The manifestation of psychiatric symptoms

1. The manifestation of psychiatric symptoms Mental disorders due to general medical condition Organic disorders Symptomatic disorders Functional disorders (psychiatric dis- ord. in the narrow sense)

2. Basic classification of psychiatric disorders (in the narrow sense) ICD-9 (old) Psychoses Neuroses Persona-lity disorders Disorders: Anxiety Stress Dissociative Somatoform Eating Sex.dysfunc ICD-10 (new) Schizophrenia Affective dis. Developm. dis. Conduct dis. ADHD Substance- related dis.

3. Psychiatric history I. • Identifying data, incl. data promoting involunt. admission • Family history • Personal history (anamnesis): • Past illnesses (psychiatric, medical, substance abuse) • Prenatal, perinatal history and early psychomotor development • Preschool and school history • Occupational history • Marital and relationship history, incl. sexual history • Social history and current living situation • Traumatic experiences

4. Psychiatric history II. • Present illness • Onset, precipitating factors • Course, periodicity • Chief complaint and problem • Mental status examination • General description (orientation, appearence, behavior, atttitude, speech ) • Mood and affectivity • Perception (e.g.,hallucinations) • Thought process and content (e.g.formal thought disturb., delusions) • Memory. • Judgment and insight, suicidal thoughts.

5. Psychiatric history III. • Diagnosis • Differential diagnosis • Further diagnostic plan (interviews with family members; psychological, neurological, laboratory examination, imaging methods etc.) • Treatment plan

6. Disturbances of perception • illusion = misperception of real external sensory stimuli • hallucination = false sensory perception not associated with real external stimuli • auditory, visual, olfactory, gustatory, tactile, somatic (visceral) • micropsia • mood-congruent and –incongruent hallucinations • command hallucination

7. Formal thought disturbances • neologism = new word created by a patient • word salat = incoherent mixture of words and phrases • incoherence = no logical or grammatical connection • perseveration = persisting response to a previous stimulus after a new stimulus has been presented • verbigeration = meaningless repetition of words/phrases • loosening of associations = shift without logical relation • blocking = abrupt interruption in train of thinking

8. Delusion - definition • disturbance in thought content • not a solitary sign, but a part of a psychotic illness • false belief with 3 characteristics: • false presumption • not consistent with patients intelligence and cultural background • cannot be corrected by reasoning

9. Delusions • paranoid • of persecution = being harassed, cheated or persecuted • of grandeur = exaggerated conception of importance, power, or identity • of reference = behavior of others refers to the patient

10. Delusions • nihilistic = self, others, or the world is nonexistent • of poverty = to be bereft of all material possessions • somatic = incvolving functioning of the body • of self-accusation = feeling of remorse and guilt • delusion of control = person´s will, thoughts, or feelings are beeing controlled by external forces (thought withdrawal, t. insertion, t.broadcasting, t. control) • of infidelity • erotomanic

11. Catatonic symptoms • catatonic stupor = markedly slowed motor activity, often to a point of immobility • catatonic excitement = agitated, purposeless motor activity • catatonic posturing = voluntary assumption of an inappropriate or bizarre posture • echopraxia = pathological imitation of movements • stereotypy = repetitive fixed pattern of physical action • mannerism = habitual involuntary movement • command automatism = automatic following of suggestions