How to manage it

1. SYMPTOMATOLOGY IN
PSYCHIATRY ILLNESS

2. PSYCHIATRY SYMPTOMS AND SIGNS
 Disorders of Perception
 Disorders of Thinking
 Disorders of Speech
 Disorders of Emotions
 Disorders of Motor Behavior
 Disorders of Memory
 Disorders of Attention
Disorder of Orientation
Disorders of Consciousness
 Judgment
Insight

3. Disorders of Perception
 Perception is the process by which sensory stimuli are given a
meaning.
Common disorders of perception are the following:
1. Illusions:
 Misinterpretation of real external sensory stimuli (e.g., mistaking a
rope for a snake, mirage). • May affect any sensory modality (visual,
auditory, etc...).
 May occur in normal or pathological conditions (e.g., delirium).
2. Hallucinations:
Hallucination is a false perception in the absence of any external
stimulus.

4. Disorders of Perception
3.Depersonalization :
The person perceives himself, his body or parts of his body as
different, unreal or unfamiliar.
4. Derealization:
The person perceives the external world, objects or people as
different, strange or unreal.
Depersonalization and Derealization may occur in normal people
(during stress), in anxiety disorders, mood disorders, schizophrenia,
and in organic conditions (e.g., temporal lobe epilepsy).

5. TYPES OF HALLUCINATION
1. According to complexity:
Elementary (e.g., noises, flashes of light).
Complex (voices, music, faces, scenes)
2. According to sensory modalities :
 Auditory Hallucinations
 Visual Hallucinations:
 Tactile Hallucinations:
 Olfactory (smell) and Gustatory (taste) Hallucinations
 Somatic Hallucinations:

6. 1. AUDITORY HALLUCINATION
They are the most common type of hallucinations. They mainly occur in
psychotic disorders especially schizophrenia.
Varieties:
1. Voices talking to the patient (2nd person), i.e., addressing or
commanding
2. Voices talking about the patient (3rd person), e.g., commenting on his
thoughts or actions
3. Voices repeating patient's thoughts
Most common in organic mental conditions, (e.g., delirium, substance
intoxication or withdrawal).
May occur in schizophrenia, severe mood disorders or dissociative
disorders.

7. 2. TACTILE HALLUCINATION
 False perception of touch. •e.g., phantom limb (from amputated
limb); and crawling sensation on or under the skin in cocaine
intoxication and withdrawal.
3. ALFACTORY AND GUSTATORY HALLUCINATION
Most common in organic conditions, e.g., temporal lobe epilepsy. •
May occur in schizophrenia or severe mood disorders.
4. SOMATIC HALLUCINATION
 False sensation of things occurring in the body (mostly visceral).
They usually occur in psychotic disorders, particularly schizophrenia

8. DISORDERS OF THINKING
These are classified into:
1. Disorders of Form of Thinking
2. Disorders of Stream of Thinking
3. Disorders of Content of Thinking

9. 1. Disorders of Form of Thinking
They are also called Formal Thought Disorders.
They are abnormalities in the logical structure and association of
thoughts.
They lead to failure in producing coherent and logically connected
meanings.
 Formal thought disorders usually occur in psychotic disorders and
some organic mental disorders.

10. Cont…
The following are the commonest types:
1. Flight of ideas : thoughts and conversation move quickly from one topic to another
so that one train of thought is not completed before another appears.
2. Loosening of associations:
3. Word Salad: Refer to a random a random words or phrases linked together in an
often uniteligible manner. E.g “happy green friendly running monkeys”
4. Verbigeration : refers to the sereotypy in which sounds, words or phrases are
repeated in a senseless way.
5. Perseveration: is the persistent and inappropriate repetition of the same thought.
6. Neologism: use of words or phrase invented by one self self often to describe one
experience

11. Disorders of stream of thinking
These are abnormalities in the progress of thought including its
speed (tempo) and continuity.
1. Flight of ideas:
2. Circumstantiality: Circumstantiality occurs when thinking proceeds
slowly with many unnecessary and trivial details, but finally the
point is reached.
3. Tangentiality: continuous dervsion from the topic of focus with no
return to it.
4. Blocking: occurs when there is a sudden arrest of the train of
thought, leaving a ‘blank’. – An entirely new thought may then
begin

12. Disorder of content of thinking
These are abnormalities in the ideas or beliefs contained in thought.
1. Delusions
2. Obsessions

13. Delusion
A delusion is a false belief.
 It is based on incorrect inferences about reality.
 It is not consistent with the patient's cultural background.
 It cannot be corrected by experience or reasoning.
Delusions may be:
1. primary or secondary
2. Bizare or non bizare

14. Cont..
• N.B. Delusions and Hallucinations occur in psychotic disorders such
as:
• 1- Schizophrenia.
• 2- Delusional disorders.
• 3- Psychotic mood disorders.
• 4- Some organic or substance related mental disorders

15. Types of delusions
Types of Delusions (according to theme):
1. Delusion of persecution:
2. Delusion of grandeur (grandiosity):
3. Delusion of reference:
4. Delusion of guilt or self accusation.
5. Nihilistic delusion:
6. Somatic delusion:
7. Hypochondriacal delusion
8. Delusion of infidelity (delusional jealousy):
9. Erotomania (delusion of love):
10. Delusions of influence & control (Passivity phenomena)

16. Persecutory delusions
 persecutory delusions are also known as paranoid delusions
Ideas that people or organizations are trying to inflict harm on the
patient, damage his reputation, or make him insane.
Sometimes normal in some people
 Common in schizophrenia , Occur in organic states and severe
depressive disorders .

17. Delusion of control
This is a false belief that a person's thoughts, feelings, actions or will
are being controlled by external forces.
 Delusions concerning the possession of thoughts:
i. Thought insertion:
ii. Thought withdrawal:
iii. Thought broadcasting:

18. Delusions of Reference
Concerned with the idea that objects, events or the actions of other
people have a special significance for the patient.
Ex: A remark heard on television is believed to be directed
specifically to the patient, or a gesture by a stranger is believed to
convey something about the patient • Associate with schizophrenia

19. Grandiose & Expansive delusions
Beliefs of exaggerated self-importance
Occur in mania & sometimes in schizophrenia
Delusions of guilt and worthlessness
 Beliefs that the person has done something shameful or sinful. • Usually
concerns innocent errors • Most often in severe depressive disorders
Nihilistic Delusions
 Beliefs that the patient’s career is finished, or that he is about to die or
has no money, or that the world is doomed
 Common in severe depressive disorders .

20. Hypochondriacal Delusions
 False beliefs about the presence of disease.
 Common among elderly
Related dysmorphophobic delusions – concerned with the appearance of
parts of the body •
Severe depressive & schizophrenia
Delusions of jealousy( infedility)
• Common among men ‘Morbid (pathological) jealousy’
• May lead to dangerously aggressive behavior towards the person who is
believed to be unfaithful

21. Arotomania ( delusion of love)
Common among women
They believe that she is loved by a man who has never spoken to her &
who is inaccessible.

22. Obsession
• • Obsessions are recurrent, persistent thoughts, impulses or images
that cannot be eliminated from consciousness by logic or reasoning
although the person is aware that they are unreasonable.

23. compulsive
 If the thought urges the patient to perform a certain act, repetitive
compulsion results, e.g., obsession of dirt leads to compulsive
washing. Like obsessions, compulsions are recognized as senseless
and alien

24. Disorders of speech
1. Volubility : talkativeness with enthusiasm eg mania
2. Poverty of speech: also known as alogia reduction in the amount of speech.
Common feature of depression
3. Stuttering and stammering: the most common fluency disorder, is an
interruption of flow of speaking • Ex. W-w-w- where are you?
4. Dysarthria: Weakness or paralysis of speech muscle caused by damage to the
nerves. This leads to slurred speech
5. Aphasia: Is a language disorder that is caused by damage to left side brain. This
makes it difficult to speak, read, understand what is being said. • E.x –
switching sound such as saying ‘ way drive’ instead of ‘driveway’
I. Motor aphasia (expressive)
II. Sensory aphasia (receptive)
6. Mutism: Complete inability to speak
7. Apraxia : Inconsistent production of speech sounds and rearranging of sounds
in a word • E.x- ‘potato’ may become ‘topato’ and next ‘totapo’

25. Disorders of emotions
 Emotion is a complex feeling state with psychic, somatic and
behavioral components.
 The clinical study and evaluation of emotion is concerned with two
main aspects:
1. Mood: a sustained and pervasive emotional tone subjectively
experienced and reported by the patient. (e.g., depression, elation,
anger).
2. Affect: usually used to indicate the subjective and immediate
"short lived" or transient experience of emotion. It also refers to the
external expression or observed aspect of emotions.

26. Disorders of mood
Disorders of mood may be unpleasant or pleasant.
Unpleasant moods
1. Dysphoric mood: state of profound unhappiness and dissatisfaction
2. Irritable mood: state that involves feelings of anger or frustration
3. Depression: Feelings of hopelessness
4. Anhedonia: inability to feel pleasure in normally pleasurable
activities

27. Pleaasant :
1-Euphoria:
2- Elation
3- Ecstasy

28. Disorder of affect
These are disturbances related to observed expression of emotions.
 They include the following disorders:
1. Constricted or restricted affect
2. Blunted affect
3. Flat affect (apathy)
4. .Inappropriate affect (incongruity of affect)
5. Lability of affect (emotional incontinence)
6. Swings of affect
7. Ambivalence: mixed affect

29. Disorders of motor behavior
Abnormalities of social behavior, facial expression and posture
Theses include:
1- Tics : brief rapid motor movements or vocalizations that are typically
performed in response to irresistible urges
2- Mannerisms: repetitive, purposeful movements 3- Stereotypy
4- Psychomotor retardation
5- Psychomotor agitation
6- Excitement
Lack of Volition (Avolition)
8- Catatonic Symptoms

30. Catatonic symptoms
1. Posturing: maintenance of bizarre postures
2. Immobility: lack or paucity of movement
3. Stereotypes: purposeless, repetitive movements
4. Negativism: active or passive refusal to follow commands
5. Grimacing: repetitive facial posturing
6. Catalepsy or Waxy Flexibility: maintenance of posture
7. Echopraxia or Echolalia: repetition of words or the imitation of actions
8. Excitement: purposeless, excessive movement

31. Disorders of memory
 Memory is the psychological function by which information stored in
the brain is later recalled in consciousness.
 Clinically, 4 levels of memory are described:
1. Immediate Memory
2. Recent (short-term) Memory
3. Recent Past Memory
4. Remote (Long-term)
• )

32. Disorders of memory
A. Amnesia
1. Anterograde
2. Retrograde
3. Circumscribed amnesia (amnestic gap)
C. Paramnesia :It is falsification or distortion of recalled memories.
Common types:
1- Confabulation : generation of false memoery without the intention of
deceit.
2- Déjà vu: the feeling that you have already already experienced something
that is actualling happening for the first time.
3- Jamais vu : is the experience of being unfamiliar with a person or situation
that is very familiar

33. Disorder of attention
Attention is the ability to focus awareness on certain important or
relevant aspects of an experience, activity or task.
Concentration is the ability to sustain or maintain that focus. 
Disorders of Attention:
1. Distractibility
2. Selective inattention
3. Hypervigilance (hyperprosexia)

34. Disorders of orientation
Orientation is awareness of time, place and persons.
Disorientation : disturbed orientation to time, place or persons. It is
usually related to disturbed consciousness.
.

35. Disorders of consciousness
Consciousness is the general state of awareness of the self and the
environment.
Common disorders of consciousness are:
1- Clouding of Consciousness:
2- Stupor:
3- Coma:
4- Dream-like state (oneroid or twilight state):
5- Somnolence:
N.B.: Most symptoms indicating disturbances in consciousness, orientation,
memory, and attention highly suggest an "Organic Mental Disorder".

36. Disorder of judgment
 Judgment is the ability to assess a situation rationally and to act
appropriately within that situation.
Judgment has several aspects (cultural, social, moral, etc...) that
should be considered in order to be assessed by the clinician.

37. Disorder of insight
 insight refers to the patient's conscious recognition of his condition,
i.e., awareness that: 1 - he is disturbed or ill 2- his illness is psychiatric
in nature 3- he should seek professional help 4- he should cooperate
with the offered treatment
 Full or partial awareness of these aspects indicates the degree of his
insight