, in which all attempts to learn maturation. Distributed learning has been found to be signifcantly more eff precognition cient than massed practice. Increased performance in learning tasks preconscious with repeated learning trials. Massed practice has been relating to material which is not presently 395 preconventional morality prefrontal lobotomy conscious but can be readily called into preference consciousness. In learning preconventional morality theory, the relative frequency of two or more n. Two stages compose this level of young people may be the ones to teach adults moral reasoning. Anterior part of the frontal lobes, located In stage 2, individualism and exchange, also in front of the cortical motor areas (primary called instrumental relativism, children motor cortex and premotor cortex). From the begin to understand that people hold multi cytoarchitectonic point of view, it is defned ple perspectives but judge morality of actions by the internal granular cortex; because of in terms of the practical benefts that can be that, it is also referred to as the frontal granu gained by those behaviors. Three major divisions are usually dren will judge that actions are appropriate recognized: dorsolateral or convexital, orb if concrete gains can be obtained. This ages 4 to 10 are often considered to be in this prefrontal cortical region has been related level of moral reasoning. A form of aggression in which animals kill tion and behavior are referred to with the other animals for food. Damage in the prefrontal cortex results in a diversity of prediction, statistical impairments referred to as dysexecutive syn n. Anatomically, the frontal lobes are the likelihood of future events on the basis of most evolved anterior areas of the brain and the relative frequency with which they have also late-maturating areas during ontogeny. Laterally, they are anterior to the Rolandic fssure and superior to the Sylvian fssure. A parameter used in a regression or other thought to play a signifcant role in neurobe statistical analysis either to attempt to predict havioral syndromes. In genetics, a chromosomal confgu lobes of the brain from the rest of the brain, ration that makes the development of a par which results in a chronic lack of motiva ticular trait likely in normal conditions of tion and self-direction and grossly fattened maturation. A stated idea assumed to be true from sympathetic nervous system whose axons con which a train of reasoning begins and which nect with a peripheral ganglion in the sympa is usually necessary to reach a conclusion. Of or premotor cortex is a dysgranular cortex (tran relating to a child who has not yet learned to sition between the granular prefrontal cortex read and write. The idea that if any two behaviors are both motor cortex possible in a given situation and differ in their probability of occurrence, then engaging in prenatal development the more probable behavior will increase the n. All growth and elaboration of organic likelihood of engaging in the less likely behav structures in a fetus that takes place from the ior in the future. In Piagetian psychology, the second stage terized by cyclic periods of depressed mood, of intellectual development from approxi anxiety, marked affective variability, marked mately 2 to 6 years of age, during which the irritability, lethargy, sleep disturbance, child is egocentric and gradually develops decreased interest in normal activities, and both linguistic and mathematical symbolic a sense of being overwhelmed, whose symp thinking, including the ideas of conservation, toms begin the week before menstruation predicate thinking, and transductive reason and disappear shortly after menstruation. An emotional disorder in women charac preoperational stage terized by cyclic periods of depressed mood, n. In Piagetian psychology, the second stage anxiety, marked affective variability, marked of intellectual development from approxi irritability, lethargy, sleep disturbance, mately 2 to 6 or 7 years of age, during which 397 preoperational thought primary drive the child is egocentric and gradually develops presynaptic neuron both linguistic and mathematical symbolic n. Any nerve cell whose depolarization results thinking, including the ideas of conservation, in the release of neurotransmitters into a par predicate thinking, and transductive reason ticular synapse. An experience of self-satisfaction that occurs when an individual positively evalu preoperational thought ates himself/herself and believes others n. The tendency for the frst information presbyopia encountered to be better remembered and n. Acuity for distant objects is usually unimpaired as it requires less stretch primal scene ing of the lens in order to focus. A general and pervasive loss of cognitive functions such as judgment, memory, and primary auditory cortex language abilities which begins before 65 n. In the motivational theories of Henry it results in subjective deafness although a Murray, motivation that occurs as a result person with an intact auditory thalamus may of environmental circumstances rather react to sounds he/she cannot hear. The colors blue, green, and red, from which all other colors can be made by adding various pressure receptor proportions of each colored light in human n. Some researchers argue that yellow respond to deformation of the shape of the and violet should be added because of sensitiv skin or some internal organs. Magenta, cyan, and yellow are presynaptic the basic colors used in mixing paints or other adj. Of or relating to the portion of a nerve art materials, which is a subtractive process. In contrast, secondary drives primary reinforcement are acquired through learning. A stimulus which increases the likelihood that an act immediately prior to the stimulus primary emotion will increase in frequency and which seems n. The basic set of emotional responses of not to have been acquired by learning but human beings, which commonly is held to to be innate to the organism. As contrasted include anger, contempt, disgust, fear, hap to a secondary reinforcement, which does piness, and sadness, which have been found not initially increase the likelihood of an act to have panculturally recognized facial that precedes it but does so after having been expressions. A difference between male and female only a few items for several seconds in mem organisms in their genitals or gametes. These ory theories that had a dual storage model contrast with secondary sexual characteris and was supplanted by the term short-term tics, such as facial hair, breast enlargement, memory. It receives information from basis of the content of the items most com the ventral posterior nucleus of the thalamus. It is the main receptive area for the sense of touch, kinesthesia (movement), and proprio primary motor cortex ception (body position). Damage pyramidal motor system (voluntary move in the primary somatosensory cortical area ments) and contains the body cells of the results in contralateral hypesthesia, dif pyramidal neurons (Betz cells); axons of fculties in two-point discrimination, posi these neurons descend through the internal tion sense impairments, tactile recognition capsule, forming the upper motor neuron defects, and similar types of body recognition of the corticobulbal and corticospinal pyra disorders. The primary motor cortex is See also somatosensory cortex arranged in such a way that its lower segment controls the movements of the upper part of primary visual cortex the body (face, etc. Cortical area of projection of the visual of the lower part of the body (knees, etc. This around the calcarine fssure in the occipital cortical representation of the motor control lobe.

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Retinal receptor cells Each of these components consists of a fnite show only graded potentials, whereas some number of formal principles, which, paired other neurons with short axons show graded with the set of lexical entries represented potentials to some limit and then generate a in the lexicon (vocabulary store), generate typical action potential. The form and operation of gram grandiose self matical principles are understood as being n. Thoughts which portray the self in an universal and part of the genetic endowment unrealistically grand, important, and nearly of humans. A form of epilepsy which involves the motor grammar, transformational generative grammar) is cortex and so produces tonic-clonic con a grammar formulated in the tradition devel vulsions as part of the seizure process. This tradition assumes that the gram mars of natural languages are subsumed under graphic rating scale the principles of universal grammar, which n. Transformations teristics, which has not had much empirical account for the relationship between active and success. Excessive, uncontrolled, and incoherent surface structure: a transformation has been writing such as in lists or memoirs. This is a applied to generate the surface form of the frequent symptom of mania or hypomania. The notion of transformation remains a central component of most theories of gram grasp re ex mar formulated in the Chomskyan frame n. An involuntary refex in which the fngers work; rule types and levels of representation close around an object that touches or strokes have evolved dramatically, though. The refex quickly disappears grammar, transformational See gram in human infants, and its reappearance or mar, generative maintenance is often a symptom of neurolog ical disorder. A theoretical human grammar that is sup grati cation posed to underlie all the structures of all nat n. The parts of the brain and spinal cord in grandiose ideas which cell bodies and unmyelinated nerve n. Thoughts which are unrealistically grand, fbers, which are gray in color and contrast self-important, and nearly impossible to bring with the shiny yellow-white myelin sheaths of into reality. Although there is signifcant cul actions of an individual in a group and especially tural variation, no consistent cognitive or per as they differ from similar actions when alone. A set of four conversational guides for that is perceived to be cohesive is likely to be maximizing the effciency of conversation perceived as an entity rather than a collection proposed by the philosopher Paul Gricel: of individuals. The collective awareness or experience of knows to be false or for which one lacks a group. The rapid spread of ideas, attitudes, and of relation or relevance, which suggests what behaviors through crowds of people or other is said should pertain to the conversation animals. Any change in the average of a variable be orderly in presentation of information, between experimental groups or any other be brief, and avoid saying things in diffcult characteristic difference between naturally to-understand manners (eschew obfusca occurring groups. These maxims have been widely used in analysis of natural language and in com group dynamics puter models of language. The ongoing processes and changes that go on in functioning groups, including grief affliation, cohesiveness, consciousness, com n. The emotion experienced after a great loss, munication patterns, confict and confict as in the death of a close relative. A feeling of management, decision making, leadership, distress and intense sorrow. The formation of a group from individ the ability to test many people at one time, ual components. In research design, drawback to group tests is the lack of indi it involves assigning subjects to experimental vidualized information that can be obtained conditions. Group testing offers of things, such as furniture, in a group or no safeguards to ensure that individual test noticing that some things appear together. As such, low scores on group grouping error tests can be diffcult to interpret as there is no n. An experimental error caused by the man information to ensure that scores obtained ner in which the data were combined or from a group setting are not attributable to grouped. In most statistical procedures there nonability factors such as motivation, cooper are assumptions that data in a group or range ation, or emotional state. Most approaches children, one of which includes children from use the group to provide emotional support 1 to 5 years of age and one which includes and alternative points of view for the mem children from 6 to 19 years of age, we would bers in dealing with psychological disorders. Any of numerous processes of psychother growth hormone apy done in a group setting. In humans excessive secretion of growth hor group test mone leads to gigantism in children and n. A psychometric evaluation that may be acromegaly in adults and is usually caused by administered by a single examiner to more a benign tumor on the pituitary gland. Galvanic skin response is a change in the group test, the test administrator provides ease with which the skin conducts electricity, directions and imposes time limits while the which tends to decrease when subcutaneous test taker records his/her own responses. The muscles relax and increase when those mus objective nature of most group tests trans cles tense. It is a crude indicator of general lates into more effcient and reliable scoring bodily tension and has been used in inaccu with less training and skill required of the test rate attempts to create a lie detector. Perceptions of taste are Items are then selected which can be formed composed of the sensation from receptors into the hierarchy Guttman Scales require. A ridge or raised portion of the brain; a Guttman scale convoluted surface, as opposed to a sulcus, n. A dependence on a drug in which the usually repeated without conscious decision person feels pleasure or release from ten making in appropriate circumstances. The process of altering metabolism to accommodate the continuing habitat presence of a drug in the body so that the per n. The environment in which an organism, son needs increasing doses to reach a given a species, or an identifable group of people level of reaction (tolerance) and unpleasant live. In ecology, it includes the physical envi and sometimes dangerous consequences ronment, food sources, and other organisms when the substance is withdrawn. A kind of conditioning in which an organ organ of Corti in the inner ear, which trans ism is reinforced for making one of two pos duces pressure waves into electrical impulses sible choices, and, after this behavior has in the auditory nerve. A long, slender, hair been well established, the reinforcement is like cell in the ampullae of the semicircular reversed and the other choice is reinforced canals, which transduces pressure into elec until the organism reliably makes the second trical impulses sent through the afferent ves choice. The strength between a stimulus and Haldol response measured by the number or amount n. The brand name for haloperidol, a high of reinforcement, rapidity of response, and potency, relatively long-lasting antipsychotic response-reinforcement interval. The weakening in response to a sensory dive dyskinesia and extrapyramidal effects stimulus when it is repeated many times or in a which sometimes become endogenous if the prolonged way. Most Its use has been sharply curtailed since the hallucinogens work by stimulating serotonin development of atypical antipsychotic drugs, or catecholamine receptors. Hallucinogens have vide assistance in making transitions such as shown some promise in psychotherapy, but counseling and job placement. Research on person perception demon be auditory, visual, tactile, olfactory, or gus strates that we form initial impressions of tatory; auditory hallucinations are by far the others very quickly. Hallucinations are most com once we form an initial positive impression of monly seen in the psychotic disorders, spe a person, we tend to have a bias in our sub cifcally schizophrenia, although they can sequent perceptions of that individual such be found in severe cases of bipolar disorder, that we pay attention to behavior confrming major depressive disorder, substance abuse our positive impressions, and we discount or and dependence (including alcohol and stim ignore information that is inconsistent with ulant abuse and dependence), and occasion our positive impression. Researchers have also demonstrated a par hallucinogen allel bias for confrming initially negative n. Any drug which causes perception in the impressions, which is sometimes referred to absence of the things perceived. Most hal haloperidol See Haldol lucinogens work by stimulating serotonin or catecholamine receptors. The name assigned to a little boy in a pub their use in the United States has been banned. This was caused by anxi hallucinogenic drug ety over masturbation, hatred and envy of his n. Any drug which causes perception in the father, and sexual desire for his mother and absence of the things perceived. Typically the guilt these entailed, all of which were pro they also produce dreamlike alterations jected onto horses. In psychology, the ability to adapt to sud cal theory and research to understand and den or unexpected changes and stress as well promote health and to prevent and treat ill as to maintain a sense of personal control, ness. Health psychologists recognize that emotional commitment, and high activity health and illness are infuenced by many level in daily life. In gardening, the ability factors, such as behavioral, cognitive, emo to withstand disease and a wide variety of con tional, social, environmental, and biological ditions of temperature, soil, moisture, and factors. A n aver age ca lculated by t ak ing t he recipro scale, knowledge from health psychology can cal of the arithmetic mean of the reciprocals be used to improve health care delivery and of a group of numbers. An attitude or disposition that includes much higher frequencies, and others, such intense feelings of dislike, animosity, hostil as whales, can hear lower frequencies. Although many individuals believe that hatred is an emotion, it is better consid hebephrenic schizophrenia ered an attitude or disposition, because it is n. An archaic term for disorganized schizo long-lasting and not temporary or transient, phrenia, which is characterized by dis as feeting emotions are. Hatred is consid organized speech and behavior and by ered to play a central role in many theories of inappropriate affect. The speech of indi aggression, including those involving terror viduals with this disorder is often incoherent ist groups and other ideologically motivated and accompanied by laughter or silly ges groups. Hawthorne is taken from the Hawthorne plant of the Western Electric Company, in which hedonic tone it was noted that productivity rose as soon as n. The degree of pleasantness or unpleasant workers knew they were being observed by ness of an experience. A set of seven studies of this plant are sometimes considered the birth of the hedonism human relations approach to management. The belief or theory that pleasure is intrin sically good and the natural object of all health psychology human activity, which has been a central n. Health psychology is a feld of psychology point of debate in both philosophy and psy that focuses on health, illness, and health chology. It is often qualifed with short-term 230 helping behaviors versus long-term pleasures, the necessity of and emotional skills and changes in social enduring discomfort to obtain greater plea context. The research on gender differences sure, and group versus individual needs and is more mixed. Helping behaviors are those actions that differences and at other times report none. The term helping behaviors covers a dren sometimes report gender differences wide range of actions, from sharing to volun favoring girls, while others report no gender teerism and philanthropy. In studies of stranger helping different forms of helping, and there can be behaviors, men have been found to help more different motives for helping. However, these fndings helping that has attracted much attention is may be infuenced by certain design charac altruism. For example, these gen whose primary intent is to beneft another der differences are greatest when a helping person. Thus, some easygoing, compliant temperament may be helping behaviors are selfessly motivated more willing to provide help when asked. Similarly to temperament, important social (including health and edu adult personality characteristics are also cation), political, and economic implications. People high in Topics of interest in the study of helping agreeableness and conscientiousness tend to behaviors include age and gender differences, engage in more helping behaviors.