Psychopathology-SRIK 2010.B-12

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PsychopathologyPsychopathology



The term psychopathology The term psychopathology

is borrowed from Greek ´psycheµis borrowed from Greek ´psycheµ--soulsoul´Pathosµ´Pathosµ--suffering suffering

´Logosµ´Logosµ--sciencescience



PsychopathologyPsychopathology

is the description, interpretation, explanationis the description, interpretation, explanation

and classification of those, particular mentaland classification of those, particular mental

phenomena that have, clinical meaning, i.e.,phenomena that have, clinical meaning, i.e., whose perception, analysis and assessment a whose perception, analysis and assessment arereuseful in diagnostic and therapeutic managementuseful in diagnostic and therapeutic management

of persons with mental disorders.of persons with mental disorders.



For a psychiatrist a patient·s experiences andFor a psychiatrist a patient·s experiences and ways of behavior are the same as observed ways of behavior are the same as observed

physical phenomena for a physicistphysical phenomena for a physicist



Difficulties in defining abnormalityDifficulties in defining abnormality

Psychopathology is characterized by Psychopathology is characterized by subjective subjective

discomfort discomfort

P rivate feelings of pain, unhappiness, emotional distress

P rivate feelings of pain, unhappiness, emotional distress

Can disturbance be without discomfort?Can disturbance be without discomfort?

Yes Yes-- manic episodemanic episode

Yet, lack of discomfort might reveal a problem Yet, lack of discomfort might reveal a problem



Statistical abnormalityStatistical abnormality

Abnormality is defined on the basis of an Abnormality is defined on the basis of an

extreme score on some dimension, e.g. IQ,extreme score on some dimension, e.g. IQ,

anxiety, depressionanxiety, depression Design a test/scale to measure & identify the personDesign a test/scale to measure & identify the person

who deviated from the average who deviated from the average

It tells nothing about the meanings of deviationsIt tells nothing about the meanings of deviations

from the normfrom the norm



Social nonconf ormitySocial nonconf ormity

Abnormality is defined by a failure to conform Abnormality is defined by a failure to conform

to social norms or the minimum standards forto social norms or the minimum standards for

social conductsocial conduct Extreme non conformity could lead to destructive orExtreme non conformity could lead to destructive or

self self--destructive behaviourdestructive behaviour

S ituational context S ituational context

Cultural relativity Cultural relativity



Core Features of Disordered Behav iourCore Features of Disordered Behav iour

Maladaptive: difficult to meet the demands of Maladaptive: difficult to meet the demands of

day day--toto--day lifeday life

Loss of ability to control thoughts, feelings andLoss of ability to control thoughts, feelings and

behaviours adequately behaviours adequately



Abnormal

behavior

Thought

Mood

H Mental

functions

Perception



Thought disorder Thought disorder

Any disturbance of thinking that affects Any disturbance of thinking that affects

language, communication, or thought content;language, communication, or thought content;characterized by a failure to follow semantic andcharacterized by a failure to follow semantic and

syntactic rules that is inconsistent with thesyntactic rules that is inconsistent with theperson's education, intelligence, or culturalperson's education, intelligence, or cultural

backgroundbackground



Disturbance of thoughtDisturbance of thought

Form

Stream

Content



FormForm

Flight of ideasFlight of ideas

Loosening of associationLoosening of association

DerailmentDerailment Tangentiality Tangentiality

Circumstantiality Circumstantiality



Flight of ideasFlight of ideas

1.1. Rapid shift from one to anotherRapid shift from one to another

2.2. Understandable link with no logicalUnderstandable link with no logical

connectionconnection3.3. The determining tendency is decided by The determining tendency is decided by

rhyme, pun, distraction, clanging rhyme, pun, distraction, clanging





Loosening of associationLoosening of association

Lack of logical connection between sequence of Lack of logical connection between sequence of

thoughtsthoughts

Replies are hard to follow Replies are hard to follow Sometimes knight·s move thinking (oddSometimes knight·s move thinking (odd

tangential association between ideas)tangential association between ideas)



Sample of speechSample of speech

I don·t know. I might be thrown out. Benito MussoliniI don·t know. I might be thrown out. Benito Mussoliniactually came alive out in waiting room. I figured it out.actually came alive out in waiting room. I figured it out. There was a picture in the book. If its not my mother, it There was a picture in the book. If its not my mother, it

could have been Hitler. What if that was one of hiscould have been Hitler. What if that was one of hisarmed guards? Mussolini was hanging from a tree.armed guards? Mussolini was hanging from a tree. Thank you for letting me reason it out. Oh that·s Thank you for letting me reason it out. Oh that·sanother thing that I wanted to talk about is being brainanother thing that I wanted to talk about is being brain washed. I didn·t buy the Beatles tape; I never did washed. I didn·t buy the Beatles tape; I never did



OthersOthers

PerseverationPerseverationPersistent and inappropriate repetition of the same responsePersistent and inappropriate repetition of the same responsebeyond the point of relevancebeyond the point of relevance

DerailmentDerailment Total break in the chain of association between the meaning of Total break in the chain of association between the meaning of thoughtsthoughts

Tangentiality Tangentiality Oblique, digressive, or even irrelevant manner of speech inOblique, digressive, or even irrelevant manner of speech in

which the central idea is not communicated which the central idea is not communicated NeologismNeologism

Coining of a new word or using a new word in a idiosyncraticCoining of a new word or using a new word in a idiosyncraticmannermanner



Samples of speechSamples of speech

What is your name ? What is your name ?

John John

Where have you come from? Where have you come from?

John John

Can you state your age?Can you state your age?

John John



SamplesSamples

What city are u from? What city are u from?

´That·s a hard question to answer. Becoz my parents«..´That·s a hard question to answer. Becoz my parents«..I was born in Iowa, But I Know that I am white insteadI was born in Iowa, But I Know that I am white insteadof Black, So apparently I came from the Northof Black, So apparently I came from the NorthSomewhere, And I don·t know where, You Know, ISomewhere, And I don·t know where, You Know, Idon·t know whether I am Irish or Scandinavianµdon·t know whether I am Irish or Scandinavianµ



SamplesSamples

Did you enjoy college?Did you enjoy college?

´I really enjoyed some communities, I Tried it, And the,´I really enjoyed some communities, I Tried it, And the, And the next day when I would be going out, I took And the next day when I would be going out, I took control, I put bleach in my hair, in Californiacontrol, I put bleach in my hair, in California.µ.µ



SamplesSamples

I heard you were late for your morning group session.I heard you were late for your morning group session.

I am having a rough day. I woke up late. My alarmI am having a rough day. I woke up late. My alarmclock has been working poorly. Then it took forever forclock has been working poorly. Then it took forever for

me to brush my teethme to brush my teeth becozbecoz I couldn·t find my toothI couldn·t find my toothpaste. I started talking to my roommate and I lost track paste. I started talking to my roommate and I lost track of time. I got to the bus stop in time to see the busof time. I got to the bus stop in time to see the buspulling away. I caught the next bus and talked to a manpulling away. I caught the next bus and talked to a manfrom INDI A «««..from INDI A «««..



StreamStream

1.1. Pressure of thought/speechPressure of thought/speech

2.2. Poverty of thoughtPoverty of thought

3.3. Thought block Thought block



Thought content Thought content

DelusionsDelusions

Overvalued ideasOvervalued ideas

ObsessionsObsessions Thought alienation Thought alienation



DelusionsDelusions

False belief, based on incorrect inference aboutFalse belief, based on incorrect inference about

external reality, that is firmly held despiteexternal reality, that is firmly held despiteobjective and obvious contradictory proof orobjective and obvious contradictory proof or

evidence and despite the fact thatevidence and despite the fact that other members of other members of

the culture do not share the belief the culture do not share the belief ..



Delusional themesDelusional themes

Delusion of persecutionDelusion of persecution--being harmedbeing harmed

Delusion of grandeurDelusion of grandeur--self importanceself importance

Delusion of referenceDelusion of reference--special significance givenspecial significance givento neutral stimulusto neutral stimulus

Delusions of guiltDelusions of guilt -- Pathological guilt overPathological guilt over

innocent errorsinnocent errors



Delusional themesDelusional themes

Nihilistic delusionsNihilistic delusions--non existencenon existence

Delusion of loveDelusion of love

Delusion of jealousy Delusion of jealousy--infidelity infidelity

Delusion of controlDelusion of control

Thought insertion, withdrawal and broadcast Thought insertion, withdrawal and broadcast



PrimaryPrimary vs vs secondary delusionsecondary delusion

A primary delusion occurs suddenly which arises de A primary delusion occurs suddenly which arises denovonovo

Secondary delusions arise in response to otherSecondary delusions arise in response to other

abnormality or experienceabnormality or experience

ExamplesExamples

Delusion of guilt in DepressionDelusion of guilt in Depression

Delusion secondary to hallucinationsDelusion secondary to hallucinations



Factors in volv ed in the f ormation of Factors in volv ed in the f ormation of

delusiondelusion

Disorder of brain functioning Disorder of brain functioning

Personality Personality

Affect Affect

Perceptual disordersPerceptual disorders

Cognitive deficitsCognitive deficits



O v ervalued ideaO v ervalued idea

An isolated, preoccupying strongly held belief An isolated, preoccupying strongly held belief

which has come to unreasonably dominate the life and which has come to unreasonably dominate the life andmay affect his or her actionsmay affect his or her actions

Examples: paranoid state, morbid jealousy,Examples: paranoid state, morbid jealousy,

body image disturbancesbody image disturbances



Obsessions and compulsionsObsessions and compulsions

ObsessionObsessionRecurrentRecurrent persistent unwanted ideas orpersistent unwanted ideas orimpulses or imagesimpulses or images

RecognizedRecognized by the individual as his or herby the individual as his or her ownownResistedResisted at the expense of mounting anxiety at the expense of mounting anxiety At times the anxiety may be relieved by performing At times the anxiety may be relieved by performing certain acts referred to as compulsionscertain acts referred to as compulsions



ObsessionalObsessional themesthemes

Dirt and contaminationDirt and contamination

Aggression Aggression

ReligionReligion

SexSex

OrderlinessOrderliness

DiseaseDisease



CompulsionsCompulsions

Repeated ,stereotyped acts that the person is compelledRepeated ,stereotyped acts that the person is compelledto carry out but resists recognizing the act as irrationalto carry out but resists recognizing the act as irrational

Most of the compulsions follow obsessionsMost of the compulsions follow obsessions

Examples : cleaning rituals, checking ritualsExamples : cleaning rituals, checking rituals



Perce ptionPerce ption

Conscious awareness of elements in theConscious awareness of elements in the

environment by the mental processing of environment by the mental processing of sensory stimuli; sometimes used in a broadersensory stimuli; sometimes used in a broader

sense to refer to the mental process by which allsense to refer to the mental process by which allkinds of data, intellectual, emotional, andkinds of data, intellectual, emotional, and

sensory, are meaningfully organized.sensory, are meaningfully organized.



A bnormalities of perce ption A bnormalities of perce ption

Sensory distortionsSensory distortions ² ² A real object is perceived in a distorted A real object is perceived in a distorted way way

Change in intensity Change in intensity

Example : Drug induced statesExample : Drug induced states Change in Quality Change in Quality

Example :Food tastes differently or colored visionExample :Food tastes differently or colored vision

Change in spatial formChange in spatial form

Example: micropsia and macropsiaExample: micropsia and macropsia







Factors in volv ed in the f ormation of Factors in volv ed in the f ormation of

illusionillusion

Clouding of sensoriumClouding of sensorium

Reduction in the level of sensory stimulationReduction in the level of sensory stimulation

Intense state of emotionIntense state of emotion

Lack of attentionLack of attention

A young woman describes looking up into the clouds A young woman describes looking up into the cloudsand seeing an image of her fiancéand seeing an image of her fiancé



HallucinationHallucination

Perception experienced in the absence of externalPerception experienced in the absence of externalstimulusstimulus

The percept is experienced as a true perception The percept is experienced as a true perception

Arises in the external objective space Arises in the external objective space

Can hallucination occur in healthy people?Can hallucination occur in healthy people?



Hallucinations in normal indi v idualsHallucinations in normal indi v iduals

HypnagogicHypnagogic hallucinationhallucination

occurs while falling asleepoccurs while falling asleep

HypnopompicHypnopompic hallucinationhallucinationoccurs while waking occurs while waking

Intense emotionIntense emotion

FatigueFatigue

Suggestibility Suggestibility



Functional hallucination Functional hallucination vs vs ref lex ref lex

hallucinationhallucination

Functional hallucinationFunctional hallucination

Experiencing a hallucination while experiencing aExperiencing a hallucination while experiencing anormal percept in the same modality normal percept in the same modality

´́I hear the voice of my long dead father, as if he were talking to me now, when II hear the voice of my long dead father, as if he were talking to me now, when Ihear water running from the bath tap.µhear water running from the bath tap.µ

Reflex hallucinationReflex hallucination

A real percept in one modality triggers hallucination A real percept in one modality triggers hallucinationin another modality in another modality

´́I hear the voice of my long dead father, as if he were talking toI hear the voice of my long dead father, as if he were talking tome now, if/after I hear water running from the bath tap.µme now, if/after I hear water running from the bath tap.µ



HallucinationsHallucinations

Auditory Auditory

Visual Visual

Tactile Tactile Olfactory Olfactory

Gustatory Gustatory



A uditory hallucinations A uditory hallucinations

Thought Echo: hearing ones thought spoken Thought Echo: hearing ones thought spoken

aloudaloud

Second person: voices talking to the personSecond person: voices talking to the person Third person: voices discussing, arguing.. Third person: voices discussing, arguing..

Command hallucinationsCommand hallucinations

Running commentary Running commentary



MoodMood -- A ffect A ffect

MOODMOOD--Pervasive and sustained feeling tonePervasive and sustained feeling tone

that is experienced internally and that, in thethat is experienced internally and that, in theextreme, can markedly influence virtually allextreme, can markedly influence virtually all

aspects of a person's behavior and perception of aspects of a person's behavior and perception of the world. Distinguished fromthe world. Distinguished from affectaffect, the, the

external expression of the internal feeling tone.external expression of the internal feeling tone.



DepressionDepression Pervasive lowering of mood accompanied by Pervasive lowering of mood accompanied by

feelings of sadness and a loss of ability tofeelings of sadness and a loss of ability to

experience pleasureexperience pleasureElation of moodElation of mood

Excessive cheerfulnessExcessive cheerfulness

Can progress to ecstasy Can progress to ecstasy



A bnormalities in the variability of A bnormalities in the variability of

moodmood

ReducedReduced eg blunt,flat,rescrictedeg blunt,flat,rescricted

IncreasedIncreased eg lability,exapansiveeg lability,exapansive

Emotional incontinenceEmotional incontinence

Incongruity/inappropriatenessIncongruity/inappropriateness of affectof affect

Mood and thinking do not correspond to each otherMood and thinking do not correspond to each other



Disorders of self Disorders of self

DepersonalisationDepersonalisation

Experience of being unreal, detached and unable to feelExperience of being unreal, detached and unable to feelemotionemotion

DerealisationDerealisation

Similar experience related to environmentSimilar experience related to environment



Motor signs and symptomsMotor signs and symptoms

NegativismNegativism An apparently motiveless resistance to all instructions An apparently motiveless resistance to all instructionsor attempts to be movedor attempts to be moved

Posturing Posturing Voluntary assumption of bizarre and abnormal Voluntary assumption of bizarre and abnormalposturespostures

MutismMutismabsence of speech without impairment in consciousnessabsence of speech without impairment in consciousness

Waxy flexibility Waxy flexibility Maintenance of limbs and body in externally imposedMaintenance of limbs and body in externally imposedpositionspositions



Motor signs and symptomsMotor signs and symptoms

EcholaliaEcholaliaPurposeless repetition of words/phrases spoken by thePurposeless repetition of words/phrases spoken by theexaminerexaminer

EchopraxiaEchopraxiaPurposeless repetition of the body movements of thePurposeless repetition of the body movements of theexaminerexaminer

StuporStuporMarked decrease in reactivity to the environment andMarked decrease in reactivity to the environment and

in spontaneous movements and activity in spontaneous movements and activity ExcitementExcitement

Apparently purposeless increased motor activity not Apparently purposeless increased motor activity notinfluenced by external stimuliinfluenced by external stimuli



A bnormalities of memory A bnormalities of memory

Anterograde Anterograde amnesiaamnesia

Period between the event and the resumption of Period between the event and the resumption of continuous memory continuous memory

Retrograde amnesiaRetrograde amnesiaPeriod of amnesia between an event and the lastPeriod of amnesia between an event and the last

continuous memory continuous memory

Déjà vuDéjà vu

A sense that events experienced for the first time have A sense that events experienced for the first time havebeen encountered beforebeen encountered before



A bnormalities of memory A bnormalities of memory

Jamais vu Jamais vu

Failure to recognise events that have beenFailure to recognise events that have been

encountered beforeencountered before

ConfabulationConfabulation

Describing plausibly false memories for a period forDescribing plausibly false memories for a period for which the patient is amnesic which the patient is amnesic



A bnormalities of consciousness A bnormalities of consciousness

Clouding of consciousnessClouding of consciousness

A state of drowsiness with incomplete reaction to A state of drowsiness with incomplete reaction tostimulistimuli

StuporStupor

Absence of response and movement along with Absence of response and movement along with

mutism. Consciousness may be preservedmutism. Consciousness may be preserved



InsightInsight

Patient·s awareness of morbid nature of the experiencePatient·s awareness of morbid nature of the experience

Assessed by Assessed by

A wareness of the nature of individual symptoms A wareness of the nature of individual symptoms

Whether they believe they are ill Whether they believe they are ill

Whether they think the illness is physical or Whether they think the illness is physical or

mentalmental

Whether they think they need treatment Whether they think they need treatment



Judgement Judgement

M ental act of comparing or evaluating choices within the M ental act of comparing or evaluating choices within the

framework of a given set of values for the purpose of framework of a given set of values for the purpose of

electing a course of action electing a course of action ..

If the course of action chosen is consonant with reality If the course of action chosen is consonant with reality or with mature adult standards of behavior, judgment isor with mature adult standards of behavior, judgment issaid to be intact or normal; judgment is said to besaid to be intact or normal; judgment is said to be

impaired if the chosen course of action is frankly impaired if the chosen course of action is frankly maladaptive, results from impulsive decisions based onmaladaptive, results from impulsive decisions based onthe need for immediate gratification, or is otherwise notthe need for immediate gratification, or is otherwise notconsistent with reality as measured by mature adultconsistent with reality as measured by mature adult

standardsstandards



Thank you









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Psychopathology-SRIK 2010.B-12