Classification of mental disorders

1. Uzhhorod National University
Chair of Neurology, Neurosurgery and Psychiatry
M.D. Nina Sofilkanych

3.  Object and task of psychiatry, place among other medical
disciplines.
 History of development and modern state of psychiatry.
 Classifications.
 Etiology.
 Psychopathological phenomena, symptoms of abnormal states of
mind

5. Psychiatry
(from the Greek words
"psyche" - the soul, "iatreia" -
treatment) is a branch of
medicine concerned with the
study, diagnosis, treatment
and prevention of mental
disorders.

6. - psychiatrist has attended medical school and is a
physician and therefore holds an M.D.
- in residency received specialised training in the
field of psychiatry
- psychiatry tends to focus mainly on the use of
medications for treatment

7. A SUZY PRESENTATION3/5/2015
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8. VIDEO 1

9. When you speak to God it's called praying; but when God
speaks to you it's called schizophrenia.
2/15/17 8A SUZY PRESENTATION

10.  awareness and feeling of continuity, constancy and identity
of one's physical and mental self;
 feeling of constancy and identity of experience in similar
circumstances;
 insight (good judgement) concerning oneself, one's own
mental production and its results;
 accordance (adequacy) of mental reactions to intensity and
frequency of environmental influences,, social
circumstances and situations;
 capacity to self-regulation of one's behaviour in accordance
with social norms, rules and laws;
 capacity to plan one's life activities and to realise these
plans;
 capacity to change one's behaviour depending on the
changes of life situations and circumstances.

11. F00-09Organic, including symptomatic, mental disorders
F10-19 Mental and behavioural disorders due to psychoactive
substance use
F20-29 Schizophrenia, schizotypal and delusional disorders
F30-39 Mood (affective) disorders
F40-48Neurotic,stress-related and somatoform disorders
F50-59 Behavioural syndromes associated with physiological
disturbances and physical factors
F60-69 Disorders of adult personality and behaviour
F70-79 Mental retardation
F80-89 Disorders of psychological development
F90-98 Behavioural and emotional disorders with onset usually
occurring in childhood and adolescence

12. 1) endogenous disorders (schizophrenia, bipolar
affective disorder and genuine epilepsy) caused by
internal mechanisms, the nature of which isn't yet
quite clear; these are disorders with hereditary
predisposition.
2) exogenous disorders, caused by external reasons:
infection, intoxication, head injury, etc.;
3) psychogenous disorders are caused by
psychological trauma (posttraumatic stress
syndrome) and other psychological factors
(adjustment disorders, behavioural disorders,
neuroses, etc.).

14.  to study the aetiology and pathogenesis of mental disorders;
 to carry out their classification;
 to investigate the epidemiology of mental disturbances;
 to study the symptoms and signs, as well as syndromes and the
clinical course of different mental disorders;
 to develop find practice effective methods of their diagnosing;
 to work out and use efficient treatment methods;
 to develop a network of mental health services for the population;
 to develop a system for the prevention of mental disorders.

15.  the first period (pre-scientific), characterised
by primitive religious understanding of the
mentally ill people's abnormal behaviour;
 the secend period of ancient antique
medicine, a more progressive period, when the
first attempts at organising mental health
treatment were made;
 the third period, corresponding to the Middle
Ages, was in general a period or regress, when
psychiatry returned to its prescientific period
(theological scholastics);

16.  the fourth period, from the beginning of the
XVIII to the beginning of XIX century was the
stage of formation of psychiatry part of the
medical science;
 the fifth period was the epoch of E.
Krepellin's nosological psychiatry. The creation
of a nosological classification of mental
disorders was the main outcome of this stage;
 the sixth period, modern stage of
development of psychiatry, formed in the XX
century can be called the period of social
psychiatry; it is characterised by wide
development community, social forms of
mental health services; somatological aspects
of mental disorders got more attention.

18.  General psychopathology - studies the basic laws
of an etiopathogenesis, clinic, diagnostics, therapy
and prophylaxis of alienations.
 Private psychiatry - studies separate mental
diseases.
 Age psychiatry.
 Organizational psychiatry.
 Judicial psychiatry - solves questions of a sanity
and capacity for acting.
 Psychopharmacotherapy - studying of action on
mentality of medicinal substances.
 Social psychiatry.

19.  Addictology - studies influence of the psychotropic
substances on a condition of the person.
 Trans-cultural psychiatry - is engaged in
comparison of a mental pathology in the different
countries, cultures.
 Orthopsychiatry - surveys alienations from the
point of view of different disciplines.
 Biological psychiatry.
 Sexology.
 Suicidology.
 Military psychiatry - studies posttraumatic stressful
frustration, psychopathology a wartime.
 Ecological psychiatry - studies influence of
ecological factors on mentality.

20.  Addictology - studies influence of the psychotropic
substances on a condition of the person.
 Trans-cultural psychiatry - is engaged in
comparison of a mental pathology in the different
countries, cultures.
 Orthopsychiatry - surveys alienations from the
point of view of different disciplines.
 Biological psychiatry.
 Sexology.
 Suicidology.
 Military psychiatry - studies posttraumatic stressful
frustration, psychopathology a wartime.
 Ecological psychiatry - studies influence of
ecological factors on mentality.

21. F00-09Organic, including symptomatic, mental
disorders
F10-19 Mental and behavioural disorders due to
psychoactive substance use
F20-29 Schizophrenia, schizotypal and delusional
disorders
F30-39 Mood (affective) disorders
F40-48Neurotic,stress-related and somatoform
disorders
F50-59 Behavioural syndromes associated with
physiological disturbances and physical factors
F60-69 Disorders of adult personality and behaviour
F70-79 Mental retardation
F80-89 Disorders of psychological development
F90-98 Behavioural and emotional disorders with onset
usually occurring in childhood and adolescence

22. 1) endogenous disorders (schizophrenia, bipolar
affective disorder and genuine epilepsy) caused by
internal mechanisms, the nature of which isn't yet
quite clear; these are disorders with hereditary
predisposition.
2) exogenous disorders, caused by external reasons:
infection, intoxication, head injury, etc.;
3) psychogenous disorders are caused by
psychological trauma (posttraumatic stress
syndrome) and other psychological factors
(adjustment disorders, behavioural disorders,
neuroses, etc.).

23. Mental Illness
What are the symptoms of
Mental Illness?
What do you think causes Mental
Illness?

25. Thinking
When the brain is not working properly,
one or more of its 6 functions will be disrupted
Perception
Emotion Signaling
Behavior
Physical

26. Symptoms can include
Sleep problemsExtreme emotional
highs and lows
Thinking difficulties or
problems focusing
attention

27. When these symptoms
significantly disrupt a person’s life,
we say that the person has a
mental disorder
or a mental illness.

28. So, what are the
CAUSES
of mental illness??

29. Genetics Environment
+ →
Brain Disorder

30.  Psychiatry studies the causes of mental disorders,
gives their description, predicts their future course
and outcome, looks for prevention of their
appearance and presents the best ways of their
treatment
 Psychopathology describes symptoms of mental
disorders
 Special psychiatry is devoted to individual mental
diseases
 General psychiatry studies psychopathological
phenomena, symptoms of abnormal states of mind:
1. consciousness 5. mood (emotions)
2. perception 6. intelligence
3. thinking 7. motor
4. memory 8. personality

31.  Consciousness is awareness of the self
and the environment
 Disorders of consciousness:
• qualitative
• quantitative
 short-term
 long-term
 Hypnosis – artificially incited change of
consciousness
 Syncope – short-term unconsciousness

32.  Quantitative changes of consciousness mean
reduced vigility (alertness):
• somnolence
• sopor
• coma
 Qualitative changes of consciousness mean
disturbed perception, thinking, affectivity, memory
and consequent motor disorders:
• delirium (confusional state) – characterized by disorientation,
distorted perception, enhanced suggestibility,
misinterpretations and mood disorders
• obnubilation (twilight state) – starts and ends abruptly,
amnesia is complete; the patient is disordered, his acting is
aimless, sometimes aggressive, hard to understood
 stuporous
 vigilambulant
 delirious
 Ganser sy

33.  Perception is a process of becoming aware of what
is presented through the sense organs
 Imagery means an experience within the mind,
usually without the sense of reality that is part of
reality
 Pseudoillusions – distorted perception of objects
which may occur when the general level of sensory
stimulation is reduced
 Illusions are psychopathological phenomena;
they appear mainly in conditions of qualitative
disturbances of consciousness (missing insight)
 Hallucination are percepts without any obvious
stimulus to the sense organs; the patient is unable
to distinguish it from reality

34. Hallucinations:
 auditory (acousma)
 visual
 olfactory
 gustatory
 tactile (or deep somatic)
 extracampine, inadequate
 intrapsychic (belong rather to disturbances of thinking)
 hypnagogic and hypnopompic (hypnexagogic)
Pseudohallucinations - patient can distinguish
them from reality

48.  Thinking
 Cognitive functions
 Disorders of thinking:
• quantitative
• qualitative

49. Quantitative (formal) disorders of thinking:
 pressure of thought
 poverty of thought
 thought blocking
 flight of ideas
 perseveration
 loosening of associations
 word salad - incoherent thinking
 neologisms
 verbigeration

50. Quantitative disorders of thought (content thought
disorders):
 Delusions:
a)belief firmly held on inadequate grounds,
b)not affected by rational arguments
c)not a conventional belief
 Obsessions (obsessive thought) are recurrent
persistent thoughts, impulses or images entering the
mind despite the person's effort to exclude them.
Obsessive phenomena in acting (usual as senseless
rituals – cleaning, counting, dressing) are called
compulsions.

51. Division of delusions:
 according to onset
a)primary (delusion mood, perception)
b)secondary (systematized)
c)shared (folie a deux)
 according to theme
a)paranoid (persecutory) - d. of reference, d. of jealousy, d. of
control, d. concerning possession of thought
b)megalomanic (grandiose, expansive) – d. of power, worth,
noble origin, supernatural skills and strength, amorous d.
c)depressive (micromanic, melancholic) – d. of guilt and
worthlessness, nihilistic d., hypochondriacal d.
d)concerning the possession of thoughts
 thought insertion
 thought withdrawal
 thought broadcasting

52. A SUZY PRESENTATION
DELUSION IS A FALSE BELIEF IN
SOMETHING WHICH IS NOT A FACT,
AND THE BELIEF PERSISTS EVEN
AFTER ITS FALSITY HAS BEEN
CLEARLY DEMONSTRATED.
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53. A SUZY PRESENTATION
GRANDEUR OR EXALTATION
PERSECUTION(PARANOID)
REFERENCE
INFLUENCE
INFEDILITY
SELF-REPROACH
NIHILISTIC
HYPOCHONDRIAL
OTHER TYPES
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54. A SUZY PRESENTATION
The person imagines that he is very
rich, powerful, while in reality he may
be a pauper and may squander away
his money or property. It is usually
seen in mania, and may be
associated with delusion of
persecution.
This is a pleasant delusion.
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55. A SUZY PRESENTATION
DELUSION OF GRANDEUR OR EXALTATION
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56. A SUZY PRESENTATION
The person imagines that people are
after him and may kill him, poison
him(wife, sons or parents) or harm him,
or someone is going to rob his property.
The person remains suspicious and
depressed and may commit some crime.
( He may commit suicide or kill his
family members or innocent person
thinking him/her to be his enemy.)
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57. A SUZY PRESENTATION
DELUSION OF PERSECUTION/PARANOID
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58. A SUZY PRESENTATION
The patient complains that his
thoughts processes, feelings and
actions are being influenced and
controlled by some external power,
like radio, hypnotism or telepathy. On
the basis of this imaginary
“command”, he may commit an
unlawful act.
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59. A SUZY PRESENTATION
In this, the person thinks that his/her
spouse is not loyal to him/ her.
Usually, males suffer more from this
delusion as compared to females.
The person may commit crime in
this state.
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60. A SUZY PRESENTATION
DELUSION OF
INFEDILITY/JEALOUSY-OTHELLO
SYNDROME
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61. A SUZY PRESENTATION
The person criticises himself for
some imaginary offence or misdeed
committed by him in the past. In
serious cases, the person may
punish himself by committing
suicide.
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62. A SUZY PRESENTATION
In this, the person does not believe
in his existence or that the world
exists. They may commit suicide or
kill others.
It is commonly seen in depression.
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63. A SUZY PRESENTATION
The person in this delusion thinks
that he is ill always, while medically
he may be completely fit. He keeps
on visiting doctors. Usually the
person gives vague abdominal
complaints.
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64. A SUZY PRESENTATION
The patient is convinced that he is,
or will be, bereft of all material
possessions.
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65. A SUZY PRESENTATION
Patient believes that another person
has been physically transformed into
themselves.
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66. A SUZY PRESENTATION
The person believes that everybody
is thinking about him only and is
being referred by all agencies,
media and persons around him in all
matters(usually of negative nature)
and this may put him in conflict with
the world.
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67.  Sensory stores - retains sensory
information for 0.5 sec.
 Short - term memory (working
memory) - for verbal and visual
information, retained for 15-20 sec., low
capacity
 Long-term memory – wide capacity and
more permanent storage
• declarative (explicit) memory – episodic (for
events) or semantic (for language and
knowledge)
• procedural memory – for motor arts
• priming – unconscious memory
• conditioning – classic or emotional

68. Disorders of memory:
 Amnesia – inability to recall past events
 Jamais vu, déja vu
 Confabulation, amnesic disorientation, Korsakov’s
syndrome
 Pseudologia phantastica
 Hypomnesia
 Hypermnesia

69.  Concentration
 Capacity
 Tenacity
 Irritability
 Vigility
 Hypoprosexia (global, selective)
 Hyperprosexia
 Paraprosexia

70. Normal affect – brief and strong emotional
response
Normal mood – subjective and for a longer
time lasting disposition to appear affects
adequate to a surrounding situation and
matters discussed
Higher emotions:
• intellectual
• aesthetic
• ethic
• social

71. Pathological affect – very strong, abrupt affect
with a short change of consciousness on its
peak
Pathological mood – two poles:
• manic
• depressive
Phobia – persistent irrational fear and wish to
avoid a specific situation, object, activity:
• agoraphobia
• claustrophobia
• social phobias
• hipsophobia
• aichmophobia
• keraunophobia
Depersonalization – change of self-awareness, the
person feels unreal, unable to feel emotion

72.  Pathological mood:
• origin – based on pathological grounds, no psychological cause
• duration – unusually long-lasting
• intensity – unusually strong, large changes in intensity
• impossibility to be changed by psychological means
 Pathological features of mood:
• euphoria
• expansive
• exaltation
• explosive
• mania
• hypomania
• depression
• apathy (anhedonia)
• blunted, flattened affect
• emotional lability
• helpless

73.  Intelligence:
• abstract
• practical
• social
 Intelligence quotient (IQ):
IQ = (mental age : calendar age) x 100
 Disorders of intellect:
• mental retardation
• dementia

74.  quantitative:
• hypoagility
• hyperagility
• agitated behaviour
 qualitative:
• mannerisms
• stereotypies
• posturing
• waxy flexibility
• echopraxia
• schizophrenic impulse
• negativism
• short-circuit behaviour
• automatism
• agitation
• tics
• abulia
• compulsions
Motor disorders occur frequently in mental
disorders of all kinds, especially in catatonic
schizophrenia.

76. Disorders of volition:
• hypobulia
• abulia
• hyperbulia

77.  Personality means a complex of
persistent mental and physical traits of a
person
 Disturbances of personality:
• transformation of personality
• appersonalization
• multiple personality (alteration of personality)
• specific personality disorder
• deprived personality

78. A SUZY PRESENTATION
Abreaction:-This is a
release phenomenon
where old, forgotten things
or events are brought into
conscious state again.
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79. A SUZY PRESENTATION
It is commonly called
mood or feeling.
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80. A SUZY PRESENTATION
Loss of memory about a
person or event is called
‘amnesia’.
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81. A SUZY PRESENTATION
AMNESIA
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82. A SUZY PRESENTATION
Loss of sensory or motor
ability to express by use
of speech or writing is
called ‘aphasia’.
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84. A SUZY PRESENTATION
Unconscious filling of gaps in memory
by imagining experiences or events
that have no basis in fact, commonly
seen in amnestic
syndrome. Confabulation is
considered “honest lying,” but is
distinct from lying because there is
typically no intent to deceive and the
individual is unaware that their
information is false.
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86. A SUZY PRESENTATION
When a person is not able to
answer properly, in a straight
manner, and keeps on giving
irrelevant details or wanders
off the subject many times in a
conversation, the condition is
called circumstantiality.
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87. A SUZY PRESENTATION
CIRCUMSTANTIALITY
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88. A SUZY PRESENTATION
It is a repetitive behaviour done
by an individual in spite of
knowing that it is not correct.
Examples being, repeatedly
washing hands, checking
locked premises again and
again.
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89. A SUZY PRESENTATION
COMPULSION
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90. A SUZY PRESENTATION
It is an acute reversible mental disorder
characterised by confusion and impairment of
consciousness, disorientation(most commonly
time), emotional lability, hallucination, or
illusion and inappropriate, impulsive, irrational
or violent behavior.
The mental faculty of an individual does not
work properly. It may be seen in high grade
fevers or due to overwork, mental stress, acute
poisoning(dhatura), chronic alcoholics or drug
intoxication.
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91. 91

92. A SUZY PRESENTATION
The person becomes a
wanderer who keeps on
moving from place to place in
an altered state of mind. He
has episodes of amnesia. This
stage is seen in depression,
schizophrenia and other
mental disorders.
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93. A SUZY PRESENTATION
FUGUE STATE
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94. A SUZY PRESENTATION
Repeating the act of
another
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95. A SUZY PRESENTATION
ECHOPRAXIA
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96. A SUZY PRESENTATION
The degree to which the
observer is able to enter
into the thoughts and
feelings of the patient
and establish good
contact.
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97. A SUZY PRESENTATION
EMPATHY
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98. A SUZY PRESENTATION
Doing just the opposite of
what he is asked to do.
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100. A SUZY PRESENTATION
A condition arising out of
physical or mental
exhaustion.
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101. A SUZY PRESENTATION
NEURASTHENIA
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102. A SUZY PRESENTATION
IS AN EXCESSIVE
IRRATIONAL FEAR OF A
PARTICULAR OBJECT OR
SITUATION.
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104. A SUZY PRESENTATION
Rare psychiatric syndrome marked
by the gradual development of a
highly elaborate and complex
delusional system, generally
involving persecutory or grandiose
delusions, with few other signs of
personality disorientation or
thought disorder.
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106. A SUZY PRESENTATION
It is a conscious often
impulsive, manipulative act,
undertaken to get rid of an
intolerable situation.
(attempted suicide or
pseudicide)
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PARASUICIDE

108. A SUZY PRESENTATION
Used synonymously with mutism
and does not necessarily imply a
disturbance of consciousness; in
catatonic stupor, patients are
ordinarily aware of their
surroundings.
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109. A SUZY PRESENTATION
STUPOR
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110. A SUZY PRESENTATION
Disturbed consciousness of short
duration with hallucination during
which the patient may carry out
actions of which he has little or no
subsequent memory.
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112. A SUZY PRESENTATION
In depression, denoting
characteristic symptoms, such
as sleep disturbance(especially
early morning awakening),
decreased appetite,
constipation, weight loss and
loss of sexual response.
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113. A SUZY PRESENTATION
VEGETATIVE SIGNS
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114. A SUZY PRESENTATION
psychopath is a person who is neither
insane nor mentally ill, but fails to conform
to the normal standards of behavior. It
refers to individuals who have
psychopathic personality. They are usually
antisocial and have long criminal records.
They have no remorse feeling and are not
amenable to counseling. Some of them
have extra Y chromosome in their
chromatin.
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115. A SUZY PRESENTATION
PSYCHOPATH
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116. A SUZY PRESENTATION
It is a dream like state which may last for
days or weeks. the patient suffers from
confusion, amnesia, illusions,
hallucination, disorientation agitation
and anxiety.
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117. A SUZY PRESENTATION
ONEIROID STATES
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118. A SUZY PRESENTATION
Neurosis is when a patient suffers from
emotional or intellectual disorders which
causes subjective distress, but does not
lose touch with reality. Psychosis is
characterised by gross impairment in
reality-testing(with drawl from reality),
as if living in a world of fantasy.
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119. A SUZY PRESENTATION
NEUROSIS PSYCHOSIS
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120. A SUZY PRESENTATION
Psychoses are usually of the following two
types:
1. Manic-depressive Psychosis: It is expressed
in following two phases:
(a) Mania phase: In this, the person is very
active, full of life, talking too much, mostly
irreverent, the mood is elated and he does
some action continuously. But he does not
have touch with reality. He can commit any
crime during this phase. Sleep is very less.
Appetite is also less.
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121. A SUZY PRESENTATION
(b) Depressive phase: It is just the reverse of
mania. The person is very sad, mood is
depressed. The person sits alone and may
speak very little. Touch with reality is not there.
He may commit suicide. The motor functions
are also quite depressed. A person suffering
from manic depressive psychosis may fluctuate
between the two phases of mania and
depression. It may be possible that the person
may be normal between the two phases of
mania. This may be lucid interval and the
person is completely responsible for his
actions.
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122. A SUZY PRESENTATION
Neurosis is a minor mental illness. It is of
following types:
1. Anxiety Neurosis: It is a very common
variety. The person remains anxious about
future events, relationships and individuals.
His pulse rate may be high, blood pressure
raised, respiratory rate high and he may be
sweating. He may be restless, confused and
apprehensive. Treatment usually involves
counseling and use of anti-anxiety drugs
like diazepam. Meditation also helps a lot.
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123. A SUZY PRESENTATION
Depression: It is the reverse of anxiety.
Here, a person would be aloof, sad and
withdrawn. His motor activities would
be quite less. He may have a low
appetite and may not eat well. However,
in chronic cases of depression, the
person may keep on eating the whole
day, while withdrawn at home and hence
may gain weight. The following are the
types of depression commonly seen:
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124. A SUZY PRESENTATION
Reactive depression: It may be due to
some event or situation like the death of
spouse or a near one, failure in exam,
love, etc. It usually remains there for
sometime. Some form of reactive
depression is seen in all individuals.
Usually, with counseling and use of anti-
depressive drugs, most come out of it.
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125. A SUZY PRESENTATION
Endogenous depression: It is more
serious as its etiology is not known and
develops slowly. Early morning
awakening, loss of appetite and mood
depression are quite common. This
depression may be associated with
psychosis too, where it carries a bad
prognosis. Usually with anti-depressive
drugs, most of the individuals recover.
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126. A SUZY PRESENTATION
126
S.NO FEATURE PSYCHOSIS NEUROSIS
1 Contact with reality lost Preserved
2 Interpersonal
behavior
Marked disturbance in reality and
behavior
Preserved
3 Empathy Absent Present
4 Insight Absence of understanding
current symptoms
Symptoms are
recognised as
undesirable
5 Organic causative
factor
Present absent
6 Symptoms Delusions. Illusions and
hallucinations
Usually physical or
psychic symptoms
7 Dealing with reality Capacity is grossly reduced Preserved
8 Examples Dementia, Schizophrenia Anxiety, phobia,
depression,
conversion disorder
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127. A SUZY PRESENTATION
This is also called ‘sleep walking’. A
person may move around while asleep
and may commit some crime or theft, and
then come back normally. He may not be
aware that he has committed a crime.
He will not be held responsible if it is
proved that he has done this act while
asleep.
127
3/5/2015

128. A SUZY PRESENTATION3/5/2015
128
SOMNAMBULISM

129.  Mentally healthy man.
 Persons in a state of simple and, even, heavy degree of
alcoholic intoxication.
 Persons in the state of intoxication.
 Persons with the affects reactions and antisocial forms
conducts, which do not suffer by the psychical diseases.
 Persons with psychopath’s character traits.
 Persons in which found out the neurotic reactions.
 Persons with a mental backwardness (after the
exception of examination).
 Persons with total dementia.
 Mentally ill with acute somatic pathology which requires
surgical intervention.