Signs And Symptoms of Mental Disorders
Fareed MinhasProfessor of Psychiatry
Head, Institute of PsychiatryRawalpindi Medical College
Rawalpindi
General Issues…Psychopathology-study of abnormal states of mind
Three approachesPhenomenological- objective descriptions of abnormal states entirely of conscious experiences and observable behavior
Psychodynamic- explains causation of the abnormal events by postulating unconscious mental processes in addition to description
Experimental- relationships between abnormal phenomena examined by inducing change in one and observing impact on others
General Issues…(contd.)
Significance of individual symptoms- characteristic grouping of symptoms is important.
Primary and Secondary Symptoms- establishing a temporal relationship between symptoms if possible.
Form and Content of Symptoms- eg. “form” of a chair contains a seat, back and four legs whilst “content” is wood and straw
Categorizing Disorders…
Disorders of perception Disorders of thinking Disorders of mood Disorders of general behavior Motor Signs and Symptoms Disorders of Body Image Disorders of Memory Disorders of Consciousness Disorders of Attention/Concentration Disorders of Insight
Disorders of Perception Perception is the process of becoming aware of
what is presented through the sense organs
Imagery is the experience within the mind (without sense of reality ) which is a part of perception eg. Eidetic imagery, pareidolia etc
Alterations in perception of intensity eg. mania or depression and quality eg. Schizophrenia
Illusions are misperceptions of external stimuli eg. Delirium, normal situations
Disorders of Perception (contd.)
Hallucination is a percept experienced in absence of external stimulus to sense organ and with a similar quality to a true percept
AuditoryVisualOlfactory or gustatorySomatic (tactile or deep)Delusional PerceptionNormal situations(hypnagogic/hypnopompic)
Pseudohallucinations are of a less intensity and the person recognizes the absence of external correlates
[Description of Hallucinations] According to complexity Elementary Complex
According to sensory modality Auditory Visual Olfactory and gustatory Somatic (tactile or deep)
According to special features Auditory : second-person or third-person
Gedankenlautwerden echo de la pensee
Visual : extracampine Autoscopic hallucinations
Disorders of Thinking
STR EAM O F THO U G HT-Pressure-Thought block
FO R M O F THO U G HT-Flight of ideas-Perseveration-Loosening of association
PAR TI CU LAR K I N DS-Delusions-O bsessions
THO U G HT D I SO R DER S
Disorders of Thinking(contd.) Pressure of thought- when ideas arise in unusual
variety and pass through the mind rapidly
Thought Block- sudden, striking and repeated interruptions in speech when the patient describes an abrupt emptying of the mind
Flight of ideas- thoughts/conversations move quickly from one topic to another with understandable links eg. Clang associations, punning, rhyming
Persevaration- persistent inappropriate repetition of same thoughts
Disorders of Thinking(contd.) Loosening of association- loss of normal
structural links such as: Knight’s move or derailment Word salad Verbigeration Talking past the point
Neologisms- use of self-invented words and phrases to describe morbid experiences
Delusions – false, firm belief impervious to reasoning and against the social and cultural norms
Disorders of Thinking(contd.) According to theme:
Persecutory(paranoid) delusions Delusions of reference Grandiose(expansive) delusions Delusions of guilt and worthlessness Nihilistic Hypochondriacal Delusions of control Sexual Delusions concerning possession of thought:
thought insertion, thought withdrawal, thought broadcast
Disorders of Thinking(contd.) Other delusional experiences:
Delusional mood Delusional perception Delusional memory
Obsessions- recurrent persistent thoughts, impulses or images that enter the mind despite the person’s efforts to exclude them. Types maybe:
Thoughts Ruminations Doubts Impulses Phobias
Disorders of Thinking(contd.)
Compulsions- repetitive and seemingly purposeful behaviors performed in a stereotyped way (compulsive rituals) eg. Cleaning, counting, dressing and these may lead to obsessional slowness
Obsessions are not always followed by compulsions but compulsions always have preceding obsessions associated with them
Disorders of Mood Change in nature of mood- which can be
towards anxiety, depression, elation or anger
Abnormal fluctuations of mood- such as: Apathy Blunting or flattening of affect Labile Emotional incontinence
Incongruity of mood- for eg. A patient may laugh when describing the death of his mother
Disorders of general behavior
Phobias- A phobia is a persistent irrational fear of a specific object/activity/situation which the person recognizes as his own and tries to avoid it at all possible costs eg. Claustrophobia
Depersonalization- change of self-awareness such that the person feels unreal
Derealization- objects around the person appear unreal and people as seen as two-dimensional cardboard figures
Motor Symptoms and Signs Tics- irregular repeated movements involving a
group of muscles, eg. Raising of shoulders
Mannerisms- repeated movements seeming to have a functional significance eg. Saluting
Stereotypies- repetitive regular movements having no obvious functional significance eg. Rocking to and fro
Posturing- adoption of unusual body postures for long periods of time
Motor Symptoms and Signs Negativism- Patients doing completely opposite
of what is being asked and resisting persuasion
Echopraxia- immitation of interviewer’s movement automatically even when asked not to do so
Ambitendence- Patients alternate between opposite movements eg. Putting out an arm to shake hands then withdrawing
Waxy flexibility- when patient’s limbs can be placed in any position for long periods while muscle tone is uniformly increased
Disorders of Body Image Phantom Limb- continuing awareness of a part of
body that has been lost
Unilateral awareness and neglect- resulting from parietal lobe lesions and in extreme forms patient may neglect washing that particular side, puts on one shoe etc
Hemisomatognosis- or hemidepersonalization
Anosognosia- lack of awareness of disease
Pain asymbolia- recognising a painful stimulus as painless
Disorders of Body Image(contd.)
Autotopagnosia- inability to recognize, name or point on command to parts of the body
Distorted awareness of size and shape- feelings that a limb is becoming smaller, larger etc
Reduplication phenomenon- experience that part or all of the body has doubled
Coenesthopatic states- localized distortions of body awareness eg. Nose feels as if made of cotton wool
Disorders of Memory
Normal process: Sensory stores Short-term Memory
Long-term Memory
Amnesia- Failure of memory Anterograde Retrograde
Confabulation- Patients have so much difficulty remembering that they recall even those events that never happened
Disorders of Consciousness Consciousness- awareness of the self in relation
to environment. Level may vary from extreme alertness to coma
Coma- Extreme of impaired consciousness unresponsive to the strongest stimulus. 4 grades
Clouding of consciousness- All cognitive functions are impaired
Stupor- Immobile, mute, unresponsive patient appearing to be fully conscious
Disorders of Consciousness(cont)
Confusion- inability to think clearly, usually a feature of organic states. Three variations exists: Oneiroid State (dream-like) Twilight State Torpor
Disorders of Attention/Concentration
Attention – is the ability to focus on the matter in hand
Concentration – ability to maintain that focus
Latent Inhibition – the ability of a person to recognize a previously irrelevant stimulus when it becomes relevant. In disorders this process is slowed down
Insight
I s the patientaw are of the phenom ena
other people haveobserved?
Does he recognisethat these phenom ena
areabnorm al?
I f abnorm al, does heconsider them to be
resulting from am ental illness?
I f he is m entallyill, does he th ink he
needstreatm ent?
TO CHECK FO RI N SI G HT
Thankyou
Reference: Oxford Textbook of Psychiatry
(Third Edition)
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