PIIMIC Glossary

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Decompensate - See compensate.

Delirium - Acute mental confusion, sometimes with hallucinations, illusions and violence, brought on by a severe physical illness, usually with high fever and disturbed body chemistry, or by drugs and alcohol, or by various poisons.

Delirium tremens - Confusion, trembling and vivid hallucinations usually arising in chronic alcoholics after withdrawal.

Delusion - In mental disorders, a psychotic delusion is a persistent and fixed idea or belief, not open to reason and not in accord with reality. it is a more disabling symptom than the distorted thinking that occurs in some neurotic conditions: the neurotic patient recognizes the irrationality of the belief and is at least partly willing to open it to examination and objective argument. In a psychotic delusion, reality is distorted and evidence is stubbornly misinterpreted to provide a structured support for the belief.

The delusion is not explained by culture or religion but is firmly fixed- and usually held intensely. Delusions are internally generated but the patient labels them as externally validated facts exempted from objective analysis. For example, in a paranoid delusion (which involve persecution or jealousy): "I know the security services are spying on me because a stranger looked at me in the street." (The stranger may in fact be a spy but the evidence cited does not support that conclusion.) In delusions of grandeur, the subject believes he is someone famous or has supernatural powers or exaggerated abilities.

Psychotic delusional thinking often occurs together with Hallucinations (see Glossary). Anti-psychotic medications are usually able to provide effective control of delusions.

Variations of delusions: An autochthonous delusion is sometimes present in schizophrenia. It has no identifiable mental antecedents, no evidence, and bypasses logical justification, but arises as a fully formed notion, not open to argument. Example: patient maintained his head had been split by an axe, insisted it was not a figure of speech but had really happened, despite being unable top produce any grounds for his belief. A non-psychotic variation related to delusion is known as a obsessional ruminations, which are unwanted, persistently intrusive and sometimes dominating thoughts that the patient experiences as "alien" thoughts (contrary to the patient's own values or intentions). Unlike psychotic delusions, they are recognized by the patient as being internally generated; they are regarded as unreasonable, and they are usually resisted. Some patients feel tormented by these thoughts and believe they are going mad. Usually diagnosed as obsessional neurosis (not psychotic) but can be associated with psychotic disorders - including schizophrenia where thought intrusions can occur between psychotic episodes and be recognized as internally generated.

Dementia - Refers to a group of brain diseases, including Alzheimer’s, associated with advanced age and causing a general decline in all areas of mental ability. Advanced symptoms can include paranoia, depression, and psychotic delusions. About 90 per cent of dementing disorders can not be reversed but some forms and some symptoms can be alleviated. Dementia is becoming an increasing problem in the modern developed world as more people live longer - and the general population ages. Dementia is a great health problem of old age, affecting one in five people over age 75 to some degree. Patients become increasingly difficult to live with, and may need constant nursing care. See Brain Disease in the Glossary.

Dementia praecox - Obsolete term for severe schizophrenia when it developed in teenagers.

Dependence - Abuse of alcohol and drugs can cause both physical and emotional dependence, resulting in severe withdrawal symptoms. See Drug abuse in the Glossary.

Depot injection - Giving an antipsychotic or other drug by intramuscular injection in a long-lasting buffered formulation. Not all antipsychotic drugs are available in Canada in this form.

Depression – Severe Depression (also called major or clinical depression as compared with dysthymia or mild, temporary depression) has a high suicide rate (in the range of 15 per cent of those affected) but responds well to psychiatric treatment. The diagnosis is indicated when a sad mood and pessimistic views of the future last more than two weeks for most of the time, and strongly affect sleep, appetite, energy and libido. Other diagnostic criteria include impairment in one or more important areas of function (e.g. social or occupational). There may be no obvious external cause for such depression. Often occurs in tandem with anxiety, or sometimes with other mental disorders. Onset is most likely in the teens, late thirties or old age. Symptoms of severe depression usually respond very well to a variety of treatments including psychotropic medication, guidance, attention to physical health and life-style habits. Other common forms of depression: Dysthymia or depressive personality, is characterized by low-level, chronic feelings of sadness; and Seasonal Affective Disorder - winter blues or cabin fever - which often responds well to repeated exposure to a controlled-intensity light source. Police need to know that persons with severe depression may become psychotic, disabled, or suicidal, and especially so when untreated, or when there is substance dependency or another mental disorder. Abruptly discontinuing anti-depressant medication can lead to rapid and severe relapse, especially when the subject is stressed.

Derangement - An obsolete term for a "disarranged" type of mental illness. Now applied to wild, disturbed behaviour arising from any source.

Desensitization - A type of behaviour therapy used to treat phobias.

Designer drugs - Some of these cheap illegal drugs are supplied in toxic concentrations or contain toxic impurities which can cause seizures, psychosis, permanent brain damage, and death.

Diagnosis –a label on a set of signs and symptoms, according to established medical criteria. See DSM-IV in Glossary for general criteria for a Mental Disorder. Diagnostic descriptions of disorders in DSM-IV are listed at: www.psych-net.org/disorders.html

Disorder - Interchangeable with "illness." Disorder is mostly used in legal and medical terminology, and in the BC Mental Health Act, and therefore in PIIMIC. "Illness" is considered to be more appropriate in community and advocacy use.

Disorientation - Muddled, confused speech and behaviour, seemingly half asleep: subject not aware of time, date, present location, name or address. Usually caused by intoxication, brain injury or psychiatric disorder.

Dissociative disorders - Loss of a particular mental function (through disturbance or alteration of the normally integrative functions of identity, memory or consciousness) as though it was blocked off from the rest of the mind, e.g. hysterical amnesia: unable to remember personal history or a traumatic event but can learn new material and function normally otherwise. Mild forms are common in everyday life but they can become severe and even disabling, causing numbness, distress, and depression when active. They are triggered by stimuli that invoke suppressed or submerged traumatic experiences in childhood or adult life, e.g. physical, sexual or emotional abuse, war experience, severe accident, rape. Examples are: DID or Dissociative Identity Disorder, formerly called multiple personality disorder; and various forms of Amnesia. Post Traumatic Stress Disorder is similar but is classified as an anxiety disorder.

Drug abuse (addiction or dependence) - There are many reasons for drug abuse, including calming or exciting effects, escape from reality, search for awareness & mysticism, masking pain, blunting anxiety, fighting depression, escaping mental or physical deficits, lightening other burdens, improving performance, etc. Such drugs often require increasing dosage to obtain the same effect, leading to mental and physical dependence and possibly severe withdrawal symptoms with high risks (see Withdrawal). Injected drugs tend to be highly addictive and risky. Street and designer drugs can be toxic through either purity or impurity. Drugs in combination with each other or with alcohol can cause endangering symptoms. When hard drugs or alcohol are linked with an untreated psychiatric disorder, the combination increases the risks of harm, endangerment or violence. In a separate and safer category are tobacco or marijuana, popular for their soothing mental effect.

Drug poisoning - Excessive doses can be accidental (children, elderly confused people; drug abuse; homicide) or deliberate (suicidal). Subject should be seen by a physician immediately. Bring the drug container or packaging and leftover loose pills to help identify it. In suicide, the most common overdoses are benzodiazepines, antidepressants, and painkillers.

Dual diagnosis - used in this website generically to mean a psychiatric disorder in combination with another diagnostic condition such as:
a) drug addiction and/or alcoholism (this is also a specialized use of the term, depending on context);
b) a congenital mental disorder or handicap, example - Fetal Alcohol Syndrome;
c) a severe personality disorder, example - psychopathy.

Dual Disorder – According to current regional health usage in BC in early 2003, dual disorder means a psychiatric disorder co-occurring with a developmental (mentally-challenged) disorder. See Glossary item on Concurrent Disorder. Sometimes also used to indicate a psychiatric disorder co-occurring with a substance abuse disorder.

DUP (duration of untreated psychosis) - The period between the onset of early symptoms of psychiatric disorder and the start of treatment. Often two or three years or more, due to stigma, hiding, and denial; or sometimes due to error in diagnosis, for example diagnosing and treating a person for depression when the true cause of the symptoms is oncoming schizophrenia or bipolar disorder. The shorter the DUP, the better the outlook for appropriate treatment and recovery. Increasing emphasis is being placed on early intervention programs (see EPI in the Glossary) in order to shorten DUP.

DSM-IV – The Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, published by the American Psychiatric Association. The bible of clinical psychiatry, used as a reference for clinical diagnostic criteria. It gives the following general definition of Mental Disorder: “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning*) or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom.” *For example, social or occupational functioning. Diagnostic criteria and descriptions of disorders in DSM-IV are listed at: www.psych-net.org/disorders.html

Dysthymic Disorder or dysthymia – chronic mild depression. Diagnostic criteria include symptoms lasting at least two years in adults, or at least one year in children. Can become disabling, especially when coupled with another mental disorder, and/or substance abuse, and/or stressful circumstances.