Descriptive Psychopathology: The Signs and Symptoms of ...

216 Section 3: Examination domainsTable 8.5. Symptoms of the melancholia in manic-depressionDistinct quality of mood different from grief (100%)Irritability (75%)Anxiety attacks (60%)Gloomy ruminations (90%)Abnormal and inappropriate pessimism (100%)Psychomotor retardation and prolonged latency of response (80%)Poor concentration or memory (90%)Diminished speed and clarity of thought (90%)Guilt (100%)Hopelessness (50%)Worthlessness (95%)Delusions (33%)Excessive concern for finances (45%)Fear of losing mind (50%)Suicidal thoughts (80%)Suicide attempts (15%)Insomnia (100%)Anorexia (95%)Decreased libido (70%)Symptoms worse in the morning (60%)Headache (60%)Their patients described the experience as “a black cloud or shadow coming overme” or as “a heavy weight on me”, and their features are classic for melancholia. 75Classic syndromes and features of anxietyAcute anxietyAcute anxiety is an adaptive physiologic state associated with flight/fight mechanismsresponsive to external threat. In humans it occurs with the subjectiveexperience of fear. The subjective emotion, physiologic signs of sympatheticsurge, and the behavioral expression of acute anxiety is the same whether theperson is facing real, sudden danger or a phobic situation. Chronically experiencedanxiety differs from acute anxiety in its persistence and lower intensity, butit is similar in other behavioral and physiological aspects to acute anxiety, and isthe same whether the person is facing real and persistent danger or experiencingconstant amorphous unrealistic worry.Precisely what triggers abnormal acute and chronically experienced anxiety isuncertain, but once triggered, the anxiety cascade is a shared final commonpathway. There are no laboratory tests that distinguish normal from abnormally