Symptomatology PDF

Presented by Omaima Ezzat Mahmoud Assis.Prof. of psychiatric mental health nursing  Introduction  Composition of Mind  Cognition  Disturbance of Thought  Disturbance of Perception  Disturbance of Memory  Disturbance of Consciousness  Disturbance of Attention and...

Presented by Omaima Ezzat Mahmoud Assis.Prof. of psychiatric mental health nursing  Introduction  Composition of Mind  Cognition  Disturbance of Thought  Disturbance of Perception  Disturbance of Memory  Disturbance of Consciousness  Disturbance of Attention and concentration  Disturbance of Orientation  Disturbance of Insight  Disturbance of Judgment  Emotion  Disturbance of affect / mood  Behavior  Disturbance of behavior  References A symptom is usually defined as a subjective experience described by the patient, while a sign is defined as an objective finding observed by the nurse. In psychiatry, the terms symptom and sign tend to be used synonymously because abnormalities of mental state are largely elicited by exploring, with the patient, their internal experiences. The mind is composed of (3) spheres that represent the aspects of mental functioning. These spheres are interrelated to each other. They are:  Cognition (Mental process or Intellect).  Affect.  Behavior.  Cognition Behavior Affect  It includes the following functions:  Thought  Perception.  Memory.  Consciousness.  Attention and concentration.  Orientation.  Judgment.  Insight.  General knowledge.  Intelligence.  Thought Thinking is a mental activity which is described only by patient’s speech.  1- 1-Pressure of 1. Delusion speech 2- Obsession 2- Poverty of 3- Thought thought preoccupation 4- Suicidal 3- Blocking ideation They are related to the amount and the speed of thoughts which include the following:  Pressure of speech: Forceful rapid loud speech that increases in the amount and difficult to interrupt.  Poverty of speech: restriction in the amount of speech used; replies may be monosyllabic. Blocking: Sudden cessation in train of thinking before a thought or idea is finished, usually in the middle of a sentence. After a brief pause, person indicates no recall of what was being said or was going to be said. The patient feels suddenly that his mind has gone blank Example: Patient: "I was going to get a new dress for...." after the patient stops abruptly Nurse: "What just happened now?" Patient: "1 forgot what I was saying". A. General disturbances include : Before discussing the disorder of the form of thought we should define abstract thinking: it is the ability to conceptualize idea and to understand the implicit meaning behind sentences and to make interpretations about a comment. 1. Concrete thinking: Patient use literal meaning without understanding the implicit meaning behind sentences. Patient with concrete thinking has not the ability to conceptualize the words. So, patients with concrete thinking did not understand what is said to him.  Example:  Proverb (people who live in glass houses should not throw stones).  Concrete thinking answer:  Do not throw stones because windows will break. 2. Autistic thinking: It is a form of thinking that is egocentric and has no regard for reality. The patient is preoccupied with inner, private world in order to gratify in fantasy unfulfilled needs. It is seen in young children, in those who have lost or never developed the ability to generalize.  N.B. Concrete and autistic thinking are normal forms of thought during the early stages of personality development. They are related to amount and association between thoughts, the goal directed sequences and the succession of thoughts. Tangentiality: The patient never gets from desired point to the desired goal. So, he or she goes off the core of the topic. The speaker introduces many unrelated topics, until the original topic of discussion is lost, in which the central idea is not communicated. Example: The nurse asked the patient to talk more about his family. The patient continuously left the topic and talks about his apartment, his work and TV. Programs. Each time the nurse tried to help the patient to focus, he would go off on another topic. Circumstantiality : The patient gives countless and unnecessary details before communicating the central idea but gets from desired point to the desired goal. Example:  Nurse: Where are you going for the weekend?"  Patient: "Well!! First thought of going to my mother's place, but that was before. I remembered that she was going to my sister's house. My sister is having a picnic she always has. Picnics at the beach. The beach that she goes to is large and gets crowded. That is why Won't like that beach. So, I decided to go someplace else. I thought of going to my brother's house. He has a large house on a quiet street.......I finally decided to stay home." Flight of ideas: Rapid, continuous jumping from one idea to another. The connection between ideas is through stimuli from last idea or from an external stimulus. Example:  "Tell me, how is it going… going to my sister to get some money… money, honey., bees give honey. honey is sweet...." Loosening associations: Flow of thought in which ideas shift from one subject to another in a completely unrelated way, when severe, speech may be incoherent. Example: When the-wind bowled, the shoelaces were uptight. Incoherence: Mixture of phrases that have no meaning with no logical connection. The extreme is word salad. Example: "I am fine…. apple pie…no sale…. furniture store…. take it slow…” World salad: Incoherent mixture of words & phrase. that have no meaning with no logical connection. Example: "Birds... fishes.... mud.... stars...." Clang Association: The meaningless rhyming of words, in which the connection between words is their sound rather than their meaning and words have no logical connection. Example: "On the track...have a Big Mac...or get the sack...." Neologism: The person invents new words or phrases, often by combining syllables of other words. These new words only have a special meaning for the person (e.g., head shoe to mean hat). Example: "I want all the vetchkisses to leave the room". Retardation: Refers to slow speech and prolonged latent period before responding. Echolalia: Pathological repeating of words or phrases of one person by another Example: Nurse: Ms. Sally, come for your medication. Sally: Ms. Sally, come for your medication Palalial: Pathological repetition of the last word said. Example: Patient: “my name is Ahmed, Ahmed,"  Preservation:  Pathological repetition of the same response to different stimuli as in repetition to the same answer in response to different questions.  Example:  Nurse: How are you doing?  Patient: fine nurse just fine.  Nurse: Did you go for a walk?  Patient: fine nurse just fine.  Nurse: are you going out today?  Patient: fine nurse just fine. Irrelevant answer: The answer that is not in harmony with question asked (appears to ignore or not attend to question). Example: Nurse: Tell me your name? Patient: My mother is alive. Describe what the client saying it include:  Delusions.  Obsessions.  Suicidal ideation.  Thought preoccupation such as anorexia nervosa may have overloaded idea about being overweight.  It is a false fixed belief which cannot be accepted by persons of the same social standard as the patient express it, not consistent with patient's educational and cultural background, and cannot be corrected by logic or by reasoning and patient fight for it. Delusions are of many kinds and may be categorized as follows: a. Delusion of grandeur: The false fixed belief that one is a very powerful and important person. Example: I am known in all universes as the smartest person b. Delusion of persecution: False fixed belief of being harassed or persecuted or chased by another. Example: They poison my food through telepathy. c. Delusion of reference: False fixed belief that the behavior of others refers to oneself Example: People on television or radio are talking about the person. d. Delusion of infidelity: False belief that one's lover is unfaithful sometimes called (pathological jealousy). e. Litigious delusion: Pathological tendency to take legal actions because of imagined mistreatment, the patient writes complaints and sends them to a responsible person. f. Erotomaniac delusion: The patient believes that high status person, famous person has love relation with him. False belief that person's will, thoughts or feelings are being controlled by external forces. a. Thought withdrawal: False belief that one's thoughts are being removed from one's mind by other people or forces. b. Thought insertion: Delusion that thoughts are being implanted in one's mind by other people or forces. c. Thought broadcasting: Delusion that one's thoughts can be heard by others, as though they were being broadcast into the air. a. Nihilistic delusion: False feeling that self, a part of the body, others, or the world is nonexistent or ending. b. Delusion of self-blame False fixed belief that person is full of sins and unfit to live (worthless). c. Delusion of poverty: False belief that one is bereft or will be deprived of all material possessions. False fixed belief that person has a physical disease that is not based on a real organic pathology, but on unrealistic interpretations of physical signs or sensations as abnormal. False belief about body functions that the body is changing in an unusual way. Example: One's brain is rotting or melting, the bugs crawl under my skin and eat my brain. Pathological persistent & recurrent idea, thought, or impulse that cannot eliminated from consciousness by logical effort or reason, is associated with anxiety and against one's will. Centering of thought content on particular idea, associated with strong affective tone, such as anorexia nervosa may have overloaded idea about being overweight, paranoid trend or suicidal preoccupation. It is a recurrent idea affecting the individual to put an end by himself to his own life.