Psychopathology

1. Psychopathology Dr.Wail Araim Board psychiatry/Germany Fach. arzt. Associate prof. Consultant psychiatrist

2. Psychopathology Is the definition of abnormal personality functioning or the study of abnormal states of mind. . phenomenological psychopathology psychodynamic psychopathology experimental psychopathology

3. PHENOMENOLOGICAL PSYCHOPATHOLOGY It is an attempt to understand the signs and symptoms observed in the patient . It is concerned with objective description of abnormal states of mind .

4. DESCRIPTION OF SIGNS AND SYMPTOMS DISORDER OF PERCEPTION PERCEPTION Is a process to be aware of what is presenting through the sense organs IMAGERY Is an experience within the mind, usually without the sense of reality that is part of perception.

5. ILLUSIONS These are distortion of real perception ( misperception or misinterpretation of external stimuli ) Illusion occurs when the level of sensory stimulation is reduced or level of consciousness is reduced ILLUSIONS always raise the possibility of organic disorders D�j� vu : Illusion of visual recognition in which a new situation is incorrectly regarded as a repetition of a previous experience .

6. HALLUCINATIONS A hallucination is percept experienced in the absence of an external stimulus to the sense organs with a similar quality to a true percept . DESCRIPTION OF HALLUCINATIONS NONPATHOLOGICAL : Hypnagogic hallucination : false sensory perception occurring while falling asleep . Hypnopompic hallucination : false sensory perception occurring while awakening from sleep .

7. HALLUCINATIONS OF INDIVIDUAL SENSES: Auditory hallucinations : Voices ( words ,phrases, or sentences ). They may be experienced as noises or music . Second person hallucination : One voice only may seem address the patient directly. Third person hallucination : Two voices or more talk to one another referring to the patient as �he� or �she�and may give a running commentary on the patient s action or intention . Thoughts are spoken aloud : Patient hears his own thoughts as he thinks them. Thought echo : Patient hears his own thoughts after he has thought of them .

8. VISUAL HALLUCINATIONS : Are much less frequent and are false perception involving sight consisting of formed images ( like person ) or unformed images ( like flashes of light ), most commen in acute organic states: 1-Extracampine visual hallucination : Are experienced as located outside the field of vision ,behind the head . 2-Lilliputian visual hallucination : False perception in which objects are seen as reduced in size .

9. OLFACTORY AND GUSTATORY HALLUCINATIONS : Are frequently experienced together, often as unpleasant smells or tastes . They are uncommon and may be encountered as part of the aura of temporal lobe epilepsy . SOMATIC HALLUCINATIONS : Tactile (haptic) hallucination : This may take the form of small animal crawling on or under the skin ,so called formication, although it may occur in schizophrenia ,but it is more common in acute brain syndrome. Hallucination of deep sensation : May occur as feeling of the viscera being distended or of sexual stimulation or electrical shock.

10. DEPERSONALIZATION : Patient feels that he is detached from his surrounding and unable to feel emotion or being detached from once own body DEREALIZATION: Patient describe things in his surrounding that are artificial and lifeless JAMAIS VU: Paramnestic phenomenon characterized by a false feeling of unfamiliarity with a real situation that one has previously experienced

11. DISORDERS OF THINKING : Thought is the most highly organized of psychobiological integrations.thinking is referred to idealtion components of mental activity,process used to imagine,evaluate,forcast plan,creat and will.

12. DISORDEERS OF STREAM OF THOUGHTS 1-Preasure of thought When patients thoughts are rich in variety and pass quickly through his mind 2-Poverty of thoughts When the patient has only few thoughts and pass slowly through his mind 3-Thought blocking Sudden interruption of the flow of thoughts for seconds or minutes in which the patient experiences as his mind going blank or his mind is empty

13. DISORDERS OF THE FORM OF THE THOUGHT(FORMAL THOUGHT DIS ORDERS) 1-Flight of ideas The subjects train of thoughts is changing repeatedly in response to external stimuli. the patients thoughts move rapidly from one idea to another, each idea being more or less meaningfully related to the preceding idea. flight of idea is a characteristic of mania 2-Perseveration The patient may give the correct answer to the first questions but continue to give the same answer inappropriately to subsequent questions, mainly seen in organic brain disorders

14. 3-Loosening of association There is a breakdown in the normal structure of thinking or the flow of thoughts,in which ideas shift from one subject to another in completely unrelated way 4-Knight�s move or derailment Refers to arapid change from one topic to another, either between sentences or in mid sentence with no logical links between the two topics. This condtion is characteristic of schizophrenia 5-Word salad Incoherent mixture of words and phrases seen in schizophrenia 6-Verbigration meaningless repetition of specific words or phrases in a stereotypic way

15. 7-neologism new words words invented by the patient. 8-Circumstantiality Indirect speech that is delayed in reaching the point 9-Tangentiality Inability to have goal directed association of thoughts, he never gets from poins to desired goals 10-Echolalia The patient repeats apart or the whole of what have been said to him

16. DISORDER OF THE CONTENT OF THOUGHT Delusion: Is a false unshakable belief, held firmly on inadequate grounds , not consistent with patients intelligence ,religious ,and cultural background ,can not be corrected by reasoning to the contrary.

17. DESCRIPTION OF DELUSIONS according to fixity: Complete and partial According to onset: Primary and secondary According to delusional experience: Delusional mood, Delusional perception, Delusional memory According to themes: Persecutory (paranoid), Delusion of reference, Grandiose, Guilt, Nihilistic, Hypochondriacal, Religious, Jealous, Control Delusion concerning possession of thoughts : Thought insertion , thought withdrawal and thought broad casting Shared delusion

18. PERSECUTORY (PARANOID) DELUSION: A persons false belief that he or she is being persecuted or cheated. Seen in schizophrenia, severe affective disorder, and organic brain disorders DELUSION OF REFERENCE: A person false belief that the behavior of others refer to oneself as article read in newspaper, or remark heard on TV is believed to be directed specifically to himself GRANDIOSE DELUSION Exaggerated conception of ones importance, power, or identity. DELUSION OF CONTROL: False feeling ,in which the patient believes that his actions ,impulses and thoughts are controlled by others.

19. DILUSIONS CONCERNING THE POSSESSION OF THOUGHTS 1-Thoughts withdrawal Thoughts are being removed from the mind of the patient by other persons or forces 2-Thoughts insertion Thoughts are being implanted or inserted in a person�s mind 3-Thought broadcasting Patient�s thought are known by other people through radio,telepathy or in some other way

20. OBSESSION AND COMPULSION Obsession: is a recurrent persistent and intrusive thoughts, impulses or images that keep coming to mind despite the patients effort to exclude them from his mind The characteristic feature of obsession: 1-thoughts are repetitive and stereotype 2-irresistible 3-subjective sense of a struggle 4-thoughts are recognized by the patient as untrue and senseless 5-thoughts are distressing the patient

21. compulsion : is repetitive stereotype goal directed behavior characteristic of compulsion: 1-they must be performed by an urge to resist 2-they are recognized by the patient as senseless 3-they are usually associated with an obsession in order to reduce the anxiety caused by the obsession

22. obsessional and compulsive forms: obsession compulsion thoughts rituals rumination clean doubts counting impulses dressing/order obsessional phobias checking obsessional slowness

23. PHOBIAS Irrational fears out of proportion to the feared object or situation which lead to avoidance Types of phobias; 1-agoraphobia : fear from overcrowded and open places 2-claustrophobia :fear from closed places 3-heightphobia 4-flightphobia 5-socialphobia �����etc

24. SPEECH DISORDERS; 1-Stammering: in stammering the normal flow of speech is interrupted by pauses by the repetition of fragment of the word 2-Stuttering: frequent repetition or prolongation of a sound or a syllable, leading to markedly impaired speech fluency 3-Mutism: complete loss of speech or whispered speech and may occur in children with range of emotional or psychiatric disorders and in adult with hysteria,depression,schizophrenia or organic brain disorders

25. DISORDERS OF MOOD .Changes and the nature of mood can be towards anxiety,depression,elation or anger .Irritable mood a state in which a person is easily annoyed and provoked to anger .Mood swings (labile mood) when emotions change in an excessively rapid and abrupt way .Euphoria: intense elation with feeling of grandear .Ecstasy : feeling of intense rapture .Depression : psychopathological feeling of sadness. .Apathy : inability to feel pleasure associated with detachment or indifference. .Anhedonia : loss of interest in, and withdrawal from all regular and pleasurable activities, usually associated with depression .Grief or mourning : sadness appropriate to a real loss, also called bereavement

26. DISORDER OF AFFECT: Affect: emotional feeling tone, possibly inconsistent with patients description Of emotion. Appropriate affect :harmony of affect and ideation. Inappropriate affect: disharmony of affect and ideation. Blunting affect : a state of reduced emotional responsiveness rather than a Total loss of the ability to express emotion. Flat affect : absence or near absence of any signs of affective expression. Labile affect : rapidly changing emotional responses which are Exaggerated but not incongruous. Ambivalence: coexistence of two opposing impulses toward the same thing In the same person at the same time. ANXIETY: Is a disagreeable emotional state with feeling of impending danger, characterized by tension and apprehension.

27. MOTOR SYMPTOMS AND SIGNS Mannerism : Stereotyped involuntary movements Posturing : Is the adoption of unusual bodily postures continuously for a long time. Negativism : Motiveless resistance to all attempts to be moved or to all instructions and they do the opposite of what is asked. Echopraxia: Pathological imitation of the interviewers movement automatically. Ambitendence: When they alternate between opposite movements Waxy flexibility (cerea flexibilitas): Condition in which a person can be molded into a position that is then maintained for long periods whilst at same time muscle tone is uniformly increased. Catalepsy : Condition in which immobile position of the body constantly maintained. Automatism : Automatic performance of acts Tics : Spasmodic, repetitive motor movements

28. DISORDERS OF MEMORY Memory : Function by which information stored in the brain , is latter recalled to consciousness. Orientation : Is the normal state of oneself and ones surroundings in terms of time ,place ,and person. Levels of memory : Immediate :recall of perceived material within seconds to minutes. Recent: Recall of events over past few days. Remote : Recall of events in distant past. Amnesia : Partial or total inability to recall past experiences. Anterograde amnesia : The interval between the ending of complete unconsciousness and the restoration of full consciousness. Retrograde amnesia : Inability to recall events before the onset of unconsciousness.

29. DISORDER OF ATTENTION AND CONCENTRATION Attention : Is the ability to focus on certain portions of an experience. Concentration : Is the ability to sustain a focus on one activity. Distractibility : State in which attention is drawn to unimportant external stimuli. Hypervigilance : Excessive attention and focus on all internal and external stimuli. Trance : Sleep-like state of reduced consciousness and activity, usually seen in hypnosis,and dissociative disorders. Intelligence : The ability to understand, recall, mobilize, and constructively integrate previous learning in facing new situation. Mental retardation : Lack of intelligence to a degree in which there is interference with social and vocational performance, profound less than 25 %,severe (25-40)%, moderate (40-55)%,mild(55-70)%, borderline(70-80)%, dull normal(80-90)%, normal(90-110)%, bright normal(110-120)%, superior (120-130)%, very superior above 130

30. dementia: organic and global deterioration of intellectual functioning without clouding of consciousness JUDGMENT Is the ability to compare facts or ideas, to understand their relations and to draw correct conclusions from them

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