Symptom matrix
| SYMPTOMS | OBSERVED | REPORTED | SUSPECTED | |||
|---|---|---|---|---|---|---|
| DEFINITION | EXAMPLE | DEFINITION | EXAMPLE | DEFINITION | EXAMPLE | |
| Cognitive | Directly observed or assessed phenomena pertaining to the mental processes of knowledge, perception, memory, judgment, and reasoning | The patient frequently asks the physician to repeat questions and is unable to decide when to book the next visit | Experience of mental processes is described by the patient or signs relating to mental processes are described by others | The patient describes concern about forgetfulness, feeling anxious, and an inability to make decisions. The patient’s mother describes observations that reflect illogical thinking | Impairment in cognitive processes is inferred on the basis of described behaviour, events, or experiences | The patient describes answering the telephone while her toddler is in the bathtub and only recalling that she has done so when alerted by a cry from the bathroom |
| Emotional | Patient displays behavioural manifestations of feelings and mood states observed by the physician* | The patient is smiling and laughing throughout the office visit | A patient’s specific description of feelings or mood, or related somatic or physiologic experience | The patient describes that she feels very content and happy and no longer has any worries | Inferred feelings or mood states from the patient’s statements or behaviour | The patient is not spontaneous in speech, speaks softly, and believes her current situation has no solution |
| Sensory | A patient’s sensory experiences cannot be observed. Beyond the standard senses of vision, hearing, taste, smell, touch, temperature, and pain, keep in mind other senses such as proprioception, kinesthesia, acceleration, velocity, orientation to gravity, etc. One can observe consequences of the sensory experience (eg, blindness, deafness) through behaviour, but these will often be inferred | The patient knocks over items and bumps into furniture as she walks into the room | A patient’s or other’s report of sensory experiences or explicit description of experiences that are confirmed to be sensations by the physician | The patient reports hearing voices | Experiences that are described or alluded to by the patient or observations by others, or direct observations by the physician that might be interpreted as sensory phenomena. Treat suspicion as a hypothesis to be tested over time | Patient frequently stops speaking mid-sentence and looks around the room. Physician infers the patient is hearing voices |
| Behavioural | Observed patient actions | The patient’s speech is extremely loud and pressured | Patient or others report behaviour | The patient reports she has been staying up all night and spending excessive amounts of money shopping | Suspected behaviour based on information received by the physician | Patient denies drinking but has a high MCV and recently had a car accident |
MCV—mean corpuscular volume.
↵* Emotions are inferred.