PSYCHOPATHOLOGY Descriptions of Symptoms & Signs Dr. Janaka Pushpakumara Department of Psychiatry FMAS/RUSL
Symptoms & Signs In General Medicine, there is a clear definition of, and separation between, a symptom & a sign. In Psychiatry, the situation is different.
Symptoms & Signs Most of the diagnostic information coming from the History and Observation of patients appearance and behaviour.
Disturbances of emotions & Mood
Mood mood refers to the emotional state that prevails in a person, at any given time. However, in psychiatry the term mood is often used to describe the emotional state that has lasted for a period of time
Emotion An emotion is a complex multi-component episode that creates a readiness to act. E.g.: Anger Anxiety Fright Guilt Shame Sadness Envy Jealousy Disgust Happiness Pride Relief Hope Love Compassion
Disturbances of emotions & Mood May be abnormal in 3 ways Nature may be altered Fluctuate more or less than usual Inconsistent with thoughts/actions/ current circumstances.
Disturbances of emotions & Mood Nature Anxious Depressed Elated Irritable Angry
Disturbances of emotions & Mood Fluctuate more or less than usual Lability of mood - variation Emotional incontinence - extreme variation Blunting/flattening - variation Apathy severe flattening
Disturbances of emotions & Mood Inconsistent with thoughts/actions/ current circumstances. Incongrous/Inappropriate
Disturbances of perception
Disturbances of perception Perception Is the process of becoming aware of what is presented through the sense organs. Imagery Is the awareness of a percept that has been generated within the mind.
Disturbances of perception Illusion Misperception of external stimuli. A stimulus from a perceived object is combined with a mental image to produce a false perception.
Illusion A stimulus from a perceived object is combined with a mental image to produce a false perception.
Disturbances of perception Hallucinations Percept is experienced in the absence of an external stimulus to the corresponding sense.
Hallucinations Different sense modalities: Auditory hallucinations Visual hallucinations Olfactory hallucinations (of smell) Gustatory hallucinations (of taste) Tactile hallucinations (of touch)
Auditory Hallucinations (AH) Auditory hallucinations are common. They could occur in normal people (e.g. when falling asleep/waking up)
Auditory Hallucinations (AH) Elementary Bangs Whistles Complex Noises / Music Voices Indistinct Clear 2 nd person AH the patient hears a voices talking to him/commanding to him. 3 rd person AH the patient hears several voices, talking about hem (among themselves).
Visual Hallucinations (VH) Elementary Flashes of light Complex Faces Scenes
Autoscopic Hallucinations Seeing one s own body projected into external space. Reflex Hallucination Stimulus in one sensory modality results in a hallucination in another.
How to Differentiate a Hallucinations from an Imagery
Disturbances of Thought
Types of thinking Fantasy thinking produces ideas which have no external reality. Imaginative thinking Rational (conceptual) thinking attempts to resolve a problem through the use of logic, excluding fantasy.
Delusions This is a firmly held belief, which is not based on logic and not amenable to logical argument, which cannot be explained in terms of a patient s social or cultural back ground
Delusional Experiences & Themes Delusional Perception Delusional memory Shared delusions Persecutory Delusions Delusions of reference Grandiose delusions Nihilistic delusions
Delusional Experiences & Themes Cont. Hypochondriacal delusions Delusion of jealousy Sexual or amorous delusions Delusions of control
Delusions concerning possession of thoughts Thought insertion Thought withdrawal Thought Broadcasting
Overvalued idea Isolated, acceptable, comprehensible idea pursued by the patient beyond the bounds of reason Differs from Delusions Understandable when background is known culturally common & acceptable shakable
Obsessional & compulsive symptoms
Obsessional & compulsive symptoms Obsessional thoughts repeated & intrusive words / phrases upsetting the patient Obsessional ruminations complex repeated worrying themes Obsessional doubts repeated themes expressing uncertainty about previous actions Obsessional impulses repeated urges to carry out actions
Disturbances of Thinking processes
Disturbances of Thinking processes Disturbance of the stream of thoughts Pressure of thoughts ideas arise in unusual variety & abundance & pass through the mind rapidly Poverty of thoughts has few thoughts Thought block
Disturbances of Thinking processes Disturbance of the form of thoughts Perseveration persistent & inappropriate repetition of the same thought Flight of ideas speech move one topic to another quickly normal logical sequence of ideas is generally preserved loosening of association
Disturbances of Thinking processes Other Neologism
Depersonalization & Derealization
Motor symptoms & Sings Tics irregular repeated movements of group of muscles Mannerisms repeated movements that appear to have some functional significance Stereotypies repeated, regular, no obvious significance Catatonia muscle tone affecting flexion & extension & abolished by voluntary movements. Catalepsy/Waxy flexibility
Disturbances of Memory Immediate Recent Long term Disturbances of Recognition Jamais vu Déjà vu Confabulation
Insight
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