Appendix 1: Terms in the field of Psychiatry and Neurology – Glossary of Psychiatry A

D

Da Costa's syndrome	Neurocirculatory asthenia; "soldier's heart"; a functional disorder of the circulatory system that is usually a part of an anxiety state or secondary to hyperventilation.
Decompensation	The deterioration of existing defenses, leading to an exacerbation of pathological behavior.
Defense mechanism	Automatic psychological process that protects the individual against anxiety and from awareness of internal or external stressors or dangers. Defense mechanisms mediate the individual's reaction to emotional conflicts and to external stressors. Some defense mechanisms (e.g., projection, splitting, and acting out) are almost invariably maladaptive. Others, such as suppression and denial, may be either maladaptive or adaptive, depending on their severity, their inflexibility, and the context in which they occur.
Déjà pensé	In Déjà pensé, a completely new thought sounds familiar to the person and he feels as he has thought the same thing before at some time.
Déjà vu	A paramnesia consisting of the sensation or illusion that one is seeing what one has seen before an individual develops an intense feeling of having 'been here before'.
Delirium (a.k.a. acute confusional state)	An acute organic brain syndrome secondary to physical causes in which consciousness is affected and disorientation results often associated with illusions, visual hallucinations and persecutory ideation. A syndrome due to brain disturbance and characterised by impairment of consciousness. The mood is commonly one of terror and bewilderment, accompanied by transient delusions and hallucinatory experiences. Afterwards there is more or less complete amnesia for external events that occurred during the period of illness.
Delusion Delusional conviction Delusional mood Delusional perception Delusional jealousy Delusion of reference	A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture (e.g., it is not an article of religious faith). When a false belief involves a value judgment, it is regarded as a delusion only when the judgment is so extreme as to defy credibility. occurs on a continuum and can sometimes be inferred from an individual's behavior. It is often difficult to distinguish between a delusion and an overvalued idea (in which case the individual has an unreasonable belief or idea but does not hold it as firmly as is the case with a delusion). Delusions are subdivided according to their content. Some of the more common types are: bizarre; delusional jealousy; grandiose; delusion of reference; persecutory; somatic; thought broadcasting; thought insertion. Also known as wahnstimmung, a feeling that something unusual is about to happen of special significance for that person. A normal perception which has become highly invested with significance and which has become incorporated into a delusional system, e.g. 'when I saw the traffic lights turn red I knew that the dog I was walking was a Nazi and a lesbian Nazi at that'. The delusion that one's sexual partner is unfaithful. erotomanic A delusion that another person, usually of higher status, is in love with the individual. A delusion whose theme is that events, objects, or other persons in one's immediate environment have a particular and unusual significance. These delusions are usually of a negative or pejorative nature, but also may be grandiose in content. This differs from an idea of reference, in which the false belief is not as firmly held nor as fully organized into a true belief. Defence Mechanism - a way of dealing with aspects of the self, which, if consciously experienced, might give rise to unbearable anxiety or psychic pain. Delusions - false beliefs that persist in spite of incontrovertible evidence to the contrary and which are out of harmony with the individual's cultural and religious background. Primary delusions - arise 'out of the blue' Sudden Delusional (Autochthonous) Ideas - delusional ideas suddenly entering consciousness like a 'brainwave', unrelated to previous real or psychic events. Delusional Perception - a normal perception is suddenly interpreted in a delusional manner - one of Schneider's first rank symptoms of schizophrenia. Delusional Mood - a state of perplexity in which the patient has some sense of some inexplicable change in his environment. He senses 'something going on' which he cannot identify, but which has a peculiar significance for him. Secondary delusions - these arise from a 'morbid' experience such as an hallucination.
Dementia	An chronic organic mental illness which produces a global deterioration in cognitive abilities and which usually runs a deteriorating course.
Dementia praecox	Psychiatrist Emil Kraepelinwas the first to draw a distinction between what he termed dementia praecox("premature dementia") and other psychotic illnesses. In 1911, dementia praecox was renamed schizophreniaby psychiatrist Eugen Bleuler, who found Kraepelin's term to be misleading, as the disorder is not a form of dementia, premature or otherwise.
Dementia pugilistica (syn. "chronic traumatic encephalopathy", "pugilistic Parkinson's syndrome", "boxer's syndrome", and "punch-drunk syndrome")	is a neurologicaldisorder which affects career boxers and others who receive multiple dazing blows to the head. The condition develops over a period of years, with the average time of onset being about 16 years after the start of a career in boxing.
Denial	A defense mechanism where certain information is not accessed by the conscious mind. Denial is related to repression, a similar defense mechanism, but denial is more pronounced or intense. Denial involves some impairment of reality. Denial would be operating (as an example) if a cardiac patient who has been warned about the potential fatal outcome of engaging in heavy work, decides to start building a wall of heavy stones. The person refuses to recognise the reality of a traumatic perception.
Depersonalization	An alteration in the perception or experience of the self so that one feels detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream). An experience where the self is felt to be unreal, detached from reality or different in some way. Depersonalisation can be triggered by tiredness, dissociative episodes or partial epileptic seizures. A feeling of some change in the self, associated with a sense of detachment from one's own body. Perception fails to awaken a feeling of reality, actions seem mechanical and the patient feels like an apathetic spectator of his own activities.
Depression	A subjective feeling of sadness, grief or dejection. The word is used to describe a symptom and also is a diagnostic label.An affective disorder characterised by a profound and persistent sadness.
Derailment ("loosening of associations")	A pattern of speech in which a person's ideas slip off one track onto another that is completely unrelated or only obliquely related. In moving from one sentence or clause to another, the person shifts the topic idiosyncratically from one frame of reference to another and things may be said in juxtaposition that lack a meaningful relationship. This disturbance occurs between clauses, in contrast to incoherence, in which the disturbance is within clauses. An occasional change of topic without warning or obvious connection does not constitute derailment.
Derealization	An alteration in the perception or experience of the external world so that it seems strange or unreal (e.g., people may seem unfamiliar or mechanical). A sense of one's surroundings lacking reality, often appearing dull, grey and lifeless.
Dereistic	Mental activity that is not in accordance with reality, logic, or experience.
Detachment	A behavior pattern characterized by general aloofness in interpersonal contact; may include intellectualization, denial, and superficiality.
Diplopia	Double vision due to paralysis of the ocular muscles; seen in inhalant intoxication and other conditions affecting the oculomotor nerve.
Disconnection syndrome	Term coined by Norman Geschwind (1926-1984) to describe the interruption of information transferred from one brain region to another.
Disinhibition	Freedom to act according to one's inner drives or feelings, with less regard for restraints imposed by cultural norms or one's superego; removal of an inhibitory, constraining, or limiting influence, as in the escape from higher cortical control in neurologic injury, or in uncontrolled firing of impulses, as when a drug interferes with the usual limiting or inhibiting action of GABA within the central nervous system.
Disorders of Form of Thinking (Formal Thought Disorder)	There is a lack of logical association between succeeding thoughts. It gives rise to incoherent speech (in the absence of brain pathology). lt is impossible to follow the patients train of thought (c.f. loosening of associations; knight's move thinking).
Disorientation	Confusion about the time of day, date, or season (time), where one is (place), or who one is (person).
Dysphoric mood	An unpleasant mood, such as sadness, anxiety, or irritability.
Displacement	A defense mechanism, operating unconsciously, in which emotions, ideas, or wishes are transferred from their original object to a more acceptable substitute; often used to allay anxiety.
Dissociation	A disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic.
Distractibility	The inability to maintain attention, that is, the shifting from one area or topic to another with minimal provocation, or attention being drawn too frequently to unimportant or irrelevant external stimuli.
Doppelgänger	The Doppelgängeris a phenomenon in which the person feels that his exact “double” is present alongside him every time and goes with him wherever he goes.
Double bind	Interaction in which one person demands a response to a message containing mutually contradictory signals, while the other person is unable either to comment on the incongruity or to escape from the situation.
Drive	Basic urge, instinct, motivation; a term used to avoid confusion with the more purely biological concept of instinct.
Dyad	A two-person relationship, such as the therapeutic relationship between doctor and patient in individual psychotherapy.
Dysarthria	Imperfect articulation of speech due to disturbances of muscular control or incoordination.
Dysgeusia	Perversion of the sense of taste.
Dyskinesia	Distortion of voluntary movements with involuntary muscular activity. Abnormal movements as in tardive dyskinesia a late onset onet of abnormal involuntary movements. Tardive dyskinesia is conventionally thought a late side effect of first generation antipsychotics, but some abnormal movements were seen in schizophrenia before the introduction of antipsychotics. A wide variety of movement patterns e.g. choreoathetosis, rocking, pouting, with a wide range of causes such as drugs, schizophrenia, structural brain disease.
Dyspraxia	A dyspraxia is a difficulty with a previously learnt or acquired movement or skill. An example might be a dressing dyspraxia or a constructional dyspraxia. Dyspraxias tend to indicate cortical damage, particularly in the parietal lobe region.
Dyslexia	Inability or difficulty in reading, including word-blindness and a tendency to reverse letters and words in reading and writing.
Dyssomnia	Primary disorders of sleep or wakefulness characterized by insomnia or hypersomnia as the major presenting symptom. Dyssomnias are disorders of the amount, quality, or timing of sleep.
Dystonia	Disordered tonicity of muscles.

E

Echo de la pensée	Meaning "thought echo" in French, thoughts seem to be spoken aloud just after being produced. The patient hears the 'echo' of his thoughts in the form of a voice after he has made the thought. See also Gedankenlautwerden and Thought Sonorization.
Echolalia	A speech disorder in which the person inappropriately and automatically repeats the last words he or she has heard. Palilalia is a form of echolalia in which the last syllable heard is repeated endlessly.
Echopraxia	A movement disorder in which the person automatically and inappropriately imitates or mirrors the movements of another. Perseveration and a return of the grasp reflex may occur.
Ego	In psychoanalytic theory, one of the three major divisions in the model of the psychic apparatus, the others being the id and the superego. The ego represents the sum of certain mental mechanisms, such as perception and memory, and specific defense mechanisms. It serves to mediate between the demands of primitive instinctual drives (the id), of internalized parental and social prohibitions (the superego), and of reality. The compromises between these forces achieved by the ego tend to resolve intrapsychic conflict and serve an adaptive and executive function. Psychiatric usage of the term should not be confused with common usage, which connotes self-love or selfishness.
Ego Ideal	The part of the personality that comprises the aims and goals for the self; usually refers to the conscious or unconscious emulation of significant figures with whom one has identified. The ego ideal emphasizes what one should be or do in contrast to what one should not be or not do.
Ego-dystonic	Referring to aspects of a person's behavior, thoughts, and attitudes that are viewed by the self as repugnant or inconsistent with the total personality.
Eidetic image	Unusually vivid and apparently exact mental image; may be a memory, fantasy, or dream.
Elaboration	An unconscious process consisting of expansion and embellishment of detail, especially with reference to a symbol or representation in a dream.
Elevated mood	An exaggerated feeling of well-being, or euphoria or elation. A person with elevated mood may describe feeling "high," "ecstatic," "on top of the world," or "up in the clouds."
Emotional Lability	A fluctuation of emotions more marked and intense than the existing circumstances might be expected to produce.
Engram	A memory trace; a neurophysiological process that accounts for persistence of memory
Entgleisen	Literally means jumping off the rails. Alternate term used for derailment of thought (a morbid form of loosening of association or #asyndesis). A Schneiderian term by origin. In this form of thought the patient jumps from one topic to another during converrsation and both topics have literally no connection with each other. This is in contrast with flight of ideas where connection is present between one topic and another.
Epigenesis	Originally from the Greek "epi" (on, upon, on top of) and "genesis" (origin); the theory that the embryo is not preformed in the ovum or the sperm, but that it develops gradually by the successive formation of new parts. The concept has been extended to other areas of medicine, with different shades of meaning. Some of the other meanings are as follows: 1. Any change in an organism that is due to outside influences rather than to genetically determined ones. 2. The occurrence of secondary symptoms as a result of disease. 3. Developmental factors, and specifically the gene-environment interactions, that contribute to development. 4. The appearance of new functions that are not predictable on the basis of knowledge of the part-processes that have been combined. 5. The appearance of specific features at each stage of development, such as the different goals and risks that Erikson described for the eight stages of human life (trust vs. mistrust, autonomy vs. doubt, etc.). The life cycle theory adheres to the epigenetic principle in that each stage of development is characterized by crises or challenges that must be satisfactorily resolved if development is to proceed normally.
Ethnology	A science that concerns itself with the division of human beings into races and their origin, distribution, relations, and characteristics.
Euthymic	Mood in the "normal" range, which implies the absence of depressed or elevated mood.
Expansive mood	Lack of restraint in expressing one's feelings, frequently with an overvaluation of one's significance or importance. irritable Easily annoyed and provoked to anger.
Extinction	The weakening of a reinforced operant response as a result of ceasing reinforcement. See also operant conditioning. Also, the elimination of a conditioned response by repeated presentations of a conditioned stimulus without the unconditioned stimulus. See also respondent conditioning.
Extraversion	A state in which attention and energies are largely directed outward from the self as opposed to inward toward the self, as in introversion.