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SYMPTOMATOLOGY, PSYCHOGNOSIS, AND DIAGNOSIS OF PSYCHOPATHIC DISEASES
Boris Sidis, Ph.D., M.D.
Boston: R. Badger, 1914
SCHEME OF EXAMINATION
Diseases with especial reference to specific and mental diseases in remote and near relatives, especially parents, brothers and sisters.
Habits of ancestors. Education.
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.
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.
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.
The presence of any of the various forms of amnesia. The presence of double or multiple consciousness, or personality.
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.
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.
Political views, religious views.
Uncontrollable motor impulses, (movements) acts, speech)—automatic, reflex.
Sense of mysteriousness,—anticipation of thoughts, mysterious agencies.
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.
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.
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 written and printed words?
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 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?
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