PSYCHOPATHOLOGY

1. CHAPTER 3
SIGNS AND SYMPTOMS OF
PSYCHIATRIC ILLNESS

2. Contents
 Disorders of emotion
 Disorders of perception
 Disorders of thought
 Speech disorders
 Disorders of memory
 Motor disorders

3. DISORDERS OF EMOTION
 Depression: psychopathological feeling of
sadness
 Elation: Mood more cheerful than normal.
 Irritability: Getting easily annoyed and
provoked to anger
 Anxiety: Feeling of apprehension due to
anticipation of danger which may be
internal or external
 Fear: anxiety due to consciously recognized
and realistic danger

4. DISORDERS OF EMOTION
 Panic: Acute, episodic, and intense attack
of anxiety associated with overwhelming
feeling of dread and autonomic discharge.
 Apathy: With out feeling, total loss of
emotion
 Blunt or flat affect: Normal variation of
emotion is reduced.
 Labile affect: Excessively rapid and abrupt
emotional change
 Incongruent affect: Emotion not congruent
with ones thoughts, actions and
circumstances

5. DISORDERS OF
PERCEPTION
Illusions
 Misinterpretations of external stimuli
 Can occur in the absence of
psychiatric disorder
 Visual are most common

6. DISORDERS OF
PERCEPTION
Hallucination
 A false perception in the absence of
external stimuli
 Hallucination is not a sensory distortion
or a misinterpretation
 Hallucinations differ from Mental
Images (Pseudo-hallucinations) in that
Pseudo-hallucinations are:
◦ Seen in full consciousness
◦ Known to be not real
◦ Located in subjective space

7. DISORDERS OF
PERCEPTION
TYPES OF HALLUCINATIONS:
 Auditory hallucination
 Visual hallucination
 Olfactory hallucination
 Tactile hallucination
 Gustatory (taste) hallucination

8. Sensory Deceptions
Auditory hallucination:
1. Elementary or unformed – simple
noises, bells, undifferentiated
whispers or voices
2. Organized – music or voices
◦ Imperative hallucinations – voices giving
instructions to the patient
◦ Voices speaking about the person in
third person or running commentary on
the person’s actions

9. Sensory Deceptions
Visual hallucinations:
1. Elementary – flashes of light
2. Completely organized – visions of
people, objects or animals
• Delirium – seeing small animals and
insects

10. Sensory Deceptions
Olfactory hallucinations:
 Differentiate from delusion – belief that
one emits smell
◦ Schizophrenia
◦ Temporal lobe epilepsy
◦ Severe depression (uncommon)

11. Sensory Deceptions
Gustatory hallucinations:
 Difficult to differentiate from delusions
– loss of taste, ‘all food tastes the
same.
Tactile hallucinations:
 ‘formication’ – small animals crawling
over the body – plus delusion -
‘cocaine bug’
 Feeling of cold wind blowing on the
person, sensations of heat

12. DISORDERS OF THOUGHT
 Disorders of thought are usually recognized from
speech and writing. The disorder may involve the
stream, form and/ or its content.
Disorders of stream of thought
 Pressure of thought: Is a condition where by
ideas arise in a unusual variety and abundance
and pass through the mind rapidly
 Poverty of thought: there are few thoughts in the
person’s mind that lack variety and richness, and
they seem to move through the mind very slowly.
 Thought blocking: Abrupt and complete emptying
of mind that leads to abrupt interruption of
conversation

13. DISORDERS OF THOUGHT
Disorders of form of thought
 Flight of ideas: Thoughts and conversation
move quickly from one topic to another, so that
one train of thought is not completed before the
next is taken up.
 Perseveration: Persistent and inappropriate
repetition of the same sequence of thoughts, as
shown by repetition of speech or action.
 Loosening of association of thought: Is lack of
logical connection between the parts of train of
thoughts,
 Incoherence (word salad): Not only connection
between sentences and phrases but also
grammatical structure of speech will be disrupted.
 Neologism: Usage of words or phrases invented
by the person himself

14. Obsessions and Compulsions
Obsession (rumination) - A thought that
persists & dominates an individual’s
thinking
 The individual is aware that thought is
entirely without purpose
Compulsions: obsessional motor acts
 OCD, Depression, Schizophrenia

15. Disorders of the Possession of
Thought
 Experiencing one’s thoughts are under
the control of an outside agency
◦ Thought insertion: others thought
inserted into his/her own mind
◦ Thought withdrawal: thoughts has
been withdrawn away from his/her
mind by alien forces
◦ Thought broadcasting: his/ her
thoughts has been broadcasted in the
air

16. Disorder of Content of
Thinking
 Delusion: Is a belief that is firmly held but
on inadequate grounds, it is not affected by
evidence to the contrary, and is not a
conventional belief that the person might be
expected to hold given his cultural
background.
Overvalued idea – false belief
◦ Can occur in normal people
◦ Thought that takes precedence over all other
ideas and persists for a long time.
◦ Less fixed than delusions
◦ Have some basis in reality

17. Disorder of Content of
Thinking
Types of delusions
Delusion of Persecution:
 Belief that one is extremely wicked that
he is about to be put to death.
 Belief that the patient or his loved ones
are about to be killed or are being
tortured.
 Delusions of being poisoned, being
robbed...

18. Disorder of Content of
thinking
Delusion of reference: patient knows that
people are talking about him or spying on
him
Delusions of infidelity:
◦ ‘morbid jealousy’
◦ Belief that one’s spouse or partner is
unfaithful
◦ Schizophrenia, delusional disorder,
alcohol dependence, mood disorders

19. Disorder of Content of
thinking
Delusions of love / ‘erotomania’:
 Conviction that some person is in love
with the patient
 The alleged lover my never have
spoken to the patient
◦ Personality disorders, Schizophrenia
Grandiose delusions: A belief that he/she
is special / above others interms of power,
knowledge, money or identity

20. Disorder of Content of
thinking
Delusions of ill health:
 Characteristic feature of depressive
illness
 May be seen in schizophrenia
 Believe that one has a serious
disease such as cancer, AIDS,
incurable insanity

21. Disorder of Content of
thinking
Delusions of guilt:
 Patient believes that he is a bad or evil
person and has ruined his family – in
severe Major depressive disorder
 Assert that he is the most terrible
sinner who will be punished for all
eternity
 Such delusions may give rise to
delusions of persecution

22. Disorder of Content of
thinking
Nihilistic delusions:
 Patient believes that he is dead, the
world has stopped, or everyone else is
dead.
 Severe depression, schizophrenia.
Delusions of poverty:
 Conviction that one is impoverished &
beliefs that destitution is facing one &
one’s family
 Seen in severe depression

23. Speech disorders
Stammering and stuttering – normal
flow of speech is interrupted by pauses
or by repetition of fragments of the
word.
Mutism – is the complete loss of speech
Neologisms – invention of new words
Verbigeration - monotonous repetition of
syllables and words.
Echolalia - repetition of words or parts of
sentences that are spoken by others.
Word Salad- Incomprehensible mixture

24. Disorders of Memory
Amnesia:- partial or total inability to
recall past experiences and events.
◦ Normal memory decay
Dèjà vu – feeling of having seen a current
event in the past
Jamais vu – an event that has been seen in
the past is not presently associated with
appropriate feelings of familiarity
Hyperamnesia: exaggerated retention
& recall

25. Motor Disorders
Psychomotor retardation – subjective
feeling that all actions have become more
difficult to initiate & carry out
Mannerism – unusual repeated
performances of goal directed motor action
Chorea – abrupt jerking movements that
resemble fragments of expressive or
reactive movements. E.g. Huntington’s,
Stereotypy – repetitive, non-goal directed
action that is carried out in a uniform way
◦ Schizophrenia

26. Motor Disorders
Automatic Obedience – the patient
carries out every instruction regardless
of the consequence
Echopraxia – patients imitate simple
actions that they see.
◦ Catatonic schizophrenia, Mental
retardation

27. Motor Disorders
Forced grasping - Despite instructions not
to touch the examiners hand, the patient
continues to shake hand when the examiner
offers his hand
Negativism - Apparently motiveless
resistance to all interference
Ambitendency – the patient makes a series
of tentative movements that do not reach the
intended goal

28. Motor Disorders
 Psychological pillow – a stereotyped
posture in which the patient lies with the
head a few inches off the pillow. E.g.
catatonia, dementia
 Posturing: Adoption of unusual bodily
posture continuously for a long time
E.g. standing on one leg
 Stupor – a complete loss of activity and
lack of reaction to external stimuli
 Excitement – uncontrolled motor
activity

29. THE END
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