Mental disorders prof. fareed minhas


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Mental disorders prof. fareed minhas

  1. 1. Signs And Symptoms of Mental Disorders Fareed Minhas Professor of Psychiatry Head, Institute of Psychiatry Rawalpindi Medical College Rawalpindi
  2. 2. General Issues…  Psychopathology-study of abnormal states of mind Three approaches Phenomenological- objective descriptions of abnormal states entirely of conscious experiences and observable behavior Psychodynamic- explains causation of the abnormal events by postulating unconscious mental processes in addition to description Experimental- relationships between abnormal phenomena examined by inducing change in one and observing impact on others
  3. 3. General Issues…(contd.)  Significance of individual symptomscharacteristic grouping of symptoms is important.  Primary and Secondary Symptoms- establishing a temporal relationship between symptoms if possible.  Form and Content of Symptoms- eg. “form” of a chair contains a seat, back and four legs whilst “content” is wood and straw
  4. 4. Categorizing Disorders…           Disorders of perception Disorders of thinking Disorders of mood Disorders of general behavior Motor Signs and Symptoms Disorders of Body Image Disorders of Memory Disorders of Consciousness Disorders of Attention/Concentration Disorders of Insight
  5. 5. Disorders of Perception  Perception is the process of becoming aware of what is presented through the sense organs  Imagery is the experience within the mind (without sense of reality ) which is a part of perception eg. Eidetic imagery, pareidolia etc  Alterations in perception of intensity eg. mania or depression and quality eg. Schizophrenia  Illusions are misperceptions of external stimuli eg. Delirium, normal situations
  6. 6. Disorders of Perception (contd.)  Hallucination is a percept experienced in absence of external stimulus to sense organ and with a similar quality to a true percept Auditory Visual Olfactory or gustatory Somatic (tactile or deep) Delusional Perception Normal situations(hypnagogic/hypnopompic)  Pseudohallucinations are of a less intensity and the person recognizes the absence of external correlates
  7. 7. [Description of Hallucinations]     According to complexity  Elementary  Complex According to sensory modality  Auditory  Visual  Olfactory and gustatory  Somatic (tactile or deep) According to special features  Auditory : second-person or third-person Gedankenlautwerden echo de la pensee  Visual : extracampine Autoscopic hallucinations
  8. 8. Disorders of Thinking TH O U GH T D ISO RD ERS STREAM O F TH O U G H T -Pressu re - T h o u g h t b lo c k FO R M O F TH O U G H T - F lig h t o f id e a s - P e r s e v e r a t io n - L o o s e n in g o f a s s o c ia t io n PARTICU LAR KIN D S - D e lu s io n s - O b s e s s io n s
  9. 9. Disorders of Thinking(contd.)  Pressure of thought- when ideas arise in unusual variety and pass through the mind rapidly  Thought Block- sudden, striking and repeated interruptions in speech when the patient describes an abrupt emptying of the mind  Flight of ideas- thoughts/conversations move quickly from one topic to another with understandable links eg. Clang associations, punning, rhyming  Persevaration- persistent inappropriate repetition of same thoughts
  10. 10. Disorders of Thinking(contd.)  Loosening of association- loss of normal structural links such as:  Knight’s move or derailment  Word salad  Verbigeration  Talking past the point  Neologisms- use of self-invented words and phrases to describe morbid experiences  Delusions – false, firm belief impervious to reasoning and against the social and cultural norms
  11. 11. Disorders of Thinking(contd.)  According to theme :  Persecutory(paranoid) delusions  Delusions of reference  Grandiose(expansive) delusions  Delusions of guilt and worthlessness  Nihilistic  Hypochondriacal  Delusions of control  Sexual  Delusions concerning possession of thought: thought insertion, thought withdrawal, thought broadcast
  12. 12. Disorders of Thinking(contd.)  Other delusional experiences:  Delusional mood  Delusional perception  Delusional memory  Obsessions- recurrent persistent thoughts, impulses or images that enter the mind despite the person’s efforts to exclude them. Types maybe:  Thoughts  Ruminations  Doubts  Impulses  Phobias
  13. 13. Disorders of Thinking(contd.)  Compulsions- repetitive and seemingly purposeful behaviors performed in a stereotyped way (compulsive rituals) eg. Cleaning, counting, dressing and these may lead to obsessional slowness  Obsessions are not always followed by compulsions but compulsions always have preceding obsessions associated with them
  14. 14. Disorders of Mood  Change in nature of mood- which can be towards anxiety, depression, elation or anger  Abnormal fluctuations of mood- such as:      Apathy Blunting or flattening of affect Labile Emotional incontinence Incongruity of mood- for eg. A patient may laugh when describing the death of his mother
  15. 15. Disorders of general behavior  Phobias- A phobia is a persistent irrational fear of a specific object/activity/situation which the person recognizes as his own and tries to avoid it at all possible costs eg. Claustrophobia  Depersonalization- change of self-awareness such that the person feels unreal  Derealization- objects around the person appear unreal and people as seen as two-dimensional cardboard figures
  16. 16. Motor Symptoms and Signs  Tics- irregular repeated movements involving a group of muscles, eg. Raising of shoulders  Mannerisms- repeated movements seeming to have a functional significance eg. Saluting  Stereotypies- repetitive regular movements having no obvious functional significance eg. Rocking to and fro  Posturing- adoption of unusual body postures for long periods of time
  17. 17. Motor Symptoms and Signs  Negativism- Patients doing completely opposite of what is being asked and resisting persuasion  Echopraxia- immitation of interviewer’s movement automatically even when asked not to do so  Ambitendence- Patients alternate between opposite movements eg. Putting out an arm to shake hands then withdrawing  Waxy flexibility- when patient’s limbs can be placed in any position for long periods while muscle tone is uniformly increased
  18. 18. Disorders of Body Image  Phantom Limb- continuing awareness of a part of body that has been lost  Unilateral awareness and neglect- resulting from parietal lobe lesions and in extreme forms patient may neglect washing that particular side, puts on one shoe etc  Hemisomatognosis- or hemidepersonalization  Anosognosia- lack of awareness of disease  Pain asymbolia- recognising a painful stimulus as painless
  19. 19. Disorders of Body Image(contd.)  Autotopagnosia- inability to recognize, name or point on command to parts of the body  Distorted awareness of size and shape- feelings that a limb is becoming smaller, larger etc  Reduplication phenomenon- experience that part or all of the body has doubled  Coenesthopatic states- localized distortions of body awareness eg. Nose feels as if made of cotton wool
  20. 20. Disorders of Memory  Normal process: Sensory stores  Short-term Memory  Long-term Memory  Amnesia- Failure of memory    Anterograde Retrograde Confabulation- Patients have so much difficulty remembering that they recall even those events that never happened
  21. 21. Disorders of Consciousness  Consciousness- awareness of the self in relation to environment. Level may vary from extreme alertness to coma  Coma- Extreme of impaired consciousness unresponsive to the strongest stimulus. 4 grades  Clouding of consciousness- All cognitive functions are impaired  Stupor- Immobile, mute, unresponsive patient appearing to be fully conscious
  22. 22. Disorders of Consciousness(cont)  Confusion- inability to think clearly, usually a feature of organic states. Three variations exists:  Oneiroid State (dream-like)  Twilight State  Torpor
  23. 23. Disorders of Attention/Concentration  Attention – is the ability to focus on the matter in hand  Concentration – ability to maintain that focus  Latent Inhibition – the ability of a person to recognize a previously irrelevant stimulus when it becomes relevant. In disorders this process is slowed down
  24. 24. Insight TO CH ECK FO R IN SIGHT I s t h e p a t ie n t aw a re o f th e p h e n om en a o t h e r p e o p le h a v e o b se rve d ? D o e s h e r e c o g n is e th at th e se p h en o m en a are a b n o r m a l? I f a b n o r m a l, d o e s h e c o n s id e r t h e m t o b e r e s u lt in g f r o m a m e n t a l illn e s s ? I f h e is m e n t a lly ill, d o e s h e t h in k h e needs tre atm en t?
  25. 25. Thankyou Reference: Oxford Textbook of Psychiatry (Third Edition)