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Selected Correspondence of L. E. J. Brouwer - - Dymocks

Behavior that is strange and incomprehensible to others; includes behavior that could be interpreted as a response to auditory hallucinations or thought interference. Patient exhibits persistent mannerisms, stereotypies, posturing, catalepsy, stupor, or excitement that is not explicable by affective change.

Patient is markedly overactive. This includes motor, social, and sexual activity. Patient is excessively involved in activities with high potential for painful consequences that are not recognized, e. Patient experiences difficulty concentrating on what is going on around him or her because attention is too easily drawn to irrelevant or extraneous factors.

Patient sleeps less but there is no complaint of insomnia. Extra waking time is usually taken up with excessive activities. Patient shows excessive repetitive activity, such as fidgety restlessness, wringing of hands, or pacing up and down, all usually accompanied by expression of mental anguish. Patient complains that he or she feels slowed and unable to move. Others may report a subjective feeling of retardation, or retardation may be noted by the examining clinician. Subjective complaints of being excessively tired with no energy.


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Speech difficult to understand. Speech that makes communication difficult because of lack of logical or understandable organization; does not include dysarthria or speech impediment. Normal grammatical sentence construction has broken down; includes "word salad" and should only be rated conservatively for extreme forms of formal thought disorder. Positive formal thought disorder. Patient has fluent speech but tends to communicate poorly due to neologisms, bizarre use of words, derailments, or loosening of associations.

Contains 11 Collections and/or Records:

Negative formal thought disorder. Includes paucity of thought, frequent thought blocking, poverty of speech, or poverty of content of speech. Patient is much more talkative than usual or feels under pressure to continue talking; includes manic type of formal thought disorder with clang associations, punning and rhyming, etc. Patient experiences thoughts racing through his or her head or others observe flights of ideas and find difficulty in following what the patient is saying or in interrupting because of the rapidity and quantity of speech.

Patient's emotional responses are restricted in range, and at interview there is an impression of bland indifference or "lack of contact". Where the patient's emotional responses are persistently flat and show a complete failure to "resonate" to external change. The difference between restricted and blunted affect should be regarded as one of degree, with "blunted" only being rated in extreme cases. Patient's emotional responses are inappropriate to the circumstance, e. Patients predominant mood is one of elation.

Patient's mood is predominantly irritable. Persistently low or depressed mood, irritable and sad mood, or pervasive loss of interest. Score 1 if present for at least 1 week, 2 if present for 2 weeks, and 3 if present for 1 month. Pervasive inability to enjoy any activity. This includes marked loss of interest or loss of libido. Score 1 for duration of 1 week, 2 for 2 weeks, and 3 for 1 month.


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Clear and persistent reduction in sexual interest or drive compared with levels before disease onset. Subjective complaint of being unable to think clearly, make decisions, etc. Extreme feelings of guilt and unworthiness. This may be of delusional intensity "worst person in the whole world". Preoccupation with thoughts of death not necessarily own ; includes thinking of suicide, wishing to be dead, and attempts to kill self. Patient complains of being unable to get to sleep and lies awake for at least 1 hour.

Only score this item if there is evidence of insomnia. Sleep is disturbed, the patient wakes in the middle of sleep and has trouble going back to sleep most majority. Patient complains of persistently waking up at least 1 hour earlier than usual waking time. Patient complains of sleeping too much. Score 1 if present for 1 week, 2 for 2 weeks, and 3 for 1 month.

Subjective complaint that the patient has a poor appetite not necessarily observed to be eating less. Includes all delusions with persecutory ideation.


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Well-organized delusions:. Illness is characterized by a series of well-organized or well-systematized delusions. Patient believes that he or she is an exceptional person with special powers, plans, talents, or abilities. Rate positively here if overvalued idea, but if delusional in quality also score item 57 grandiose delusions.

Patient has grossly exaggerated sense of his or her own importance, has exceptional abilities, or believes that he or she is rich or famous, titled, or related to royalty. Also included are delusions of identification with God, angels, the Messiah, etc also see item Events, objects, or other people in the patient's immediate surroundings have a special significance, often of a persecutory nature; includes ideas of reference from the television, radio, or newspapers, where the patient believes that these are providing instructions or prescribing certain behavior.

Correspondence

Strange, absurd, or fantastic delusions whose content may have a mystical, magical, or "science fiction" quality. Include all "made" sensations, emotions, or actions. Include all experiences of influence where the patient knows that his or her own thoughts, feelings, impulses, volitional acts, or somatic sensations are controlled or imposed by an external agency. The patient perceives something in the outside world that triggers a special, significant, relatively non understandable belief of which he or she is certain and that is in some way loosely linked to the triggering perception.

Other primary delusions. Includes delusional mood and delusional ideas. Delusional mood is a strange mood in which the environment appears changed in a threatening way but the significance of the change cannot be understood by the patient, who is usually tense, anxious, or bewildered. This can lead to a delusional belief.

A delusional idea appears abruptly in the patient's mind fully developed and unheralded by any related thoughts. Delusions and hallucinations lasting for 1 week. Any type of delusion accompanied by hallucinations of any type lasting l week 0, absent; 1, present. Persecutory or jealous content delusions accompanied by hallucinations of any type:. This is self-explanatory, but note that abnormal beliefs are of delusional intensity and quality and are accompanied by true hallucinations. The patient recognizes that thoughts are being put into his or her head that are not the patient's own and have probably or obviously been imposed by an outside agency.

The patient experiences thoughts ceasing in his or her head and may be interpreted as an external agency removing or stealing thoughts from his or her head. The patient experiences thoughts diffusing out of his or her head, in such a manner that they are shared with others or even experienced by others. The patient maintains the firm belief that he or she has committed some type of sin or crime or has caused suffering to others despite the lack of any objective evidence whatsoever to support the belief. The patient maintains the firm belief that he or she has lost all or most of their money or possessions and become poor, despite the lack of any objective evidence whatsoever to support the belief.

The patient maintains the firm belief that that some part of his or her body has disappeared, rotted or is affected by a malignant or devastating disease, despite the lack of any objective evidence whatsoever to support the belief. Score l if the patient experiences thoughts repeated or echoed in his or her head. Score 2 if thoughts are repeated by a voice outside the patient's head. Third-person auditory hallucinations.

Contains 11 Collections and/or Records:

Two or more voices discussing the patient in the third person. Score if either "true" or "pseudo-" hallucinations, i. Patient hears voices describing his or her actions, sensations, or emotions as they occur. Score if there are possible "pseudo-" hallucinations, or definite true hallucinations. Voices talking to the patient in an accusatory, abusive, or persecutory manner. Other non affective auditory hallucinations. Any other kind of auditory hallucinations; includes pleasant or neutral voices and nonverbal hallucinations 0, absent; 1, present. Non affective hallucination.

Hallucinations in which the content has no apparent relationship to elation or depression.

Correspondence Management by Acumen Solutions

Continued use, despite the knowledge of a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use of alcohol; or recurrent use in situations which are physically prejudicial; or symptoms clearly indicative of dependence. One of the items described above must have occurred persistently for at least a month or repeatedly over a longer period. Continued use, despite the knowledge of a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use of cannabis; or recurrent use in situations which are physically prejudicial; or symptoms clearly indicative of dependence.

Continued use, despite the knowledge of a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use of other substances; or recurrent use in situations which are physically prejudicial; or symptoms clearly indicative of dependence.

Abuse or dependence as defined in item 78 accompanied by any of the preceding items describing psychopathology.

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Abuse or dependence as defined in item 79 accompanied by any of the preceding items describing psychopathology. Abuse or dependence as defined in item 80 accompanied by any of the preceding items describing psychopathology. Information not credible. Patient gives misleading answers to questions and provides a jumbled, incoherent, or inconsistent account. Patient is unable to recognize that his or her experiences are abnormal or that they are the product of an anomalous mental process, or recognizes that the experiences are abnormal but gives a delusional explanation.

Interviewer finds difficulty in establishing contact with the patient, who appears remote or cut off; does not include patients who are difficult to interview because of hostility or irritability. Deterioration from premorbid level of functioning. Patient does not regain premorbid social, occupational, or emotional functioning after an acute episode of illness. Schizophrenic symptoms respond to neuroleptics.