The observable expression of emotion — what you see on the patient's face and in their body language. Distinct from mood, which is the subjective internal state the patient reports. A patient may report feeling fine (mood) while appearing flat or tearful (affect).

A medication side effect causing intense restlessness and urge to move — often misidentified as anxiety or agitation. Commonly caused by antipsychotics and some antidepressants (especially SSRIs at higher doses). Patients describe it as "can't sit still" or "crawling out of my skin."

Loss of pleasure or interest in activities previously enjoyed. A core feature of major depressive disorder and one of the two symptoms required for MDD diagnosis (along with depressed mood). Patients may not use this word — they describe it as "nothing feels fun anymore" or "I don't care about anything."

Persistent depressive disorder — a chronic, lower-grade depression lasting 2 or more years in adults. Patients often don't identify as depressed because the mood state feels like their baseline. "I've always been this way" is a common presentation.

A disruption in the normal integration of consciousness, memory, identity, or perception. Ranges from mild (highway hypnosis, daydreaming) to severe (dissociative identity disorder). Trauma histories often underlie dissociative presentations.

A baseline or stable, non-depressed, non-manic mood state. Not the same as happiness — it means the absence of pathological mood elevation or depression. A treatment goal in bipolar disorder.

Rapid, loosely connected stream of thought — thoughts move quickly from one topic to the next, often with some discernible connection. Associated with mania and hypomania. Distinct from loose associations, where the connections between ideas are absent.

Inflated sense of self-importance, ability, or identity. In mania, may manifest as belief in special powers, connections to famous people, or extraordinary talents. Distinct from high self-esteem — grandiosity is disconnected from reality.

Rapid, unpredictable shifts in emotional expression — laughing then crying within the same conversation, for example. Associated with bipolar disorder, borderline personality disorder, TBI, and some neurological conditions.

A pattern of thought characterized by mistrust and suspicion of others' motives. On a spectrum from subclinical suspiciousness to frank delusions. Important to distinguish: Is this realistic concern based on the patient's actual situation, or a distortion beyond what their circumstances warrant?

Rapid, loud, difficult-to-interrupt speech — the patient seems driven to keep talking. Associated with mania, hypomania, anxiety, and stimulant use. Note rate, volume, and whether the patient can be redirected.

A state in which a person has lost contact with reality. Core features include hallucinations (perceptions without a stimulus) and delusions (fixed false beliefs not shared by their culture). Psychosis is a symptom, not a diagnosis — it can occur in schizophrenia, bipolar disorder, severe depression, substance use, and medical conditions.

A potentially life-threatening reaction to excess serotonergic activity — often from combining serotonergic medications. Triad: mental status changes, autonomic instability, neuromuscular abnormalities. Can be triggered by combinations including SSRIs, SNRIs, triptans, tramadol, linezolid, and St. John's Wort.

Suicidal Ideation / Homicidal Ideation. Always assess and document at each psychiatric encounter. Passive SI (wishes to be dead) is distinct from active SI (plans, intent, means). Document specifically what the patient reported.

Responses to questions that veer off topic and never return to the original point. Different from circumstantiality, where the patient eventually gets to the point but takes a long indirect route. Both can indicate thought process disorganization.