Introduction to Psychopathology PDF

06022025 Introduction to Psychopathology The Language of Psychiatry β language it Dr Y Minty, Department of Psychiatry Ynii...

06022025 Introduction to Psychopathology The Language of Psychiatry β language it Dr Y Minty, Department of Psychiatry Yniiaa.euiapresentation Acknowledgements: withother communicate Hopsinpsychiatry Dr T Melapi, Dr G Jonsson Overview of Lecture  Introductory vignette cases  Psychiatric symptom clusters signs disturbances  Case vignette discussion frombeginningoflectures Case Vignette A 34 year old male patient comes to see you, having being referred to you by his family. They are concerned that he has been acting strangely for the past 6 months, and this has gotten progressively worse. His family complains to you that they have seen him talking to unseen objects and he never seems to sleep. He has been writing excessively in a diary which he refuses to show to anyone. He has not bathed in a week and seems suspicious of any food they give him. He does not believe that he has a problem and is not happy about coming to see the doctor. On Further Enquiry You discover that he has been using cannabis for the last year and was previously told that he has schizophrenia, by a nurse in the community. He admits to hearing the voice of God who is instructing him to observe everyone and write it all down in his diary as it will become the law on completion. He does not find this strange and in fact has written to parliament, describing his actions and his instructions from God. Your Findings Your patient is initially calm and cooperates with you. You note that he is unkempt and dishevelled. Later on, he becomes agitated as you continue to question him. You struggle to make sense of what he is saying, as he seems to provide very little ‘useful information’. His speech sounds nonsensical. No matter what you ask him, he only seems to want to talk about is his relationship with God. He seems to be talking to himself in the consultation. He does not appear to believe that anything is wrong with him. Assessment  You assess him as having schizophrenia  What signs and symptoms support this (history taking)?  Hallucinations, delusions  What do you find on your examination of the patient (mental state exam)?  Disorganised appearance  Disorganised speech and thoughts  Abnormal psychomotor behaviour  Poor insight and judgement willbediscussedlater The Language of Psychopathology  Psychopathology is the term used to describe abnormalities in a patient’s thinking, beliefs, mood, behaviour and cognitive functioning that point towards a psychiatric diagnosis  Look for patterns in a constellation of signs and symptoms – constitutes a psychiatric syndrome/diagnosis a Disturbances of Consciousness consciousnessDefinitions  Being aware of and having knowledge of surroundings and environment rangesfrom  Occurs on a continuum (fully alert → unconscious)  Attention – ability to mentally attend to and focus on one or more aspects of the environment  Concentration – sustained focus or attention to a particular task or aspect of environment  Delirium (disturbance of cognitive functioning, due to some medical cause) – impaired awareness and attention to surroundings Disturbances of Consciousness - Psychopathology  Psychopathology terms –  Disorientated – not fully aware of place, time or personal info egnamesdateofbirthetc offgeq.gginptswith  Stuporous – not fully awake or aware of surroundings looking sleepyaretoa psychiatriccause  Impaired attention – lacking complete or full attention  Distractible – attention is easily diverted Eaten to  Hypervigilant – too highly focused on a particular fixated hyper onsomething aspect of the environment (while not paying attention to other aspects) Disturbances of Perception  Complex process which aims to make sense of physical/environmental stimuli Epeien.in5siYn enYppens  Illusions vs hallucinations types Illusion Hallucination Misperception of an Sensory perception in the existing/real sensory absence of an external stimulus sensorystimuluspresent stimulus tmall.mseYotmInIgare Disturbances of Perception - Psychopathology  Types of illusions – smaller larger  Micropsia vs macropsia (objects perceived as smaller or larger than actual size)  Synaesthesia – experiencing a stimulus in the incorrect sensory modality egseeingasoundorhearingtaste  Types of hallucinations (five senses) –  Auditory eghearingvoices  Visual egseeingdeadpeople  Olfactory  Gustatory  Tactile feelingstrangesensations feelingscratures Disturbances of Thought Form and Content Thought  Ideational experiences as opposed to emotive experiences  Rational thought – goal directed flow of ideas, logical association of concepts, reality-orientated  Thought form disturbances – problem in the way putthoughtstogetherin athem thoughts are put together (and expressed) can't coherentform can'texpress  Thought content disturbances – problems with the ideas that are being thought about and expressed Disturbances of Thought Form and Content - Psychopathology  Thought form disturbances –  Circumstantiality – unnecessary detail, ‘beats around the bush’ ite eE in  Tangentiality – diverts from actual topic it Eritrea  Derailment/loosening of associations – ideas/topics are unrelated Isee following example  Thought blocking – sudden stop in the flow of thoughts/speech abruptspeechhalt  Echolalia – echoing/repeating the words of another  Flight of ideas – thoughts/speech jump from one topic to another, occursinmaniapts often distracted by environmental stimuli oftenbipolardisorder  Incoherence – illogical, unclear, hard to follow  Irrelevance – response unrelated to actual topic  Word salad – nonsensical jumble of words that make no sense no clearsentence structure  Neologisms – newly formed words/expressions that have no clear prior establishment wordsmadeupbypt Disturbances of Thought Form and Content - Psychopathology I put the salad in the fridge when I left the house. Then my uncle went swimming in the river because the dogs liked to chew bones at that time of the day – loosening of associations Yea peace no I went to watch that movie with my mom. My mom has two pet dogs that are now very old. I saw a dog the other day, lying on the road, it looked so sick. You know, I had flu the other day and wasn’t feeling so well – flight of ideas 8hftp.tfedanInEndompts jumpsfrom noassociation betweensentencesor relationship The nerflexes in my head are scrounding - neologisms madeupwords Disturbances of Thought Form subsequentiallyspeech and Content - Psychopathology  Thought content disturbances –  Delusions – fixed, false belief that is firmly held cannotbechallenged  Magical thinking – ‘superstitious’ thinking Tiree.no i i i Eien  Poverty of thought content – lacking detail and richness vaguesentence  Overvalued ideas – ideas that are held very strongly (but not delusional) aeneeesai.isepigions  Fantasy – imaginary/wishful thinking, not realistically based  Phobia – irrational intense fears phobia ofsmall spacesdogsnotesetc  Obsession – idea/thought that is intrusive and causes distress common inobsessivecompulsive disordersintrusivethoughts  Ideas of reference – strong belief that one’s actions/behaviour has a strong correlation with unrelated external factors Enition Disturbances of Thought Form and Content - Psychopathology  Types of delusions –  Control – body/mind/actions being controlled by another  Bizarre – outside of the realm of possibility esspace shhooikigta.fi fai5dausions a  Grandiose – involving fame, wealth, high status etc delusionsofbeingmillionaires famousactorsetc  Nihilistic – idea that individual/others/the world is non- existent, not alive, dead etc  Religiose – involves religiose concepts, eg Jesus, God, prophetic powers etc eg.ggiisEesre  Persecutory – belief that others wish one harm/pain/death/are jealous invalid veactionsperpetrated onindividual  Referential – external unrelated events have special reference meaning to an individual egradio songthatwasspecifically playedfor them  Somatic – involving aspects of the body egptsarepregnant believing they Disturbances of Speech and Language  How thoughts, ideas and emotions are expressed  Disturbances can be a result of – anydetailunentalking includingtoomuchunneces  Too much speech (talkative, over-inclusive, pressured speech)  Too little speech (impoverished/poverty of if intense bant speech/mutism) Initiate astute beingaisle I talk  Quality of speech (loud, soft, monotonous, staccato) Disturbances of Mood and Affect  Mood – subjective internal experience of a sustained emotion, can be observed by others whatptfeels  Affect – external representation/expression of the internal mood/emotion unity feelingswhat nowtheyshowuswhat they'refeeling Disturbances of Mood - Psychopathology  Words used to describe mood –  Euthymic – ‘normal’ stable  Dysphoric – unhappy, uneasy, ‘not normal’  Depressed  Irritable  Elevated – overly happy happierthannormal  Expansive – overly friendly, boisterous, loud  Euphoric – overly excited Disturbances of Affect - Psychopathology  Words used to describe affect –  Appropriate/congruent – mood and affect match 55 Piaget the fish's  Inappropriate/incongruent – mood and affect don’t match es.EEtein isaa  Reactive – appropriate range of facial expression  Restricted – restricted range of facial expression  Blunted – no facial expression worsethanrestriction  Flat – no reactions worsethanblunted  Labile – changes quickly, not stable Yes p Disturbances of Mood and Affect  Other ways to describe emotions –  Anxious/fearful  Anhedonia – loss of interest in pleasurable activities (associated with depression)  Alexithymia (inability to recognise and express emotions) eitherinone'sownselfor in peoplearoundyou other Memory and Learning Disturbances anosteps involves Tennis  myregistration, retention, recallageiger Process of forming memories – attention, being event einitial a  Types (levels) of memory –  Immediate esfrom hsechnttoemm.PE  Short term/recent in Emayeredfrom memories  Long term egchildhood years since memons  Working memory tianya.it sntiienmEgtagainiater e5EEimb  Memory disturbances – canttormnewmemaies iogenpgguio.us Ent.fi clossofmemory 9speesortim mmmbiossotALLmemoriesfromevery  Amnesia – anterograde vs retrograde, selective vs global aspect  Confabulation – ‘fills in the gaps’ with fabricated ideas/responses Confabulation refers to the unintentional recollection of false memories, including elaborations or  Pseudodementia – type of memory/cognitive disturbance that embellishments that can range from subtle to occurs in patients with depression nostructualorpermanentcognitiveproblem delusional in nature. maycause psychiatry ix likedepression ix memory hisbutoncedepressionisresolved fiigginthe gaps cognitivedisturbance is dementia calledpseudo Motor Disturbances  Motor functioning –  Capacity to plan, initiate and appropriately execute an action  Motor disturbances –  Too much movement – psychomotor agitated (anxiety, irritability, mania)  Too little movement – psychomotor retarded (depression, medication side effects)  Abnormal movements – tremor, gesticulation, mannerisms, odd repetitive behaviours serious life disorder quite threatening  Catatonia – psychiatric syndrome which involves many abnormal motor features Motor Disturbances - Psychopathology  Types of abnormal behaviours –  Tic – sudden short-lived involuntary movement/action or vocalisation  Mannerism – habitual involuntary action or behaviour  Automatism – automatic, unconscious repetition of an act  Stereotypical movements – bizarre, repetitive, purposeless movements  Akathisia – subjective (often distressing) desire to be in constant motion  Mutism – absence of speech production/verbal engagement, no structural abnormality thatpreventspt fromtalking  Echopraxia – imitation of the movements of another individual Insight and Judgement  Insight – ability to understand and appreciate the nature and true meaning of one’s illness or symptoms completelynocomprehension r  Insight can be poor/absent, partial/superficial, fair or good seendefending  Judgement – ability to act rationally and make correct and reasonable decisions  When insight is poor, judgement is impaired ie. When a pt doesn't understand their illness or how what they do will impact their functioning, the decisions they make will be poor and they won't be able to act rationally  A mental status exam is an important tool healthcare providers use to evaluate your mental capacity This includes your cognition, mood, behaviour and perceptions Mental State Exam These exams can help point to mental health or neurological conditions you may have. But you'll likely need more testing to con rm a diagnosis. It is the equivalent of a physical exam in a medically ill pt to assess the pt You do this throughout the entire consultation and not just at the end  Appearance – dishevelled/unkempt, neatly dressed, flamboyant  Motor behaviour – psychomotor agitated/retarded, abnormal behaviours  Attitude towards examiner – friendly, hostile, unco-operative  Reliability – responses are factual? can you into relyonthe theptgives youtomakea Dx assessment  Level of consciousness – clear/clouded  Speech  Mood and affect  Thoughts (form and content)  Perceptual disturbances – hallucinations or illusions  Insight and judgment MinimentalstatExam  Basic cognitive screening – Folstein’s MMSE mm Folstein’s Mini Mental State Exam Example Cognitive screening tools (such as the MMSE) are brief instruments or tools which are used to assess an individual’s cognitive capacity (higher brain functions). These include orientation, memory, language functions, visuospatial functions and ability to follow instructions. Back to the vignette…. A 34 year old male patient comes to see you, having being referred to you by his family. They are concerned that he has been acting strangely for the past 6 months, and this has gotten progressively worse. His family complains to you that they have seen him talking to unseen objects and he never seems to sleep. He has been writing excessively in a diary which he refuses to show anyone. He has not bathed in a week and seems suspicious of any food they give him. He does not believe that he has a problem and is not happy about coming to see the doctor. You discover that he has been using cannabis for the last year and was previously told that he has schizophrenia, by a nurse in the community. He admits to hearing the voice of God who is instructing him to observe everyone and write it all down in his diary as it will become the law on completion. He does not find this strange and in fact has written to parliament, describing his actions and his instructions from God. Your patient is initially calm and cooperates with you. You note that he is unkempt and dishevelled. Later on, he becomes agitated as you continue to question him. You struggle to make sense of what he is saying, as he seems to provide very little ‘useful information’. His speech sounds nonsensical. No matter what you ask him, he only seems to want to talk about his relationship with God. He seems to be talking to himself in the consultation. He does not appear to believe that anything is wrong with him. A 34 year old male patient comes to see you, having being referred to you by his family. They are concerned that he has been acting strangely for the past 6 months, and this has gotten progressively worse. specifically His family complains to you that they h allucinationhe's anauditory have seen him been teens iiion teatiftggggg.in Disorganised talking to unseen objects and he never seems to sleep. He has been writing excessively in a diary which he behaviour refuses to show anyone. wants family believes himperceptions tokill He has not bathed in a week and seems suspicious of any food they give him. He does not believe that he has a problem and is not happy about coming to see the doctor. Delusions You discover that he has been using cannabis for the last year and was previously told that he has schizophrenia, by a nurse in the community. h allucination auditory He admits to hearing the voice of God who is instructing him to observe everyone and write it all Hallucinations down in his diary as it will become the law on completion. raiseGoainvolved He does not find this strange and in fact has written to parliament, describing his actions and his instructions from God. Appearance Your patient is initially calm and cooperates with you. You note that he is unkempt and dishevelled.will state mental on benoticed exam Later on, he becomes agitated as you continue to Attitude, motor question him. behaviour You struggle to make sense of what he is saying, as he seems to provide very little ‘useful thoughtdisorder Thought disorder information’. His speech sounds nonsensical. No matter what you ask him, he only seems to want to talk about his relationship with God. Insight He seems to be talking to himself in the consultation. He does not appear to believe that anything is wrong with him. hehaspoorinsigne likelyto have judgement insigne judgement Assessment  You assess him as having schizophrenia  What signs and symptoms support this (history taking)?  Hallucinations, delusions reasons  What do you find on your examination of the patient (mental state exam)?  Disorganised appearance  Disorganised speech and thoughts  Abnormal psychomotor behaviour ypppggn.nu  Poor insight and judgement  The End. Questions? Email – [email protected]