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PsychoPathology
Definition : psychiatry 
• It is a branch of medicine that 
deals with the diagnosis 
,treatment and prevention of 
mental illness .
Definition : Psychiatric nursing 
• It is a specialized area of nursing 
practice , employing theories of human 
behavior as it is a science , and the 
purposeful use of self as it is an art , in 
the diagnosis and treatment of human 
responses to actual or potential mental 
health problems . 
( ANA1994 )
SIGNS 
& 
SYMPTOMS OF 
MENTAL ILLNESS
DISORDERS OF 
PERCEPTION
• Perception is the 
meaningful organization of 
sensory data and their 
interpretation in the light 
of one’s past experience.
• Hyper aesthesia: Increased intensity of 
sensations, seen in intense emotions and 
hypochondriacal personalities. 
In hyper aesthesia sounds appear louder, 
colors brighter ,and pain unbearable . 
• Illusions: Misperceptions or 
misinterpretations of real external sensory 
stimuli: 
e.g. Shadows may be misperceived as 
frightening figures., In a fading light rope is 
misperceived as a snake .
• Hallucinations: 
Perception in the absence of real 
external stimuli; experienced as true 
perception coming from the external 
world (not within the mind). 
e.g. Hearing a voice of someone when 
actually nobody is speaking within the 
hearing distance.
Types
Auditory hallucinations (voice, 
sound, noise). 
is a form of hallucination 
that involves perceiving 
sounds without auditory 
stimulus.
Types of auditory hallucination: 
•Second-person hallucinations: voice 
speaking to the person addressing 
him as “you”. 
•Third-person hallucinations: voice 
talking about the person as “he” or 
“she”: 
•Thought echo: hearing one’s own 
thoughts spoken aloud.
• Visual hallucination 
is the seeing of things that are 
not there .
Olfactory hallucinations is the 
phenomenon of smelling odors that are 
not really present. The most common 
odors are unpleasant smells such as 
rotting flesh ,vomit, urine, feces, smoke, 
or others 
Gustatory hallucination is the 
perception of taste without a 
stimulus.
• Tactile hallucinations occurs when someone 
feels a sensation on the body that is, in fact, 
not present. 
Tactile hallucination is the false perception of tactile 
sensory input that creates a hallucinatory sensation 
of physical contact with an imaginary object. 
One subtype of tactile hallucination, formication, is 
the sensation of insects crawling underneath the 
skin and is frequently associated with prolonged 
cocaine use.
• somatic hallucination 
Somatic hallucinations refer to 
sensations or perceptions 
concerning body organs that have 
no known medical cause or reason, 
such as the notion that one's brain 
is radioactive.
• Imperative hallucination: voices giving 
instructions to patients, who may or may not 
feel obliged to carry them out. 
• ‘Thought echo’ : hearing one’s own thoughts 
being spoken aloud; the voice may come from 
inside or outside the head. 
• Running commentary hallucinations: are 
usually abusive and often talk about sexual 
topics.
• Scenic hallucinations: hallucinations 
in which whole scenes are 
hallucinated like a cinema film; more 
common in psychiatric disorders 
associated with epilepsy.
• Lilliputian hallucinations: 
A term used to denote a 
hallucination featuring 
miniature individuals, animals, 
objects, or fantasy figures.
• Autoscopy (phantom mirror image): the 
patient sees himself and knows that it is 
he. Seen in normal subjects when they 
are depressed or emotionally disturbed. 
• ‘Negative autoscopy’: the patient looks 
in the mirror and sees no image; in 
organic states. 
• Internal autoscopy: the subject sees his 
own internal organs.
• Extracampine hallucinations: a 
hallucination which is outside the limits 
of the sensory field. 
• Extracampine hallucinations are 
hallucinations beyond the possible 
sensory field. 
• e.g., 'seeing' somebody standing behind 
you is a visual extracampine hallucination 
experience.
• Hypnagogic hallucinations: 
hallucinations when falling asleep. 
• Hypnopompic hallucinations: 
hallucinations when waking from 
sleep.
ABNORMALITIES IN THINKING 
• Autistic thinking is a form of 
thought disturbance and is a term 
used to refer to thinking not in 
accordance with consensus reality 
and emphasizes preoccupation with 
inner experience.
A. Abnormalities of Stream of 
Thought 
• Flight of ideas: the thoughts 
follow each other rapidly and 
there is no general direction 
of thinking, seen in mania 
/excited schizophrenics.
• Flight of ideas 
Flight of ideas describes excessive 
speech at a rapid rate that 
involves fragmented or unrelated 
ideas. It is common in mania. It 
has also been described 
in schizophrenia and ADHD
• Pressure of thoughts: Rapid abundant 
varying thoughts associated with 
pressure of speech and flight of ideas. 
• Poverty of thoughts: Few, slow, 
unvaried thoughts associated with 
poverty of speech. 
• Thought block: Sudden cessation of 
thought flow with complete emptying of 
the mind not caused by an external 
influence.
B. Abnormalities of Form of thought 
• Formal thought disorder: 
a synonym for the disorders of 
conceptual or abstract thinking 
which occur in schizophrenia and 
coarse brain disease.
Loosening of Association: (Loose Association) A 
thought disorder in which series of ideas are 
presented with loosely apparent or 
completely in apparent logical connections. 
A manifestation of a thought disorder whereby 
the patient's responses do not relate to the 
interviewer's questions, or one paragraph, 
sentence, or phrase is not logically connected 
to those that occur before or after. 
Example: I sang out for my mother …… for this 
to hell I went…how long is road …
Tangentiality: It is a form of derailment. 
Wandering from the topic 
and never returning to it or providing the 
information requested. 
e.g. In answer to the question "Where are 
you from?", a response "My dog is from 
England. They have good fish and chips 
there. Fish breathe through gills."
• Derailment: direction of thought is lost and the 
thought goes away from the intended theme . 
Example: 
• "The next day when I'd be going out you know, I 
took control, like uh, I put bleach on my hair in 
California.”
Neologism: completely new word or 
phrase whose deviation cannot be 
understood. 
OR 
is the name for a newly coined term, word, 
or phrase that may be in the process of 
entering common use but that has not yet been 
accepted into mainstream language.
C. Abnormal Thought 
Content 
• Overvalued Ideas: abnormal 
beliefs ,unique to the individual 
which dominates his life .
Example: *A woman falsely believes herself 
unusually unattractive. 
* A person with no computer science training might, 
believe he is going to write the next great computer 
program and fixate on this idea rather than 
pursuing training in computer science or going to 
work. 
* A person who works at a company may rigidly 
maintain the idea that he or she is the most 
valuable member of the company, that he/she will 
save the company from ruin, or that he/she will 
soon be made president of the company.
•Delusions: Fixed false beliefs 
which are not shared by others 
,are out of keeping with one’s 
educational ,social and cultural 
background and are unshakable 
in the face of evidence to the 
contrary.
Delusional Contents: 
• Persecutory (paranoid) delusion: Delusion of 
being persecuted (cheated, mistreated, etc.) 
• Grandiose delusion: Delusion of exaggerated 
self-importance, power or identity. 
• Delusion of reference: Delusion that some 
events and others behavior refer to oneself. 
• “Idea of Reference”: misattribution of events 
as referring to oneself.
• Delusion of jealousy: Delusion that a 
loved person (wife/husband) is 
unfaithful (infidelity delusion) 
• Delusions of love (‘fantasy lover’, 
‘erotomania’): Delusion that 
someone, (usually inaccessible, high 
social class person) is deeply in love 
with the patient.
• Nihilistic delusion: Delusion of 
nonexistence of self, part of the body, 
belongings, others or the world. 
• Delusion of self - accusation: Delusion 
that a patient has done something 
sinful, with excessive feeling of remorse 
and guilt. 
• Delusion of influence: Delusion that 
person’s thoughts, actions, or feelings 
are controlled by outside forces.
• Passivity phenomena: person 
reports being made feel, made 
think or made act. 
• Delusions of Replacement 
(Capgras Syndrome): a belief that 
important people in one's life 
have been replaced by impostors.
• Delusions can be either : 
• Mood-Congruent Delusion – Delusional 
content has association to mood: 
- in depressed mood: delusion of 
self - accusation. 
- in elevated mood: grandiose delusion. 
• Mood-Incongruent Delusions – 
Delusional content has no association to 
mood, e.g. patient with elevated mood 
has delusion of thought insertion.
• Delusions can also be either: 
• Systematized Delusion - Delusion 
united by a single event or theme e.g. 
delusion of jealousy/thematically well 
connected with each other. 
• Bizarre Delusion - Totally odd and 
strange delusional belief, e.g. 
delusion that person’s acts are 
controlled by stars.
D. AbnormAlities of 
Possession of 
thought
• Obsessions: 
–Repetitive ideas, images, feelings 
or urges insistently entering 
person’s mind despite resistance. 
They are unwanted, distressful and 
recognized as senseless and 
irrational. Obsessions are 
frequently followed by compelling 
actions (compulsions).
• Common obsessional 
Contents: 
–dirt/contamination/cleaning 
–orderliness 
–doubts/checking/counting 
–aggressive impulses/inappropriate 
acts 
–Ruminations: internal debates in 
which arguments for and against even 
the simplest everyday actions are 
reviewed endlessly .
• Thought Alienation: 
– Thought Insertion: Delusion that some of 
person’s thoughts being put into the mind by an 
external force (other people, certain agency). 
– Thought Withdrawal: Delusion that some of 
person’s thoughts being taken out of the mind. 
– Thought Broadcasting: Delusion that others can 
read or hear the person’s thoughts, as they are 
broadcast over the air, radio or some other 
unusual way.
• Dysmorphophobia: 
a type of overvalued idea where 
the patient believes one aspect of 
his body is abnormal or 
conspicuously deformed.
ABNORMALITIES OF MOOD /EMOTION 
• Feeling: a positive or negative reaction to 
some experience 
• Emotion: a stirred up state due to 
physiological changes which occurs as a 
response to some event and which tends to 
maintain or abolish the causative event. 
• Mood: the pervasive feeling tone which is 
sustained (lasts for a length of time) and 
colors the total experience of the person.
• Affect: is the outward objective 
expression of the immediate cross-sectional 
emotion at a given time. 
• Euthymia: a normal mood state, 
neither depressed nor manic. 
• Cheerfulness: being in good spirits. 
• Perplexity: a state of puzzled 
bewilderment.
• Anxiety: feeling of apprehension 
accompanied by autonomic 
symptoms (such as muscles tension, 
perspiration and tachycardia), 
caused by anticipation of danger. 
• Free-floating anxiety: diffuse, 
unfocused anxiety, not attached to a 
specific danger.
• Fear: anxiety caused by realistic 
consciously recognized danger. 
• Panic: acute, self-limiting, 
episodic intense attack of anxiety 
associated with overwhelming 
dread and autonomic symptoms.
• Phobia: irrational exaggerated fear and 
avoidance of a specific object, situation 
or activity. 
• Agoraphobia: patients rigidly avoids 
situations in which it would be difficult 
to obtain help. 
• Social phobia - Intense and excessive 
fear of being observed by other people 
–Eg: eating or drinking in public or 
talking to the other member of sex
• Specific phobia: irrational fear of a 
specific object or stimulus. 
Acrophobia : fear of heights 
Arachnophobia : fear of spiders 
Claustrophobia : fear of closed spaces 
Gamophobia : fear of marriage 
Hemophobia : fear of blood 
Zoophobia : fear of animals
• Agitation: severe feeling of inner tension 
associated with motor restlessness. 
• Irritable mood: easily annoyed and 
provoked to anger. 
• Dysphoria: mixture feelings of sadness 
and apprehension. 
• Depressed mood: feeling of sadness, 
pessimism and a sense of loneliness. 
• Anhedonia: lack of pleasure in acts 
which are normally pleasurable.
• Diurnal variation: a variation in the severity 
of symptoms (mood) depending on the time 
of the day 
• Grief: sadness appropriate to a real loss (e.g. 
death of a relative) 
• Guilt: unpleasant emotion secondary to 
doing what is perceived as wrong. 
• Shame: unpleasant emotion secondary to 
failure to live up to self-expectations. 
• Perplexity: anxious mood with 
bewilderment.
• Ambivalent Mood: coexistence of 
two opposing emotional tones 
towards the same object in the 
same person at the same time. 
• Alexithymia: inability to, or 
difficulty in, expressing one’s own 
emotions. 
• Elevated Mood: a mood more 
cheerful than usual .
• Elevated Mood: 
– Euphoria (Stage I): mild elevation of mood in which 
feeling of elevated mood with optimism and self-satisfaction 
not keeping with ongoing events. Usually 
seen in hypomania. 
– Elation (stage II): (Moderate elevation of mood) - a 
feeling of confidence and enjoyment, along with 
increased PMA. –a feature of manic illness 
– Exaltation (stage III): (severe elevation of 
mod): intense elation with delusions of grandeur, seen 
in severe mania. 
– Ecstasy (Stage IV): (very severe elevation of mod): 
a sense of extreme well-being associated with a feeling 
of rapture, bliss and grace. typically seen in delirious 
and stuporous mania .
• Expansive Mood: expression of euphoria with an 
overestimation of self-importance. 
• Grandiosity: feeling and thinking of great 
importance (in identity or ability). 
• Constricted Affect: significant reduction in the 
normal emotional responses. 
• Flat affect: absence of emotional expression. 
• Apathy: lack of emotion, interest or concern, 
associated with detachment. 
• Labile Affect: rapid, abrupt changes in emotions in 
the same setting, unrelated to external stimuli.
• La Belle Indifference: inappropriate 
denial of expected affect and lack of 
concern about physical disability (seen 
in conversion disorders). 
• Inappropriate Affect: disharmony 
between emotions and the idea, 
thought, or speech, accompanying it. 
• Cyclothymia: There is cyclical mood 
variation to a lesser degree than in 
bipolar disorder.
ABNORMALITIES OF SPEECH 
• Echolalia: imitation of words or phrases 
made by others. 
• Verbigeration : repetition of words of 
phases while unable to articulate the 
next word in the sentence/senseless 
repetition of same words or phrases 
over and over again. 
• Pressure of Speech: rapid, uninterrupted 
speech that is increased in amount.
–Mutism: inability to speak. 
–Elective Mutism: refusal to 
speak in certain circumstances. 
–Poverty of Speech: restricted 
amount of speech.
–Stuttering (Stammering): frequent 
repetition or prolongation of a sound 
or syllable, leading to markedly 
impaired speech fluency. 
–Cluttering: dysrhythmic rapid and 
jerky speech. 
–Clang Associations 
(Rhyming): association of word similar 
in sound but not in meaning (e.g. 
deep, keep, sleep)
–Punning: playing upon words, by using a 
word of more than one meaning (e.g. ant, 
aunt) 
–Word Salad: incoherent mixture of words 
and phrases. 
–Dysphasia: impairment in producing or 
understanding speech. 
–Dysarthria: difficulty in articulation and 
speech production. 
–Sensory Aphasia: nonsensical fluent 
speech due to lesion affecting Wernicke’s 
(receptive) area.
–Motor Aphasia: impairment in the 
ability to formulate fluent speech due 
to lesion affecting Broca’s (motor) 
area. 
–Dysphonia: difficulty in voicing speech 
clearly, due to dysfunction of vocal 
cords or soft palate. 
–Circumstanciality: over inclusion of 
details delaying reaching the desired 
goal.
–Coprolalia: forced vocalization of 
obscene words or phrases, 
–Palilalia: is characterized by the 
repetition of a word or phrase; i.e., the 
subject continues to repeat a word or 
phrase after once having said. It is 
a perseveratory phenomenon. 
–Alogia: lack of speech output. 
• Mutism: complete absence of speech.
ABNORMALITIES OF MOTOR BEHAVIOUR 
• Psychomotor Retardation: Slowed mental 
and motor activities. 
• Stupor: A state in which a person does not 
react to the surroundings: (mute, immobile 
and unresponsive). 
• Catatonic Stupor: Stupor with rigid posturing. 
• Psychomotor Agitation: Restlessness with 
psychological tension. (Patient is not fully 
aware of restlessness.)
• Catatonic Excitement: Marked 
agitation, impulsivity and aggression 
without external provocation. 
• Chorea: sudden involuntary 
movement of several muscle groups 
with the resultant action appearing 
like part of voluntary movement. 
• Aggression: Verbal or physical hostile 
behavior, with rage and anger.
• Akathisia: Inability to keep sitting 
still, due to a compelling subjective 
feeling of restlessness. 
• Dyskinesia: Restless movement of 
group of muscles (face, neck, hands).
• Dystonia: Painful severe muscle spasm. 
• Torticollis: Contraction of neck muscles. 
• Tics: Sudden repeated involuntary 
muscle twisting. e.g. repeated blinking, 
grimacing. 
• Compulsions: Compelling repeated 
irrational actions associated with 
obsessions. e.g. repeated hand washing.
• Echopraxia: Imitative repetition of 
movement of somebody. 
• Stereotypies: Purposeless repetitive 
involuntary movements. e.g. foot 
tapping, thigh rocking. 
• Mannerism: Odd goal-directed 
movements. e.g. repeated hand 
movement resembling a military 
salute.
• Waxy Flexibility: Patient’s limbs may 
be moved like wax, holding position 
for long period of time before 
returning to previous position.
• Cerea flexibilitas, meaning "waxy flexibility", refers 
to people allowing themselves to be placed in 
postures by others, and then maintaining those 
postures for long periods even if they are obviously 
uncomfortable. It is characterized by a patient's 
movements having the feeling of a plastic 
resistance, as if the person were made of wax. This 
occurs in catatonic schizophrenia, and a person 
suffering from this condition can have his limbs 
placed in fixed positions as if the person were in 
fact made from wax.
• Automatic obedience: the pt. carries 
out every instruction regardless of 
the consequences. 
• Perseveration: is a senseless 
repetition of a goal-directed action, a 
particular response, such as a word, 
phrase, or gesture which has already 
served its purpose (beyond their 
relevance).
• Dyspraxia; inability to carryout 
complex motor tasks, although the 
component motor movements are 
preserved. 
• Omega sign (Athanassio): the 
occurrence of a fold like the Greek 
letter omega in the forehead above 
the root of the nose produced by the 
excessive action of the corrugator 
muscle; seen in depression.
• Ambitendency: a motor symptom of 
schizophrenia in which there is an alternating 
mixture of automatic obedience and 
negativism. 
• Mitgehen: The pt. moves his body in the 
direction of the slightest pressure on the part 
of the examiner. seen in catatonia 
• Mitmachen (Co-operation): The body can be 
put to any position without any resistance on 
the part of the patient seen in catatonia.
• Trichotillomania: a condition 
characterized by an overwhelming urge 
to pluck out specific hairs. 
• Pyromania: is an impulse control 
disorder in which individuals repeatedly 
fail to resist impulses to deliberately start 
fires, in order to relieve tension or for 
instant gratification.
• Dipsomania: uncontrollable craving for 
alcohol or compulsive drinking of alcohol. 
• Kleptomania: a disorder in which the 
individual impulsively steals things other 
than personal use or financial gain. 
• Negativism: an apparently motiveless 
resistance to all commands and attempts 
to be moved or doing just the opposite.
Collective Symptoms 
• Positive symptoms: refers to presence of 
delusions, disordered thoughts and speech, and 
tactile, auditory, visual, olfactory and 
gustatory hallucinations 
• Negative symptoms : are deficits of normal 
emotional responses or of other thought 
processes, and respond poorly to medication 
which includes flat or blunted affect and emotion, 
poverty of speech (alogia), inability to experience 
pleasure (anhedonia), lack of desire to form 
relationships (asociality), and lack of motivation 
(avolition).
• Biological symptoms (somatic 
symptoms./melancholic 
symptoms.): refers to changes in 
sleep, appetite, libido, activity, 
diurnal changes in mood, anhedonia, 
early morning awakening, and 
psychomotor agitation or 
retardation. 
• Psychotic symptoms: presence of 
hallucinations and delusions.
• First Rank Symptoms of Schizophrenia (Kurt 
Schneider) 
– Audible thoughts (thought echo) 
– Voices heard arguing 
– Voices heard commenting on one's actions 
– Somatic/thought passivity experiences (delusions of 
control) 
– Thought withdrawal 
– Thought insertion - Thoughts are ascribed to other 
people who intrude their thoughts upon the patient 
– Thought broadcasting (also called thought diffusion) 
– Delusional perception.
• Motor Symptoms of schizophrenia 
• Catatonia 
• Catalepsy 
• Automatic obedience 
• Negativism 
• Ambitendency 
• Mitgehen . Psychological pillow 
• Mitmachen 
• Mannerism 
• Stereotypy 
• Echopraxia
• In Capgras syndrome, the patient feels 
that a person familiar to him, usually a 
family member has been replaced by 
an imposter.[1] This is a type 
of delusion that can be experienced as 
part of schizophrenia. Capgras Syndrome 
and several other related disorders are 
referred to as delusional 
misidentification syndrome.
Terminologies of psychiatry

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Terminologies of psychiatry

  • 2. Definition : psychiatry • It is a branch of medicine that deals with the diagnosis ,treatment and prevention of mental illness .
  • 3. Definition : Psychiatric nursing • It is a specialized area of nursing practice , employing theories of human behavior as it is a science , and the purposeful use of self as it is an art , in the diagnosis and treatment of human responses to actual or potential mental health problems . ( ANA1994 )
  • 4. SIGNS & SYMPTOMS OF MENTAL ILLNESS
  • 6. • Perception is the meaningful organization of sensory data and their interpretation in the light of one’s past experience.
  • 7. • Hyper aesthesia: Increased intensity of sensations, seen in intense emotions and hypochondriacal personalities. In hyper aesthesia sounds appear louder, colors brighter ,and pain unbearable . • Illusions: Misperceptions or misinterpretations of real external sensory stimuli: e.g. Shadows may be misperceived as frightening figures., In a fading light rope is misperceived as a snake .
  • 8. • Hallucinations: Perception in the absence of real external stimuli; experienced as true perception coming from the external world (not within the mind). e.g. Hearing a voice of someone when actually nobody is speaking within the hearing distance.
  • 10. Auditory hallucinations (voice, sound, noise). is a form of hallucination that involves perceiving sounds without auditory stimulus.
  • 11. Types of auditory hallucination: •Second-person hallucinations: voice speaking to the person addressing him as “you”. •Third-person hallucinations: voice talking about the person as “he” or “she”: •Thought echo: hearing one’s own thoughts spoken aloud.
  • 12. • Visual hallucination is the seeing of things that are not there .
  • 13. Olfactory hallucinations is the phenomenon of smelling odors that are not really present. The most common odors are unpleasant smells such as rotting flesh ,vomit, urine, feces, smoke, or others Gustatory hallucination is the perception of taste without a stimulus.
  • 14. • Tactile hallucinations occurs when someone feels a sensation on the body that is, in fact, not present. Tactile hallucination is the false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object. One subtype of tactile hallucination, formication, is the sensation of insects crawling underneath the skin and is frequently associated with prolonged cocaine use.
  • 15. • somatic hallucination Somatic hallucinations refer to sensations or perceptions concerning body organs that have no known medical cause or reason, such as the notion that one's brain is radioactive.
  • 16. • Imperative hallucination: voices giving instructions to patients, who may or may not feel obliged to carry them out. • ‘Thought echo’ : hearing one’s own thoughts being spoken aloud; the voice may come from inside or outside the head. • Running commentary hallucinations: are usually abusive and often talk about sexual topics.
  • 17. • Scenic hallucinations: hallucinations in which whole scenes are hallucinated like a cinema film; more common in psychiatric disorders associated with epilepsy.
  • 18. • Lilliputian hallucinations: A term used to denote a hallucination featuring miniature individuals, animals, objects, or fantasy figures.
  • 19. • Autoscopy (phantom mirror image): the patient sees himself and knows that it is he. Seen in normal subjects when they are depressed or emotionally disturbed. • ‘Negative autoscopy’: the patient looks in the mirror and sees no image; in organic states. • Internal autoscopy: the subject sees his own internal organs.
  • 20. • Extracampine hallucinations: a hallucination which is outside the limits of the sensory field. • Extracampine hallucinations are hallucinations beyond the possible sensory field. • e.g., 'seeing' somebody standing behind you is a visual extracampine hallucination experience.
  • 21. • Hypnagogic hallucinations: hallucinations when falling asleep. • Hypnopompic hallucinations: hallucinations when waking from sleep.
  • 22. ABNORMALITIES IN THINKING • Autistic thinking is a form of thought disturbance and is a term used to refer to thinking not in accordance with consensus reality and emphasizes preoccupation with inner experience.
  • 23. A. Abnormalities of Stream of Thought • Flight of ideas: the thoughts follow each other rapidly and there is no general direction of thinking, seen in mania /excited schizophrenics.
  • 24. • Flight of ideas Flight of ideas describes excessive speech at a rapid rate that involves fragmented or unrelated ideas. It is common in mania. It has also been described in schizophrenia and ADHD
  • 25. • Pressure of thoughts: Rapid abundant varying thoughts associated with pressure of speech and flight of ideas. • Poverty of thoughts: Few, slow, unvaried thoughts associated with poverty of speech. • Thought block: Sudden cessation of thought flow with complete emptying of the mind not caused by an external influence.
  • 26. B. Abnormalities of Form of thought • Formal thought disorder: a synonym for the disorders of conceptual or abstract thinking which occur in schizophrenia and coarse brain disease.
  • 27. Loosening of Association: (Loose Association) A thought disorder in which series of ideas are presented with loosely apparent or completely in apparent logical connections. A manifestation of a thought disorder whereby the patient's responses do not relate to the interviewer's questions, or one paragraph, sentence, or phrase is not logically connected to those that occur before or after. Example: I sang out for my mother …… for this to hell I went…how long is road …
  • 28. Tangentiality: It is a form of derailment. Wandering from the topic and never returning to it or providing the information requested. e.g. In answer to the question "Where are you from?", a response "My dog is from England. They have good fish and chips there. Fish breathe through gills."
  • 29. • Derailment: direction of thought is lost and the thought goes away from the intended theme . Example: • "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California.”
  • 30. Neologism: completely new word or phrase whose deviation cannot be understood. OR is the name for a newly coined term, word, or phrase that may be in the process of entering common use but that has not yet been accepted into mainstream language.
  • 31. C. Abnormal Thought Content • Overvalued Ideas: abnormal beliefs ,unique to the individual which dominates his life .
  • 32. Example: *A woman falsely believes herself unusually unattractive. * A person with no computer science training might, believe he is going to write the next great computer program and fixate on this idea rather than pursuing training in computer science or going to work. * A person who works at a company may rigidly maintain the idea that he or she is the most valuable member of the company, that he/she will save the company from ruin, or that he/she will soon be made president of the company.
  • 33. •Delusions: Fixed false beliefs which are not shared by others ,are out of keeping with one’s educational ,social and cultural background and are unshakable in the face of evidence to the contrary.
  • 34. Delusional Contents: • Persecutory (paranoid) delusion: Delusion of being persecuted (cheated, mistreated, etc.) • Grandiose delusion: Delusion of exaggerated self-importance, power or identity. • Delusion of reference: Delusion that some events and others behavior refer to oneself. • “Idea of Reference”: misattribution of events as referring to oneself.
  • 35. • Delusion of jealousy: Delusion that a loved person (wife/husband) is unfaithful (infidelity delusion) • Delusions of love (‘fantasy lover’, ‘erotomania’): Delusion that someone, (usually inaccessible, high social class person) is deeply in love with the patient.
  • 36. • Nihilistic delusion: Delusion of nonexistence of self, part of the body, belongings, others or the world. • Delusion of self - accusation: Delusion that a patient has done something sinful, with excessive feeling of remorse and guilt. • Delusion of influence: Delusion that person’s thoughts, actions, or feelings are controlled by outside forces.
  • 37. • Passivity phenomena: person reports being made feel, made think or made act. • Delusions of Replacement (Capgras Syndrome): a belief that important people in one's life have been replaced by impostors.
  • 38. • Delusions can be either : • Mood-Congruent Delusion – Delusional content has association to mood: - in depressed mood: delusion of self - accusation. - in elevated mood: grandiose delusion. • Mood-Incongruent Delusions – Delusional content has no association to mood, e.g. patient with elevated mood has delusion of thought insertion.
  • 39. • Delusions can also be either: • Systematized Delusion - Delusion united by a single event or theme e.g. delusion of jealousy/thematically well connected with each other. • Bizarre Delusion - Totally odd and strange delusional belief, e.g. delusion that person’s acts are controlled by stars.
  • 40. D. AbnormAlities of Possession of thought
  • 41. • Obsessions: –Repetitive ideas, images, feelings or urges insistently entering person’s mind despite resistance. They are unwanted, distressful and recognized as senseless and irrational. Obsessions are frequently followed by compelling actions (compulsions).
  • 42. • Common obsessional Contents: –dirt/contamination/cleaning –orderliness –doubts/checking/counting –aggressive impulses/inappropriate acts –Ruminations: internal debates in which arguments for and against even the simplest everyday actions are reviewed endlessly .
  • 43. • Thought Alienation: – Thought Insertion: Delusion that some of person’s thoughts being put into the mind by an external force (other people, certain agency). – Thought Withdrawal: Delusion that some of person’s thoughts being taken out of the mind. – Thought Broadcasting: Delusion that others can read or hear the person’s thoughts, as they are broadcast over the air, radio or some other unusual way.
  • 44. • Dysmorphophobia: a type of overvalued idea where the patient believes one aspect of his body is abnormal or conspicuously deformed.
  • 45. ABNORMALITIES OF MOOD /EMOTION • Feeling: a positive or negative reaction to some experience • Emotion: a stirred up state due to physiological changes which occurs as a response to some event and which tends to maintain or abolish the causative event. • Mood: the pervasive feeling tone which is sustained (lasts for a length of time) and colors the total experience of the person.
  • 46. • Affect: is the outward objective expression of the immediate cross-sectional emotion at a given time. • Euthymia: a normal mood state, neither depressed nor manic. • Cheerfulness: being in good spirits. • Perplexity: a state of puzzled bewilderment.
  • 47. • Anxiety: feeling of apprehension accompanied by autonomic symptoms (such as muscles tension, perspiration and tachycardia), caused by anticipation of danger. • Free-floating anxiety: diffuse, unfocused anxiety, not attached to a specific danger.
  • 48. • Fear: anxiety caused by realistic consciously recognized danger. • Panic: acute, self-limiting, episodic intense attack of anxiety associated with overwhelming dread and autonomic symptoms.
  • 49. • Phobia: irrational exaggerated fear and avoidance of a specific object, situation or activity. • Agoraphobia: patients rigidly avoids situations in which it would be difficult to obtain help. • Social phobia - Intense and excessive fear of being observed by other people –Eg: eating or drinking in public or talking to the other member of sex
  • 50. • Specific phobia: irrational fear of a specific object or stimulus. Acrophobia : fear of heights Arachnophobia : fear of spiders Claustrophobia : fear of closed spaces Gamophobia : fear of marriage Hemophobia : fear of blood Zoophobia : fear of animals
  • 51. • Agitation: severe feeling of inner tension associated with motor restlessness. • Irritable mood: easily annoyed and provoked to anger. • Dysphoria: mixture feelings of sadness and apprehension. • Depressed mood: feeling of sadness, pessimism and a sense of loneliness. • Anhedonia: lack of pleasure in acts which are normally pleasurable.
  • 52. • Diurnal variation: a variation in the severity of symptoms (mood) depending on the time of the day • Grief: sadness appropriate to a real loss (e.g. death of a relative) • Guilt: unpleasant emotion secondary to doing what is perceived as wrong. • Shame: unpleasant emotion secondary to failure to live up to self-expectations. • Perplexity: anxious mood with bewilderment.
  • 53. • Ambivalent Mood: coexistence of two opposing emotional tones towards the same object in the same person at the same time. • Alexithymia: inability to, or difficulty in, expressing one’s own emotions. • Elevated Mood: a mood more cheerful than usual .
  • 54. • Elevated Mood: – Euphoria (Stage I): mild elevation of mood in which feeling of elevated mood with optimism and self-satisfaction not keeping with ongoing events. Usually seen in hypomania. – Elation (stage II): (Moderate elevation of mood) - a feeling of confidence and enjoyment, along with increased PMA. –a feature of manic illness – Exaltation (stage III): (severe elevation of mod): intense elation with delusions of grandeur, seen in severe mania. – Ecstasy (Stage IV): (very severe elevation of mod): a sense of extreme well-being associated with a feeling of rapture, bliss and grace. typically seen in delirious and stuporous mania .
  • 55. • Expansive Mood: expression of euphoria with an overestimation of self-importance. • Grandiosity: feeling and thinking of great importance (in identity or ability). • Constricted Affect: significant reduction in the normal emotional responses. • Flat affect: absence of emotional expression. • Apathy: lack of emotion, interest or concern, associated with detachment. • Labile Affect: rapid, abrupt changes in emotions in the same setting, unrelated to external stimuli.
  • 56. • La Belle Indifference: inappropriate denial of expected affect and lack of concern about physical disability (seen in conversion disorders). • Inappropriate Affect: disharmony between emotions and the idea, thought, or speech, accompanying it. • Cyclothymia: There is cyclical mood variation to a lesser degree than in bipolar disorder.
  • 57. ABNORMALITIES OF SPEECH • Echolalia: imitation of words or phrases made by others. • Verbigeration : repetition of words of phases while unable to articulate the next word in the sentence/senseless repetition of same words or phrases over and over again. • Pressure of Speech: rapid, uninterrupted speech that is increased in amount.
  • 58. –Mutism: inability to speak. –Elective Mutism: refusal to speak in certain circumstances. –Poverty of Speech: restricted amount of speech.
  • 59. –Stuttering (Stammering): frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency. –Cluttering: dysrhythmic rapid and jerky speech. –Clang Associations (Rhyming): association of word similar in sound but not in meaning (e.g. deep, keep, sleep)
  • 60. –Punning: playing upon words, by using a word of more than one meaning (e.g. ant, aunt) –Word Salad: incoherent mixture of words and phrases. –Dysphasia: impairment in producing or understanding speech. –Dysarthria: difficulty in articulation and speech production. –Sensory Aphasia: nonsensical fluent speech due to lesion affecting Wernicke’s (receptive) area.
  • 61. –Motor Aphasia: impairment in the ability to formulate fluent speech due to lesion affecting Broca’s (motor) area. –Dysphonia: difficulty in voicing speech clearly, due to dysfunction of vocal cords or soft palate. –Circumstanciality: over inclusion of details delaying reaching the desired goal.
  • 62. –Coprolalia: forced vocalization of obscene words or phrases, –Palilalia: is characterized by the repetition of a word or phrase; i.e., the subject continues to repeat a word or phrase after once having said. It is a perseveratory phenomenon. –Alogia: lack of speech output. • Mutism: complete absence of speech.
  • 63. ABNORMALITIES OF MOTOR BEHAVIOUR • Psychomotor Retardation: Slowed mental and motor activities. • Stupor: A state in which a person does not react to the surroundings: (mute, immobile and unresponsive). • Catatonic Stupor: Stupor with rigid posturing. • Psychomotor Agitation: Restlessness with psychological tension. (Patient is not fully aware of restlessness.)
  • 64. • Catatonic Excitement: Marked agitation, impulsivity and aggression without external provocation. • Chorea: sudden involuntary movement of several muscle groups with the resultant action appearing like part of voluntary movement. • Aggression: Verbal or physical hostile behavior, with rage and anger.
  • 65. • Akathisia: Inability to keep sitting still, due to a compelling subjective feeling of restlessness. • Dyskinesia: Restless movement of group of muscles (face, neck, hands).
  • 66. • Dystonia: Painful severe muscle spasm. • Torticollis: Contraction of neck muscles. • Tics: Sudden repeated involuntary muscle twisting. e.g. repeated blinking, grimacing. • Compulsions: Compelling repeated irrational actions associated with obsessions. e.g. repeated hand washing.
  • 67. • Echopraxia: Imitative repetition of movement of somebody. • Stereotypies: Purposeless repetitive involuntary movements. e.g. foot tapping, thigh rocking. • Mannerism: Odd goal-directed movements. e.g. repeated hand movement resembling a military salute.
  • 68. • Waxy Flexibility: Patient’s limbs may be moved like wax, holding position for long period of time before returning to previous position.
  • 69. • Cerea flexibilitas, meaning "waxy flexibility", refers to people allowing themselves to be placed in postures by others, and then maintaining those postures for long periods even if they are obviously uncomfortable. It is characterized by a patient's movements having the feeling of a plastic resistance, as if the person were made of wax. This occurs in catatonic schizophrenia, and a person suffering from this condition can have his limbs placed in fixed positions as if the person were in fact made from wax.
  • 70. • Automatic obedience: the pt. carries out every instruction regardless of the consequences. • Perseveration: is a senseless repetition of a goal-directed action, a particular response, such as a word, phrase, or gesture which has already served its purpose (beyond their relevance).
  • 71. • Dyspraxia; inability to carryout complex motor tasks, although the component motor movements are preserved. • Omega sign (Athanassio): the occurrence of a fold like the Greek letter omega in the forehead above the root of the nose produced by the excessive action of the corrugator muscle; seen in depression.
  • 72. • Ambitendency: a motor symptom of schizophrenia in which there is an alternating mixture of automatic obedience and negativism. • Mitgehen: The pt. moves his body in the direction of the slightest pressure on the part of the examiner. seen in catatonia • Mitmachen (Co-operation): The body can be put to any position without any resistance on the part of the patient seen in catatonia.
  • 73. • Trichotillomania: a condition characterized by an overwhelming urge to pluck out specific hairs. • Pyromania: is an impulse control disorder in which individuals repeatedly fail to resist impulses to deliberately start fires, in order to relieve tension or for instant gratification.
  • 74. • Dipsomania: uncontrollable craving for alcohol or compulsive drinking of alcohol. • Kleptomania: a disorder in which the individual impulsively steals things other than personal use or financial gain. • Negativism: an apparently motiveless resistance to all commands and attempts to be moved or doing just the opposite.
  • 75. Collective Symptoms • Positive symptoms: refers to presence of delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations • Negative symptoms : are deficits of normal emotional responses or of other thought processes, and respond poorly to medication which includes flat or blunted affect and emotion, poverty of speech (alogia), inability to experience pleasure (anhedonia), lack of desire to form relationships (asociality), and lack of motivation (avolition).
  • 76. • Biological symptoms (somatic symptoms./melancholic symptoms.): refers to changes in sleep, appetite, libido, activity, diurnal changes in mood, anhedonia, early morning awakening, and psychomotor agitation or retardation. • Psychotic symptoms: presence of hallucinations and delusions.
  • 77. • First Rank Symptoms of Schizophrenia (Kurt Schneider) – Audible thoughts (thought echo) – Voices heard arguing – Voices heard commenting on one's actions – Somatic/thought passivity experiences (delusions of control) – Thought withdrawal – Thought insertion - Thoughts are ascribed to other people who intrude their thoughts upon the patient – Thought broadcasting (also called thought diffusion) – Delusional perception.
  • 78. • Motor Symptoms of schizophrenia • Catatonia • Catalepsy • Automatic obedience • Negativism • Ambitendency • Mitgehen . Psychological pillow • Mitmachen • Mannerism • Stereotypy • Echopraxia
  • 79. • In Capgras syndrome, the patient feels that a person familiar to him, usually a family member has been replaced by an imposter.[1] This is a type of delusion that can be experienced as part of schizophrenia. Capgras Syndrome and several other related disorders are referred to as delusional misidentification syndrome.