Abut psychiatry

1. PSYCHOPATHOLOGY
•Study of abnormal states of mind
•Manifested as disturbances in mental functions:
•Thinking
•Perception
•Emotion

2. DISORDERS OF THINKING
•Usually recognized from patient's speech or writings
•Can also be inferred from actions and behaviours
CLASSIFIED INTO:-
•Disorders of stream of thought
(speed and amount)
•Disorders of form of thought
(linking of thoughts together)

3. DISORDERS OF STREAM OF THOUGHT
(SPEED AND AMOUNT)
PSYCHOPATHOLO
GY 3
Pressure of thoughts
At one extreme: ideas arise in unusual variety and
abundance and pass through the mind rapidly
 in mania
•May be found in schizophrenia
Poverty of thought
At the other extreme: has only a few thoughts,
which lack variety and richness seem to move
through the mind slowly
 in depression
• May be experienced in schizophrenia

4. PSYCHOPATHOLO
GY 4
Thought block
•Stream of thought interrupted suddenly
•The patient experiences as his mind going blank, an
observer notices a sudden interruption in the flow of
conversation
•Minor degree of this experience is common, especially
in people who are tired or anxious
•In schizophrenia the interruption is abrupt and complete
•Manifested as sudden, striking, and repeated
interruption of speech
•Describes by the experience as an abrupt & complete
Emptying of his/her mind
•If he interprets the experience in a bizzare way -
strengthened the diagnosis of schizophrenia

5. DISORDER OF FORM OF THOUGHT
PSYCHOPATHOLO
GY 5
Loosening of Association
Flight of Ideas
Perseveration

6. LOOSENING OF ASSOCIATION
PSYCHOPATHOLO
GY 6
•A loss of the normal structure of thinking
•Appear as muddled, illogical, or tangential conversation
•There is a general lack of clarity in the patient's
conversation - incoherence – ‘woolly thinking’ – difficult
to understand, it could be irrelevant to the main theme
•The more we try to clarify the patient's thoughts, the
less we understand them
Can take several forms:
Knight's move or derailment - transition from topic to
topic without logical connection
Verbigeration - senseless repeating words, phrases
Word salad - extreme form, senseless mix-up of
words with finer grammatical structural abnormalities

7. CIRCUMSTANTIALITY & TANGENTIALITY
•Circumstantiality: circuitous and non-direct thinking or
speech that digresses from the main point of a conversation.
•Overinclusion of information
•Eventually arrives at the answer to the initial question
•Tangentiality: disturbance in the thought process that
causes the individual to relate excessive or irrelevant detail.
•Never reaches the essential point of a conversation or the
desired answer to a question

8. FLIGHTS OF IDEAS
PSYCHOPATHOLO
GY 8
•Patient's thoughts and conversation move quickly from
one topic to another so that one train of thought is not
completed before another appear
•The links between these rapidly changing topic are
understandable (differs from loosening of association)
•This distinction is difficult especially when patient
speaks rapidly
Types of link:
Clang associations (He rained the train and gained the crane)
Puns (Why are teddy bears never hungry? They are always stuffed!)
Rhymes (Roses are red, violets are blue, / Sugar is sweet, and so
are you)

9. PERSEVERATION
PSYCHOPATHOLO
GY 9
•Persistent and inappropriate repetition of the same
thoughts
•E.g., dementia & frontal lobe injury

10. Freudenreich O. (2020) Psychotic Signs and Symptoms. In:Psychotic Disorders. Current Clinical Psychiatry.
Humana, Cham. https://doi.org/10.1007/978-3-030-29450-2_1

11. • Delusion
• Obsession
PSYCHOPATHOLO
GY 11
NATURE OF IDEAS
DELUSION
•Is a belief that is firmly held on inadequate grounds,
that is not affected by rational argument or evidence
to the contrary, and that is not a conventional belief
that might be expected with given educational,
cultural, and religious background
•Overvalued Ideas
•False ideas, understandable in the context of the
patient’s
background
•E.g., life experience, cultural environment

12. PSYCHOPATHOLO
GY 12
•Overvalued ideas form an intermediate group on the
borders of normal beliefs and delusions, i.e.:
Normal beliefs  overvalued ideas  delusions
•With an overvalued idea, there is some willingness
to consider alternative views

13. CLASSIFICATION OF DELUSION
PSYCHOPATHOLO
GY 13
PRIMARY DELUSION
•Primary delusion is one that appear suddenly and
with full conviction without any mental events
leading up to it
•They arise de novo not secondarily to any preceding
morbid mental phenomena
•Occur as 'sudden delusional ideas' (i.e., the belief
or ideas arrive in the mind suddenly and fully
formed)

14. AUTOCHTHONOUS DELUSION
•Also known as delusional intuition
•Example:
A patient with schizophrenia may be suddenly
and completely convinced that he is a royal
descendent, without ever having thought of it
before and without any preceding ideas or events
which could have led in any explainable way to
this belief

15. DELUSIONAL PERCEPTION
PSYCHOPATHOLO
GY 15
•The patient give a peculiar and distorted meaning
(usually of personal significant) to the normal
perception
•Attribute a new meaning usually in the sense of self-
reference, to a normally perceived object, provided
that the new meaning cannot be explained by the
person mood or disturbed perception

16. DELUSIONAL MOOD
PSYCHOPATHOLO
GY 16
•Also known as delusional atmosphere
•A prevailing mood during which the sufferer will feel
that something strange is going on but will be unable
to put their finger on it – a strange uncanny feeling
that 'something is going on' around him which
concerns him, but he does not know what it is
•The patient may appear perplexed or suspicious
•Usually, the meaning of the delusional mood
becomes obvious when a sudden delusional ideas or
delusional perception appears

17. DELUSIONAL MEMORY
•Two types:
1. A delusional interpretation of a normal memory
(c.f. delusional perception)
2. A false memory that is given a delusional interpretation

18. SECONDARY DELUSION
•Secondary delusions are understandable when
detailed psychiatric history and examination are
available, i.e., derived from a preceding morbid
experience, e.g., mood state, hallucination
•Example:
A depressed patient believed that he had
committed ‘unforgivable sins’

19. DELUSIONS ACCORDING TO THEMES
•Persecutory delusion
•Grandiose delusion
•Delusion of jealousy
•Erotomanic delusion
•Delusion of reference
•Hypochondriacal delusion
•Nihilistic delusion
•Delusion of guilt
•Delusion of control
•Thought possession
•Thought insertion
•Thought withdrawal
•Thought broadcasting

20. DELUSIONS
PSYCHOPATHOLO
GY 20

21. OBSESSION & COMPULSION
Obsessions:
•Recurrent, repetitive thoughts, impulse, or image
that enter patient's mind
•Arising from oneself, despite patient's effort to
exclude them
•Regarded as untrue/senseless, unpleasant,
distressing

22. PSYCHOPATHOLO
GY 22
Types of obsession:
•Thoughts
•Impulses (e.g., aggressive to stab/ injure others)
•Images
•Phobias
•Ruminations (complex thoughts)
•Doubts

23. PSYCHOPATHOLO
GY 23
Content/themes of obsession:
•Dirt & contamination
•Aggression
•Orderliness
•Illness
•Sex
•Religion

24. PSYCHOPATHOLO
GY 24
•Compulsions (a.k.a. compulsive rituals)
•Repetitive, seemingly purposeful behaviours
performed in a stereotyped way in response to an
obsession
•Examples: Cleaning, checking, counting, dressing
•Obsessional slowness
•Obsession with/ without compulsion: OCD,
depression, schizophrenia, organic

25. DISORDERS OF PERCEPTION
PSYCHOPATHOLO
GY 25
Normal perception:
•The process of becoming aware of what is presented
through the sense organ
•Giving meaning to stimuli (must be with the presence
of stimuli
Perception
Normal
perception
Illusion Imagery
Pseudo-
hallucination
Hallucination

26. ILLUSION
Misperception of external stimuli
Cognitive illusions
PSYCHOPATHOLO
GY 26
•Other factors:
•When general level of sensory stimuli is reduced
(e.g., at dusk)
•Level consciousness reduced: delirium
•Strong affective state: frightened

27. HALLUCINATION
PSYCHOPATHOLO
GY 27
•A perception experienced in the absence of an
external stimulus to the sense organ with a similar
quality to a true percept
•Is experienced as originating in outside world (or
within one's own body) not within mind like
imaginery
•Not restricted to the mentally ill, can occur in
normal - when tired, during transition between
sleep and awakening (hypnagogic & hypnopompic)

28. PSYCHOPATHOLO
GY 28
According to complexity:
•Elementary hallucination- bangs, flashes of light
•Complex hallucination - voices, or music
According to sensory modality
•Auditory, visual, tactile, gustatory, olfactory
•Autoscopic - seeing one's own body projected
outside

29. HALLUCINATIONS

30. DIAGNOSTIC ASSOCIATIONS
PSYCHOPATHOLO
GY 30
•Auditory hallucinations
•Functional, occasional organic
•Third person, running commentary, thought
echo: Schneiderian first rank symptoms
•Visual hallucinations
•May occur in hysteria, affective, schizophrenia
•Should always raise the possibility of organic

31. PSYCHOPATHOLO
GY 31
•Gustatory and olfactory hallucinations
•May occurs in schizophrenia/severe affective disorder
•Also suggest organic: TLE, tumours irritate olfactory
bulb
•Somatic hallucinations
•Tactile: alcoholic withdrawal, cocaine intoxication
•Deep: schizophrenia

32. DISORDERS OF EMOTION
PSYCHOPATHOLO
GY 32
•Affect: instant, objectively recognized feeling state
at any particular time
•Mood: sustained feeling state over a period of time
•Example: happiness, sadness (dysphoria),
anxiousness, and anger

33. TYPES OF ABNORMALITY
PSYCHOPATHOLO
GY 33
1. Changes in Nature
•Excessively increased happiness: elation  Mania
•Sadness: dysphoria  Depression
2. Abnormal Fluctuation
•Changes too rapid: labile  Bipolar disorder
•No changes: flattened/blunted  Schizophrenia
3. Incongruent/inappropriate affect
• Inappropriate to person's circumstances and
incongruent with thoughts & actions  Schizophrenia

34. DEPERSONALIZATION & DEREALIZATION
PSYCHOPATHOLO
GY 34
•Depersonalization: Change of self-awareness that
a person feels unreal, detached from his own
experience, and unable to feel emotion
•Derealization: Change in relation to the
environment, that objects appear unreal and
people appears as lifeless ‘cardboard’ figures
•Described as unpleasant experiences

35. PSYCHOPATHOLO
GY 35
•“As if my brain has stopped working”
•“As if the people I meet are lifeless”
•Causes:
Fatigue, sleep & sensory deprivation,
hallucinogens, anxiety disorders, depressive
disorders, schizophrenia, TLE