2. the systematic study of
abnormal experience,
cognition and
behaviour
PSYCHOPATHOLOGY
assumed causative
factors according to
theoretical constructs
EXPLANATORY
precisely describes
and categorizes
abnormal experiences/
behavior
DESCRIPTIVE
the observation of
behaviour
OBSERVATION
the empathic
assessment of
subjective experience
PHENOMENOLOGY
4. SYMPTOM
• Hypnogogic hallucination
Normal
experience
• Hallucinations
Abnormal
experience
• Primary as in schizophrenia or
secondary to drugs or a GMC
Primary or
secondary
• Modality, frequency, duration …
• What exactly the voices said
Form and
Content
7. ILLUSION
Top down process
• Strong affective states
Bottom up process
• reduced sensory
stimulation,
consciousness or
attention level
8. HALLUCINATION -
DEFINITIONS
A perception without an object (Esquirol, 1838)
Hallucinations proper are false perceptions which are not in
any way distortion of real perceptions but spring up on their
own as something quite new and occur simultaneously with
and alongside real perception (Jasper, 1962)
An hallucination is an exteroceptive or interoceptive percept
which does not correspond to actual object (Smythies, 1956)
13. Perception / Hallucination Pseudo-
hallucination
Fantasy / Imagery
Experience Concrete, tangible,
objective, real
Pictorial, subjective
Location Outer objective space Inner subjective space
Definition Definite outline, complete
sound
Indefinite, incomplete
Vividness Full, fresh, bright Dim or neutral
Constancy Retained Evanescent
Independence from
volition
Cannot be dismissed,
recalled or changed at will
Requires voluntary
creation
Insight Has quality of perception Fantasy has quality of
idea
Behavioral relevance Relevant to emotions,
needs and actions
Not relevant
Sensory modality Could experience object in
another modality
Could not
Existence Object exists independent
of observer
Depends on observer
for existence
14. DISORDER
OF THINKING
FORM
Flight of ideas
Perseveration
Loosening of
associations
FLOW
(stream)
Pressure of
thought
Poverty of
thought
Thought
blocking
CONTENT
Delusions
Obsessions
POSESSION
Thought
insertion
Thought
withdrawal
Thought
broadcasting
Oxford Textbook of Psychiatry, Second Edition, 1989
16. A MODEL OF ASSOCIATIONS
Thought
Possible thought
Possible thought
Possible thought
Actual thought
Constellation
Possible thought
Possible thought
Possible thought
Actual thought
Constellation
ASSOCIATIONS
GOAL
ASSOCIATIONS
18. FLIGHT OF IDEAS
Connection between 2 topics may
be based on chance relationship,
verbal and clang association or
distracting stimuli No central direction
19. LOOSENING OF
ASSOCIATIONS
Denotes loss of the
normal structure of
thinking
Appears as muddled
and illogical
conversation to the
interviewer
Examples
• Knight’s move
(derailment), word
salad, verbigeration
Occurs most often in
schizophrenia
21. ORIGIN OF A
DELUSION
• Delusional
mood
Trema
• Searching for
a new
meaning
Apophany
• Heightening
of psychosis
Anastrophy
• Forming a
new world
based on new
meanings
Consolidation
• Eventual
autistic state
Residuum
22. PRIMARY DELUSIONS
Jaspers describes four types of primary delusion:
delusional intuition - where delusions arrive 'out of the blue', without
external cause. [autochthonous delusion]
delusional perception - where a normal percept is interpreted with
delusional meaning. For example, a person sees a red car and knows
that this means their food is being poisoned by the police.
delusional atmosphere - where the world seems subtly altered,
uncanny, portentous or sinister. This resolves into a delusion, usually in
a revelatory fashion, which seems to explain the unusual feeling of
anticipation. [delusional mood]
delusional memory - where a delusional belief is based upon the recall
of memory or false memory for a past experience. For example, a man
recalls seeing a woman laughing at the bus stop several weeks ago and
now realizes that this person was laughing because the man has
animals living inside him.
23. DELUSIONAL
ATMOSPHERE/MOOD
‘Wherever you are looking, everything looks unreal.’
‘People went down the street like in a puppet theatre’
‘People look confusing... they are almost like they’re made
up... People that I know... have masks on or they’re
disguising themselves. It’s like a big play... like a big
production story’
‘When you go somewhere, everything seems already set up
for you like in a theatre – it’s really eerie, and you get terribly
frightened’
24. OVERVALUED IDEA
An acceptable, comprehensible idea pursued by the patient
beyond the bound of reason
Neither delusional or obsessional, but preoccupying to the
extent of dominating the sufferer’s life
Associated with strong affect and abnormal personality
Disorders with overvalued ideas;
• Paranoid state, Morbid jealousy, Hypochondriasis,
Dysmorphophobia, Parasitophobia (Ekbom’s syndrome),
Anorexia nervosa, Transsexualism and etc
26. OBSESSION
For 20 years V had had a fear of being transported into another
world. At age 17 he worried that reflections in mirrors
represented another world, and had complex checking rituals
involving mirrors. This gradually spread to all reflective
surfaces. He believed that turning on electrical switches, using
the television remote control or hearing car engines turned on
could cause him to be ‘transported’ and constantly checked to
make sure this had not happened. He believed that if he ate
while in another world, he would be forced to stay there, and so
either avoided eating, or ate with complex rituals, or induced
vomiting. Other rituals involved switching electrical switches on
and off and wearing particular clothes. The ‘other’ world was
tangibly the same as the real one, but ‘felt’ different - he felt that
friends and family, although appearing the same, were ‘
different’ and might have been replaced by ‘doubles’. The
symptoms gradually worsened, occupying all of his time prior to
admission to hospital.
27. DEFINITIONS OF DELUSION
overriding rigid convictions
which create a self-evident,
private, and isolating reality
requiring no proof
false unshakable belief
which is out of keeping with
the patient's social and
cultural background
29. WHAT IS THE THEME?
Ah Seng, a 55-year-old divorced coffee shop assistant, was
remanded at the state mental hospital a total of four times in 5
years, for distributing seditious materials. He was convinced
that the government was oppressing the poor people and
infiltrating an opposition party with their stooges in order to
make the opposition look foolish. He thus saw it his duty to
distribute anti-government materials to force the government to
step down. His resentment for the government first began
decades ago when his family had to be resettled after the
government acquired the land they were living on. His siblings
were equally upset by the resettlement too. However, it was not
till years later that, while in his fifties, he began to develop
systematized delusions about how the government was doing
wrong to the people. Ah Seng interpreted every action of the
government as a ruse to oppress the poor people. He believed
that drug taking flourished because the government caught only
the middlemen, but colluded with the drug lords.
30. WHAT IS THE THEME?
He also harboured delusions of having the
power of causing national calamities and
deaths of prominent political figures by the
sheer force of his prayers. As an example,
he cited a politician’s suicide that was
caused by his prayers.
31. WHAT IS THE THEME?
A 35-year-old single clerk was deluded that a
fellow church member, who was a company
executive, was in love with her. She took to
stalking him at his home. When she found
him going out with another woman, she was
so incensed with jealousy that she attacked
the woman, and was remanded.
33. WHAT IS THE THEME?
A 62-year-old elderly and unattractive man
was remanded for locking in and seriously
attacking his 45-year-old attractive wife at
home. Both his teenage children readily
testified to his unfounded jealous rantings
and checks on his wife for years. It
transpired that his first marriage had ended
in divorce when his first wife could not
tolerate his delusions of infidelity, although
he did not assault her then.
35. WHAT IS THE THEME?
For 5 years a 35-year-old man was convinced
that the blood in his left brain was flowing
backwards, thus causing a “block”, and
making his head “uncomfortable” and painful.
He adhered to his belief tenaciously despite
repeated reassurances by various
neurologists. Not surprisingly, he was non-
compliant with medications and, eventually
jumped to his death when the symptom
became intolerable
36. DIMENSIONS OF
DELUSIONAL SEVERITY
PRESSURE
•Extent of preoccupation
BIZARRENESS
•Bizarre/ non-bizarre
CONVICTION
•Complete/ partial
DISORGANIZATION
•Systematized/ non-systematized
EXTENSION
•Encapsulated
Hinweis der Redaktion
LEARNING OBJECTIVES - PHENOMENOLOGY
1. To understand the definition of phenomenology and its importance in psychiatry
2. To comprehend how to elicit and describe common signs and symptoms in psychiatry
3. To understand the basic classification of signs and symptoms in psychiatry
4. To be aware of common perceptual disturbances.
5. To distinguish the differences between true and pseudohallucinations
6. To define thinking and understand the four basic components of thought and the disturbances associated with each one of them.
Two distinct parts to descriptive psychopathology
The observation of behavior
Accurate observation
The empathic assessment of subjective experience
Empathy is a clinical instrument to measure another person’s internal subjective state using the observer’s own capacity for emotional and cognitive experience as a yardstick
Ophthalmologists call it Charles Bonnet Syndrome, a condition that often affects people with macular degeneration or diabetic eye disease.
Autoscopy (phantom mirror image) – experience of seeing oneself and knowing that it is oneself
Extracampine hallucination (Concrete awareness) – hallucinations experienced outside the limits of sensory field
Functional hallucination – a hallucination is provoked by external stimulus. Both hallucination and the normal percept are experience in the same sensory modality simultaneously
Reflex hallucination – same as above except the percept and hallucination occur in different modality
FORM = formal thought disorder (linking of thought together)
FLOW = disorders of the stream of thought (speed and pressure)
Rational (conceptual) thingking - external reality and goal-directness are taken into account
Based on Conrad
“A judgment which cannot be accepted by other people of the sane class, education, race and period of life as the person who experienced it” (Stoddart,1980)
“A false unshakeable belief which arises from internal morbid experience. It is out of keeping with the patient’s educational and cultural background” (Hamilton, 1978
PRESSURE: Extent of preoccupation
BIZARRENESS: Extent of departure from culturally determined consensual reality
CONVICTION: Degree to which patient is convinced of the reality of the delusion
DISORGANIZATION: Degree to which the beliefs are NOT internally consistent, logical and systematized
EXTENSION: Extent of involvement of areas of patient’s life
AFFECTIVE RESPONSE
DEVIANT BEHAVIOR
