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)