Members of the mental health community speak their own language, and it’s important to understand it. It’s even more important to speak it, too. Why? Well, it makes communicating with clinicians and other mental health care professionals easier, and it makes reading articles, documentation, research papers, abstracts, medical records, and books a helluva lot more enjoyable if you understand the relevant vocabulary.*
affect: this needs to become part of your vocabulary if it isn’t already. The word ‘affect’ as it is often used in describing mood is short for ‘affect display’ which refers to one’s gestures, facial expressions, and vocal behaviors which serves as indicators for how one is experiencing one’s emotions and experiences/perceptions of the environment. So, if Grace is feeling hypomanic, I might describe her as having a very “aroused and euphoric affect”. When she is feeling confused and depressed, she has a “flat affect” because she is wholly unresponsive and unexpressive.
Axis I: the top-level diagnosis in the DSM-IV’s “multiaxial” system of assessment that usually represents the acute symptoms that need treatment. The Axis I diagnoses are often widely recognizable (e.g. Major Depressive Disorder). In Grace’s case, she has an Axis I Schizophrenia Spectrum Disorder specifically Schizoaffective Disorder-bipolar type diagnosis. Note: The DSM-V, scheduled to be released in May, 2013, may look different. The American Psychiatric Association states:
The subgroup has recommended that DSM-5 collapse Axes I, II, and III into one axis that contains all psychiatric and general medical diagnoses. This change would bring DSM-5 into greater harmony with the single-axis approach used by the international community in the World Health Organization’s (WHO) International Classification of Diseases (ICD).
For more information on the DSM-IV’s “multiaxial” system of assessment including more information on Axes I-V, refer to this link: The Multiaxial System of Diagnosis in the DSM-IV.
Bipolar Disorder NOS (BD-NOS): Bipolar Disorder-Not Otherwise Specified means that a clinician feels strongly that a person meets the criteria for Bipolar Disorder, but it’s hard to tell where the person falls on the bipolar spectrum. There may be periods of depression with a few days of mania or hypomania. There may be more mania or hypomania with less depression. There may be a mix. It may not be clear enough to diagnose Bipolar Disorder Type I or Type II. Or, the patient may be too young but displaying bipolar symptoms clearly enough to warrant a bipolar diagnosis.
cognitive symptoms: Symptoms of schizophrenia are divided into three types–positive, negative, and cognitive. According to the Mayo Clinic, cognitive symptoms involve problems with thought processes. These symptoms may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms. It is interesting to note that Grace struggles with positive, negative, and cognitive symptoms. Cognitive symptoms include:
- Problems with making sense of information
- Difficulty paying attention
- Memory problems (online source)
congruity: Just as the word ‘congruous’ or ‘congruent’ can be used to discuss geometric shapes corresponding exactly when superimposed, one can also discuss emotional or mood congruity. A marked characteristic of people on the schizophrenia spectrum is a flat affect that is not congruous with their state of mind or “inner landscape”, if you will. Part of Grace’s treatment plan is actually working towards mood congruity which is the work of matching her affect to her emotional state. This is also a common problem for those on the bipolar and autism spectrum. In other words, angry affect=angry state of mind. Happy affect=happy state of mind. If she is experiencing suicidal ideation, then she should appear to be deeply upset rather than placid and peaceful as is her habit.
depression: Depression is a big topic. There are feelings of sadness or being “blue” that almost all people experience from time to time. Then, there is true clinical depression or a mood disorder which is part of Bipolar Disorder. For more information about depression, refer to this: Major Depression.
DSM-IV: The Bible for all diagnostic criteria in the mental health industry. Officially, it stands for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; the fifth edition is scheduled to be released in 2013. The DSM is considered to be the ultimate guide to mental disorders, published by the American Psychiatric Association.
euphoria: The surge of energy and exhilaration that is from the brain creating a hormonal high.
“I feel good. I feel too good. I feel weirdly good.”–Grace during one of her hypomanic episodes. Related link.
grandiosity: Feeling larger than life or more capable than one is, superior to others in all things.
“I’m the best writer. You can’t criticize me because I’m a better writer than you. What do you know about writing a book? I’m gonna be famous one day. Be rich and famous and everyone will buy my books because I’m brilliant.”–Grace during one of her hypomanic episodes. Related link.
hypomania: literally means “below mania”. This mood state is recognized by a persistent and pervasive elevated mood state–often it’s euphoria and/or irritability. Hypomanic individuals have a decreased need for sleep, increased energy, oftentimes experience a flight of ideas (racing thoughts), rapid speech, grandiosity, engage in risk-taking behaviors, and, in adolescents and adults, can become hypersexual. One of the key differences between hypomania and mania is functionality. The hypomanic individual is fully functional and not psychotic.
“I have so many ideas in my head all at once, and I can’t grab onto any of them. I’m drowning in ideas! And, you’re in my way! You need to leave me alone so that I can write them all down. Stop talking to me. Get out of my room. I can’t concentrate if you’re talking to me! Get out!!!!”–Grace during a hypomanic episode, experiencing racing thoughts.
For the proposed revision to the upcoming DSM-V’s definition for a “hypomanic episode”, refer to this related link.
mania: mania means “madness, frenzy”, and it’s different from hypomania in that the manic individual often will not know when they have become manic. What hypomanic and manic individuals have in common is “flight of ideas” or “racing thoughts”. The characteristics of hypomania are amplified, and one can even become suspicious and paranoid, developing a persecution complex. Another difference between mania and hypomania is the lack of understanding between actions and consequences. Engaging in risk-taking behavior is prevalent, but there is little understanding that there are consequences and a disregard for them as well. Mania is on a spectrum from hypomania to psychosis–gregarious and euphoric to completely separated from reality.
“I’m gonna climb that rock face and get to the cave up there. I really need to climb, climb, climb. I have to. Climb. Climb. Climb. I can so do it. I’m a great climber.” –Grace, on her way to mania, physically agitated, engaging in risk-taking behaviors, and delusions of grandeur. No, she is not a “great climber”, and she did NOT climb the rock face.
For the proposed revision to the upcoming DSM-V’s definition for a “manic episode”, refer to this related link.
Mood Disorder-NOS: When it comes to childhood onset Bipolar Disorder, this seems to be the blanket diagnosis. Clinicians don’t want to “label” a young patient fearing an incorrect diagnosis because the bipolar diagnosis is seen as burdensome and lifelong. On the other hand, if it’s the right diagnosis, then it’s necessary because it will open doors to necessary services and help families get what they need. If clinicians are leaning towards a bipolar diagnosis but have their doubts, they will often issue a Mood Disorder NOS diagnosis instead.
negative symptoms: Symptoms of schizophrenia are divided into three types–positive, negative, and cognitive. The negative symptoms refer to the absence or diminishment of normal function. They are:
- Loss of interest in everyday activities
- Appearing to lack emotion
- Reduced ability to plan or carry out activities
- Neglect of personal hygiene
- Social withdrawal
- Loss of motivation (online source)
normalize: In my own words, to normalize a behavior is to call something ‘acceptable’, ‘normal’, or even ‘good’ that is ‘unacceptable’, ‘abnormal’ or even ‘bad’. An example is to refuse to seek treatment for a child who is experiencing depressive or hypomanic moods, and telling the child the he or she is “fine”. One would be normalizing the extreme mood for not only the child but for their family members, too, who witness the extreme behaviors that would manifest as a result of a depressed state of mind or a hypomanic or manic mood. We don’t want to normalize such things.
positive symptoms: Symptoms of schizophrenia are divided into three types–positive, negative, and cognitive. The positive symptoms refer to an abnormal distortion of normal behaviors and functioning, and they might include:
- Delusions. These beliefs are not based in reality and usually involve misinterpretation of perception or experience. They are the most common of schizophrenic symptoms.
- Hallucinations. These usually involve seeing or hearing things that don’t exist, although hallucinations can be in any of the senses. Hearing voices is the most common hallucination among people with schizophrenia.
- Thought disorder. Difficulty speaking and organizing thoughts may result in stopping speech midsentence or putting together meaningless words, sometimes known as word salad.
- Disorganized behavior. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation. (online source)
Schizophrenia Spectrum Disorder: As with other mental illnesses like depression and bipolar disorder, schizophrenia falls on a spectrum, too. There’s paranoid, catatonic, disorganized, residual, and undifferentiated schizophrenia. Schizoaffective disorder belongs to the schizophrenia spectrum.
*I will add to this list as I expand the blog.