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The document discusses psychopathology and the signs and symptoms of mental disorders. It begins by defining key terms like symptoms, signs, and syndromes. It then describes the characteristics of mental disorders and explains descriptive psychopathology. Descriptive psychopathology involves precisely observing behaviors and understanding subjective experiences in order to diagnose and understand mental disorders. The document outlines the principal categories of symptoms seen in mental disorders, including perceptual abnormalities, thought content and form, affect, motor activity, and others. It provides examples of specific symptoms within each category, such as types of hallucinations and delusions.

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BACHELOR OF SCIENCE IN MENTAL HEALTH & PSYCHIATRIC NURSING (POST BASIC) PSYCHOPATHOLOGY JAPHET MYABa 25/07/2022
Learning outcome 12 August 2022 KUHeS,School of Nursing-Mental Health Department 2 1. Discuss psychopathology of psychiatric disorders 2. Describe typical signs and symptoms of mental disorders
Outline of presentation  Introduction  Psycho-pathology and  Phenomenology of mental disorders  Principal categories of symptoms and signs of mental disorders 12 August 2022 3 KUHeS,School of Nursing-Mental Health Department
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. 12 August 2022 4 KUHeS,School of Nursing-Mental Health Department
Introduction continue…. 12 August 2022 KUHeS,School of Nursing-Mental Health Department 5  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.
Mental disorder : 12 August 2022 KUHeS,School of Nursing-Mental Health Department 6  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.
Mental disorder continue…. 12 August 2022 KUHeS,School of Nursing-Mental Health Department 7  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.
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) 12 August 2022 8 KUHeS,School of Nursing-Mental Health Department
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” 12 August 2022 9 KUHeS,School of Nursing-Mental Health Department
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. 12 August 2022 10 KUHeS,School of Nursing-Mental Health Department
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) 12 August 2022 11 KUHeS,School of Nursing-Mental Health Department
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 12 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 13 KUHeS,School of Nursing-Mental Health Department
Questions or comments 12 August 2022 KUHeS,School of Nursing-Mental Health Department 14
Group Work/Assignment 12 August 2022 KUHeS,School of Nursing-Mental Health Department 15  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
Group work continue…. 12 August 2022 KUHeS,School of Nursing-Mental Health Department 16 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
Principal Categories of Symptom  Perception  Thought Content  Thought Control  Thought Form  Affect  Motor Activity  Consciousness  Memory 12 August 2022 17 KUHeS,School of Nursing-Mental Health Department
PERCEPTUAL ABNORMALITIES  False perceptions  Hallucinations  Illusions  Sensory distortions  Real objects perceived as altered  Micropsia, macropsia, colour vision 12 August 2022 18 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 19 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 20 KUHeS,School of Nursing-Mental Health Department
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) 12 August 2022 21 KUHeS,School of Nursing-Mental Health Department
When do hallucinations occur?  Schizophrenia and related disorders  Organic psychiatric disorders  Affective disorders  Alcoholic hallucinosis  Sensory deprivation 12 August 2022 22 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 23 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 24 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 25 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 26 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 27 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 28 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 29 KUHeS,School of Nursing-Mental Health Department
Thanks questions or comments 12 August 2022 30 KUHeS,School of Nursing-Mental Health Department
DISORDERS OF THINKING  Thought Content  (Thought Control)  Thought Form 12 August 2022 31 KUHeS,School of Nursing-Mental Health Department
Disorders of Thought Content  Two main types  DELUSIONS  Overvalued ideas 12 August 2022 32 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 33 KUHeS,School of Nursing-Mental Health Department
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 disorder 12 August 2022 34 KUHeS,School of Nursing-Mental Health Department
Delusions by Content: I  Delusions of reference  Delusions of persecution  Grandiose delusions  Somatic delusions  E.g., Delusional infestation 12 August 2022 35 KUHeS,School of Nursing-Mental Health Department
Delusions by Content: II  Delusion of being controlled  Made feelings  Made actions  Made impulses  Thought withdrawal  Thought insertion  Thought broadcasting vs. Mind reading 12 August 2022 36 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 37 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 38 KUHeS,School of Nursing-Mental Health Department
When Do Overvalued Ideas Occur?  Body Dysmorphic Disorder  Paranoid Personality Disorder  Hypochondriacal Disorder  Anorexia Nervosa  Emerging psychosis… 12 August 2022 39 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 40 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 41 KUHeS,School of Nursing-Mental Health Department
Continue.... Obsessions are:  Associated with compulsions  Central to obsessive-compulsive disorder 12 August 2022 42 KUHeS,School of Nursing-Mental Health Department
Disorders of Thought Form  Disorders of thought form are conveyed by speech  Disorders of the Flow of Thought  Formal Thought Disorder 12 August 2022 43 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 44 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 45 KUHeS,School of Nursing-Mental Health Department
FTD: Terms  Derailment  A pattern of speech in which successive ideas or sentences are completely unrelated  Tangentiality  Illogicality  12 August 2022 46 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 47 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 48 KUHeS,School of Nursing-Mental Health Department
Questions or comments or concerns ! ! ! 12 August 2022 49 KUHeS,School of Nursing-Mental Health Department
DISORDERS OF MOVEMENT 1. Increased motor activity 2. Decreased motor activity 3. Catatonic symptoms 12 August 2022 50 KUHeS,School of Nursing-Mental Health Department
Increased Motor Activity  Hyperactivity  Goal-directed  Typical of mania  Agitation  Non goal-directed  You need to rule out akathisia 12 August 2022 51 KUHeS,School of Nursing-Mental Health Department
Decreased Motor Activity  Retardation  Depression  Drugs  Stupor  Akinesis and mutism in preserved consciousness  Depression, mania, catatonia 12 August 2022 52 KUHeS,School of Nursing-Mental Health Department
Catatonia: Spontaneous Disorders  Posturing  Psychological pillow  Stereotypies  Mannerisms  Obstruction  Mutism  Stupor 12 August 2022 53 KUHeS,School of Nursing-Mental Health Department
Catatonia: Induced Disorders  Flexibilitis cerea  Automatic obedience  Mitmachen (Co-operation)  Echolalia / Echopraxia  Gegenhalten (Opposition)  Negativism 12 August 2022 54 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 55 KUHeS,School of Nursing-Mental Health Department
Abnormal Moods / Affects  Mood  Depression  Elation  Irritability  Anxiety  Depersonalisation  Affect  Lability  Blunting  Flatness  Restriction  Inappropriateness 12 August 2022 56 KUHeS,School of Nursing-Mental Health Department
Depression  A psychopathological feeling of sadness”  Sad, despondent, despairing, hopeless, apathetic  Often comorbid with anxiety  Agitation, restlessness  Anhedonia  Stupor 12 August 2022 57 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 58 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 59 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 60 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 61 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 62 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 63 KUHeS,School of Nursing-Mental Health Department
Consciousness  The state of being awake and aware of one's surroundings 12 August 2022 64 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 65 KUHeS,School of Nursing-Mental Health Department
Disturbances of Consciousness  Drowsiness  Confusion  Disorientation  Delirium  Bewildered, restless, confused, disoriented state, associated with fear and hallucinations  Clouding of consciousness  Coma 12 August 2022 66 KUHeS,School of Nursing-Mental Health Department
Attention  Attention: ability to focus on one activity  Disturbances include:  Distractibility  Selective inattention  Hypervigilance 12 August 2022 67 KUHeS,School of Nursing-Mental Health Department
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 12 August 2022 68 KUHeS,School of Nursing-Mental Health Department
Paramnesia  Falsification of memory by distortion of recall:  Confabulation  Déjà vu & déjà entendu  Déjà pensé  Jamais vu  False memory  Delusional memory 12 August 2022 69 KUHeS,School of Nursing-Mental Health Department
Summary  Disorders of movement  Disorders of mood  Disorders of affect  Disorders of consciousness  Disorders of attention  Disorders of memory 12 August 2022 70 KUHeS,School of Nursing-Mental Health Department
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. 12 August 2022 71 KUHeS,School of Nursing-Mental Health Department
Questions or comments or concerns ! ! ! 12 August 2022 72 KUHeS,School of Nursing-Mental Health Department

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Psychopathology-Signs_symptoms_Myaba.pptx

  • 1.
    BACHELOR OF SCIENCEIN MENTAL HEALTH & PSYCHIATRIC NURSING (POST BASIC) PSYCHOPATHOLOGY JAPHET MYABa 25/07/2022
  • 2.
    Learning outcome 12 August2022 KUHeS,School of Nursing-Mental Health Department 2 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 12 August 2022 3 KUHeS,School of Nursing-Mental Health Department
  • 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. 12 August 2022 4 KUHeS,School of Nursing-Mental Health Department
  • 5.
    Introduction continue…. 12 August2022 KUHeS,School of Nursing-Mental Health Department 5  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 : 12August 2022 KUHeS,School of Nursing-Mental Health Department 6  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…. 12August 2022 KUHeS,School of Nursing-Mental Health Department 7  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 thesystematic 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) 12 August 2022 8 KUHeS,School of Nursing-Mental Health Department
  • 9.
    Psychopathology continue.. 2. Descriptivepsychopathology: 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” 12 August 2022 9 KUHeS,School of Nursing-Mental Health Department
  • 10.
    Psychopathology continue..  Twoessential 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. 12 August 2022 10 KUHeS,School of Nursing-Mental Health Department
  • 11.
    Uses of DescriptivePsychopathology  Diagnostic  Clarity & Classification  Communication  Therapeutic  Empathy  Scientific & Forensic- can be used for scientific (e.g. research) and forensic purposes (mental health and law) 12 August 2022 11 KUHeS,School of Nursing-Mental Health Department
  • 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 12 KUHeS,School of Nursing-Mental Health Department
  • 13.
    Schneider (1959)  Clinicaldiagnosis 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 12 August 2022 13 KUHeS,School of Nursing-Mental Health Department
  • 14.
    Questions or comments 12 August2022 KUHeS,School of Nursing-Mental Health Department 14
  • 15.
    Group Work/Assignment 12 August2022 KUHeS,School of Nursing-Mental Health Department 15  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…. 12August 2022 KUHeS,School of Nursing-Mental Health Department 16 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 ofSymptom  Perception  Thought Content  Thought Control  Thought Form  Affect  Motor Activity  Consciousness  Memory 12 August 2022 17 KUHeS,School of Nursing-Mental Health Department
  • 18.
    PERCEPTUAL ABNORMALITIES  Falseperceptions  Hallucinations  Illusions  Sensory distortions  Real objects perceived as altered  Micropsia, macropsia, colour vision 12 August 2022 18 KUHeS,School of Nursing-Mental Health Department
  • 19.
    Illusions  Occur whenstimuli 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 12 August 2022 19 KUHeS,School of Nursing-Mental Health Department
  • 20.
    Hallucination  An experienceinvolving 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 12 August 2022 20 KUHeS,School of Nursing-Mental Health Department
  • 21.
    Hallucination: Symptom orSign?  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) 12 August 2022 21 KUHeS,School of Nursing-Mental Health Department
  • 22.
    When do hallucinationsoccur?  Schizophrenia and related disorders  Organic psychiatric disorders  Affective disorders  Alcoholic hallucinosis  Sensory deprivation 12 August 2022 22 KUHeS,School of Nursing-Mental Health Department
  • 23.
    Are hallucinations evernormal?  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 12 August 2022 23 KUHeS,School of Nursing-Mental Health Department
  • 24.
    Auditory Hallucinations  Elementarynoises 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 12 August 2022 24 KUHeS,School of Nursing-Mental Health Department
  • 25.
    Types of AuditoryHallucination  Third Person:  Thoughts spoken aloud (x 2)  Running commentary  Voices arguing  Second person:  Talking to or commanding  May be mood-congruent in mood disorder 12 August 2022 25 KUHeS,School of Nursing-Mental Health Department
  • 26.
    Visual Hallucinations  Rangefrom:  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 12 August 2022 26 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 27 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 28 KUHeS,School of Nursing-Mental Health Department
  • 29.
    Hallucinations: Summary  Perceptionin 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 12 August 2022 29 KUHeS,School of Nursing-Mental Health Department
  • 30.
    Thanks questions or comments 12August 2022 30 KUHeS,School of Nursing-Mental Health Department
  • 31.
    DISORDERS OF THINKING Thought Content  (Thought Control)  Thought Form 12 August 2022 31 KUHeS,School of Nursing-Mental Health Department
  • 32.
    Disorders of ThoughtContent  Two main types  DELUSIONS  Overvalued ideas 12 August 2022 32 KUHeS,School of Nursing-Mental Health Department
  • 33.
    Delusion: DSM-IV-TR  Afalse 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 12 August 2022 33 KUHeS,School of Nursing-Mental Health Department
  • 34.
    Bizarre Delusion  Adelusion 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 disorder 12 August 2022 34 KUHeS,School of Nursing-Mental Health Department
  • 35.
    Delusions by Content:I  Delusions of reference  Delusions of persecution  Grandiose delusions  Somatic delusions  E.g., Delusional infestation 12 August 2022 35 KUHeS,School of Nursing-Mental Health Department
  • 36.
    Delusions by Content:II  Delusion of being controlled  Made feelings  Made actions  Made impulses  Thought withdrawal  Thought insertion  Thought broadcasting vs. Mind reading 12 August 2022 36 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 37 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 38 KUHeS,School of Nursing-Mental Health Department
  • 39.
    When Do OvervaluedIdeas Occur?  Body Dysmorphic Disorder  Paranoid Personality Disorder  Hypochondriacal Disorder  Anorexia Nervosa  Emerging psychosis… 12 August 2022 39 KUHeS,School of Nursing-Mental Health Department
  • 40.
    Thought Control  Disturbanceof thought control, or thought possession, involves a loss of the sense of ownership of thoughts or feelings that we all take for granted:  Obsessions 12 August 2022 40 KUHeS,School of Nursing-Mental Health Department
  • 41.
    Obsessions 1.Recurrent and persistentthoughts, 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 12 August 2022 41 KUHeS,School of Nursing-Mental Health Department
  • 42.
    Continue.... Obsessions are:  Associatedwith compulsions  Central to obsessive-compulsive disorder 12 August 2022 42 KUHeS,School of Nursing-Mental Health Department
  • 43.
    Disorders of ThoughtForm  Disorders of thought form are conveyed by speech  Disorders of the Flow of Thought  Formal Thought Disorder 12 August 2022 43 KUHeS,School of Nursing-Mental Health Department
  • 44.
    Disorders of theFlow of Thought  Disorders of various kinds present in all diagnoses:  Flight of ideas  Pressure of speech  Retardation  Circumstantiality  Perseveration  Clanging  Distractible speech 12 August 2022 44 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 45 KUHeS,School of Nursing-Mental Health Department
  • 46.
    FTD: Terms  Derailment A pattern of speech in which successive ideas or sentences are completely unrelated  Tangentiality  Illogicality  12 August 2022 46 KUHeS,School of Nursing-Mental Health Department
  • 47.
    Continue...  Loosening ofassociations  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 12 August 2022 47 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 48 KUHeS,School of Nursing-Mental Health Department
  • 49.
    Questions or comments orconcerns ! ! ! 12 August 2022 49 KUHeS,School of Nursing-Mental Health Department
  • 50.
    DISORDERS OF MOVEMENT 1.Increased motor activity 2. Decreased motor activity 3. Catatonic symptoms 12 August 2022 50 KUHeS,School of Nursing-Mental Health Department
  • 51.
    Increased Motor Activity Hyperactivity  Goal-directed  Typical of mania  Agitation  Non goal-directed  You need to rule out akathisia 12 August 2022 51 KUHeS,School of Nursing-Mental Health Department
  • 52.
    Decreased Motor Activity Retardation  Depression  Drugs  Stupor  Akinesis and mutism in preserved consciousness  Depression, mania, catatonia 12 August 2022 52 KUHeS,School of Nursing-Mental Health Department
  • 53.
    Catatonia: Spontaneous Disorders Posturing  Psychological pillow  Stereotypies  Mannerisms  Obstruction  Mutism  Stupor 12 August 2022 53 KUHeS,School of Nursing-Mental Health Department
  • 54.
    Catatonia: Induced Disorders Flexibilitis cerea  Automatic obedience  Mitmachen (Co-operation)  Echolalia / Echopraxia  Gegenhalten (Opposition)  Negativism 12 August 2022 54 KUHeS,School of Nursing-Mental Health Department
  • 55.
    Disorders of Moodand 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 12 August 2022 55 KUHeS,School of Nursing-Mental Health Department
  • 56.
    Abnormal Moods /Affects  Mood  Depression  Elation  Irritability  Anxiety  Depersonalisation  Affect  Lability  Blunting  Flatness  Restriction  Inappropriateness 12 August 2022 56 KUHeS,School of Nursing-Mental Health Department
  • 57.
    Depression  A psychopathologicalfeeling of sadness”  Sad, despondent, despairing, hopeless, apathetic  Often comorbid with anxiety  Agitation, restlessness  Anhedonia  Stupor 12 August 2022 57 KUHeS,School of Nursing-Mental Health Department
  • 58.
    Elation  Feelings ofgreat 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 12 August 2022 58 KUHeS,School of Nursing-Mental Health Department
  • 59.
    Anxiety  Feeling ofapprehension caused by anticipation of danger, which may be internal or external  Normal and necessary – up to a certain point  Three components:  Somatic  Cognitive  Behavioural 12 August 2022 59 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 60 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 61 KUHeS,School of Nursing-Mental Health Department
  • 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 12 August 2022 62 KUHeS,School of Nursing-Mental Health Department
  • 63.
    Appropriate vs. InappropriateAffect  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 12 August 2022 63 KUHeS,School of Nursing-Mental Health Department
  • 64.
    Consciousness  The stateof being awake and aware of one's surroundings 12 August 2022 64 KUHeS,School of Nursing-Mental Health Department
  • 65.
    Orientation  The normalstate of oneself and one's surroundings in terms of time, place, and person  Disturbance of consciousness; & Disturbance of orientation: ? Organic Pathology 12 August 2022 65 KUHeS,School of Nursing-Mental Health Department
  • 66.
    Disturbances of Consciousness Drowsiness  Confusion  Disorientation  Delirium  Bewildered, restless, confused, disoriented state, associated with fear and hallucinations  Clouding of consciousness  Coma 12 August 2022 66 KUHeS,School of Nursing-Mental Health Department
  • 67.
    Attention  Attention: abilityto focus on one activity  Disturbances include:  Distractibility  Selective inattention  Hypervigilance 12 August 2022 67 KUHeS,School of Nursing-Mental Health Department
  • 68.
    Memory  The functionby which information stored in the brain is later recalled to consciousness  Levels: immediate, recent, recent past, remote  Disturbances include:  Anterograde amnesia  Retrograde amnesia  Paramnesia 12 August 2022 68 KUHeS,School of Nursing-Mental Health Department
  • 69.
    Paramnesia  Falsification ofmemory by distortion of recall:  Confabulation  Déjà vu & déjà entendu  Déjà pensé  Jamais vu  False memory  Delusional memory 12 August 2022 69 KUHeS,School of Nursing-Mental Health Department
  • 70.
    Summary  Disorders ofmovement  Disorders of mood  Disorders of affect  Disorders of consciousness  Disorders of attention  Disorders of memory 12 August 2022 70 KUHeS,School of Nursing-Mental Health Department
  • 71.
    References  American PsychiatryAssociation. (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. 12 August 2022 71 KUHeS,School of Nursing-Mental Health Department
  • 72.
    Questions or comments or concerns! ! ! 12 August 2022 72 KUHeS,School of Nursing-Mental Health Department

Editor's Notes

  • #9 Cognition refers to mental processes involved in gaining knowledge and comprehension. e.g., thinking, knowing,remembering,judging, & problem solving Psychoanalysis theory (Sigmund Freud)- these theories explain human behaviour in terms of the interaction of various components of personality; in therapy the goal of psychoanalysis is to bring what exists at the unconscious or subconscious level up to consciousness. Similaly to understand psychopathology, it can explained with such theories , the things which happened and are in unconscious or subconscious may explain what is happening in the conscious level. This can experimental-behaviourism or theoretical. Behaviourism- theory that human and animal behaviour can be explained in terms of conditioning, without appeal to thoughts or feelings, and that psychological disorders are best treated by altering behaviour patterns. E.g., teacher reward their class or certain students with a party or special treat at the end of the week for good behaviour throughout the week. Same concept can be used with punishment,- teacher can take away certain privileges if the student misbehaves. Similarly in the concept of abnormal behaviour, it can be learned-so this also can explain psychopathology. Behaviourism emphasizes the role of environmental factors in influencing behaviour, to the near exclusion of innate or inherited factors. We learn new behaviour through classical or operant conditioning (collectively known as learning theory). Therefore when born our mind is tabula rasa (blank slate). This type of theory can be used in therapy of conditions like phobias, PTSDs.
  • #13 Syndrome-a group of symptoms which consistently occur together, or a condition characterized by set of associated symptoms.
  • #61 Deperosnalisation: a state in which one’s thoughts and feelings seem unreal or not to belong to oneself. Derealisation: a feeling that one’s surroundings are not real. E.g., like you are living in a movie or dream; Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall. Can be seen in schizophrenia but also in drug reaction problems.
  • #67 Clouding of consciousness- others call it Brain/mental fog- can happen for various reasons e.g., a medical condition, stress, poor diet, a lack of sleep, or the use of some medications.
  • #68 Hypervigilance: extreme or excessive vigilance-state of being highly or abnormally alert to potential danger or threat. A person suffering from PTSD may have sleep disturbances, irritability, hypervigilance, heightened startle responses and flashbacks of the original trauma.