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PHENOMENOLOGYPHENOMENOLOGY(MED 4048)(MED 4048)
Assoc Prof DrAssoc Prof Dr MuhdMuhd. Najib Mohd.. Najib Mohd.AlwiAlwi
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PHENOMENOLOGYPHENOMENOLOGY
Definition:Definition:
-- The study of events, either psychological or physical,The study of events, either psychological or physical,
without embellishing those events with explanation ofwithout embellishing those events with explanation of
cause or functioncause or function-- In psychiatry, it involves theIn psychiatry, it involves the observationobservation andand categorizationcategorization
ofofabnormal psychic eventsabnormal psychic events, the internal experiences of the, the internal experiences of the
patient and his consequent behaviourpatient and his consequent behaviour
-- NB: It is sometimes called Descriptive Psychopathology:NB: It is sometimes called Descriptive Psychopathology:
-- Empathic evaluation of patients subjective experienceEmpathic evaluation of patients subjective experience
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General objectives
To know the main headings under which the
mental state is described.
To know the main phenomenology conceptsand their descriptions.
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Specific ObjectivesSpecific Objectives
To understand the definition of phenomenology and itsTo understand the definition of phenomenology and itsimportance in psychiatry.importance in psychiatry.
To comprehend how to elicit and describe common signs andTo comprehend how to elicit and describe common signs andsymptoms in psychiatry.symptoms in psychiatry.
To understand the basic classification of signs and symptomsTo understand the basic classification of signs and symptomsin psychiatry.in psychiatry.
To be aware of common perceptual disturbances.To be aware of common perceptual disturbances.
To distinguish the differences between true andTo distinguish the differences between true andpseudohallucinations.pseudohallucinations.
To define thinking and understand the basic components ofTo define thinking and understand the basic components ofthought and the disturbances associated with each one ofthought and the disturbances associated with each one ofthem.them.
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SOME DEFINITIONS..SOME DEFINITIONS..
Symptoms:Symptoms:
-- subjective experiences described by the patientsubjective experiences described by the patient
-- e.g. Depressed mood, poor concentratione.g. Depressed mood, poor concentration
Signs:Signs:
-- objective findings observed by the clinicianobjective findings observed by the clinician
-- e.g. Psychomotor retardation, restricted affecte.g. Psychomotor retardation, restricted affect
Syndrome:Syndrome:-- a group of signs and symptoms that occur together as aa group of signs and symptoms that occur together as a
recognizable condition that may be less than specific thanrecognizable condition that may be less than specific than
a cleara clear--cut disorder or diseasecut disorder or disease
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Becoming an expert in recognizing specific
signs and symptoms allows the clinician to:
Becoming an expert in recognizing specific
signs and symptoms allows the clinician to:understandably communicate with otherclinicians,
understandably communicate with otherclinicians,
accurately make a diagnosis,
accurately make a diagnosis,
effectively manage treatment,
effectively manage treatment,
reliably predict prognosis, and
reliably predict prognosis, and
thoroughly explore pathophysiology and causesof a patients condition.
thoroughly explore pathophysiology and causesof a patients condition.
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observation and categorizationof abnormal psychic
events
Phenomenology:
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DESCRIPTION OF SYMPTOMSDESCRIPTION OF SYMPTOMS
Significance:Significance:
symptoms are more likely to indicate mental disorder ifsymptoms are more likely to indicate mental disorder if
theythey areare intenseintense andand persistentpersistent..
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DESCRIPTION OF SYMPTOMSDESCRIPTION OF SYMPTOMS
Primary and Secondary:Primary and Secondary:
Temporal:Temporal:
PrimaryPrimary antecedentantecedent
SecondarySecondary subsequentsubsequent
Causal:Causal:
PrimaryPrimary direct expression of the pathological processdirect expression of the pathological process SecondarySecondary a reaction to the primary symptomsa reaction to the primary symptoms
primary secondary
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DESCRIPTION OF SYMPTOMSDESCRIPTION OF SYMPTOMS
Normally is what the doctor is interested in
e.g. Voices - internal/external,second/third person, true
voices/implanted thoughts etc.
Form
What the patient is pre-occupied with e.g. Voices - what the voices says, his
feelings towards them etc.Content
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DESCRIPTION OF SYMPTOMSDESCRIPTION OF SYMPTOMS
Asking the patient:
imagine someoneasking you:
Do you hav anyfix d,fals eliefs
that are outof
keeping with yourculture or
educationalackground?
thus, it is veryimportant to start off
ith open-ended
uestion (screening)an then procee to
close-ended uestion(specific symptoms)
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DESCRIPTION OF SYMPTOMSDESCRIPTION OF SYMPTOMS
Asking the patient:Asking the patient:now imagine you asking the patient:now imagine you asking the patient:
Do you have any odd experiences lately?Do you have any odd experiences lately?
Well, like strange sensasations, feelings or thoughts?Well, like strange sensasations, feelings or thoughts?
If so, is it in the form of voices that other people cannot hear?If so, is it in the form of voices that other people cannot hear?
..... And so on......... And so on....
Sometimespeople earthings henthereisnothingSometimespeoplehearthings henthereisnothing
actually theretoexplainit, likeavoicecalling theiractually theretoexplainit, likeavoicecalling their
name. Do youhavesuchanexperience?name. Do youhavesuchanexperience?
can youtell memoreaboutit?can youtell memoreaboutit?
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Quiz
Please indicate TRUE or FALSE:
A. Doctors are more interested in the CONTENT of
a symptom
B. Psychopathology is determined by the
INTENSITY of a symptom
C. Closed ended questions should never be used in
patient interviewD. Secondary psychiatric symptoms do develop
from physical causes
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Classification of signs and symptomsClassification of signs and symptomsin Psychiatryin Psychiatry
Disorders of PerceptionDisorders of Perception
Disorders of ThinkingDisorders of Thinking
Disorders of MoodDisorders of Mood
Disorders ofCognitionDisorders ofCognition
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Perception:Perception:
the process of becoming aware of what is presentedthe process of becoming aware of what is presentedthrough the sense organs i.e. the understanding of athrough the sense organs i.e. the understanding of a
sensory stimulussensory stimulus
c/fc/fimagery (fantasy): an experience within the mind,(fantasy): an experience within the mind,
usually without the sense of reality, can be called outusually without the sense of reality, can be called out
and terminated by voluntary effort.and terminated by voluntary effort.
e.g.e.g.
Eidetic imagery: a visual image which is so intense andEidetic imagery: a visual image which is so intense and
detailed that it has a photographic qualitydetailed that it has a photographic quality
Pareidolia: images created out of admixture of sensoryPareidolia: images created out of admixture of sensory
percepts and imagination; maybe provoked by psychomimeticpercepts and imagination; maybe provoked by psychomimetic
drugsdrugs
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Alterations in Perception:Alterations in Perception:
intensityintensity
E.g.E.g.
Hyperacusis (a/w hangover, depression, migraine)Hyperacusis (a/w hangover, depression, migraine)
Visual hyperaesthesia (colours more vivid/intense): LSD,Visual hyperaesthesia (colours more vivid/intense): LSD,mania, epileptic auramania, epileptic aura
qualityquality
shapeshape -- e.g. macropsia, micropsia, dysmegalopsia (larger one.g. macropsia, micropsia, dysmegalopsia (larger on
one side), distortedone side), distorted foodfood bitterbitter
Changes occur in epilepsy, acute schizophrenia, mescalinChanges occur in epilepsy, acute schizophrenia, mescalin
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Disorders of PerceptionDisorders of Perception
IllusionsIllusions
misperceptions of external (objective) stimulimisperceptions of external (objective) stimuli
conditions more likely to occur:conditions more likely to occur:
reduced level of sensory stimulation (e.g. at dusk)reduced level of sensory stimulation (e.g. at dusk)
reduced level of consciousness (e.g. delirious pts.)reduced level of consciousness (e.g. delirious pts.)
when attention is not focussed on the sensory modality (e.g. inwhen attention is not focussed on the sensory modality (e.g. in
darkness)darkness)
when there is a strong affective state (e.g. stressed up / angry)when there is a strong affective state (e.g. stressed up / angry)
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Disorders of PerceptionDisorders of Perception
HallucinationsHallucinations
sensory perception without an objectivesensory perception without an objectivestimulus but with a similar quality to a truestimulus but with a similar quality to a true
perceptpercept experienced as originating in the outside worldexperienced as originating in the outside world
and not in the mind (like imagery)and not in the mind (like imagery)
can be of all sensory modalities:can be of all sensory modalities:
visual / auditory / tactilevisual / auditory / tactile
gustatory / vestibular / olfactorygustatory / vestibular / olfactory
presencepresence
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Disorders of PerceptionDisorders of Perception
HallucinationsHallucinations
objective spaceobjective space
perceived via a sensoryperceived via a sensory
modalitymodalityclear, distinct, vividclear, distinct, vivid
beyond voluntarybeyond voluntary
controlcontrol
no *insight (towards theno *insight (towards thesymptom)symptom)
PseudohallucinationsPseudohallucinations
subjective spacesubjective space
may not be perceived bymay not be perceived by
a sensory modalitya sensory modalityunclear, foggyunclear, foggy
within voluntary controlwithin voluntary control
of a personof a person
there is insightthere is insight
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*about the absurdity of the perception
True differentiating factors are only: voluntary control and insight.Other criteria can overlap.
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Description of hallucinationsDescription of hallucinations
According to complexityAccording to complexity
elementaryelementarycomplexcomplex
According to sensory modalityAccording to sensory modality
According to special featuresAccording to special featuresauditory: 2nd or 3rd personauditory: 2nd or 3rd person
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Auditory hallucinationsAuditory hallucinations
Elementary / complexElementary / complex
VoicesVoices
single/multiplesingle/multiple male/femalemale/female
known/unknown personknown/unknown person
personperson
1st person: thought echo1st person: thought echo -- hearing own thoughtshearing own thoughtsspoken aloud (spoken aloud (GedankenlautwerdenGedankenlautwerden,, echo de la penseeecho de la pensee))
2nd person: calling patient by you2nd person: calling patient by you
3rd person:calling patient by he or she3rd person:calling patient by he or she
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Auditory hallucinationsAuditory hallucinations
VoicesVoices
commanding / running commentary / arguing withcommanding / running commentary / arguing with
each othereach other
timing:timing:
day / night / all the timeday / night / all the time
circumstances when it occurscircumstances when it occurs
continuous / intermittent / frequencycontinuous / intermittent / frequency
theme:theme:
friendly, derogatoryfriendly, derogatory
patients response to the voicespatients response to the voices
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Visual HallucinationsVisual Hallucinations
elementary (e.g. flashes of light)elementary (e.g. flashes of light)
complexcomplex
semisemi--formed: with some structureformed: with some structurefullyfully--formed: e.g. human figures, treesformed: e.g. human figures, trees
black and white / colouredblack and white / coloured
static / mobilestatic / mobile
stable form / changing designstable form / changing designsize (e.g.size (e.g. lilliputianlilliputian))
commonly associated with organicitycommonly associated with organicity
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Olfactory an gustatory hallucinationsOlfactory an gustatory hallucinations
often experienced togetheroften experienced togetheroften unpleasant in nature (e.g. rotten fish, bitter)often unpleasant in nature (e.g. rotten fish, bitter)
common in temporal lobe epilepsycommon in temporal lobe epilepsy
Somatic (tactilean deep)Somatic (tactileand deep)
tactile (haptic): touched, pricked e.g. insecttactile (haptic): touched, pricked e.g. insect
crawling under the skin (e.g. formication in coccainecrawling under the skin (e.g. formication in coccaine
abuse)abuse)
deep sensation: e.g. viscera being pulled out,deep sensation: e.g. viscera being pulled out,
sexual stimulation, electric shocksexual stimulation, electric shock
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AutoscopichallucinationAutoscopichallucination
seeing own body projected into objective space (can happen inseeing own body projected into objective space (can happen indepression)depression)
negative autoscopy also can occur!negative autoscopy also can occur!
ExtracampinehallucinationsExtracampinehallucinations
perceiving a sensation from beyond the limits of the senseperceiving a sensation from beyond the limits of the sense
organorgan
e.g. visions from outside visual field, hearing voices from far fare.g. visions from outside visual field, hearing voices from far far
awayaway
Functional hallucinationFunctional hallucination
Normal perception of a stimulus and a hallucination in theNormal perception of a stimulus and a hallucination in the
same modality are experienced simultaneouslysame modality are experienced simultaneously
E.g. hearing hallucinatory voices only when water was runningE.g. hearing hallucinatory voices only when water was running
through the pipes.through the pipes.28
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ReflexhallucinationsReflexhallucinations
stimulus in one sensory modality causing astimulus in one sensory modality causing a
hallucination in a different sensory modalityhallucination in a different sensory modality
e.g. music causing visual hallucination (LSDe.g. music causing visual hallucination (LSD
abuse)abuse)
Hypnogogicand hypnopompicHypnogogicand hypnopompichallucinationshallucinations
occurs at the point of falling to or waking fromoccurs at the point of falling to or waking from
sleepsleep
usually brief and elementaryusually brief and elementary
Feeling ofPresenceFeeling ofPresence
feeling the presence of somebody near butfeeling the presence of somebody near but
realises that he is nonrealises that he is non--existent!existent!29
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Other Perceptual Disturbances
Depersonalization:Depersonalization: a feeling that his bodya feeling that his bodyparts are abnormal, unrealparts are abnormal, unreal
e.g. my brain becomes big until it fills the roome.g. my brain becomes big until it fills the room Derealization:Derealization: a feeling that the externala feeling that the external
environment is abnormal, unrealenvironment is abnormal, unreal
e.g. people are 2 dimensional card board figurese.g. people are 2 dimensional card board figures
BOTHBOTH can occur in tiredness, TLE, depressioncan occur in tiredness, TLE, depressionetc.etc.
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ThinkingThinking
Definition:Definition:
a goal directed flow of ideas, symbols ora goal directed flow of ideas, symbols or
associations, initiated by a problem/task, leading toassociations, initiated by a problem/task, leading to
a reality orientated conclusiona reality orientated conclusion disorders of thinking are usually recognized fromdisorders of thinking are usually recognized from
speech and writingspeech and writing
4 components of thinking:4 components of thinking:
form of thoughtform of thought
flow (stream) of thoughtflow (stream) of thought
contentcontent
possessionpossession32
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Formal Thought DisorderFormal Thought Disorder
Disorder in the form (structure) of thoughtsDisorder in the form (structure) of thoughts
3 main subgroups:3 main subgroups:
loosening of associationloosening of associationflights of ideasflights of ideas
perseverationperseveration
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Loosening of AssociationLoosening of AssociationLoss of the normal structure of thinkingLoss of the normal structure of thinking
muddled and illogical conversation that cannot be clarified bymuddled and illogical conversation that cannot be clarified by
further enquiry.further enquiry.
Several forms:Several forms:
Knights move / derailment:Knights move / derailment:transition from one topic to another with no logical connectiontransition from one topic to another with no logical connection
between the twobetween the two
Word salad:Word salad:
severe form of derailment affecting the grammatical structure ofsevere form of derailment affecting the grammatical structure of
speechspeech
Talking past the point (Talking past the point (vorbeiredenvorbeireden) / tangentiality:) / tangentiality:
touching the point just a little bit before going offtouching the point just a little bit before going off
Circumstantiality:Circumstantiality:
going round and round before finally reaching the pointgoing round and round before finally reaching the point
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Flights of IdeasFlights of Ideas
Patients thoughts and conversation move quickly fromPatients thoughts and conversation move quickly from
one topic to another so that one train of thought is notone topic to another so that one train of thought is not
completed before the another appears but there is ancompleted before the another appears but there is an
apparent association between them (clang (similarapparent association between them (clang (similar
sound) or chance associations)sound) or chance associations)
3 components have to be there:3 components have to be there:
pressure of speechpressure of speech
shifting topicsshifting topics
apparent association (can be followed)apparent association (can be followed)NB: if without pressure of speech =NB: if without pressure of speech = PROLIXITYPROLIXITY
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Other Formal Thought DisordersOther Formal Thought Disorders
Perseveration:Perseveration:
Giving a response beyond the point of relevance i.e. sameGiving a response beyond the point of relevance i.e. same
answer to each question (stimulus)answer to each question (stimulus)
c/f verbal stereotypy (verbigeration): words, sounds or phrasec/f verbal stereotypy (verbigeration): words, sounds or phrase
repeated in a senseless way (no stimulus)repeated in a senseless way (no stimulus)
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Perseveration
Verbal Stereotypy
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Disorder of flow (stream)Disorder of flow (stream)
Both the amount and the speed of thoughts areBoth the amount and the speed of thoughts are
changedchanged
Different levels:Different levels:
mutenessmuteness
poverty of thoughtpoverty of thought
thought blockthought block
volubility:volubility: amount & speed, still can interruptamount & speed, still can interrupt
pressure of speech:pressure of speech: amount & speed, cannotamount & speed, cannot
interrupt speechinterrupt speech
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Disorders ofContent of ThoughtDisorders ofContent of ThoughtDelusion:Delusion:
false belief, unshakeable, inappropriate to a personsfalse belief, unshakeable, inappropriate to a persons
educational and social backgroundeducational and social background
double orientation: wholly convinced about the truth of thedouble orientation: wholly convinced about the truth of the
delusional belief but the conviction may not influence hisdelusional belief but the conviction may not influence his
feelings and emotionsfeelings and emotions
OverOver--valued ideas:valued ideas:
ideas held with a lot of emotion (highly charged) but withideas held with a lot of emotion (highly charged) but with
some degree of ambivalence and doubts about the belief.some degree of ambivalence and doubts about the belief.
(Emotions are expressed to compensate for the ambivalence)(Emotions are expressed to compensate for the ambivalence)
PrePre--occupation:occupation:
ideas which comes to mind, again and again and may preventideas which comes to mind, again and again and may prevent
the patient from performing his day to day activitiesthe patient from performing his day to day activities
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Classification of DelusionsClassification of Delusions
According to fixity:According to fixity: complete / partial / overcomplete / partial / over--valued ideas / ideasvalued ideas / ideas
According to onset:According to onset:
Primary: autochthonous delusionsPrimary: autochthonous delusions
sudden onset (out of the blue) of delusionsudden onset (out of the blue) of delusion other forms:other forms:
delusional mood: anxiety, foreboding something to happendelusional mood: anxiety, foreboding something to happen((WahnstimmungWahnstimmung))
delusional perception:delusional perception: false meaning to a normal perceptfalse meaning to a normal percept
memory: attribute new meaning to old experiencememory: attribute new meaning to old experience
Secondary: derived from preceding morbidSecondary: derived from preceding morbidexperience e.g. hallucinations, depressive moodexperience e.g. hallucinations, depressive moodetc.etc.
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Classification of DelusionsClassification of Delusions
According to special features:According to special features:
Systematised delusion:Systematised delusion:
chronic, presence of nucleus, well knitted, interchronic, presence of nucleus, well knitted, inter--
connected, layered and wellconnected, layered and well--encapsulated.encapsulated.NonNon--systematised delusionsystematised delusion
Shared delusion:Shared delusion:
folie a deuxfolie a deux(two person, including patient)(two person, including patient)
folie a massfolie a mass (> than two person)(> than two person)
According to themeAccording to theme
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Themes of DelusionThemes of Delusion
Persecutory (paranoid):Persecutory (paranoid):
others/organizations trying to inflict harm on himothers/organizations trying to inflict harm on him
Delusion ofReference:Delusion ofReference:
idea that objects/events/people have a personalidea that objects/events/people have a personalsignificance for patient e.g. TV programmes, newssignificance for patient e.g. TV programmes, news
Grandiose (expansive):Grandiose (expansive):
beliefs of exaggerated selfbeliefs of exaggerated self--importanceimportance
e.g. wealth, special powers, beautye.g. wealth, special powers, beauty
Religious:Religious:
delusions with religious contentdelusions with religious content
e.g. chosen to be prophet, communicating directly to Gode.g. chosen to be prophet, communicating directly to God
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Themes of DelusionThemes of Delusion
Amorous DelusionAmorous Delusion
more common in womenmore common in women
(? stalking in men)(? stalking in men)
De Clerambaults SyndromeDe Clerambaults Syndromebeing lovedbeing loved by a man who is inaccessible, high status, neverby a man who is inaccessible, high status, never
spoken before, unable to reveal his love for herspoken before, unable to reveal his love for her
Delusion of Jealousy:Delusion of Jealousy:
common in mencommon in mendelusion of unfaithfulness of spouse (infidelity)delusion of unfaithfulness of spouse (infidelity)
spying, checking on spouse, examine for sexualspying, checking on spouse, examine for sexual
secretionssecretions
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Themes of DelusionThemes of Delusion
Delusion of Guilt and Worthlessness:Delusion of Guilt and Worthlessness:e.g. minor past faults will be exposed, being sinful,e.g. minor past faults will be exposed, being sinful,
deserves to be punisheddeserves to be punished
Nihilistic DelusionNihilistic Delusion
belief about nonbelief about non--existence of some person / thing +existence of some person / thing +pessimistic ideas e.g. career is gonepessimistic ideas e.g. career is gone
CotardsSyndromeCotardsSyndrome: failures of bodily functions e.g.: failures of bodily functions e.g.
bowels are rotting etc.bowels are rotting etc.
Hypochondriacal DelusionsHypochondriacal Delusionsbelief of ill health despite contrary medicalbelief of ill health despite contrary medical
evidenceevidence
usually of a particular theme & may haveusually of a particular theme & may have
relative/friend suffering the supposed illnessrelative/friend suffering the supposed illness 44
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OTHER DISORDERS OF THOUGHTOTHER DISORDERS OF THOUGHT
CONTENTCONTENT
Obsessions:Obsessions:recurrent persistent thoughts, impulses or images thatrecurrent persistent thoughts, impulses or images thatenter the mind despite efforts to exclude thementer the mind despite efforts to exclude them
subjective sense of struggle to resist themsubjective sense of struggle to resist them
recognized as his own (not implanted)recognized as his own (not implanted)
regarded as untrue and senselessregarded as untrue and senseless
Compulsions:Compulsions:repetitive, purposeful behaviours performed in arepetitive, purposeful behaviours performed in a
stereotyped way, accompanied with subjective sensestereotyped way, accompanied with subjective sense
that it must be carried out and an urge to resistthat it must be carried out and an urge to resistmost common: cleaning, counting, dressingmost common: cleaning, counting, dressing
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DESCRIPTION OF OBSESSIONSDESCRIPTION OF OBSESSIONS
FiveFive forms:forms: thoughtsthoughts: intrusive words: intrusive words
or phrases, upsetting e.g.or phrases, upsetting e.g.
blasphemous phrasesblasphemous phrases
ruminationrumination: worrying: worrying
themes e.g. ending of thethemes e.g. ending of the
worldworld
doubtsdoubts: uncertainty about: uncertainty about
previous action (realizesprevious action (realizes
done)done)
impulsesimpulses: urges to carry: urges to carryout actions: dangerous orout actions: dangerous or
embarrassingembarrassing
obsessional phobiaobsessional phobia
SixSix common themes:common themes: dirt & contaminationdirt & contamination
aggressivethoughtsaggressivethoughts: e.g.: e.g.striking othersstriking others
orderlinessorderliness: how things / work: how things / workneed to be arranged / doneneed to be arranged / done
illnessillness: e.g. dread about: e.g. dread aboutcancercancer
sex:sex: e.g. perverse sexual actse.g. perverse sexual acts
religionreligion: doubts about: doubts aboutfundamental beliefs e.g. Doesfundamental beliefs e.g. DoesGod exist?God exist?
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Disorders of Thought PossessionDisorders of Thought Possession
Thought Insertion:Thought Insertion:
delusion that some thoughts have beendelusion that some thoughts have been
implanted by outside agencyimplanted by outside agency
Thought Withdrawal:Thought Withdrawal:
delusion that thoughts have taken out of hisdelusion that thoughts have taken out of his
mind (may accompany/explain thought block)mind (may accompany/explain thought block)
Thought Broadcasting:Thought Broadcasting:delusion that his unspoken thoughts are knowndelusion that his unspoken thoughts are known
to other peopleto other people
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SCHNEIDERIAN FIRSTSCHNEIDERIAN FIRST--RANK SYMPTOMSRANK SYMPTOMS
(FRS)(FRS)
arespecifictypesofarespecifictypesofdelusions andand hallucinations thatthatinvolvethemesofpassivity.involvethemesofpassivity. FRSarehighly suggestiveofFRSarehighly suggestiveofschizophrenia,ratherthan being suresignsofthat disorder.,ratherthan being suresignsofthat disorder.
Patients ithPatients ithneurological impairment thatproducethatproducepathological impulsesor behaviors ill commonly saypathological impulsesor behaviors ill commonly say "Thisbehaviorisnotme," yet ill readily acceptresponsibility foryet ill readily acceptresponsibility forthe behavior.the behavior.
Incontrast,patients ithIncontrast,patients ithFirstRank Symptoms denydenyresponsibility forthestrange behavior,claiming thatresponsibility forthestrange behavior,claiming that"othersmademe doit."
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Auditory Hallucinations
Audiblethoughts
auditory hallucinations in which the patient hears his ownthoughts being spoken aloud by others
Voicesarguing
are auditory hallucinations in which the patient hears two ormore people arguing, typically about the patient, whom theyrefer to as a third party
Voicescommenting
are auditory hallucinations in which the patient hears peoplecommenting on his actions while they are occurring
Made Phenomenon
Beingcontrolled(delusions of)
reflect the patient's experience of his actions beingcompletely under the control of external influences. He feelslike an automaton, a totally passive observer of his ownactions. These are also called "made acts."
"Made"feelings
are delusions in which the patient experiences emotionswhich she insists are not her own, but have been imposed onher by others
Somaticpassivity
are somatic hallucinations in which the patient is convincedthat an external agent has caused him to be a passiverecipient of unwanted bodily sensations made sensations
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Thought Alienation
Thoughtbroadcasting
are beliefs that one's inner thoughts are no longer private,have escaped from one's mind, and have become knownto everyone
Thoughtinsertions
are ego-alien convictions that thoughts have been placedinto one's mind, with the person believing his thoughts arenot his own
Thoughtwithdrawal
is a patient's ego-dystonic belief that thoughts are taken,or stolen, from her mind or brain, and that she has fewerthoughts than before. "I was discussing Rome, when mybrain was sucked empty by the Pope's vacuum cleaner
Primary Delusion
DelusionalPerception
A normal perception which has become highly investedwith significance and which has become incorporated intoa delusional system, e.g. 'when I saw the traffic lights turnred I knew that the calculator that I brought has changedinto a KGB detector'.
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SCHNEIDERS FIRST RANK SYMPTOMSSCHNEIDERS FIRST RANK SYMPTOMS
Remembering SchneiderianFirstRank symptomsisasRemembering SchneiderianFirstRank symptomsisaseasy asABCD:easy asABCD:
A=A=AuditoryAuditory hallucinationshallucinations -- 3rd person (arguing &3rd person (arguing &
commenting)/thoughtechocommenting)/thoughtecho
B=B=BroadcastingBroadcasting ofthoughts/ insertion/ ithdrawalofthoughts/ insertion/withdrawal
C=C=ControlControl experiences/ passivity phenomenaexperiences/ passivity phenomena
(madeact,feeling,sensation)(madeact,feeling,sensation) D=D= DelusionalDelusional perceptionperception
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3A, 3B, 3C, 1D3A, 3B, 3C, 1D
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ReferencesReferences
Oxford Textbook ofPsychiatry (Third
Edition) Gelderetal
Symptomsinthe Mind:An Introductionto
Descriptive Psychopathology (Second
Edition) AndrewSims
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