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SYMPTOMATOLOGY, PSYCHOGNOSIS, AND DIAGNOSIS OF PSYCHOPATHIC DISEASES Boris Sidis, Ph.D., M.D. Boston: R. Badger, 1914 |
APPENDIX I
SCHEME OF EXAMINATION
Heredity:
Diseases with especial reference to specific and mental diseases in remote and
near relatives, especially parents, brothers and sisters.
Habits of ancestors. Education.
Personal History:
Condition of parents prior to birth, and of mother during gestation.
Birth, labor, whether protracted or not; instrumental delivery or not; whether
there were any injuries produced by delivery. Early psychomotor development of
patient; when he began to walk, to talk at proper times, to show normal
physical and mental development. Character and degree of patient’s education.
Occupation; its nature and under what conditions carried on; whether exposed
to the influence of toxic agents, impure air, absence of sun light. Overwork,
physical, or mental. Domestic conditions; food, sleep, light, air,
cleanliness.
Previous diseases, with especial reference to specific and nervous disorders.
Supposed cause of present disease. Initial symptoms. Course of disease and
treatment up to the present time.
Status Praeseus:
General bodily conditions.
Physical anomaly and assymmetry.
State of nutrition; color of skin and mucous membranes; amount of fat deposit
and muscular development.
Respiration; frequency, regularity, and character.
Circulation: Frequency and character of pulse and of heart beat.
Examination of the various viscera of the body, such as digestion,
alimentation, etc., and analysis of the urine and, where deemed advisable, of
the blood.
Trophic Condition:
Skin; dry or moist; pigmentation, atrophy, ulcerations; condition of hair,
nails, teeth, bones and joints; surface temperature and vaso-motor system;
secretions, tears, saliva; condition and development of sexual organs and
functions.
Reflexes: Footsole, patellar, abdominal, biceps and triceps, periosteal,
conjunctival, pupillary (for light and convergence), pharyngeal.
Sexual life, the history of its development.
Kinaesthetic sensations and ideas. Active and passive movements of the various
groups of muscles. Movements of eye balls in various directions. Movements of
lids in opening and closing the eyes; wrinkling forehead; laughing; whistling;
blowing and chewing movements; movements of tongue in various directions;
swallowing movements; movements of vocal cords in speech; movements of head in
various directions; movements of arms and shoulders, of hands and fingers in
various directions. Active and passive movements of trunk, legs, feet and
toes.
Motor co-ordination: Equilibrium with eyes opened and closed; walking,
standing on one foot with eyes open and closed; power in sitting posture, to
place heel of one foot upon toes of other. Ability to produce or reproduce
given positions of various extremities with eyes open and closed; such as
touching nose with tip of finger, or bringing finger tips together after
holding hands apart; power to appreciate small differences in weight in palm
of hands, with the hand at rest and when aided by movement.
Power to recognize and localize tactile impressions of various intensity on
different parts of body and whether patient is in this respect normal,
hyperaesthetic, hypoaesthetic, anaesthetic or paraesthetic.
Recognition of heat and cold and application of differences in temperature on
various parts of the body.
Appreciation of painful stimuli, normal, hyperalgesic, hypalgesic, analgesic,
or paralgesic.
Examination of special senses: taste on either side of tongue, to different
stimuli, such as sweet, bitter, sour, and salt.
Hearing, whether acusis, or paracusis.
Sight: in each eye, normal or defective. Field of vision; appreciation of
colors.
Olfactory sense; normal or defective.
Subjective sensations: of heat and cold; of pain; of taste; of smell, etc.,
whether general or local (during rest and during exertion).
Examination of higher mental functions. Imagination: Visual, motile, audile,
etc.
Recognition of concrete objects and of pictures.
Intellectual operations not habitual to the patient.
Power of conceiving abstract ideas.
Logical acuteness (a) for points and distinctions, (b) for comprehension of
train of reasoning, (c) for disputation by logical processes.
Voluntary and involuntary attention, strong or weak.
Memory of present and past events.
Comprehension of speech; imitation of speech; spontaneous speech; appreciation
of music or melodies. (a) early heard; (b) of such already known to patient;
power of patient to imitate or reproduce them, spontaneous singing or playing.
Recognition of objects, of letters, of written or printed words and phrases;
imitation of them and their reproduction. Naming at sight common objects,
numerals, letters, or words. Reading aloud, writing from dictation, numerals,
letters, words, phrases. Naming objects through direct perception, hearing,
sight, touch, or smell, through all of them or through one sense.
In case of aphasia patient may be unable to recognize an object by sight; an
apple, for instance, but might be able to identify it by smell or taste, or
the contrary may be true.
Ability of patient to make himself understood by gestures and to interpret the
gestures of others. Ability of patient to make articulate sounds, or to make
inarticulate, though rational sounds. Power of patient to make appropriate use
of objects. Ability to walk; to interrelate movements, to correlate different
space volumes. Ability of patient to dress; to recognize various articles of
dress and their use, to handle common utensils, such as spoons, forks; proper
use of food.
Attention: persistency of motor processes (a) without distraction, (b) under
distraction; whether motor process under these conditions is continued or
intermittent.
Amnesic states.
The presence of any of the various forms of amnesia. The presence of double or
multiple consciousness, or personality.
Paramnesia :
Is the paramnesia immediate, or does it occur some time after the first
reproduction?
Attacks of partial or local loss of consciousness, with or without motor
manifestations.
Observations of different forms of automatisms; emergence of subconscious
states.
Perception of flow of time.
Sense of localization upon different surfaces of body.
Perception of relative size.
Secondary sensations: Sound photism, taste; odor; photism or phonism; pain
phonism; light phonism, etc.
Dynamometric power: rapidity of movements; precision of movements; accuracy of
aim; steadiness of hand; intentional and unintentional tremor; abnormal
impressionability; (a) starting at slight impressions; (b) involuntary
imitations; subconscious motor manifestations; unconscious phonation; slow
speech, scanning or staccato speech; speech in which words are run together.
Echolalia; involuntary, or impulsive speech. Inverted, or mirror speech;
handwriting, steady or tremulous; mirror writing; handwriting with left hand;
observe any manifestations of mirror writing.
Appreciation of different forms, such as letters and figures inscribed on
different surfaces of body.
Localization of direction of sounds; appreciation of form; memory and span of
prehension; memory for motor processes; suggestibility of the subject.
1. Suggestion by slight stimuli.
2. Choice suggestion.
3. Suggestion of phrases and acts.
Dreams: their nature, character and frequency; vivid or vague, pleasant,
indifferent, distressing. Memory of dreams; relation of the dreams to the
disease.
Illusions; visual, auditory, olfactory, gustatory, tactile.
Frequency of illusions:
Hallucinations; visual, auditory, olfactory, gustatory, tactile.
Hypnagogic, hypnapagogic hallucinations.
Pseudo-hallucinations.
Frequency of hallucinations.
Disposition—irritable—sensitive to disturbances, vehement in response,
persistent in response. Quarrelsome, gloomy, cheerful, dissatisfied,
complaining, apathetic, fickle. (In relation to self or environment.)
Predominant emotion—sex, love, joy, hope, suspicion, fear, grief, anger,
remorse.
Aesthetic feelings—power of appreciating beauty, power of appreciating the
incongruous, power of appreciating the ludicrous, power of appreciating the
ugly.
Moral feelings (Duties)—to others, to God, to state, to society, to family, to
self. Homicidal tendencies, suicidal tendencies.
Self-indulgence—sex, drink.
Political views, religious views.
Fixed ideas.
Insistent emotions.
Uncontrollable motor impulses, (movements) acts, speech)—automatic, reflex.
Sense of mysteriousness,—anticipation of thoughts, mysterious agencies.
Symbolization.
Formation of new symbolic words and signs.
Character of delusion.
Persistency of delusion.
Change of self—total, partial.
Habitual expressions (attitude, movements, speech)—conscious, unconscious,
automatic, imperative, with motivation.
Simple reaction time.
Cognition time.
Discrimination time.
Choice time.
Association time.
Reaction time is the time which elapses from the moment a certain signal is
given to the moment the subject reacts with some movement. A signal, auditory,
visual or other, is given to the subject who is supposed to react with some
muscular movement as soon as he perceives the signal. The moment the signal is
given it is registered automatically on a time registering apparatus. The
subject’s reaction is also registered on the same apparatus automatically. The
time line between the two points is the simple reaction time. In simple
reaction time only one signal is given and only one particular movement is
made as a reaction to the given signal known before. Of course, simple
reaction time is really physiologically complex, inasmuch as it requires at
least six stages:
1. The stimulation of the peripheral sense organ.
2. Centripetal conduction in the sensory nerve.
3. Centripetal conduction in the sensory centres.
4. Centrifugal conduction in the motor centres.
5. Centrifugal conduction in the spinal cord and motor nerve.
6. Stimulation of muscle to reaction.
Clinical, simple reaction time, given in hundredths of a second, varies from
about 0.12 sec. to 0.35, 0.68 sec. Reaction time varies with the individual,
with age, with state of fatigue, with concentration of attention, with
practice and with the intensity and quality of signal. Sound gives a shorter
reaction time than sight or touch, while taste and smell give the longest
reaction time.
The following may be used as a rough clinical method: Have the patient knock
with a pencil at a moving sheet of paper as fast as possible for five seconds.
Divide the five seconds by the number of points made by the patient on the
paper. The result is simple reaction time. Thus if the patient makes 30 points
then the reaction time will be 5 divided by 30 or about 0.16 sec.
The experimenter should also find out whether the subject’s attention was
given to the signal or to the reaction. In the first case when the attention
is given to the sense-stimulus, and hence termed sensorial reaction, the
reaction time is much longer than when the attention is directed to the
movement made which is termed muscular reaction. Thus Lange who first
discriminated between the two types of reaction finds that in his case the
sensorial time averaged 0.23 sec. while the muscular 0.12 sec. (All the values
of clinical reaction time are given in hundredths of a second.)
Cognition time is determined by having the subject react as soon as a visual
stimulus, such as color, or auditory, such as sound or a word is identified,
or any other sensory stimulus is cognized. The time when the stimulus is given
and the time when the reaction comes are chronographically registered. From
this should be subtracted the subject’s simple reaction time which should be
determined separately. The cognition time varies from about .03 sec.-0.05 sec.
Discrimination time is the time of reaction which takes the subject to
identify one of two or many stimuli. Two or more stimuli are given and the
subject is to react when he identifies a definite stimulus. The stimuli and
the reaction made by the subject are registered automatically, and the
interval between the two is found out. From this time should be subtracted the
simple reaction time and the cognition time. Discrimination time varies from
about 0.15 sec. to 0.10 sec.
Choice time is the time it takes the subject to react with a definite
movement, such as with the right or left hand to a definite stimulus. From
this must be subtracted the simple reaction time and cognition or apperception
time. The choice time varies from 0.06 sec. to 0.4 sec. according to the
complexity of the movements.
Association time is the time it takes for the formation of an association. The
subject is given a word and he is supposed to reply with another word as soon
as possible. The time of the word given and the time of the answer are
registered automatically. The interval is the time requested from which
however should be subtracted the simple reaction and the apperception or
cognition time; the result is the association time. The association time
varies from 0.59 sec. to 0.34 sec.
For clinical purposes a stop watch will do. The moment a word is given to the
patient the watch is set going and is stopped as soon as the patient replies
with some word. In fact, an ordinary watch will do as well. Of course this
method of taking association time is not accurate, but we must remember that
all we need is the clinical relative estimate of the patient's condition. As
Wundt insists “The value of these figures is not their absolute magnitude, but
their utility as checks for introspection.”
Suggestibility in Waking State.
Hypnoidal state.
Hypnoid state.
Hypnoidic state.
Hypnolepsy.
Hypnotization.
State of Hypnosis—sensory suggestions, motor suggestions, post-hypnotic
suggestions, amnesia, personality metamorphosis, hallucinations.
EXAMINATION FOR APHASIA
I. Presence of
orientation, space, time.
II. What is patient's power:
Of producing articulate sounds?
Of comprehending spoken words?
Of imitation or reproduction of speech?
Of spontaneous speech?
Of utterance of sounds, words, and of their combination into phrases and
sentences?
Of analysis of spoken words into sounds and their reverse process of
synthesis?
Test with more familiar and less familiar or even unfamiliar words.
III. What is the patient's power of visual recognition of objects and making
proper use of them?
Of pictures?
Of written and printed words?
Of letters?
If he cannot name them, make signs such as pressing the hand a number of
times.
Test with more familiar and less familiar or even strange objects, foreign
words.
IV. What is patient's power of picturing or representing images, when eyes
closed?
V. What is patient's power of naming objects:
a. When looking at them?
b. When eyes closed?
VI. What is patient's ability of naming letters? Of reading words?
If he cannot name spontaneously (voluntarily), can lie understand when it is
done for him? can he repeat the name soon after? How long can he remember,
when recognizing name of object, letter, word on being told?
Test with the more familiar and then with the less familiar.
VII. What is patient’s power:
Of writing?
Of copying?
Of writing from dictation?
VIII. What is patient's power of recognizing and naming objects through direct
perception of the different senses, such as hearing, touch, smell, etc.?
If patient cannot speak nor write,
IX. What is patient’s power:
Of making himself understood by gestures, and of interpreting gestures of
others?
X. What is patient’s power of counting?
Of working the elementary operations?
Of solving arithmetical problems?
XI. What is patient's power:
Of memorizing (with a given time and with different intervals)?
XII. What is patient’s power:
Of giving a connected account of his history?