Application

Using the phenomenon correctly inside a realistic clinical context — applying the concept to a presentation, sequencing enquiry, and reasoning about what the finding does and does not license.

Cognitive operation: SEQUENCE A CLINICAL ENQUIRY · 205 items

Deliberate practice, not a test. Items are organised by target (phenomenon or defence) and by evidence axis. Nothing here is scored, graded or recorded — you weigh the prompt, then reveal the worked phenomenological reasoning. Fictional teaching material.

• Apply · Abnormal Emotional Reaction open

  Abnormal Emotional Reaction

  A patient has felt persistently low in mood for several months, with the low mood present most days regardless of what is actually happening in her life, worsening steadily despite generally positive circumstances. Before revealing the answer: is this an abnormal emotional reaction?

• Apply · Abnormal Expression of Emotion open

  Abnormal Expression of Emotion

  A man involved in a minor car accident becomes intensely distressed and remains so, out of all proportion to the event, for several weeks afterward, describing his own reaction as clearly excessive but unable to shift it; how he outwardly shows this distress is unremarkable. Before revealing the answer: is this an abnormal expression of emotion?

• Apply · Acute Dystonia open

  Acute Dystonia

  A patient with a years-long history of catatonic schizophrenia, on no new or recently changed medication, is found holding a bizarrely twisted body position, unresponsive to attempts to move it, with no sign of spasm. Before revealing the answer: is this acute dystonia?

• Apply · Blunting of Affect open

  Blunting of Affect

  A woman shows a flat, unreactive expression only when discussing one specific traumatic memory, but her expression, tone, and gesture are otherwise full and appropriately varied across every other topic in the interview. Before revealing the answer: is this affect blunting?

• Apply · Constriction of Affect open

  Constriction of Affect

  A patient shows almost no interest in activities he previously enjoyed, rarely initiating anything on his own, and appears outwardly indifferent even when told genuinely significant news about his own health. Before revealing the answer: is this constriction of affect?

• Apply · Affective Incontinence open

  Affective Incontinence

  During a single conversation, a patient moves rapidly between tearfulness, laughter, and irritability, each shift abrupt and more pronounced than the conversation would seem to call for, though she is able to compose herself again within moments each time. Before revealing the answer: is this affective incontinence?

• Apply · Agnostic Alexia open

  Agnostic Alexia

  A patient cannot understand anything said to him, though he can hear that speech is occurring and other sounds normally, but reads and writes without any difficulty at all. Before revealing the answer: is this agnostic alexia?

• Apply · Akathisia open

  Akathisia

  A woman recently started on an antipsychotic reports feeling 'more anxious' and is noted to be pacing in the waiting room. Her team considers whether this represents a worsening of her underlying anxiety or something else. Before revealing the answer: what should specifically be asked to clarify this?

• Apply · Akinetic Mutism open

  Akinetic Mutism

  A psychiatric inpatient becomes unresponsive and immobile over several hours, but on recovery accurately recalls conversations that took place around her during the episode, including details she should not have been able to register if her consciousness had genuinely been impaired throughout. Before revealing the answer: does this fit akinetic mutism?

• Apply · Ambitendency open

  Ambitendency

  Asked to shake hands, a patient makes no attempt whatsoever, simply refusing outright with no visible hesitation, partial movement, or apparent internal conflict, and this same flat refusal is seen across every request made of her throughout the interview. Before revealing the answer: is this ambitendency?

• Apply · Amnesia open

  Amnesia

  A patient with dementia cannot recall attending her granddaughter's wedding last month, but when asked about it, she confidently and in detail describes a different wedding — one that, on checking, never took place — with no apparent awareness that anything is wrong. Before revealing the answer: is this simply amnesia?

• Apply · Amnestic State open

  Amnestic State

  A patient recovering from a serious head injury three months ago can recall his life in vivid detail up to the day before the injury, and now shows normal immediate recall on testing (repeating a list of words just given to him), but cannot remember anything from the days spent in intensive care or reliably learn new information day-to-day. Before revealing the answer: is this an amnestic state?

• Apply · Anankastic Personality Disorder open

  Anankastic Personality Disorder

  A patient presenting for assessment of a separate mood disorder is noted, incidentally, to keep an extremely detailed and rigid daily schedule going back over a decade, to become visibly agitated by minor changes to it, and to have caused repeated arguments by insisting his family follow his exact standards for household organisation. He does not raise this pattern himself as a concern. Before revealing the answer: is the fact that he did not raise it himself unusual for this presentation?

• Apply · Anhedonia open

  Anhedonia

  A 45-year-old woman with low mood says she still goes out to dinner with friends every week because "it's just what we do," but when asked directly, admits the food tastes the same as always and the conversation doesn't lift her mood the way it used to — she just goes through the evening. Before revealing the answer: what is this finding, and why is it significant that she still attends despite this?

• Apply · Anosognosia open

  Anosognosia

  A 71-year-old man is admitted after a right-hemisphere stroke. On the ward round he is cheerful and talkative. Asked to squeeze the doctor's hand with his left hand, nothing happens; he says he did squeeze it, and when his flaccid left arm is lifted and dropped onto the bed in front of him, he seems unbothered and remarks that the physiotherapist "hasn't gotten round to that side yet." Before revealing the answer: what would you document in the mental state examination, and what would you specifically avoid concluding?

• Apply · Anterograde Amnesia open

  Anterograde Amnesia

  A man recalls, in detail, everything that happened up to and including the moment of his accident, but has no memory of the several hours immediately afterward, during which witnesses say he was talking and behaving normally. Before revealing the answer: is this retrograde or anterograde amnesia, and what does the witnesses' account add?

• Apply · Movement Disorders Associated with Antipsychotic Medication open

  Movement Disorders Associated with Antipsychotic Medication

  A patient recently started on an antipsychotic sits calmly during the interview and denies feeling unwell, but when asked directly whether he feels any inner restlessness or urge to move, he says yes, describing it as tension he can never quite shake and has not mentioned to anyone. Before revealing the answer: does the calm outward appearance rule out a movement disorder here?

• Apply · Anxiety Amnesia open

  Anxiety Amnesia

  A patient is found wandering in an unfamiliar town, unable to recall her own name or personal history, though she has been managing daily tasks and behaving appropriately with strangers; this began abruptly after witnessing a violent assault two days earlier. Before revealing the answer: is this anxiety amnesia?

• Apply · Anxiety open

  Anxiety

  A patient describes sudden episodes, several times a week, in which within a couple of minutes her heart pounds, she feels she cannot breathe, and she is gripped by a fear that she is about to die — each episode passing within about twenty minutes, after which she feels essentially back to normal until the next one. Before revealing the answer: is this simply anxiety?

• Apply · Anxious Foreboding open

  Anxious Foreboding

  A man describes brief episodes, several times a week, in which intense dread suddenly overwhelms him, peaking within a few minutes along with a racing heart and breathlessness, before subsiding completely and leaving him feeling entirely normal in between episodes. Before revealing the answer: is this anxious foreboding?

• Apply · Anxious Personality Disorder open

  Anxious Personality Disorder

  A woman describes intense fear specifically and only when required to eat in front of others or speak at meetings, but is otherwise socially confident, has a wide circle of established friends, and does not describe any generalised low self-worth. Before revealing the answer: is this anxious (avoidant) personality disorder?

• Apply · Apathy open

  Apathy

  A patient facing a difficult, ongoing legal dispute describes feeling helpless and discouraged specifically about that situation, while remaining actively engaged, motivated, and emotionally responsive in every other area of her life, including work and her relationships with friends and family. Before revealing the answer: is this apathy?

• Apply · Aphasia open

  Aphasia

  A patient with a confirmed brain tumour affecting the left temporal lobe has marked difficulty finding the right words in conversation, though her comprehension of what is said to her remains largely intact, and there are no other signs of broader psychiatric disturbance. Before revealing the answer: is this best classified as aphasia?

• Apply · Auditory Hallucination open

  Auditory Hallucination

  A grieving widow reports hearing her late husband's voice, but is clear that it feels like an inner experience rather than a real external sound — she describes it as 'in my mind, not in my ears' and knows, even as it happens, that it is not really him speaking aloud. Before revealing the answer: is this a true auditory hallucination?

• Apply · Autochthonous Delusion (Sudden Delusional Idea) open

  Autochthonous Delusion (Sudden Delusional Idea)

  While looking at an ordinary traffic light change from red to green, a patient suddenly becomes completely convinced that this means he must abandon his family immediately, a belief he holds with total, unshakeable conviction from that moment on. Before revealing the answer: is this an autochthonous delusion?

• Apply · Automatic Obedience open

  Automatic Obedience

  A patient follows straightforward, reasonable instructions during an examination but declines an instruction that would cause obvious pain, explaining that it would hurt. Before revealing the answer: is this automatic obedience?

• Apply · Autoscopy open

  Autoscopy

  A patient describes floating above their own body during a medical emergency, looking down at themselves lying on the ground, with their sense of viewpoint clearly located above rather than in their physical body. Before revealing the answer: is this autoscopy?

• Apply · La Belle Indifférence open

  La Belle Indifférence

  A man with a functional non-epileptic seizure disorder discusses his diagnosis calmly and seems relatively untroubled by it, but when you ask directly, he says he does worry about it and simply prefers not to dwell on it, and his sleep and appetite have been affected. Before revealing the answer: is this la belle indifference?

• Apply · Body Image Disturbance open

  Body Image Disturbance

  A severely depressed patient states, with complete conviction, that his legs no longer exist at all, insisting this is a literal fact despite clear visual evidence to the contrary, and that his body has effectively ceased to be. Before revealing the answer: is this body image disturbance?

• Apply · Borderline Personality Disorder open

  Borderline Personality Disorder

  On an inpatient ward, a patient praises one nurse extravagantly as "the only person who actually cares," while calling another "completely incompetent and uncaring" after a minor disagreement about visiting hours. By the following week, which nurse is 'good' and which is 'bad' has completely swapped. Before revealing the answer: what is this pattern called, and why does it matter for how the clinical team manages it?

• Apply · Capgras Syndrome open

  Capgras Syndrome

  A man with dementia becomes convinced his daughter, who visits him daily and whom he agrees looks exactly like his real daughter, is "an impostor sent to trick him," and asks staff to call the police each time she visits. Before revealing the answer: is this Capgras syndrome?

• Apply · Catalepsy open

  Catalepsy

  During a catatonia examination, a patient is not warned beforehand that they need not hold any position their limb is placed in, and their arm remains raised for several minutes after being lifted. Before revealing the answer: is this finding fully reliable as catalepsy?

• Apply · Catathymic Amnesia open

  Catathymic Amnesia

  Following a traumatic assault, a patient cannot recall her own name or family history for several days, though she can still perform complex everyday tasks competently, before her full memory and sense of identity gradually return. Before revealing the answer: is this catathymic amnesia?

• Apply · Catatonic Speech Disturbance open

  Catatonic Speech Disturbance

  Asked what colour the sky is, a patient answers, in a completely normal speaking voice, "green," and asked what colour grass is, answers "blue," with every answer showing clear understanding of the question but consistently and noticeably wrong. Before revealing the answer: is this catatonic speech disturbance?

• Apply · Catatonic Stupor open

  Catatonic Stupor

  A 30-year-old man with a known diagnosis of schizophrenia is found rigid, mute, and unresponsive on the ward, his face utterly blank. When a nurse gently lifts his arm and lets go, it remains suspended in the air where she left it. Before revealing the answer: what is this specific finding on his arm called, and what does its presence, alongside his other features, tell you about the type of stupor he is in?

• Apply · Central Aphasia open

  Central Aphasia

  A patient's grammar, sentence structure, and comprehension are all entirely intact, but she has a specific, isolated difficulty finding the names of objects when asked, sometimes substituting a vague description in place of the correct word. Before revealing the answer: is this central aphasia?

• Apply · Chromatopsia open

  Chromatopsia

  A patient reports seeing a small, brightly coloured figure standing in the corner of an otherwise empty room, describing it with the same full perceptual vividness as anything else she looks at, though nothing is actually there. Before revealing the answer: is this chromatopsia?

• Apply · Circumstantiality open

  Circumstantiality

  Asked a simple question, a patient produces a rapid stream of associated ideas — one word or image suggesting the next through rhyme, chance resemblance, or passing distraction — and after several minutes has still not addressed, or seemingly even registered, the original question at all. Before revealing the answer: is this circumstantiality?

• Apply · Compulsion open

  Compulsion

  A patient describes recurrent, intrusive thoughts that he might have left the stove on, causing him significant distress and preoccupation throughout the day, but he does not actually go and check the stove or perform any related action in response. Before revealing the answer: is this a compulsion?

• Apply · Confabulation open

  Confabulation

  A 58-year-old man with a history of heavy alcohol use is asked what he did over the weekend. He answers instantly and confidently that he attended his daughter's graduation — but she graduated three years ago and was not visiting this weekend. He shows no hesitation and becomes mildly irritated when this is gently questioned. Before revealing the answer: what is happening here, and what feature of his response would make you doubt this was simply a lie?

• Apply · Cryptamnesia open

  Cryptamnesia

  A patient with a significant organic memory impairment, when asked what she did yesterday, confidently and elaborately describes attending a family celebration that did not take place and that bears no resemblance to anything she is known to have previously experienced. Before revealing the answer: is this cryptamnesia?

• Apply · Déjà Vu open

  Déjà Vu

  A 45-year-old man walking into a hotel lobby for the first time is suddenly gripped by absolute certainty that he has stood in that exact spot before, right down to the pattern of the carpet, even though he has never visited before and knows this is impossible. The feeling passes within seconds and he is only mildly unsettled by it. Before revealing the answer: what is this, and what specifically about his account makes it not a delusion?

• Apply · Delusion open

  Delusion

  A profoundly depressed patient believes with complete conviction that she has committed a terrible, unforgivable sin and deserves to be punished. When asked how she came to this conclusion, she explains it follows naturally from how worthless and wicked her depression makes her feel about herself. Before revealing the answer: is this a primary delusion?

• Apply · Delusion of Guilt open

  Delusion of Guilt

  A woman with severe depressive illness tells you, with complete conviction, that she is responsible for a house fire that occurred in her neighbourhood three years ago, despite having been abroad at the time — a fact her family has confirmed to her repeatedly and which she cannot recall disputing when told. Before revealing the answer: is this a delusion of guilt?

• Apply · Delusion of Ill Health open

  Delusion of Ill Health

  A man tells you he is certain his internal organs have "stopped working properly" and that he is slowly dying from the inside, despite a full set of recent investigations, including blood tests and imaging, all returning entirely normal. He becomes visibly more distressed, not reassured, when you mention the normal results. Before revealing the answer: is this a delusion of ill health?

• Apply · Delusion of Infidelity open

  Delusion of Infidelity

  A man with a long history of heavy alcohol use tells you he is certain his partner is having an affair, describing in detail how he has begun checking her phone daily and timing her return from work to the minute. He becomes agitated and mentions that he "won't let this go on." Before revealing the answer: what should this specific detail about his agitation and intent prompt you to assess directly?

• Apply · Delusion of Love open

  Delusion of Love

  A woman tells you with complete conviction that a senior colleague she has spoken to only briefly is secretly in love with her, and that his recent promotion to a role in another building is a coded message meant only for her to understand. She has begun waiting outside his usual entrance each morning. Before revealing the answer: is this a delusion of love?

• Apply · Delusion of Persecution open

  Delusion of Persecution

  A patient believes his former business partner, who recently defrauded him in a documented, ongoing legal dispute, is now trying to sabotage his new business — and describes specific, verifiable actions consistent with this. Before revealing the answer: is this a delusion of persecution?

• Apply · Delusion of Poverty open

  Delusion of Poverty

  A retired man with severe depressive illness refuses to let his wife buy groceries, insisting they "can't afford it and never will again," despite a substantial pension being paid into their account every month, which you confirm with his wife present. He does not appear reassured even as she shows him the most recent statement on her phone. Before revealing the answer: is this a delusion of poverty?

• Apply · Delusional Mood open

  Delusional Mood

  A patient reports that, on seeing a red car parked outside his house one morning, he suddenly and completely understood, with absolute conviction, that this was a coded signal that he was about to be arrested. Before revealing the answer: is this delusional mood?

• Apply · Delusional Perception open

  Delusional Perception

  A 29-year-old woman says that the moment she saw a red car pull into her street, she instantly and completely knew that she had begun being watched by a government agency. She cannot explain how the car led to this conclusion, only that the certainty arrived all at once. Before revealing the answer: what is this finding, and why does it not simply count as an illusion?

• Apply · Demoralization open

  Demoralization

  A woman managing a difficult, prolonged legal dispute over several years describes feeling worn down and doubtful she can see it through, but remains actively engaged with her hobbies, her friendships, and her work, describing her low feeling as entirely about the legal situation itself. Before revealing the answer: is this most likely a depressive illness?

• Apply · Denial open

  Denial

  A patient describes, in a calm and curiously matter-of-fact tone, a serious car accident she survived, giving a full and accurate account of every distressing detail without any apparent emotional reaction. Before revealing the answer: is this denial?

• Apply · Dependent Personality Disorder open

  Dependent Personality Disorder

  A 29-year-old woman's partner ended their relationship two weeks ago. She describes feeling unable to function, has already begun urgently seeking a new relationship "so someone can look after things again," and says she has always let partners make even minor decisions for her because she "doesn't trust her own judgement." Before revealing the answer: does this fit dependent personality disorder, or would you want to know more first?

• Apply · Depersonalisation open

  Depersonalisation

  A 19-year-old man under heavy exam pressure and sleeping poorly describes feeling "like I'm on autopilot, watching myself from a few feet behind my own head" for the past several days. He finds it unpleasant and says he knows, rationally, that this is just how it feels rather than what's actually happening. Before revealing the answer: what is this, and what feature of his account rules out a nihilistic delusion?

• Apply · Depressive Illness open

  Depressive Illness

  A patient facing a stressful, unresolved workplace dispute describes feeling low and discouraged specifically about work, but continues to sleep normally, eat well, enjoy time with friends and family, and maintain her usual concentration and energy in every other area of life. Before revealing the answer: is this a depressive illness?

• Apply · Depressive Pseudodementia open

  Depressive Pseudodementia

  An older woman presents with several months of worsening memory complaints. She is tearful throughout the assessment, repeatedly apologises for "being so useless," and says she is terrified she is developing dementia like her mother did. Before revealing the answer: does her marked distress and awareness of her own cognitive difficulties make a diagnosis of true dementia more or less likely at this stage?

• Apply · Depressive Stupor open

  Depressive Stupor

  A patient in a profound stuporose state shows a flat, deadpan facial expression with no change when emotionally significant topics are raised, altered muscle tone with limbs that can be moulded into new positions and remain there, and episodes of urinary incontinence. Before revealing the answer: is this depressive stupor?

• Apply · Derealisation open

  Derealisation

  A 27-year-old woman going through a highly stressful period at work says that her flat has started to feel like a stage set rather than her real home, the furniture and rooms somehow flat and distant, even though she knows perfectly well nothing has actually changed there. She adds that she still feels entirely like herself throughout. Before revealing the answer: what is this, and what detail specifically rules out depersonalisation here?

• Apply · Desultory Thinking open

  Desultory Thinking

  A patient begins a sentence describing his weekend, and partway through, without any grammatical break, the sentence itself trails off mid-clause into an entirely unrelated and structurally garbled ending. Before revealing the answer: is this desultory thinking?

• Apply · Disorders of Expressive Movement open

  Disorders of Expressive Movement

  A patient's face and voice both convey markedly less emotion than expected throughout the interview, including reduced vocal tone variation, and this is not confined to any specific pattern of physical gesture; the patient does not notice any change in themselves. Before revealing the answer: is this a disorder of expressive movement?

• Apply · Disorientation open

  Disorientation

  A long-term inpatient with chronic schizophrenia gives vague or wrong answers when asked the date and his location, but staff who know him well say this has been his pattern for years and does not represent any recent change. Before revealing the answer: should this be treated as acute disorientation requiring urgent investigation?

• Apply · Dissocial Personality Disorder open

  Dissocial Personality Disorder

  A young man has multiple convictions for theft and assault, all of which occurred exclusively during periods of heavy alcohol and drug use, with no antisocial behaviour at all during his extended periods of sobriety. Before revealing the answer: does this amount to dissocial personality disorder?

• Apply · Dissociation of Affect open

  Dissociation of Affect

  Throughout a lengthy interview covering a wide range of topics, both neutral and emotionally significant, a patient's face, voice, and gestures remain flat and unchanging, showing no more feeling in response to distressing content than to mundane content. Before revealing the answer: is this dissociation of affect?

• Apply · Dissociative Amnesia open

  Dissociative Amnesia

  A young man involved in a serious road traffic collision, in which a close friend died, is unable to recall the collision itself or the weeks immediately surrounding it, though his memory for his life before and after that period is intact, and he successfully continues working and managing his daily responsibilities throughout. Before revealing the answer: is this dissociative amnesia?

• Apply · Distortion of Recall open

  Distortion of Recall

  A patient describes walking into a shop she is certain she has never visited before, yet experiencing an overwhelming, inexplicable sense that she has been there before, in exact detail, though she cannot say when. Before revealing the answer: is this a distortion of recall?

• Apply · Distortion of Recognition open

  Distortion of Recognition

  A patient with schizophrenia has, over several weeks, developed a fixed, elaborated conviction that her neighbour has been replaced by a physically identical impostor, maintained despite all reassurance. Before revealing the answer: is this an ordinary distortion of recognition?

• Apply · Distractibility open

  Distractibility

  Mid-sentence, a patient suddenly stops speaking altogether, her expression going blank for a few seconds, with no external sound or movement nearby to explain it, and afterward she cannot say what she had been about to say. Before revealing the answer: is this distractibility?

• Apply · Disturbance of Consciousness open

  Disturbance of Consciousness

  A meticulous, always well-groomed university lecturer is brought in appearing dishevelled, giving vague, patchy answers about the last day, and unable to say clearly what day of the week it is, following a urinary tract infection with fever. Before revealing the answer: is this most likely dementia?

• Apply · Disturbance of Awareness of Self-Activity open

  Disturbance of Awareness of Self-Activity

  A severely depressed elderly patient states with complete conviction that she has already died and that her body is now empty inside, and cannot be persuaded otherwise despite clear evidence to the contrary. Before revealing the answer: is this a disturbance of awareness of self-activity?

• Apply · Disturbance of the Boundaries of the Self open

  Disturbance of the Boundaries of the Self

  A patient describes feeling strangely detached from her own actions, as though she is watching herself go through the motions of daily life without any genuine sense that these actions are truly hers, though she describes no sense of any outside force or boundary being crossed. Before revealing the answer: is this a disturbance of the boundaries of the self?

• Apply · Disturbance of the Continuity of Self open

  Disturbance of the Continuity of Self

  A patient reports that, in the middle of ordinary conversations, she sometimes feels as if there are two of her present at once, one speaking normally and another watching and commenting from just behind, though she knows perfectly well this isn't literally true. Before revealing the answer: is this a disturbance of the continuity of self?

• Apply · Disturbance of the Immediate Awareness of Self-Unity open

  Disturbance of the Immediate Awareness of Self-Unity

  A man states, without any qualification and with full conviction, that he is genuinely two separate people who happen to share one body, each with a distinct name, history, and way of speaking. Before revealing the answer: is this best described as disturbance of self-unity?

• Apply · Dream-Like Change of Consciousness open

  Dream-Like Change of Consciousness

  A 68-year-old woman recovering from surgery insists there are insects crawling on the wall and becomes distressed trying to brush them off, entirely convinced they are real. She cannot say what day it is but greets her son by name the moment he enters. A nurse tells you she was calm and lucid an hour ago. Before revealing the answer: what is this presentation, and what does the fluctuation over the last hour tell you?

• Apply · Drivelling Thinking open

  Drivelling Thinking

  While describing his weekend in an otherwise clear, well-organised way, a patient's account is suddenly and repeatedly punctuated by short, unrelated, self-contained remarks about entirely different topics, each of which makes complete sense on its own before the original account resumes. Before revealing the answer: is this drivelling thinking?

• Apply · Dysmegalopsia open

  Dysmegalopsia

  A patient reports seeing a tiny, fully formed group of people walking across her empty living room floor, with no real object or person actually present. Before revealing the answer: is this dysmegalopsia?

• Apply · Echolalia open

  Echolalia

  Asked what year it is, a patient with known cognitive impairment answers correctly. Asked next what season it is, he instead answers 'what year it is' — his own previous question topic intruding into the new answer. Before revealing the answer: is this echolalia?

• Apply · Echopraxia open

  Echopraxia

  On a ward round, a psychiatry student notices that a patient with schizophrenia touches his own nose every time the consultant touches hers, seemingly without registering that he is doing it. He does not respond when asked directly whether he noticed. Before revealing the answer: what is this finding, and what other catatonic signs would be worth specifically checking for given this observation?

• Apply · Ecstasy open

  Ecstasy

  A patient has been persistently cheerful, expansive, and overly familiar with strangers for several weeks, describing life as generally wonderful and full of good feeling, but without any sense of mystical transcendence, unity, or profound cosmic significance when asked to elaborate. Before revealing the answer: is this ecstasy?

• Apply · Eidetic Imagery open

  Eidetic Imagery

  A patient, sitting quietly in a clinic waiting room, suddenly and involuntarily perceives a detailed scene unfolding in front of him as though it were happening right now, with no awareness that he is remembering rather than currently perceiving something. Before revealing the answer: is this eidetic imagery?

• Apply · Emotionally Unstable Personality Disorder open

  Emotionally Unstable Personality Disorder

  A patient shows extraordinary instability of relationships, mood, and self-image, with chronic feelings of emptiness, an intense fear of abandonment, repeated self-harm, and relationships that swing between idealisation and sudden rejection. Before revealing the answer: is describing this patient using only the umbrella term "emotionally unstable personality disorder," without further specification, the most clinically informative approach?

• Apply · Enduring Personality Change after a Catastrophic Experience open

  Enduring Personality Change after a Catastrophic Experience

  A woman has shown a hostile, suspicious, and socially withdrawn manner for as long as anyone who knows her can remember, tracing back to her teenage years, with no identifiable triggering event or illness at any point. Before revealing the answer: is this enduring personality change after a catastrophic experience?

• Apply · Excitement open

  Excitement

  After drinking only a single small measure of alcohol, a man suddenly becomes violently aggressive toward those around him for about an hour, showing none of the usual unsteadiness or slurred speech of ordinary intoxication, and afterward has no memory of the episode at all. Before revealing the answer: is this best described simply as excitement, or does it fit a more specific named pattern?

• Apply · Expressive Aphasia open

  Expressive Aphasia

  A patient sits through an entire interview producing no spoken words whatsoever, not even a single sound, despite appearing to understand and attend closely to everything said to him, though he does eventually communicate a brief message by writing on paper. Before revealing the answer: is this expressive aphasia?

• Apply · Extended Suicide open

  Extended Suicide

  A father with severe, delusional depressive illness, believing his family faces certain financial ruin and that this is entirely his fault, expresses a plan to end his own life alone, with no mention of harming his children. Before revealing the answer: does this meet the pattern of extended suicide?

• Apply · Extracampine Hallucination open

  Extracampine Hallucination

  A patient reports hearing a voice clearly coming from just behind his left shoulder, a location well within his normal field of hearing, with full sensory conviction and no real speaker present. Before revealing the answer: is this an extracampine hallucination?

• Apply · False Memory open

  False Memory

  During a police interview, a vulnerable, highly suggestible man repeatedly denies involvement in an offence, but after prolonged, suggestive questioning eventually says he 'remembers' committing it, in vague and shifting detail that changes each time he is asked. Before revealing the answer: could this be a false memory, and why does it matter?

• Apply · False Reconnaissance open

  False Reconnaissance

  A patient firmly and repeatedly insists that his wife, whom he acknowledges looks and sounds identical to his real wife in every way, is actually an impostor who has secretly replaced her, becoming suspicious and hostile toward her as a result. Before revealing the answer: is this false reconnaissance?

• Apply · Flashback open

  Flashback

  A woman says that whenever she wants to, she can recall the moment she heard about a major national tragedy in extraordinary, stable detail — exactly where she was standing, what she was wearing, who she was with — and she is highly confident in the accuracy of every detail, though the memory has never once intruded on her unbidden. Before revealing the answer: is this a flashback?

• Apply · Flashbulb Memory open

  Flashbulb Memory

  A man vividly and confidently recalls exactly where he was when he heard about a major national event twenty years ago, but when an old diary entry from the actual day is later found, several key details turn out to be inaccurate. Before revealing the answer: does this inaccuracy mean it wasn't a genuine flashbulb memory?

• Apply · Flight of Ideas open

  Flight of Ideas

  A 41-year-old man in a hypomanic episode wanders through several unrelated topics when asked a simple question, but each time, after a minute or two of tangents, he laughingly says "anyway, back to your question" and gives a reasonably direct answer. Before revealing the answer: is this flight of ideas, and what specific feature of his speech tells you which variant this is?

• Apply · Forced Grasping open

  Forced Grasping

  An examiner asks a catatonic patient to stand on one foot for as long as possible; the patient does so despite it becoming visibly painful, and continues to comply fully each time the same uncomfortable instruction is repeated, without ever refusing or adjusting. Before revealing the answer: is this forced grasping?

• Apply · Formal Thought Disorder open

  Formal Thought Disorder

  A patient speaks rapidly and at length, moving quickly from one topic to the next, each new idea clearly triggered by a word or sound from the last, so that a listener can always follow exactly how she got from one thought to the next, even though she never settles on any single topic. Before revealing the answer: is this formal thought disorder?

• Apply · Functional Hallucination open

  Functional Hallucination

  A patient on a hospital ward says that every time the bedside fan switches on, she hears a voice arguing somewhere within the noise; when the fan is off, there is no voice. She can hear the fan itself completely normally throughout, and confirms this happens every single time. Before revealing the answer: what is this finding, and why is it not simply an illusion?

• Apply · Ganser Syndrome open

  Ganser Syndrome

  A fully alert, oriented patient consistently gives approximate wrong answers to simple questions, with an amused, facetious manner, but shows no clouding of consciousness, disorientation, or hallucinations at any point. Before revealing the answer: is this Ganser syndrome?

• Apply · Gegenhalten (Opposition) open

  Gegenhalten (Opposition)

  On examination, a patient's arm resists all attempts at passive movement, gentle or firm, with a marked, apparently motiveless force that does not simply scale with the examiner's own effort, and the same pattern is seen when the examiner tries to reposition his legs and turn his head. Before revealing the answer: is this Gegenhalten?

• Apply · Grandiose Delusion open

  Grandiose Delusion

  A man with elevated mood and pressured speech tells you he has invented a device that will "solve the energy crisis for the entire planet," and that several world governments are already secretly in contact with him about it, though he cannot produce any evidence of this contact when asked. Before revealing the answer: is this a grandiose delusion?

• Apply · Gustatory Hallucination open

  Gustatory Hallucination

  A patient reports smelling burning rubber throughout the day, with no accompanying taste symptom at all, and no external source anyone else can identify. Before revealing the answer: is this a gustatory hallucination?

• Apply · Hallucination open

  Hallucination

  Walking through a dimly lit garden at dusk, a patient briefly mistakes a coat hanging on a hook for a person standing still, and on turning on a light, immediately recognises her error. Before revealing the answer: is this a hallucination?

• Apply · Hallucinosis open

  Hallucinosis

  A patient with a long history of heavy drinking reports ongoing auditory hallucinations. Before revealing the answer: is assessing his orientation and clarity of consciousness a necessary part of confirming this is hallucinosis rather than something more urgent?

• Apply · Hemiasomatognosia open

  Hemiasomatognosia

  A patient with left-sided weakness, when asked directly about her left arm, insists with conviction that it belongs to her sister and offers a detailed explanation of how it supposedly came to be attached to her body. Before revealing the answer: is this hemiasomatognosia?

• Apply · Hemispatial Neglect open

  Hemispatial Neglect

  A patient following a stroke fails to recognise her own left arm as belonging to her, insisting it belongs to someone else, but she readily notices and responds normally to objects, food, and people on her left side more generally. Before revealing the answer: is this hemispatial neglect?

• Apply · Histrionic Personality Disorder open

  Histrionic Personality Disorder

  A man becomes markedly more dramatic, flirtatious, and attention-seeking than usual during a hypomanic episode, a pattern his family says is completely unlike him when well. Before revealing the answer: does this amount to histrionic personality disorder?

• Apply · Hyperamnesia open

  Hyperamnesia

  When asked what she did over the weekend, which she cannot actually recall due to a genuine gap in her memory, a patient promptly and confidently describes a detailed outing that never happened, showing no hesitation or awareness that anything is wrong. Before revealing the answer: is this hyperamnesia?

• Apply · Hypnagogic Hallucination open

  Hypnagogic Hallucination

  In the middle of an otherwise ordinary afternoon, fully awake and alert, a patient hears a voice commenting on his actions, an experience that recurs several times over the following hours. Before revealing the answer: is this a hypnagogic hallucination?

• Apply · Hysterical Twilight State open

  Hysterical Twilight State

  A man is found wandering after a period of impaired awareness, and EEG monitoring during a similar subsequent episode shows clear epileptiform discharges, with sudden onset and end each time. Before revealing the answer: is this a hysterical twilight state?

• Apply · Illusion open

  Illusion

  A tired night-shift worker, glancing quickly across a poorly lit corridor, briefly perceives a mop propped against the wall as a person standing there, but immediately recognises the mistake on a second, closer look and is not troubled by it afterwards. Before revealing the answer: is this clinically significant?

• Apply · Impulsive Behaviour open

  Impulsive Behaviour

  A mother with severe, delusional depressive illness, convinced she has passed an incurable genetic curse to her children, kills her two children before attempting to take her own life, later explaining she believed she was sparing them from a lifetime of suffering. Before revealing the answer: is this impulsive behaviour?

• Apply · Impulsive Personality Disorder open

  Impulsive Personality Disorder

  A man with no prior history of temper problems develops, over the past two weeks during a manic episode, a markedly lowered threshold for irritation, snapping at trivial remarks that would never have bothered him before; his temper returns to normal as the episode resolves. Before revealing the answer: is this impulsive personality disorder?

• Apply · Incongruity of Affect open

  Incongruity of Affect

  A 33-year-old man smiles broadly while describing being made redundant from his job of fifteen years and losing his flat shortly afterward. When his clinician comments gently that this sounds like it must have been very difficult, he continues smiling and seems unsure why she said that. Before revealing the answer: what is this finding, and how would you document it precisely rather than just noting it as 'odd'?

• Apply · Inhibition (Slowing) of Thinking open

  Inhibition (Slowing) of Thinking

  Mid-sentence, describing his weekend, a patient suddenly stops speaking entirely, looking momentarily blank, and afterward cannot recall what he had been about to say, though his speech had been at a completely normal pace right up until that moment. Before revealing the answer: is this inhibition of thinking?

• Apply · Intermediate Aphasia open

  Intermediate Aphasia

  A patient's spontaneous speech is fluent but he cannot name any of the common objects shown to him, though his grammar, sentence structure, and comprehension of both spoken and written language are entirely intact. Before revealing the answer: is this best described simply as intermediate aphasia, or does it fit one of its more specific named sub-types?

• Apply · Involuntary Neurological Movement Signs open

  Involuntary Neurological Movement Signs

  A patient who has taken antipsychotic medication for many years develops gradually worsening, repetitive, purposeless movements of the mouth and tongue, with no family history of any neurological condition and no other relevant medical illness. Before revealing the answer: is this best described as one of the broader involuntary neurological movement signs?

• Apply · Irritability open

  Irritability

  Following a neurological illness, a patient bursts into sudden, uncontrollable laughter or tears at minor or even neutral remarks, with the intensity and nature of the display markedly disconnected from how she actually reports feeling at the time, and she cannot bring the display under control once it begins. Before revealing the answer: is this irritability?

• Apply · Lability of Affect open

  Lability of Affect

  A woman's mood shifts across a session — she is tearful when discussing a recent loss, calmer when discussing work, and briefly amused by a shared joke — with each shift proportionate to, and clearly connected with, the topic at hand. Before revealing the answer: is this lability of affect?

• Apply · Lethologia open

  Lethologia

  Over several months, a patient has developed an increasingly persistent and pervasive difficulty finding the names of common objects and people, a difficulty that does not resolve on its own and is now affecting his ability to hold ordinary conversations. Before revealing the answer: is this lethologia?

• Apply · Loss of Emotional Resonance open

  Loss of Emotional Resonance

  A man with severe depression says he feels nothing when he sees his newborn grandchild, and concludes from this that he must be a fundamentally bad, unloving person. Before revealing the answer: how should this feeling and his interpretation of it be understood?

• Apply · Lowering of Consciousness open

  Lowering of Consciousness

  A 74-year-old man is admitted with a severe chest infection. Over the following days he becomes profoundly slowed, apathetic, and gives only brief, unclear answers, sometimes repeating the same phrase, with no hallucinations or restlessness noted by staff. His family, worried, asks whether he now has dementia. Before revealing the answer: what would you tell them, and what would you want to check over the following weeks?

• Apply · Mannerisms open

  Mannerisms

  A 19-year-old university student, with no psychiatric history, has an unusual, exaggerated bow whenever she greets a lecturer, a habit her friends say is 'just her thing' and find endearing rather than concerning. Before revealing the answer: is this a mannerism in the clinical sense, and what does this case illustrate about interpreting mannerisms in isolation?

• Apply · Cooperation (Mitmachen) and Mitgehen open

  Cooperation (Mitmachen) and Mitgehen

  A patient's arm is passively raised by the examiner and remains held in that raised position for over a minute, felt as a smooth, even resistance throughout the movement, until the examiner repositions it again. Before revealing the answer: is this Mitmachen?

• Apply · Morbid Anxiety open

  Morbid Anxiety

  The night before a major exam, a student feels intensely anxious, with a racing heart and churning stomach, but the feeling resolves entirely once the exam is over and does not recur afterward. Before revealing the answer: is this morbid anxiety?

• Apply · Morbid Disorder of Emotion open

  Morbid Disorder of Emotion

  A patient's underlying mood appears entirely normal on careful direct questioning, but his face has become notably stiff and unchanging, and his family reports this change, of which he seems entirely unaware, developing gradually over recent months. Before revealing the answer: is this a morbid disorder of emotion?

• Apply · Morbid Euphoria open

  Morbid Euphoria

  A woman recently promoted at work describes feeling genuinely delighted and proud for a few days, enjoying celebratory dinners with friends, before her mood settles back to its usual baseline the following week. Before revealing the answer: is this morbid euphoria?

• Apply · Morbid Expression of Emotion open

  Morbid Expression of Emotion

  A woman deliberately keeps a composed expression in front of colleagues despite feeling intense grief, and when asked privately, readily acknowledges that she is consciously suppressing how she feels and finds it exhausting to maintain. Before revealing the answer: is this a morbid expression of emotion?

• Apply · Moria open

  Moria

  A woman with no history of neurological illness describes feeling unusually cheerful, optimistic, and full of energy for the past two weeks, with an expansive good mood but no particular tendency toward joking or facetiousness beyond her normal sense of humour. Before revealing the answer: is this moria?

• Apply · Motor and Verbal Perseveration open

  Motor and Verbal Perseveration

  During a bedside cognitive assessment, a patient is asked to draw a series of five-pointed stars. After completing the first star correctly, he continues drawing additional star points well beyond the outline, unable to stop the pen even when reminded the task is complete. Before revealing the answer: is this motor perseveration?

• Apply · Experience of Multiple Personalities open

  Experience of Multiple Personalities

  A patient describes sometimes acting or speaking in a way that feels automatic, as though driven by another part of herself, while readily acknowledging that this is just how it feels, not a literal belief that she is genuinely two separate people. Before revealing the answer: is this the experience of multiple personalities?

• Apply · Munchausen's Syndrome open

  Munchausen's Syndrome

  A young man facing an upcoming court appearance tells increasingly elaborate, grandiose stories of past heroic exploits to his friends, with no medical presentations involved at all; when a friend produces clear documentary proof he was elsewhere at the time, he eventually admits the stories were invented. Before revealing the answer: is this Munchausen's syndrome?

• Apply · Mutism open

  Mutism

  Following a focal neurological event, a patient produces no speech at all, but reading comprehension and handwritten communication both remain entirely normal and unaffected. Before revealing the answer: is this simply mutism, with nothing more specific to say?

• Apply · Narcissistic Personality Disorder open

  Narcissistic Personality Disorder

  A 38-year-old man describes feeling "completely humiliated" and becoming furious for days after a minor, constructive piece of feedback from his manager, despite an otherwise strong performance review. He says he deserves to be running the department himself and describes colleagues who disagree with him as "just jealous." Before revealing the answer: which features here point toward narcissistic personality disorder specifically, rather than just an unusually thin skin?

• Apply · Negativism open

  Negativism

  A patient refuses to take prescribed medication, explaining clearly that he believes it is being used to poison him. Before revealing the answer: is this negativism?

• Apply · Neologism open

  Neologism

  A man with a known stroke affecting language areas produces the word 'spron' when trying to say 'spoon', consistently substituting similar-sounding but incorrect words throughout the interview, with no evidence of psychotic symptoms and clear frustration at his own errors. Before revealing the answer: is this a neologism?

• Apply · Nihilistic Delusion open

  Nihilistic Delusion

  Following a right parietal stroke, a patient with an obviously paralysed left arm insists nothing is wrong with it and becomes annoyed when the paralysis is pointed out, while readily acknowledging the arm itself exists and is his. Before revealing the answer: is this a nihilistic delusion?

• Apply · Nominal Aphasia open

  Nominal Aphasia

  A patient's spontaneous speech shows frequent grammatical errors, word-substitution mistakes, and difficulty both understanding what is said to him and producing appropriate responses, in addition to word-finding trouble. Before revealing the answer: is this nominal aphasia?

• Apply · Obsession open

  Obsession

  A woman describes recurrent thoughts of contamination that she finds distressing, but on further questioning she says she is not actually sure the thoughts are irrational — she feels genuinely convinced her hands are contaminated no matter how much she washes them, and this conviction does not waver even when shown clear evidence otherwise. Before revealing the answer: is this a straightforward obsession?

• Apply · Obstruction (Blocking) open

  Obstruction (Blocking)

  A severely depressed patient moves, speaks, and thinks noticeably slowly and consistently throughout the entire interview, with no sudden stops or unpredictable interruptions, simply a uniform, steady slowness across everything he does. Before revealing the answer: is this obstruction?

• Apply · Occupational Delirium open

  Occupational Delirium

  A fully alert, oriented patient with a lifelong odd, exaggerated way of shaking hands, an idiosyncratic quirk his colleagues have always found amusing, is otherwise entirely well and shows no confusion or disorientation of any kind. Before revealing the answer: is this occupational delirium?

• Apply · Olfactory Hallucination open

  Olfactory Hallucination

  A patient reports smelling her late mother's distinctive perfume, briefly and vividly, while looking through an old photo album, and immediately recognises this as a memory triggered by the photographs rather than a present, real smell. Before revealing the answer: is this an olfactory hallucination?

• Apply · Organic Amnesia open

  Organic Amnesia

  A patient with no history of head injury or physical illness suddenly cannot recall her own name, family, or personal history following a traumatic event, while still being able to drive, hold a coherent conversation, and manage everyday tasks competently. Before revealing the answer: is this organic amnesia?

• Apply · Organic Hallucination open

  Organic Hallucination

  A patient reliably hears a hallucinated voice only while the kitchen tap is running, and the voice stops the moment the tap is turned off; he has no relevant physical illness or injury. Before revealing the answer: is this an organic hallucination?

• Apply · Overvalued Idea open

  Overvalued Idea

  A woman has, over many years and with no diagnosed mental illness, developed a passionate, dominating conviction about a particular social cause, which shapes much of her life and which she discusses with intensity, though she is willing to hear and seriously consider opposing arguments, even if she remains ultimately unconvinced by them. Before revealing the answer: could this be an overvalued idea, and does the absence of any diagnosed mental illness rule it out?

• Apply · Panic Attack open

  Panic Attack

  A man presents to the emergency department convinced he is having a heart attack, with chest pain, palpitations, and severe shortness of breath that came on abruptly ten minutes ago. Cardiac investigations are unremarkable. Before revealing the answer: what should be considered alongside cardiac causes?

• Apply · Paramnesia (Distortion of Memory) open

  Paramnesia (Distortion of Memory)

  A woman reports a complete blank for an entire week of her life, with no memory content of any kind for that period, however hard she tries or however she is prompted. Before revealing the answer: is this an example of a paramnesia?

• Apply · Paranoid Personality Disorder open

  Paranoid Personality Disorder

  A woman describes a lifelong pattern of assuming colleagues are undermining her, reading hostile intent into neutral comments, and gradually losing most of her friendships as a result, though she has never held a single fixed, specific belief that any one person is definitely plotting against her in a particular way. Before revealing the answer: is this best understood as a delusion of persecution?

• Apply · Paraphasia open

  Paraphasia

  A patient with no history of neurological illness, admitted with acute psychosis, repeatedly uses an invented word, "grendlock," to describe a private, indescribable experience, embedded within otherwise fluent, grammatically intact speech. Before revealing the answer: is this a paraphasia?

• Apply · Paraschemazia open

  Paraschemazia

  A patient confidently states that the arm attached to her left shoulder belongs to her nurse, not to her, and offers this explanation readily and without distress when the limb is pointed out to her. Before revealing the answer: is this paraschemazia?

• Apply · Passivity Phenomena open

  Passivity Phenomena

  A woman says she sometimes feels a strong urge to check the front door repeatedly, which she recognises is excessive but cannot easily resist, and which she describes as 'like something is making me do it', though she agrees on further questioning that it is her own anxious urge and no outside force is actually controlling her body. Before revealing the answer: is this a passivity phenomenon?

• Apply · Pathological Drunkenness open

  Pathological Drunkenness

  A man with a long history of heavy regular drinking becomes loudly argumentative and unsteady on his feet after finishing most of a bottle of spirits at a party, later apologising the next day and recalling the argument clearly. Before revealing the answer: is this pathological drunkenness?

• Apply · Perplexity open

  Perplexity

  A patient describes, with full clarity and coherent understanding of her circumstances, a persistent and distressing feeling that something terrible is about to happen to her family, though she cannot say what or why, and she otherwise makes complete sense of her surroundings. Before revealing the answer: is this perplexity?

• Apply · Perseveration open

  Perseveration

  A patient responds to every single question in an assessment, regardless of its content, with the same fixed phrase, 'I don't know, I don't know', showing no variation in relation to what is actually being asked. Before revealing the answer: is this perseveration?

• Apply · Perseveration of Posture open

  Perseveration of Posture

  An examiner passively moves a patient's arm into an unusual position and feels a smooth, even, wax-like resistance throughout the entire movement; once positioned, the arm remains there for several minutes, with the patient not appearing to actively resist at any point. Before revealing the answer: is this perseveration of posture?

• Apply · Personality Disorder open

  Personality Disorder

  A previously easy-going, sociable man becomes markedly suspicious, rigid, and difficult to reason with for several weeks, exactly matching the pattern of a specific personality disorder, but this change appeared only during a severe depressive episode and has begun resolving as his mood improves. Before revealing the answer: should this be diagnosed as a personality disorder?

• Apply · Phobia open

  Phobia

  A patient describes constant, free-floating unease that is present most days regardless of circumstances, with no particular object or situation she can identify as triggering it, and no specific avoidance behaviour, since there is nothing obvious to avoid. Before revealing the answer: is this a phobia?

• Apply · Primary Delusion open

  Primary Delusion

  A woman with several weeks of severe depressed mood and profound guilt develops a fixed belief that she has committed a terrible unforgivable sin and deserves to be punished. Before revealing the answer: is this a primary or secondary delusion?

• Apply · Pseudohallucination open

  Pseudohallucination

  A 15-year-old girl tells you she sometimes 'sees' her late grandmother standing at the end of her bed at night. Before revealing the answer: what two follow-up questions would help you work out whether this is a pseudohallucination, and why does age make you take particular care here?

• Apply · Pseudologia Fantastica open

  Pseudologia Fantastica

  A patient with a confirmed history of significant head injury and cognitive impairment confidently but incorrectly describes attending an event that never took place, showing no awareness that the account might be false and no particular life crisis prompting it. Before revealing the answer: is this pseudologia fantastica?

• Apply · Psychomotor Retardation open

  Psychomotor Retardation

  A 68-year-old woman with severe depressive illness sits mostly motionless during the interview, answers only after long pauses, and her daughter reports she now takes over an hour to get dressed in the morning, compared with about ten minutes previously. Before revealing the answer: is this psychomotor retardation?

• Apply · Pure Word Deafness open

  Pure Word Deafness

  A patient cannot recognise or read aloud any written words placed in front of him, though he can copy the same words by hand, and he understands everything said to him without any difficulty. Before revealing the answer: is this pure word deafness?

• Apply · Pure Word-Dumbness open

  Pure Word-Dumbness

  A patient produces only a handful of expletives and fixed phrases when trying to speak, and his written answers, while generally understandable, also show frequent spelling errors and abbreviated, telegram-style sentences he would not have produced before his illness. Before revealing the answer: is this pure word-dumbness?

• Apply · Disorders of Reactive Movements open

  Disorders of Reactive Movements

  When an examiner asks a patient to open his mouth, the patient instead clamps it firmly shut, and when asked to raise his arm, he lowers it instead, in what appears to be a consistent, reflex-like pattern of doing the opposite of every instruction given. Before revealing the answer: is this a disorder of reactive movements?

• Apply · Reactivity of Mood open

  Reactivity of Mood

  During a single interview, a patient cycles rapidly between tearfulness, sudden laughter, and irritability within a few minutes, with no clear external event prompting each shift and the changes appearing far more abrupt and pronounced than anything discussed would warrant. Before revealing the answer: is this reactivity of mood?

• Apply · Receptive Aphasia open

  Receptive Aphasia

  A patient clearly understands every spoken and written instruction given to him, following each one correctly, but struggles severely to produce any spoken response, managing only a few effortful, halting words at a time. Before revealing the answer: is this receptive aphasia?

• Apply · Reflex Hallucination open

  Reflex Hallucination

  A patient explains that she has, for as long as she can remember, experienced a distinct colour whenever she hears music, finding the experience pleasant and unremarkable rather than distressing. Before revealing the answer: is this a reflex hallucination?

• Apply · Restriction of Consciousness open

  Restriction of Consciousness

  A patient, disoriented for time and place but oriented for person, describes vivid, terrifying visions of small animals crawling on the walls, so convincing that she cannot tell them apart from things actually in the room. Before revealing the answer: is this restriction of consciousness?

• Apply · Retrograde Amnesia open

  Retrograde Amnesia

  Two days after a fall, a woman cannot recall the half hour before her fall. Assessed again a week later, that gap has narrowed to only the last few minutes before the fall. Before revealing the answer: is this evolution expected, and what does it tell you about the underlying process?

• Apply · Retrospective Delusion open

  Retrospective Delusion

  A patient recently diagnosed with depression describes her whole life, including periods collateral history confirms were happy and successful, as "one long failure from the beginning." She holds no delusional beliefs of any kind. Before revealing the answer: is this a retrospective delusion?

• Apply · Retrospective Falsification open

  Retrospective Falsification

  Asked about a specific weekend last year, a patient confidently describes attending a family wedding in detail, an event that, on checking, never took place, with no other explanation offered for the gap in his actual memory of that time. Before revealing the answer: is this retrospective falsification?

• Apply · Ribot's Law of Memory Regression open

  Ribot's Law of Memory Regression

  Following a single head injury, a patient has persistent difficulty forming new memories from that point onward, but this difficulty has remained stable in extent over the following year rather than progressively widening, and his memory for events well before the injury remains fully intact. Before revealing the answer: is this Ribot's law of memory regression?

• Apply · Running Commentary Voices open

  Running Commentary Voices

  A woman describes a single voice that speaks directly to her, saying 'you are worthless, you should stop trying', appearing at moments unrelated to what she happens to be doing at the time. Before revealing the answer: is this running commentary voices?

• Apply · Schemazia Distortion open

  Schemazia Distortion

  A patient with left-sided paralysis following a stroke insists nothing is wrong with her arm and offers a vague, confident explanation for why she is not moving it when asked, showing little concern about the situation. Before revealing the answer: is this schemazia distortion?

• Apply · Schizoid Personality Disorder open

  Schizoid Personality Disorder

  A woman describes a recent, distressing sense of watching herself from outside her own body, as though acting on autopilot, and says this feels like a frightening change from how she used to experience herself. Before revealing the answer: is this schizoid personality disorder?

• Apply · Schizophasia open

  Schizophasia

  Following a confirmed stroke affecting the language areas of the brain, a patient produces severely disorganised, hard-to-follow speech, and also shows clear difficulty with everyday practical tasks that require following instructions, alongside evident frustration at his own communication difficulties. Before revealing the answer: is this schizophasia?

• Apply · Schizotypal Personality Disorder open

  Schizotypal Personality Disorder

  A patient has shown a consistent, unchanging pattern of complete emotional detachment and social withdrawal since adolescence, with no interest whatsoever in forming relationships, no fluctuating episodes, no odd beliefs, and no unusual communication style. Before revealing the answer: is this schizotypal personality disorder?

• Apply · Screen Memory open

  Screen Memory

  In therapy, a man's vivid memory of a happy family holiday is explored, and it emerges that the holiday did happen, but one detail he consistently recalls — that his older brother was present and cheerful throughout — turns out to be inaccurate, since his brother was, in fact, absent for most of the trip following a family argument. Before revealing the answer: what does this pattern suggest?

• Apply · Secondary Delusion open

  Secondary Delusion

  A man with no preceding change in mood, perception, or personality suddenly and inexplicably becomes convinced, out of nowhere, that a television broadcaster is sending him personal messages, with no other experience that could account for how this belief arose. Before revealing the answer: is this a secondary delusion?

• Apply · Sense of Presence open

  Sense of Presence

  A recently widowed man reports feeling his late wife's presence in the house, and a junior colleague suggests this should be treated as a concerning symptom warranting urgent psychiatric review. Before revealing the answer: is this concern warranted on the information given?

• Apply · Sensory Intensity Distortion open

  Sensory Intensity Distortion

  In dim evening light, a patient glances at a coat hanging on a hook and, for a moment, is convinced it is a person standing in the room, before realising her mistake on looking more closely. Before revealing the answer: is this sensory intensity distortion?

• Apply · Smiling Depression open

  Smiling Depression

  A woman with a limb that has stopped working, with no medical cause found, describes the problem readily and in detail but shows a notable lack of worry about it, remaining calm and even mildly cheerful while discussing a symptom that most people would find alarming. Before revealing the answer: is this smiling depression?

• Apply · Somatisation open

  Somatisation

  A man recently diagnosed with a terminal illness continues to make detailed plans for events years in the future, insisting to his family that the diagnosis must be a mistake, and shows no physical symptoms or complaints related to depression at all. Before revealing the answer: is this somatisation?

• Apply · Somatoparaphrenia open

  Somatoparaphrenia

  A man with left-sided weakness after a stroke is asked to lift his left arm. He does not attempt to, and when asked why, says nothing is wrong with his arm and that he simply doesn't feel like moving it right now. Before revealing the answer: is this somatoparaphrenia?

• Apply · Stammering and Stuttering open

  Stammering and Stuttering

  A patient sits silently through an entire interview, producing no spoken words at all despite appearing alert and occasionally nodding, though he does eventually write brief answers on a notepad when offered one. Before revealing the answer: is this stammering?

• Apply · Stereotyped Posture open

  Stereotyped Posture

  An examiner passively raises a patient's arm into an awkward, uncomfortable position during examination; the patient then maintains that exact position for several minutes after being released, with no instruction to do so and no attempt to adopt it beforehand. Before revealing the answer: is this a stereotyped posture?

• Apply · Stiffening of Affect open

  Stiffening of Affect

  A patient's facial expression, vocal tone, and gestures all convey noticeably less feeling than expected across the whole interview, regardless of the topic, and she does not recognise any change in herself when this is pointed out. Before revealing the answer: is this stiffening of affect?

• Apply · Stupor open

  Stupor

  A patient is immobile, mute, and unresponsive to voice, but his eyes remain open and appear to track movement around the room; neurological examination reveals a lesion affecting the third ventricle, and there is no history of depressive or catatonic illness. Before revealing the answer: is this simply psychiatric stupor?

• Apply · Synaesthesia open

  Synaesthesia

  A patient with an acute psychotic illness reports seeing vivid colours and hearing music even in a completely silent, dark room, with no real sound or light present to account for either experience. Before revealing the answer: is this synaesthesia?

• Apply · Tactile Hallucination open

  Tactile Hallucination

  A patient reports a persistent sensation of ants crawling across her scalp and neck, leading her to shower repeatedly through the day, but she is clear that she does not actually believe there are real insects present — she says "I know it isn't really happening, but it feels exactly like it is." Before revealing the answer: does the absence of a belief in real infestation rule out a tactile hallucination here?

• Apply · Talking Past the Point (Vorbeireden) open

  Talking Past the Point (Vorbeireden)

  Asked simple factual questions, a patient's answers are frequently incoherent and difficult to follow, with sentences that trail off, blend unrelated ideas together, and never clearly answer what was asked at all. Before revealing the answer: is this talking past the point?

• Apply · Tardive Dyskinesia open

  Tardive Dyskinesia

  Two days after starting an antipsychotic medication, a patient suddenly develops a sustained, uncomfortable twisting of the neck to one side. Before revealing the answer: is this tardive dyskinesia?

• Apply · Thought Alienation open

  Thought Alienation

  A woman describes recurrent, unpleasant thoughts about contamination that intrude against her will, which she finds excessive and irrational, but which she is clear come from her own mind rather than from anywhere else. Before revealing the answer: is this thought alienation?

• Apply · Thought Blocking open

  Thought Blocking

  A 24-year-old woman describes stopping mid-conversation multiple times a day, each time completely losing the thread of what she was saying, with no recollection afterward of her original point. She denies any sense that someone or something is removing her thoughts — she says it 'just goes blank.' Before revealing the answer: what is the finding here, and what detail in her account would make you suspicious this was thought withdrawal instead?

• Apply · Thought Broadcasting open

  Thought Broadcasting

  A patient says that a voice sometimes speaks his thoughts aloud, just after he has thought them, as though echoing them back to him — but he does not believe anyone else can access his thoughts directly, and no one else is mentioned as being aware of his thinking. Before revealing the answer: is this thought broadcasting?

• Apply · Thought Echo open

  Thought Echo

  A patient reports hearing a voice that narrates what he is doing throughout the day — "he is getting up, he is walking to the kitchen" — but the voice never repeats anything he has actually thought. Before revealing the answer: is this thought echo?

• Apply · Thought Insertion open

  Thought Insertion

  A young woman says that intrusive violent thoughts sometimes enter her mind and that she finds them horrifying and wishes they would stop, but she is clear they are her own thoughts, arising from her own mind, however unwelcome. Before revealing the answer: is this thought insertion?

• Apply · Thought Withdrawal open

  Thought Withdrawal

  A patient describes his mind suddenly going blank mid-sentence, with no thought there at all where a moment before there had been one — but when asked what caused it, he simply says he doesn't know, it just happened, with no sense of anyone or anything taking it from him. Before revealing the answer: is this thought withdrawal?

• Apply · Distortion of the Experience of Time open

  Distortion of the Experience of Time

  A patient describes time feeling as though it is moving in bursts, sometimes seeming to leap forward suddenly. When asked, he can still correctly state the date, day of the week, and his location. Before revealing the answer: does his accurate orientation rule out a genuine disturbance in how he is experiencing time?

• Apply · Trailing Phenomena open

  Trailing Phenomena

  A patient with no history of substance use reports seeing a fully formed, detailed animal moving across an empty room, where nothing at all is actually present, describing it with full conviction as though genuinely there. Before revealing the answer: is this trailing phenomena?

• Apply · Transitory Thinking open

  Transitory Thinking

  A patient begins a sentence with a complete, grammatically intact plan to describe a complex worry involving several connected concerns, but as she speaks, the parts become muddled and jumbled together so the overall meaning is lost, even though she remains aware something is not right. Before revealing the answer: is this transitory thinking?

• Apply · Twilight State open

  Twilight State

  A woman describes feeling gradually more and more absorbed in vivid, dream-like scenes over several hours, with the boundary between her ordinary awareness and the altered state impossible for her to pinpoint. Before revealing the answer: is this a twilight state?

• Apply · Undirected Fantasy Thinking open

  Undirected Fantasy Thinking

  A patient insists with complete conviction that he is secretly a member of the royal family, becoming irritated and dismissive when this is questioned, and offers no acknowledgement that this could be anything other than plain fact. Before revealing the answer: is this undirected fantasy thinking?

• Apply · Verbal Stereotypy open

  Verbal Stereotypy

  Asked "what day is it today?", a patient correctly answers "Tuesday." Asked next "what is your name?", she again answers "Tuesday," and continues answering "Tuesday" to several subsequent, unrelated questions before eventually giving correct answers again. Before revealing the answer: is this verbal stereotypy?

• Apply · Verbigeration open

  Verbigeration

  Asked "how did you sleep?", a patient replies "the garden." Asked next "what is today's date?", he again replies "the garden," before eventually returning to giving relevant, correct answers to later questions. Before revealing the answer: is this verbigeration?

• Apply · Visceral Hallucination open

  Visceral Hallucination

  A patient describes a persistent sensation of his liver "twisting and shrinking" inside him, causing significant distress, in the context of a normal physical examination and normal liver function tests already performed by his GP. Before revealing the answer: what should happen next, given the phenomenon's own guidance on this kind of presentation?

• Apply · Visual Asymbolia open

  Visual Asymbolia

  A patient can see and describe the shapes of the letters on a page perfectly clearly, but cannot make sense of them as written language, and when asked to copy the same words onto another sheet, he is unable to reproduce them at all. Before revealing the answer: is this visual asymbolia?

• Apply · Visual Hallucination open

  Visual Hallucination

  A patient describes, during a period of intense grief, occasionally "seeing" her late husband sitting in his usual chair — she says the image appears in her mind's eye rather than truly out in the room, and she knows straight away that he is not really there. Before revealing the answer: is this a visual hallucination?

• Apply · Waxy Flexibility open

  Waxy Flexibility

  An examiner gently raises a patient's arm; it moves easily and without unusual resistance, and the patient immediately lowers it back down themselves once released, clearly attentive and following the examiner's actions. Before revealing the answer: is this waxy flexibility?