PSYCHOLOGY

1. BACHELOR OF SCIENCE IN MENTAL
HEALTH & PSYCHIATRIC NURSING
(POST BASIC)
PSYCHOPATHOLOGY
JAPHET MYABa
25/07/2022

2. Learning outcome
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1. Discuss psychopathology of psychiatric
disorders
2. Describe typical signs and symptoms of
mental disorders

3. Outline of presentation
 Introduction
 Psycho-pathology and
 Phenomenology of mental disorders
 Principal categories of symptoms and signs of
mental disorders
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4. Introduction
Symptoms Vs. Signs
 A symptom is what the patient complains
of.
 Subjective experience described by patients
 E.g., “depressed mood” or “lack of energy”
 A sign is what you observe.
 Observations and objective findings.
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5. Introduction continue….
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 Syndrome: a group of signs & symptoms that
together make up a recognizable condition
 which can be more equivocal than a specific disorder
or disease.
 Most psychiatric signs & symptoms are rooted in
normal behaviour
 and can be understood at various points on a
spectrum of behaviour ranging from normal to
pathological.

6. Mental disorder :
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 Is a syndrome characterised by clinically
significant disturbance in an individual’s
cognition, emotion regulation, or behaviour
that reflects a dysfunction in psychological,
biological, or developmental processes
underlying mental function.
 Mental disorders are usually associated with
significant distress or disability in social,
occupational or other important activities.

7. Mental disorder continue….
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 An expectable or culturally approved response
to a common stressor or loss, e.g., death of
loved one, is not a mental disorder.
 Socially deviant behaviour (e.g., political,
religious, or sexual) and conflicts that are
primarily between individual and society are
not mental disorders unless deviance or
conflict results from dysfunction in individual,
as described above.

8. PSYCHOPATHOLOGY
 Is the systematic study of abnormal
experience, cognition, and behaviour.
 It consists of two major divisions –
1. Explanatory psychopathologies
which assume causative factors
according to theoretical construct (e.g.
psychoanalysis).
This can be again divided into
experimental (behaviourism) and
theoretical (psychoanalysis)
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9. Psychopathology continue..
2. Descriptive psychopathology:
which precisely describes and
categorizes abnormal experiences as
reported by the patient and observed
from his or her behaviour.
“referred to as a method of precisely
describing and categorising abnormal
experiences as recounted by psychiatric
patients and observed in their behaviour”
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10. Psychopathology continue..
 Two essential components of practising descriptive
psychopathology
1. The observation of behaviour and
2. The empathic assessment of subjective
experience.
 Phenomenology (Jaspers) implies that the patient is
able to introspect and describe his internal experiences
and the nurse recognizes and understands the
description.
 Fundamental to psychiatric examination is the use of
empathic understanding to explore and clarify the
patient's subjective experiences.
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11. Uses of Descriptive Psychopathology
 Diagnostic
 Clarity & Classification
 Communication
 Therapeutic
 Empathy
 Scientific & Forensic- can be used for scientific
(e.g. research) and forensic purposes (mental
health and law)
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12. In Practical Terms
 Descriptive psychopathology allows you to
know whether a symptom is present, or not.
 It allows you to distinguish between symptoms
that may be very similar (and very different).
 Thus allows you to know whether a syndrome is
present; to make confident and reliable
diagnoses.
 Without these…
 You can do nothing. 12 August 2022
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13. Schneider (1959)
 Clinical diagnosis often precedes enquiry
 Symptoms tend to be subsequently evaluated
in the light of the diagnosis
 Ideally, unbiased observation and
description of symptoms should precede
diagnosis
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14. Questions or
comments
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15. Group Work/Assignment
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 Explain signs and symptoms/abnormal
presentation of the following principal categories
of symptoms:
1. Group 1:Perceptual abnormality e.g. Hallucinations
2. Group 2:disorders of thinking/thought content e.g
delusions and overvalued ideas
3. Group 3: Disorders of thought form/Disorder of the
flow of thoughts e.g. pressure of speech, flight of
ideas etc.
4. Group 4: Formal thought disorder e.g. derailment,
tangetiality , illogicality, loosening of association
5. Group 5: Disorder of movement e.g. increased
motor activity, decreased motor activity, catatonic
symptoms

16. Group work continue….
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6. Group 6:Disorder of mood and affect e.g.
depression, anxieted,
7. Group 7: consciousness e.g. confusion
8. Group 8: Orientation
9. Group 9: Attention
10. Group 10: Memory
Each group has 10 minutes for presentation

17. Principal Categories of Symptom
 Perception
 Thought Content
 Thought Control
 Thought Form
 Affect
 Motor Activity
 Consciousness
 Memory
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18. PERCEPTUAL ABNORMALITIES
 False perceptions
 Hallucinations
 Illusions
 Sensory distortions
 Real objects perceived as altered
 Micropsia, macropsia, colour vision
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19. Illusions
 Occur when stimuli from a perceived object are
combined with mental images to create a false
perception
 Usually combined with a negative affect
 Often associated with inattention
 Disappear when full attention given
 Pareidolia: a type of illusion
 Clouds, flames
 Do not disappear when full attention given
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20. Hallucination
 An experience involving the apparent
perception of something not present
 Three characteristics of hallucinations:
 They are perceived as being in external space
 They have the substantiality of a normal
perception
 They are not under voluntary control
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21. Hallucination: Symptom or Sign?
 A hallucination must be described
 There may be signs suggestive of hallucinations:
 Conversations with only one speaker involved
 Patient apparently absorbed, perhaps laughing
 Distractibility
 However a hallucination should not be recorded
until the person himself reports the experience
 (He does not have to regard it as a symptom)
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22. When do hallucinations occur?
 Schizophrenia and related disorders
 Organic psychiatric disorders
 Affective disorders
 Alcoholic hallucinosis
 Sensory deprivation
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23. Are hallucinations ever normal?
 Probably.
 Also in certain circumstances:
 On the point of sleeping (what do we call?)
 On the point of waking (what do we call?) –
students find out!
 After bereavement
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24. Auditory Hallucinations
 Elementary noises to fully formed voices
 “Have you ever heard noises, whispers or voices
when there was no-one around?”
 To be distinguished from thoughts
 To be distinguished from actual voices!
 Single or multiple
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25. Types of Auditory Hallucination
 Third Person:
 Thoughts spoken aloud (x 2)
 Running commentary
 Voices arguing
 Second person:
 Talking to or commanding
 May be mood-congruent in mood disorder
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26. Visual Hallucinations
 Range from:
 Elementary flashes of light…
 to fully formed people and complex scenes
 Always consider organic cause:
 Head trauma or intracranial lesion;
 Delirium, Alzheimer's, Pick's,
 Drug use- illicit and prescribed
 Rare in schizophrenia or affective disorder
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27. Somatic Hallucinations
 Skin, muscle, inner organs
 Almost always delusionally elaborated
 Somatic passivity; control
 Common in schizophrenia
 Formication
 Sensation of ants on the body
 Cocaine, other acute psychoses
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28. Gustatory and Olfactory
 Gustatory: False perceptions of taste
 May occur in schizophrenia or Temporal Lobe
Epilepsy (TLE)
 May be delusionally elaborated: poison
 Olfactory: A smell in the absence of a smell
 Different from delusion that the patient smells
 May occur in schizophrenia or TLE
 Depression
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29. Hallucinations: Summary
 Perception in the absence of a sensory stimulus
 Full force and impact of a real perception
 Unwilled, spontaneous, not under voluntary control
 Visual = look for an organic cause
 Most commonly auditory
 May be suggestive of a psychotic disorder e.g.,
schizophrenia
 Command, derogatory: affective disorders
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30. Thanks
questions or comments
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31. DISORDERS OF THINKING
 Thought Content
 (Thought Control)
 Thought Form
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32. Disorders of Thought Content
 Two main types
 DELUSIONS
 Overvalued ideas
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33. Delusion: DSM-IV-TR
 A false personal belief based on incorrect
inference about external reality and firmly
sustained in spite of incontrovertible and obvious
proof to the contrary
 False fixed belief which is firmly sustained
 The belief is not one ordinarily accepted by
other members of the person's culture or
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34. Bizarre Delusion
 A delusion which is clearly implausible and
not understandable, and which does not
derive from ordinary life experience:
 E.g: The person's brain has been removed and
replaced with someone else's brain
 Mind-reading; passivity
 Significant in schizophrenia, delusional
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35. Delusions by Content: I
 Delusions of reference
 Delusions of persecution
 Grandiose delusions
 Somatic delusions
 E.g., Delusional infestation
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36. Delusions by Content: II
 Delusion of being controlled
 Made feelings
 Made actions
 Made impulses
 Thought withdrawal
 Thought insertion
 Thought broadcasting vs. Mind reading
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37. Delusions by Content: III
 Delusions of guilt
 Religious delusions
 Delusional infidelity
 Erotomanic delusions
 Nihilistic delusions
 Delusional misidentification
 E.g., in Capgras Syndrome vs. Fregoli Syndrome
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38. Overvalued Ideas
 Isolated, preoccupying beliefs, accompanied
by a strong affective response
 Tend to dominate the sufferer's life
 Often associated with abnormal personality
 False or exaggerated beliefs, but not held with
delusional intensity
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39. When Do Overvalued Ideas Occur?
 Body Dysmorphic Disorder
 Paranoid Personality Disorder
 Hypochondriacal Disorder
 Anorexia Nervosa
 Emerging psychosis…
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40. Thought Control
 Disturbance of thought control, or thought
possession, involves a loss of the sense of
ownership of thoughts or feelings that we all
take for granted:
 Obsessions
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41. Obsessions
1.Recurrent and persistent thoughts,
impulses, or images, that are experienced
as intrusive and inappropriate, and cause
marked anxiety or distress
2.The person recognises that the
obsessional thoughts, impulses or images
are the product of his own mind
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42. Continue....
Obsessions are:
 Associated with compulsions
 Central to obsessive-compulsive
disorder
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43. Disorders of Thought Form
 Disorders of thought form are conveyed by
speech
 Disorders of the Flow of Thought
 Formal Thought Disorder
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44. Disorders of the Flow of Thought
 Disorders of various kinds present in all diagnoses:
 Flight of ideas
 Pressure of speech
 Retardation
 Circumstantiality
 Perseveration
 Clanging
 Distractible speech
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45. Formal Thought Disorder
 Formal = relating to form
 A collection of specific abnormalities of
thought, reflected in speech and written
language
 Disordered thinking inferred 2O disordered
speech
 Associated with schizophrenia
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46. FTD: Terms
 Derailment
 A pattern of speech in which successive ideas
or sentences are completely unrelated
 Tangentiality
 Illogicality

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47. Continue...
 Loosening of associations
 A pattern of speech in which successive ideas
or sentences are obliquely related
 Incoherence (word salad)
 A pattern of speech in which successive
words or clauses may be completely unrelated
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48. FTD: Terms II
 Neologism
 A completely new word or phrase whose
derivation can not be understood
 Negative thought disorders:
 Poverty of speech
 Poverty of content of speech
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49. Questions or
comments or concerns
! ! !
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50. DISORDERS OF MOVEMENT
1. Increased motor activity
2. Decreased motor activity
3. Catatonic symptoms
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51. Increased Motor Activity
 Hyperactivity
 Goal-directed
 Typical of mania
 Agitation
 Non goal-directed
 You need to rule out akathisia
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52. Decreased Motor Activity
 Retardation
 Depression
 Drugs
 Stupor
 Akinesis and mutism in preserved consciousness
 Depression, mania, catatonia
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53. Catatonia: Spontaneous Disorders
 Posturing
 Psychological pillow
 Stereotypies
 Mannerisms
 Obstruction
 Mutism
 Stupor
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54. Catatonia: Induced Disorders
 Flexibilitis cerea
 Automatic obedience
 Mitmachen (Co-operation)
 Echolalia / Echopraxia
 Gegenhalten (Opposition)
 Negativism
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55. Disorders of Mood and Affect
 Terms often used interchangably
 Involves description of mood and feelings…
 Feeling: a positive or negative subjective
reaction to an experience
 Affect: the overall emotional state, inferred
objectively; short duration; responsiveness
 Mood: a prolonged, or pervasive, emotional
state
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56. Abnormal Moods / Affects
 Mood
 Depression
 Elation
 Irritability
 Anxiety
 Depersonalisation
 Affect
 Lability
 Blunting
 Flatness
 Restriction
 Inappropriateness
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57. Depression
 A psychopathological feeling of sadness”
 Sad, despondent, despairing, hopeless, apathetic
 Often comorbid with anxiety
 Agitation, restlessness
 Anhedonia
 Stupor
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58. Elation
 Feelings of great happiness, exhilaration, joy,
triumph, intense self-satisfaction, optimism
 In mania, accompanied by other signs
 May turn to irritability
 Reduced control over temper
 Verbal or behavioural outbursts
 Always unpleasant for the patient
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59. Anxiety
 Feeling of apprehension caused by
anticipation of danger, which may be internal
or external
 Normal and necessary – up to a certain point
 Three components:
 Somatic
 Cognitive
 Behavioural
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60. Depersonalisation and Derealisation
 Feeling of unreality; unpleasant-
depersonalisation
 Non-delusional: “as if” quality
 Loss of affective response-derealisation
 May occur in healthy individuals
 Often associated with anxiety
 Also Temporal Lobe Epilepsy, drug use
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61. Affective Instability (Lability)
 Rapid changes in affect
 Similar: “mood swings”; “labile mood”
 Moods not sustained
 Manic phase of Bipolar disorders
 Mixed affective states
 Personality disorder
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62. Restriction, Blunting, Flattening
 Restricted or constricted affect:
 Reduction in intensity of emotional tone
 Blunted affect:
 Severe reduction in the intensity of emotional
tone
 Flat affect
 Absence or near absence of any signs of affective
expression; voice monotonous, face immobile
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63. Appropriate vs. Inappropriate Affect
 Appropriate affect:
 Emotional tone is in harmony with accompanying
idea, thought, or speech
 Full range of emotions correctly expressed
 Inappropriate affect
 Disharmony between emotional tone and the
thought, feeling or speech accompanying it
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64. Consciousness
 The state of being awake and aware of
one's surroundings
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65. Orientation
 The normal state of oneself and one's
surroundings in terms of time, place, and
person
 Disturbance of consciousness; & Disturbance
of orientation: ? Organic Pathology
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66. Disturbances of Consciousness
 Drowsiness
 Confusion
 Disorientation
 Delirium
 Bewildered, restless, confused, disoriented state,
associated with fear and hallucinations
 Clouding of consciousness
 Coma
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67. Attention
 Attention: ability to focus on one activity
 Disturbances include:
 Distractibility
 Selective inattention
 Hypervigilance
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68. Memory
 The function by which information stored in the
brain is later recalled to consciousness
 Levels: immediate, recent, recent past, remote
 Disturbances include:
 Anterograde amnesia
 Retrograde amnesia
 Paramnesia
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69. Paramnesia
 Falsification of memory by distortion of
recall:
 Confabulation
 Déjà vu & déjà entendu
 Déjà pensé
 Jamais vu
 False memory
 Delusional memory 12 August 2022
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70. Summary
 Disorders of movement
 Disorders of mood
 Disorders of affect
 Disorders of consciousness
 Disorders of attention
 Disorders of memory
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71. References
 American Psychiatry Association. (2013). Diagnostic and statistical manual
of mental disorders R. 5th ed. Washington DC: American Psychiatry
Association Press.
 Kaplan & Sadock’s. (2007) Synopsis of Psychiatry. Behavioural
Sciences/Clinical Psychiatry .10th Ed. Philadelphia :Lippincott Williams &
Wilkins.
 World Health Organization. (1992). International Classification of Diseases
10th Revision .Geneva: WHO.
 Gelder, M. Harrison, P. & Cowen, P. (2007).Shorter textbook of
psychiatry.5th ed. Oxford: Oxford University press Inc.
 First, M.B, Spitzer R.I, Gibbon, M & Williams, J.B.W. (2004). Structured
clinical interview for DSM-IV-TR axis I Disorders. 4th ed. New York:
Biometrics research department.
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72. Questions or comments
or
concerns ! ! !
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