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PsychopathologyPsychopathology
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The term psychopathology The term psychopathology
is borrowed from Greek ´psycheµis borrowed from Greek ´psycheµ--soulsoul´Pathosµ´Pathosµ--suffering suffering
´Logosµ´Logosµ--sciencescience
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PsychopathologyPsychopathology
is the description, interpretation, explanationis the description, interpretation, explanation
and classification of those, particular mentaland classification of those, particular mental
phenomena that have, clinical meaning, i.e.,phenomena that have, clinical meaning, i.e., whose perception, analysis and assessment a whose perception, analysis and assessment arereuseful in diagnostic and therapeutic managementuseful in diagnostic and therapeutic management
of persons with mental disorders.of persons with mental disorders.
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For a psychiatrist a patient·s experiences andFor a psychiatrist a patient·s experiences and ways of behavior are the same as observed ways of behavior are the same as observed
physical phenomena for a physicistphysical phenomena for a physicist
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Difficulties in defining abnormalityDifficulties in defining abnormality
Psychopathology is characterized by Psychopathology is characterized by subjective subjective
discomfort discomfort
P rivate feelings of pain, unhappiness, emotional distress
P rivate feelings of pain, unhappiness, emotional distress
Can disturbance be without discomfort?Can disturbance be without discomfort?
Yes Yes-- manic episodemanic episode
Yet, lack of discomfort might reveal a problem Yet, lack of discomfort might reveal a problem
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Statistical abnormalityStatistical abnormality
Abnormality is defined on the basis of an Abnormality is defined on the basis of an
extreme score on some dimension, e.g. IQ,extreme score on some dimension, e.g. IQ,
anxiety, depressionanxiety, depression Design a test/scale to measure & identify the personDesign a test/scale to measure & identify the person
who deviated from the average who deviated from the average
It tells nothing about the meanings of deviationsIt tells nothing about the meanings of deviations
from the normfrom the norm
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Social nonconf ormitySocial nonconf ormity
Abnormality is defined by a failure to conform Abnormality is defined by a failure to conform
to social norms or the minimum standards forto social norms or the minimum standards for
social conductsocial conduct Extreme non conformity could lead to destructive orExtreme non conformity could lead to destructive or
self self--destructive behaviourdestructive behaviour
S ituational context S ituational context
Cultural relativity Cultural relativity
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Core Features of Disordered Behav iourCore Features of Disordered Behav iour
Maladaptive: difficult to meet the demands of Maladaptive: difficult to meet the demands of
day day--toto--day lifeday life
Loss of ability to control thoughts, feelings andLoss of ability to control thoughts, feelings and
behaviours adequately behaviours adequately
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Abnormal
behavior
Thought
Mood
H Mental
functions
Perception
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Thought disorder Thought disorder
Any disturbance of thinking that affects Any disturbance of thinking that affects
language, communication, or thought content;language, communication, or thought content;characterized by a failure to follow semantic andcharacterized by a failure to follow semantic and
syntactic rules that is inconsistent with thesyntactic rules that is inconsistent with theperson's education, intelligence, or culturalperson's education, intelligence, or cultural
backgroundbackground
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Disturbance of thoughtDisturbance of thought
Form
Stream
Content
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FormForm
Flight of ideasFlight of ideas
Loosening of associationLoosening of association
DerailmentDerailment Tangentiality Tangentiality
Circumstantiality Circumstantiality
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Flight of ideasFlight of ideas
1.1. Rapid shift from one to anotherRapid shift from one to another
2.2. Understandable link with no logicalUnderstandable link with no logical
connectionconnection3.3. The determining tendency is decided by The determining tendency is decided by
rhyme, pun, distraction, clanging rhyme, pun, distraction, clanging
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Loosening of associationLoosening of association
Lack of logical connection between sequence of Lack of logical connection between sequence of
thoughtsthoughts
Replies are hard to follow Replies are hard to follow Sometimes knight·s move thinking (oddSometimes knight·s move thinking (odd
tangential association between ideas)tangential association between ideas)
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Sample of speechSample of speech
I don·t know. I might be thrown out. Benito MussoliniI don·t know. I might be thrown out. Benito Mussoliniactually came alive out in waiting room. I figured it out.actually came alive out in waiting room. I figured it out. There was a picture in the book. If its not my mother, it There was a picture in the book. If its not my mother, it
could have been Hitler. What if that was one of hiscould have been Hitler. What if that was one of hisarmed guards? Mussolini was hanging from a tree.armed guards? Mussolini was hanging from a tree. Thank you for letting me reason it out. Oh that·s Thank you for letting me reason it out. Oh that·sanother thing that I wanted to talk about is being brainanother thing that I wanted to talk about is being brain washed. I didn·t buy the Beatles tape; I never did washed. I didn·t buy the Beatles tape; I never did
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OthersOthers
PerseverationPerseverationPersistent and inappropriate repetition of the same responsePersistent and inappropriate repetition of the same responsebeyond the point of relevancebeyond the point of relevance
DerailmentDerailment Total break in the chain of association between the meaning of Total break in the chain of association between the meaning of thoughtsthoughts
Tangentiality Tangentiality Oblique, digressive, or even irrelevant manner of speech inOblique, digressive, or even irrelevant manner of speech in
which the central idea is not communicated which the central idea is not communicated NeologismNeologism
Coining of a new word or using a new word in a idiosyncraticCoining of a new word or using a new word in a idiosyncraticmannermanner
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Samples of speechSamples of speech
What is your name ? What is your name ?
John John
Where have you come from? Where have you come from?
John John
Can you state your age?Can you state your age?
John John
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SamplesSamples
What city are u from? What city are u from?
´That·s a hard question to answer. Becoz my parents«..´That·s a hard question to answer. Becoz my parents«..I was born in Iowa, But I Know that I am white insteadI was born in Iowa, But I Know that I am white insteadof Black, So apparently I came from the Northof Black, So apparently I came from the NorthSomewhere, And I don·t know where, You Know, ISomewhere, And I don·t know where, You Know, Idon·t know whether I am Irish or Scandinavianµdon·t know whether I am Irish or Scandinavianµ
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SamplesSamples
Did you enjoy college?Did you enjoy college?
´I really enjoyed some communities, I Tried it, And the,´I really enjoyed some communities, I Tried it, And the, And the next day when I would be going out, I took And the next day when I would be going out, I took control, I put bleach in my hair, in Californiacontrol, I put bleach in my hair, in California.µ.µ
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SamplesSamples
I heard you were late for your morning group session.I heard you were late for your morning group session.
I am having a rough day. I woke up late. My alarmI am having a rough day. I woke up late. My alarmclock has been working poorly. Then it took forever forclock has been working poorly. Then it took forever for
me to brush my teethme to brush my teeth becozbecoz I couldn·t find my toothI couldn·t find my toothpaste. I started talking to my roommate and I lost track paste. I started talking to my roommate and I lost track of time. I got to the bus stop in time to see the busof time. I got to the bus stop in time to see the buspulling away. I caught the next bus and talked to a manpulling away. I caught the next bus and talked to a manfrom INDI A «««..from INDI A «««..
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StreamStream
1.1. Pressure of thought/speechPressure of thought/speech
2.2. Poverty of thoughtPoverty of thought
3.3. Thought block Thought block
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Thought content Thought content
DelusionsDelusions
Overvalued ideasOvervalued ideas
ObsessionsObsessions Thought alienation Thought alienation
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DelusionsDelusions
False belief, based on incorrect inference aboutFalse belief, based on incorrect inference about
external reality, that is firmly held despiteexternal reality, that is firmly held despiteobjective and obvious contradictory proof orobjective and obvious contradictory proof or
evidence and despite the fact thatevidence and despite the fact that other members of other members of
the culture do not share the belief the culture do not share the belief ..
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Delusional themesDelusional themes
Delusion of persecutionDelusion of persecution--being harmedbeing harmed
Delusion of grandeurDelusion of grandeur--self importanceself importance
Delusion of referenceDelusion of reference--special significance givenspecial significance givento neutral stimulusto neutral stimulus
Delusions of guiltDelusions of guilt -- Pathological guilt overPathological guilt over
innocent errorsinnocent errors
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Delusional themesDelusional themes
Nihilistic delusionsNihilistic delusions--non existencenon existence
Delusion of loveDelusion of love
Delusion of jealousy Delusion of jealousy--infidelity infidelity
Delusion of controlDelusion of control
Thought insertion, withdrawal and broadcast Thought insertion, withdrawal and broadcast
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PrimaryPrimary vs vs secondary delusionsecondary delusion
A primary delusion occurs suddenly which arises de A primary delusion occurs suddenly which arises denovonovo
Secondary delusions arise in response to otherSecondary delusions arise in response to other
abnormality or experienceabnormality or experience
ExamplesExamples
Delusion of guilt in DepressionDelusion of guilt in Depression
Delusion secondary to hallucinationsDelusion secondary to hallucinations
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Factors in volv ed in the f ormation of Factors in volv ed in the f ormation of
delusiondelusion
Disorder of brain functioning Disorder of brain functioning
Personality Personality
Affect Affect
Perceptual disordersPerceptual disorders
Cognitive deficitsCognitive deficits
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O v ervalued ideaO v ervalued idea
An isolated, preoccupying strongly held belief An isolated, preoccupying strongly held belief
which has come to unreasonably dominate the life and which has come to unreasonably dominate the life andmay affect his or her actionsmay affect his or her actions
Examples: paranoid state, morbid jealousy,Examples: paranoid state, morbid jealousy,
body image disturbancesbody image disturbances
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Obsessions and compulsionsObsessions and compulsions
ObsessionObsessionRecurrentRecurrent persistent unwanted ideas orpersistent unwanted ideas orimpulses or imagesimpulses or images
RecognizedRecognized by the individual as his or herby the individual as his or her ownownResistedResisted at the expense of mounting anxiety at the expense of mounting anxiety At times the anxiety may be relieved by performing At times the anxiety may be relieved by performing certain acts referred to as compulsionscertain acts referred to as compulsions
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ObsessionalObsessional themesthemes
Dirt and contaminationDirt and contamination
Aggression Aggression
ReligionReligion
SexSex
OrderlinessOrderliness
DiseaseDisease
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CompulsionsCompulsions
Repeated ,stereotyped acts that the person is compelledRepeated ,stereotyped acts that the person is compelledto carry out but resists recognizing the act as irrationalto carry out but resists recognizing the act as irrational
Most of the compulsions follow obsessionsMost of the compulsions follow obsessions
Examples : cleaning rituals, checking ritualsExamples : cleaning rituals, checking rituals
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Perce ptionPerce ption
Conscious awareness of elements in theConscious awareness of elements in the
environment by the mental processing of environment by the mental processing of sensory stimuli; sometimes used in a broadersensory stimuli; sometimes used in a broader
sense to refer to the mental process by which allsense to refer to the mental process by which allkinds of data, intellectual, emotional, andkinds of data, intellectual, emotional, and
sensory, are meaningfully organized.sensory, are meaningfully organized.
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A bnormalities of perce ption A bnormalities of perce ption
Sensory distortionsSensory distortions ² ² A real object is perceived in a distorted A real object is perceived in a distorted way way
Change in intensity Change in intensity
Example : Drug induced statesExample : Drug induced states Change in Quality Change in Quality
Example :Food tastes differently or colored visionExample :Food tastes differently or colored vision
Change in spatial formChange in spatial form
Example: micropsia and macropsiaExample: micropsia and macropsia
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Factors in volv ed in the f ormation of Factors in volv ed in the f ormation of
illusionillusion
Clouding of sensoriumClouding of sensorium
Reduction in the level of sensory stimulationReduction in the level of sensory stimulation
Intense state of emotionIntense state of emotion
Lack of attentionLack of attention
A young woman describes looking up into the clouds A young woman describes looking up into the cloudsand seeing an image of her fiancéand seeing an image of her fiancé
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HallucinationHallucination
Perception experienced in the absence of externalPerception experienced in the absence of externalstimulusstimulus
The percept is experienced as a true perception The percept is experienced as a true perception
Arises in the external objective space Arises in the external objective space
Can hallucination occur in healthy people?Can hallucination occur in healthy people?
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Hallucinations in normal indi v idualsHallucinations in normal indi v iduals
HypnagogicHypnagogic hallucinationhallucination
occurs while falling asleepoccurs while falling asleep
HypnopompicHypnopompic hallucinationhallucinationoccurs while waking occurs while waking
Intense emotionIntense emotion
FatigueFatigue
Suggestibility Suggestibility
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Functional hallucination Functional hallucination vs vs ref lex ref lex
hallucinationhallucination
Functional hallucinationFunctional hallucination
Experiencing a hallucination while experiencing aExperiencing a hallucination while experiencing anormal percept in the same modality normal percept in the same modality
´́I hear the voice of my long dead father, as if he were talking to me now, when II hear the voice of my long dead father, as if he were talking to me now, when Ihear water running from the bath tap.µhear water running from the bath tap.µ
Reflex hallucinationReflex hallucination
A real percept in one modality triggers hallucination A real percept in one modality triggers hallucinationin another modality in another modality
´́I hear the voice of my long dead father, as if he were talking toI hear the voice of my long dead father, as if he were talking tome now, if/after I hear water running from the bath tap.µme now, if/after I hear water running from the bath tap.µ
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HallucinationsHallucinations
Auditory Auditory
Visual Visual
Tactile Tactile Olfactory Olfactory
Gustatory Gustatory
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A uditory hallucinations A uditory hallucinations
Thought Echo: hearing ones thought spoken Thought Echo: hearing ones thought spoken
aloudaloud
Second person: voices talking to the personSecond person: voices talking to the person Third person: voices discussing, arguing.. Third person: voices discussing, arguing..
Command hallucinationsCommand hallucinations
Running commentary Running commentary
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MoodMood -- A ffect A ffect
MOODMOOD--Pervasive and sustained feeling tonePervasive and sustained feeling tone
that is experienced internally and that, in thethat is experienced internally and that, in theextreme, can markedly influence virtually allextreme, can markedly influence virtually all
aspects of a person's behavior and perception of aspects of a person's behavior and perception of the world. Distinguished fromthe world. Distinguished from affectaffect, the, the
external expression of the internal feeling tone.external expression of the internal feeling tone.
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DepressionDepression Pervasive lowering of mood accompanied by Pervasive lowering of mood accompanied by
feelings of sadness and a loss of ability tofeelings of sadness and a loss of ability to
experience pleasureexperience pleasureElation of moodElation of mood
Excessive cheerfulnessExcessive cheerfulness
Can progress to ecstasy Can progress to ecstasy
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A bnormalities in the variability of A bnormalities in the variability of
moodmood
ReducedReduced eg blunt,flat,rescrictedeg blunt,flat,rescricted
IncreasedIncreased eg lability,exapansiveeg lability,exapansive
Emotional incontinenceEmotional incontinence
Incongruity/inappropriatenessIncongruity/inappropriateness of affectof affect
Mood and thinking do not correspond to each otherMood and thinking do not correspond to each other
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Disorders of self Disorders of self
DepersonalisationDepersonalisation
Experience of being unreal, detached and unable to feelExperience of being unreal, detached and unable to feelemotionemotion
DerealisationDerealisation
Similar experience related to environmentSimilar experience related to environment
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Motor signs and symptomsMotor signs and symptoms
NegativismNegativism An apparently motiveless resistance to all instructions An apparently motiveless resistance to all instructionsor attempts to be movedor attempts to be moved
Posturing Posturing Voluntary assumption of bizarre and abnormal Voluntary assumption of bizarre and abnormalposturespostures
MutismMutismabsence of speech without impairment in consciousnessabsence of speech without impairment in consciousness
Waxy flexibility Waxy flexibility Maintenance of limbs and body in externally imposedMaintenance of limbs and body in externally imposedpositionspositions
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Motor signs and symptomsMotor signs and symptoms
EcholaliaEcholaliaPurposeless repetition of words/phrases spoken by thePurposeless repetition of words/phrases spoken by theexaminerexaminer
EchopraxiaEchopraxiaPurposeless repetition of the body movements of thePurposeless repetition of the body movements of theexaminerexaminer
StuporStuporMarked decrease in reactivity to the environment andMarked decrease in reactivity to the environment and
in spontaneous movements and activity in spontaneous movements and activity ExcitementExcitement
Apparently purposeless increased motor activity not Apparently purposeless increased motor activity notinfluenced by external stimuliinfluenced by external stimuli
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A bnormalities of memory A bnormalities of memory
Anterograde Anterograde amnesiaamnesia
Period between the event and the resumption of Period between the event and the resumption of continuous memory continuous memory
Retrograde amnesiaRetrograde amnesiaPeriod of amnesia between an event and the lastPeriod of amnesia between an event and the last
continuous memory continuous memory
Déjà vuDéjà vu
A sense that events experienced for the first time have A sense that events experienced for the first time havebeen encountered beforebeen encountered before
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A bnormalities of memory A bnormalities of memory
Jamais vu Jamais vu
Failure to recognise events that have beenFailure to recognise events that have been
encountered beforeencountered before
ConfabulationConfabulation
Describing plausibly false memories for a period forDescribing plausibly false memories for a period for which the patient is amnesic which the patient is amnesic
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A bnormalities of consciousness A bnormalities of consciousness
Clouding of consciousnessClouding of consciousness
A state of drowsiness with incomplete reaction to A state of drowsiness with incomplete reaction tostimulistimuli
StuporStupor
Absence of response and movement along with Absence of response and movement along with
mutism. Consciousness may be preservedmutism. Consciousness may be preserved
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InsightInsight
Patient·s awareness of morbid nature of the experiencePatient·s awareness of morbid nature of the experience
Assessed by Assessed by
A wareness of the nature of individual symptoms A wareness of the nature of individual symptoms
Whether they believe they are ill Whether they believe they are ill
Whether they think the illness is physical or Whether they think the illness is physical or
mentalmental
Whether they think they need treatment Whether they think they need treatment
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Judgement Judgement
M ental act of comparing or evaluating choices within the M ental act of comparing or evaluating choices within the
framework of a given set of values for the purpose of framework of a given set of values for the purpose of
electing a course of action electing a course of action ..
If the course of action chosen is consonant with reality If the course of action chosen is consonant with reality or with mature adult standards of behavior, judgment isor with mature adult standards of behavior, judgment issaid to be intact or normal; judgment is said to besaid to be intact or normal; judgment is said to be
impaired if the chosen course of action is frankly impaired if the chosen course of action is frankly maladaptive, results from impulsive decisions based onmaladaptive, results from impulsive decisions based onthe need for immediate gratification, or is otherwise notthe need for immediate gratification, or is otherwise notconsistent with reality as measured by mature adultconsistent with reality as measured by mature adult
standardsstandards
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Thank you
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