Symptoms In Psychiatry Research Articles

Symptomatological Transversality and the Absence of Pathognomonic Symptoms in Psychiatry

IntroductionThe diagnosis of the main psychiatric syndromes is still almost exclusively phenotypic and depends essentially of the recognition of characteristic signs and symptoms. The clinical evalution allows the formulation of a set of differential diagnoses, according to the pathological meaning of certain symptomatic patterns and combinations. Aside from the entire dependence on the clinical interview, there are still no complementary psychiatric diagnostic exams and it is also worth noting the absence of pathognomonic symptoms.ObjectivesThrough the presentation of the case of a patient with Bipolar Affective Disorder who manifests, during a manic episode, a Capgras delusion, we intend to approach the heterogeneity of the manifestation of some symptoms that tend to be specific of concrete psychiatric syndromes.MethodsClinical case presentation and non-systematic literature review using Pubmed plataform.ResultsAB, female, 49 years old, diagnosed with Bipolar Affective Disorder. Hospitalized for a manic episode with dysphoric mood, increased energy levels and delusional activity of grandiose and persecutory content. During hospitalization, a Capgras delusion centered on the husband emerged: he was replaced by a stranger, I was able to detect him by smell.Capgras delusion is a delusional misidentification syndrome characterized by the belief that someone close has been replaced by an imposter. Despite being a rare syndrome, vastly more common in schizophrenia, affecting about 73% of cases, it can also occur in other psychiatric conditions such as dementia syndromes and, less often, mood disorders (16.7%).Additionally, there are several examples that demonstrate the versatility of psychiatric symptom occurrence in different diagnoses, with first-rank symptoms serving as an example. Described in 1959 by Kurt Schneider, they were considered specific symptoms of schizophrenia, assuming this diagnosis based on the recognition of only one symptom. Over time, its pathognomonic character has become extinct, and its detection in mood disorders and acute psychotic disorder is relatively common.Another example is the overlap between depressive and anxious symptoms. In fact, anxiety symptoms occur in about 85% of patients diagnosed with depressive disorder and, in turn, the presence of depressive symptoms in about 90% of patients diagnosed with anxiety disorder. This evidence has allowed, over time, a review of the diagnostic criteria for these disorders, leading to a progressive blurring of the threshold between them.ConclusionsPsychiatric diagnosis is still a delicate task, totally dependent on the clinical interview. The lack of analytical and imaging tests, as well as the absence of pathognomonic symptoms, constitute a particular challenge in diagnosis. For this reason, we highlight the importance of recognizing combinations and patterns of symptoms rather than the specificity of just one symptom.Disclosure of InterestNone Declared

Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry (4th edn) by Patricia Casey and Brendan Kelly Royal College of Psychiatrists/Cambridge University Press. 2019. £24.99 (Pb). 146 pp. ISBN: 9781108456340

Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry (4th edn) by Patricia Casey and Brendan Kelly Royal College of Psychiatrists/Cambridge University Press. 2019. £24.99 (Pb). 146 pp. ISBN: 9781108456340 - Volume 221 Issue 1

Ethical Challenges in the Treatment of Anxiety.

Ethical Challenges in the Treatment of Anxiety.

Historical Epistemology: a Research Approach in Psychiatry

Drawing on a key issue raised in the paper by Scardigno and Mininni (2021), this commentary explores the question of historical research in psychiatry. Firstly, the importance of historical research is highlighted for both psychiatry as a medical discipline, and for descriptive psychopathology, the language of psychiatry. Of significance has been the construction of psychiatry as a hybrid discipline formed through the deep participation of both the natural and the social sciences. This in turn brings to light the fundamental difference in epistemological basis to psychiatry and medicine, with ensuing consequences for our understanding of mental disorders and for the development of further research methodology. Likewise conceptually hybrid, the special role carried by mental symptoms in psychiatry places them, as concepts, in the position of crucial research tools. Secondly, given some of the complexities raised in carrying out historical research in this area, the issue of how this should be approached is examined. The method proposed here is that of historical epistemology. This is an approach that focuses on concepts, on mapping their biographies in order to clarify their structures, their roles, their discontinuities, their relationships and interactions with other concepts and so on. Given the central role of concepts in psychiatry and descriptive psychopathology, this approach to their study is most likely to provide valid and meaningful results.

Reliability and Validity of the Korean Version of Somatic Symptom Scale-8.

ObjectiveSomatic symptoms in psychiatry include underlying depression, anxiety, or other psychiatric disorders. This study aimed to conduct a validation study of a Korean version of the Somatic Symptom Scale-8 (K-SSS-8), and to utilize the K-SSS-8 effectively in clinical settings. MethodsFor reliabilty, test-retest reliability and internal consistency were analyzed. For construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Known-group validity was verified, Jonckheere-Terpstra test (J-T statistic) were used. ResultsMaternal Cronbach’s alpha was 0.85 and r value of test-retest reliability was 0.777. In the EFA, 2-, 3- and 4-factor model showed cumulative percentile for variance of 60% or more. In the CFA, the 3-factor model was found to be the most appropriated and simplest (χ2=10.992, df=17, CFI=1.000, TLI=1.022, RMSEA=0.000). The verifying the difference in K-SSS-8 also showed significant difference. (J-T statistic=-2.510, p<0.05). ConclusionK-SSS-8 can be useful for exploring symptoms such as panic symptoms, physical pain, and physiological symptoms experienced by patients in a short time. In addition, the K-SSS-8 is expected to be very useful for determining the current severity by using the severity categories and for establish additionally required assessment plans for depression and anxiety symptoms.

Getting Below the Surface of Behavioral Symptoms in Psychiatry

Getting Below the Surface of Behavioral Symptoms in Psychiatry

Schizophrenia, Not a Psychotic Disorder: Bleuler Revisited.

Current diagnostic criteria delineate schizophrenia as a discrete entity essentially defined by positive symptoms. However, the role of positive symptoms in psychiatry is being questioned. There is compelling evidence that psychotic manifestations are expressed in the population in a continuum of varying degrees of severity, ranging from normality to full-blown psychosis. In most cases, these phenomena do not persist, but they constitute risk factors for psychiatric disorders in general. Psychotic symptoms are also present in most non-psychotic psychiatric diagnoses, being a marker of severity. Research revealed that hallucinations and delusions appear to have distinct, independent biological underpinnings—in the general population, in psychotic, and in non-psychotic disorders as well. On the other hand, negative symptoms were seen to be far more restricted to schizophrenia, have other underlying pathophysiology than positive symptoms, predict outcome and treatment response in schizophrenia, and start before the first psychotic outbreak. The current work discusses the concept of schizophrenia, suggesting that a greater emphasis should be put on cases where psychotic symptoms emerge in a premorbid subtly increasing negative/cognitive symptoms background. In those cases, psychosis would have a different course and outcome while psychosis occurring in the absence of such background deterioration would be more benign—probably having no, or a milder, underlying degenerative process. This reformulation should better drive psychopathological classification, face positive symptoms as epiphenomenon of the schizophrenia process, and dishevel stigma from schizophrenia and from delusions and hallucinations.

Making psychiatric semiology great again: A semiologic, not nosologic challenge

This article analyzes whether psychiatric disorders can be considered different from non-psychiatric disorders on a nosologic or semiologic point of view. The supposed difference between psychiatric and non-psychiatric disorders relates to the fact that the individuation of psychiatric disorders seems more complex than for non-psychiatric disorders. This individuation process can be related to nosologic and semiologic considerations. The first part of the article analyzes whether the ways of constructing classifications of psychiatric disorders are different than for non-psychiatric disorders. The ways of establishing the boundaries between the normal and the pathologic, and of classifying the signs and symptoms in different categories of disorder, are analyzed. Rather than highlighting the specificity of psychiatric disorders, nosologic investigation reveals conceptual notions that apply to the entire field of medicine when we seek to establish the boundaries between the normal and the pathologic and between different disorders. Psychiatry is thus very important in medicine because it exemplifies the inherent problem of the construction of cognitive schemes imposed on clinical and scientific medical information to delineate a classification of disorders and increase its comprehensibility and utility. The second part of this article assesses whether the clinical manifestations of psychiatric disorders (semiology) are specific to the point that they are entities that are different from non-psychiatric disorders. The attribution of clinical manifestations in the different classifications (Research Diagnostic Criteria, Diagnostic Statistic Manual, Research Domain Criteria) is analyzed. Then the two principal models on signs and symptoms, i.e. the latent variable model and the causal network model, are assessed. Unlike nosologic investigation, semiologic analysis is able to reveal specific psychiatric features in a patient. The challenge, therefore, is to better define and classify signs and symptoms in psychiatry based on a dual and mutually interactive biological and psychological perspective, and to incorporate semiologic psychiatry into an integrative, multilevel and multisystem brain and cognitive approach.

Communicability of symptoms in psychiatry.

Communicability of symptoms in psychiatry.

Activational and effort-related aspects of motivation: neural mechanisms and implications for psychopathology

Motivation has been defined as the process that allows organisms to regulate their internal and external environment, and control the probability, proximity and availability of stimuli. As such, motivation is a complex process that is critical for survival, which involves multiple behavioural functions mediated by a number of interacting neural circuits. Classical theories of motivation suggest that there are both directional and activational aspects of motivation, and activational aspects (i.e. speed and vigour of both the instigation and persistence of behaviour) are critical for enabling organisms to overcome work-related obstacles or constraints that separate them from significant stimuli. The present review discusses the role of brain dopamine and related circuits in behavioural activation, exertion of effort in instrumental behaviour, and effort-related decision-making, based upon both animal and human studies. Impairments in behavioural activation and effort-related aspects of motivation are associated with psychiatric symptoms such as anergia, fatigue, lassitude and psychomotor retardation, which cross multiple pathologies, including depression, schizophrenia, and Parkinson's disease. Therefore, this review also attempts to provide an interdisciplinary approach that integrates findings from basic behavioural neuroscience, behavioural economics, clinical neuropsychology, psychiatry, and neurology, to provide a coherent framework for future research and theory in this critical field. Although dopamine systems are a critical part of the brain circuitry regulating behavioural activation, exertion of effort, and effort-related decision-making, mesolimbic dopamine is only one part of a distributed circuitry that includes multiple neurotransmitters and brain areas. Overall, there is a striking similarity between the brain areas involved in behavioural activation and effort-related processes in rodents and in humans. Animal models of effort-related decision-making are highly translatable to humans, and an emerging body of evidence indicates that alterations in effort-based decision-making are evident in several psychiatric and neurological disorders. People with major depression, schizophrenia, and Parkinson's disease show evidence of decision-making biases towards a lower exertion of effort. Translational studies linking research with animal models, human volunteers, and clinical populations are greatly expanding our knowledge about the neural basis of effort-related motivational dysfunction, and it is hoped that this research will ultimately lead to improved treatment for motivational and psychomotor symptoms in psychiatry and neurology.

Tryptophan via serotonin/kynurenine pathways abnormalities in a large cohort of aggressive inmates: markers for aggression

Aggressive behavior is one of the most challenging symptoms in psychiatry, and biological markers for aggression lack of large sample validations. Serotonin (5-HT) and other neuroactive compounds deriving from Tryptophan (Trp), including kynurenine (Kyn), have not yet been investigated in large cohorts of aggressive individuals to validate their potential as biomarkers of aggression.In 361 male inmates we measured serum levels of Trp, 5-hydroxytryptophan, 5-HT, Kyn, the ratios 5-HT/Trp∗1000 and Kyn/Trp∗1000, and performed Structured Clinical Interview for DSM-IV Axis-I and -II Disorders (SCID-I and -II), global assessment of functioning (GAF), and scales for aggressive behavior, impulsivity, adult attention-deficit/hyperactivity disorder (ADHD), and intelligent quotient (IQ).Aggressive compared to non-aggressive inmates exhibited lower Trp and Kyn serum levels but higher levels of 5-HT and 5-HT/Trp∗1000, higher levels of impulsivity and ADHD indices, lower IQ and GAF, higher prevalence of mood disorders, drug abuse/dependence, and borderline, conduct and antisocial behaviors. Interestingly, Kyn/Trp∗1000 was positively correlated to the number of severe aggressive acts (r=0.593, P<0.001). After adjusting for confounding factors, logistic regression analysis indicated that 5-HT/Trp∗1000, antisocial behavior, and GAF were predictors of aggressive behavior. The model combining these three predictors had an area under the ROC curve of 0.851 (95% CI 0.806–0.895).This study indicates that while circulating Trp is reduced in aggressive individuals, the combination of biological (5-HT/Trp ratio) and psychopathological (antisocial behavior and GAF) markers discriminates between aggressive and non-aggressive behavior suggesting the potential of a multi-marker approach in psychiatry given the heterogenic nature of mental diseases.

The co-occurrence of eating disorders and psychosis

IntroductionSeveral reviews have reported the incidence of schizophrenia in patients with eating disorders (ED) to be between 3–10% and the incidence of transient psychotic episodes to be 10–15%. On the other hand, anorexia nervosa appears to affect 1 to 4% of schizophrenia patients. Reports of psychosis and ED occurring in the same patient have led to various views as to the nature of the relationship between the two.ObjectiveAnalysis of the literature illustrated by different clinical cases in which appears to be a relationship between ED and psychosis.AimsCritical reflection about the hypothesis that could underlie the comorbidity of psychotic illness and ED.MethodsNon-systematic review of a literature search using the keywords: eating disorders; psychosis; comorbidity.ResultsThere is no consistent sequence in the co-occurrence of the two conditions – ED sometimes precede and sometimes follows the onset of psychosis. ED patients can develop psychotic symptoms, most frequently transient in the course of the disorder, while others are subsequently diagnosed with a chronic psychotic disorder. On the other hand, patients with a primary psychotic illness can develop an eating disorder. The connection between the two, however, remains speculative, considering the hypothesis that ED and psychosis can be entirely separate disorders that can, by chance, occur in the same person.ConclusionsThe area of comorbidity and overlapping symptoms in psychiatry requires more deep research. Despite evidence from case series, the comorbidity between ED and psychosis is poorly understood, and firm conclusions cannot be drawn from this analysis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Gastrointestinal System Symptoms in Psychiatry: Comparison of Direct Presentations and Referrals

Introduction and Objectives: Clinical experience and observations state that patients who have gastrointestinal system (GIS) symptoms and directly present to, or who are referred to psychiatry clinics have different clinical features. This study aims to investigate these two different groups. Methods For the present study patients with GIS symptoms who directly presented to psychiatry (n=61), and who were referred from other clinics (n=54) were compared with each other via chi-square test and independent samples t-test. The patients were diagnosed according to the DSM-IV criteria, and relative risks for the risk groups were computed. Results Direct presentations to psychiatry were more likely to be women, older, married, and believed that their symptoms had a psychological explanation (RR:2.430). Patient who were referred were more likely to have undergone invasive diagnostic tests, and to have been prescribed drugs for their symptoms (RR:3.150). Direct presentations suffered more from abdominal distention (RR:1.434) whereas those who were referred suffered more from abdominal pain (RR:3.761), constipation (RR:2.298) and swelling (RR:1.674). Patients who directly presented were more likely diagnosed with depressive disorders (RR:1.802), trauma related disorders (RR:1.605) and personality disorders (RR:2.174). Patients who were referred were more likely to be diagnosed with psychotic disorders (RR:2.271). In terms of personality traits, patients who directly presented were more likely to be impulsive (RR:1.629). Conclusions These results suggest that patients who directly present or who are referred to psychiatry clinics differ from each other on demographic, clinical and psychiatric parameters, and provide some evidence to the clinical experience and observations.

Eating disorders and psychosis: Seven hypotheses.

Psychotic disorders and eating disorders sometimes occur in the same person, and sometimes, but not always, at the same time. This can cause diagnostic confusion and uncertainty about treatment. This paper examines seven ways in which symptoms of both conditions can co-exist. The literature on this topic consists to a large extent of case reports, so that firm conclusions cannot be drawn from their examination. There is no consistent sequence in the co-occurrence of the two conditions-eating disorders sometimes precede, and sometimes follow the onset of psychosis. The advent of the psychosis, and sometimes the treatment of the psychosis can cure the eating disorder, but it can sometimes aggravate it. Psychosis is not necessarily a mark of severity in the course of an eating disorder, and food refusal can occur independent of severity in psychotic illness, but it can be a cause of death. There is some genetic association and some overlap of physiologic, cognitive and brain structure deficits in the two types of disorder. The connection between the two, however, remains speculative. The area of comorbidity and overlapping symptoms in psychiatry requires more research. Clinical recommendations include attention to the different individual ways in which these two disparate conditions often overlap.

Functional Auditory Hallucinations in a Case of Serotonin Syndrome

Functional Auditory Hallucinations in a Case of Serotonin Syndrome

John Wing and the perils of nosolatry

John Wing and the perils of nosolatry

Of Postures, Mirrors, and Models in Catatonia

Back to table of contents Previous article Next article LettersFull AccessOf Postures, Mirrors, and Models in CatatoniaUrvakhsh Meherwan Mehta, M.D., Narayana Manjunatha, M.D., D.P.M., and John P. John, M.D.Urvakhsh Meherwan MehtaSearch for more papers by this author, M.D., Narayana ManjunathaSearch for more papers by this author, M.D., D.P.M., and John P. JohnSearch for more papers by this author, M.D.Published Online:1 Jan 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Posturing in catatonia is one of its more distinctive phenomena, the bizarreness of which has fascinated psychopathologists, clinicians, and researchers alike. Fish1 describes posturing as a disorder of goal-directed movements. Cutting2 ascribes it to a disintegration of purposeful actions and gives it a status of pseudo-purposefulness. We report a case of catatonia that presented with a wide range of posturing, involving groups of muscles from head to toe, and we highlight the relevance of a broader conceptualization of posturing and newer research forays based on fundamentals of motor cognition.Case ReportA 26-year-old man from southern India with unremarkable past, personal, and family history presented with illness lasting 8 days that had abrupt onset and polymorphic course. Symptoms appeared in the sequence of paranoid delusions and extreme psychomotor excitement, and over the next 2 days, he displayed florid catatonic features, the most dramatic of them being demonstration of an array of posturing signs from head to toe.The patient's face displayed grimacing (due to facial muscle spasm giving an appearance of a sneering grin like that of risus sardonicus) and motor stereotypies of his lower jaw with instances of spasms in his jaw muscles leading to trismus. Staring was evident, with fixed gaze and poor blink rate. Stereotyped posturing was observed in the neck and shoulder muscles as he lay supine in bed with his head a few inches off the pillow (psychological pillow) and in the extensor spinal muscles which led to episodic and recurrent opisthotonus or arc de cercle. Classical mannerist posturing involving the upper limbs was evident, with his arms spontaneously held in a prayer-like folded manner (namasthe in Indian culture). Catalepsy or perseveration of posture was observed in both upper and lower limbs when placed in a series of uncomfortable postures. The posturing display occurred in episodes lasting 1–20 minutes over a period of 36 hours. There was no historical account of being administered neuroleptics. Examination did not reveal neurological deficits. Despite extensive metabolic, imaging, and EEG investigations, no organic pathology was demonstrated. The patient improved with ECT after partial response to lorazepam.DiscussionIt has been more than a century since Kahlbaum3 described catatonia as a syndrome of motor abnormalities, yet it remains a poorly understood phenomenon. Novel methods based on fundamentals of cognitive and social neurosciences may shed some light on neurobiology of catatonia. We propose a broader conceptualization of posturing as a prototype motor dysregulation state based on recent advances in mirror neurons and motor cognition. The increasing understanding of neural circuits underlying motor cognition domains of intention (presupplementary motor area and intraparietal sulcus),4 initiation (supplementary motor area),5 termination (right posterior parietal cortex),6 implicit motor feedback for execution (anterior cingulate),7 sense of agency and gnosis of these phenomena (mirror neurons of inferior parietal lobule, pars opercularis of inferior frontal gyrus and insula)8 is an exciting development. These concepts can be utilized in formulating a composite cognitive model of catatonia which can then be empirically tested.Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India1. Casey P , Kelly B: Motor disorders, in Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry, 3rd Edition. Edited by Casey PKelly B. Cambridge, UK, Gaskell, 2007Google Scholar2. Cutting J: Principles of Psychopathology: Two Worlds, Two Minds, Two Hemispheres, 3rd Edition. Oxford, UK, Oxford Univ. Press, 1997Google Scholar3. Kahlbaum KL: Catatonia. (trans. , Levi Y , Pridon T). Baltimore, MD, Johns Hopkins Univ. Press, 1973Google Scholar4. Haggard P: Conscious intention and motor cognition. Trends Cogn Sci 2005; 9:290–295Crossref, Medline, Google Scholar5. Jahanshahi M , Jenkins IH , Brown RG, et al.: Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson's disease subjects. Brain 1995; 118(part 4):913–933Crossref, Medline, Google Scholar6. Northoff G: Catatonia and neuroleptic malignant syndrome: psychopathology and pathophysiology. J Neural Transm 2002; 109:1453–1467Crossref, Medline, Google Scholar7. Berns GS , Cohen JD , Mintun MA: Brain regions responsive to novelty in the absence of awareness. Science 1997; 276:1272–1275Crossref, Medline, Google Scholar8. Rizzolatti G , Fabbri-Destro M , Cattaneo L: Mirror neurons and their clinical relevance. Nat Clin Pract Neurol 2009; 5:24–34Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 23Issue 1 Winter 2011Pages E16-E16 Metrics PDF download History Published online 1 January 2011 Published in print 1 January 2011

Neurological symptoms in psychiatry

Certain psychiatric diseases have biological pathomechanisms, and as a result they are accompanied by various neurological symptoms. Neurological examination is a simple method to assess these symptoms. Neurological signs come in two varieties; they are either of the hard or the soft type. Hard symptoms appear primarily in organic psychiatric disorders or as side effects of psychiatric therapy. They can also be encountered during neurological diseases of psychiatric patients. Their use in diagnostics and therapy is widely accepted. In contrast, soft neurological symptoms often stay unnoticed, even though they may contain important pieces of information. For this reason they will form the focus of our discussion. Soft neurological symptoms have been studied in different psychiatric disorder-groups. Up to now most attention has been devoted to schizophrenia. The study suggests that the soft symptoms are trait markers of schizophrenia. Furthermore they also signal disease activity and predict the outcome of the disease. Neurological symptoms are also important pointers for psychiatry. However, more systematic studies may increase the theoretical and practical implications of soft symptoms.

W04-01 - Catatonia: differentiation, pathophysiology and treatment

Catatonia is an intriguing psychopathological dimension and the discussion about the clinical relevance of catatonic symptoms in psychiatry is continuing for at least 125 years. The debate started from the original description by Kahlbaum and was further elaborated by Kraepelin and Bleuler who incorporated catatonia in their broad concept of schizophrenia. They regarded catatonic symptoms merely as an integral part of schizophrenia. In addition, periodic catatonia was described by Leonhard that has a considerable hereditary loading, shows a phasic course with alternating hyperkinesia and akinesia and can be delineated from the akinetic-hyperkinetic motility psychosis which belongs to the cycloid psychoses.Over the past decades, the prevalence of the diagnosis of catatonia as a separate disease and as subtype of schizophrenia is decreased considerable. This phenomenon is most probably the result of changes in the diagnostic criteria as well as underrecognition of this symptom dimension.Today's research is focussing on the pathophysiology, genetics and treatment of catatonia. As demonstrated in factor analytical studies, this disorder can be considered as a separate psychopathological dimension. Apart from the endogenous catatonias belonging to either the periodic catatonia or catatonic schizophrenia, the catatonic dimension is present in about ten percent of newly admitted patients with affective or schizophrenic psychoses.In for different presentations, the need for a differential diagnosis of catatonias will be outlined as well as their genetic and pathophysiological backgrounds and appropriate treatment strategies, such as electroconvulsive therapy.

Ecological momentary assessment in addiction

Numerous symptoms in psychiatry are subjective (e.g., sadness, anxiety, craving or fatigue), fluctuate and are environment dependent. Accurate measurement of these phenomena requires repeated measures, and ideally needs to be performed in the patient’s natural environment rather than in an artificial laboratory environment or a protected hospital environment. The usual paper and pencil questionnaires do not meet these two conditions for reasons of logistics. A recently developed method, ecological momentary assessment (EMA), made it possible to implement these field assessments via ingenious use of various devices (most frequently an electronic diary) coupling an auditory signal with computerized data capture. The subject carries the device with him/her at all times, and data is recorded in vivo in real time. The programming of repeated measures in the form of a Likert scale or pull-down menu is easily achieved. A recall alarm system can help increase compliance. Compared with classical self-report, EMA improves the validity of the assessment of certain symptoms, which are the main evaluation criteria in clinical trials concerning certain pathologies (e.g., craving and treatment of addiction), where measurement was previously liable to bias. This article sets out to present this method, its advantages and disadvantages, and the interest it presents in psychiatry, in particular via three original applications developed by the authors including: measurement of reaction time without the knowledge of the subject in order to test certain cognitive models; use of a graphic solution for the data recorded for functional analysis of disorders; and the use of data collection via mobile phone and text messages, which also enables therapeutic interventions in real time by text messages, personalized on the basis of the situational data collected (e.g., in the case of craving, the associated mood, solitary or group consumption or concomitant occupations).