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General PsychopathologyGeneral Psychopathology
Department of Psychiatry, First Faculty of Medicine, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Charles University and General University Hospital in
Prague Prague
Head: Prof. MUDr. Jiří Raboch, DrSc.Head: Prof. MUDr. Jiří Raboch, DrSc.
Basic Terms in PsychiatryBasic Terms in Psychiatry Psychiatry Psychiatry studies the causes of mental disorders, studies the causes of mental disorders,
gives their description, predicts their future course gives their description, predicts their future course and outcome, looks for prevention of their and outcome, looks for prevention of their appearance and presents the best ways of their appearance and presents the best ways of their treatmenttreatment
PsychopathologyPsychopathology describes symptoms of mental describes symptoms of mental disordersdisorders
Special psychiatrySpecial psychiatry is devoted to individual mental is devoted to individual mental diseasesdiseases
General psychiatryGeneral psychiatry studies psychopathological studies psychopathological phenomena, symptoms of abnormal states of mind:phenomena, symptoms of abnormal states of mind:
1. consciousness1. consciousness 5. mood 5. mood (emotions)(emotions)
2. perception2. perception 6. intelligence6. intelligence3. thinking3. thinking 7. 7. motormotor4. memory4. memory 8. personality8. personality
Disorders of ConsciousnessDisorders of Consciousness Consciousness Consciousness is awareness of the self is awareness of the self
and the environmentand the environment Disorders of consciousness:Disorders of consciousness:
• qualitativequalitative• quantitativequantitative
short-termshort-term long-termlong-term
Hypnosis Hypnosis – artificially incited change of – artificially incited change of consciousnessconsciousness
SyncopeSyncope – short-term unconsciousness– short-term unconsciousness
Disorders of ConsciousnessDisorders of Consciousness Quantitative changes of consciousnessQuantitative changes of consciousness mean mean
reduced vigility (alertness):reduced vigility (alertness):• somnolencesomnolence• soporsopor• comacoma
Qualitative changes of consciousnessQualitative changes of consciousness mean mean disturbed perception, thinking, affectivity, memory disturbed perception, thinking, affectivity, memory and consequent and consequent motor motor disordersdisorders::• delirium (confusional state)delirium (confusional state) – characterized by disorientation, – characterized by disorientation,
distorted perception, enhanced suggestibility, distorted perception, enhanced suggestibility, misinterpretations and mood disordersmisinterpretations and mood disorders
• obnubilation (twilight state)obnubilation (twilight state) – starts and ends abruptly, – starts and ends abruptly, amnesia is complete; the patient is disordered,amnesia is complete; the patient is disordered, his acting is his acting is aimless, sometimes aggressive, hard to understoodaimless, sometimes aggressive, hard to understood
stuporousstuporous vigilambulantvigilambulant deliriousdelirious Ganser syGanser sy
Disturbances of PerceptionDisturbances of Perception PerceptionPerception is a process of becoming aware of what is a process of becoming aware of what
is presented through the sense organsis presented through the sense organs ImageryImagery means an experience within the mind, means an experience within the mind,
usually without the sense of reality that is part of usually without the sense of reality that is part of realityreality
PseudoillusionsPseudoillusions – distorted perception of objects – distorted perception of objects which may occur when the general level of which may occur when the general level of sensory stimulation is reducedsensory stimulation is reduced
IllusionsIllusions are psychopathological phenomena; are psychopathological phenomena; they appear mainly in conditions of qualitative they appear mainly in conditions of qualitative disturbances of consciousness (missing insight)disturbances of consciousness (missing insight)
HallucinationHallucination are percepts without any obvious are percepts without any obvious stimulus to the sense organs; the patient is unable stimulus to the sense organs; the patient is unable to distinguish it from realityto distinguish it from reality
Disturbances of PerceptionDisturbances of PerceptionHallucinations:Hallucinations: auditory (acousma)auditory (acousma) visualvisual olfactoryolfactory gustatorygustatory tactile (or deep somatic)tactile (or deep somatic) extracampine, inadequateextracampine, inadequate intrapsychic intrapsychic (belong rather to disturbances of thinking)(belong rather to disturbances of thinking) hypnagogic and hypnopompic (hypnexagogic)hypnagogic and hypnopompic (hypnexagogic)
PseudohallucinationsPseudohallucinations - patient can distinguish - patient can distinguish them from realitythem from reality
Disorders of ThinkingDisorders of Thinking
ThinkingThinking
Cognitive functionsCognitive functions
Disorders of thinking:Disorders of thinking:• quantitativequantitative• qualitativequalitative
Quantitative Disorders of Quantitative Disorders of ThinkingThinking
Quantitative (formal) disorders of thinkingQuantitative (formal) disorders of thinking:: pressure of thoughtpressure of thought poverty of thoughtpoverty of thought thought blockingthought blocking flight of ideasflight of ideas perseverationperseveration loosening of associationsloosening of associations word salad - incoherent thinkingword salad - incoherent thinking neologismsneologisms verbigerationverbigeration
Qualitative Disorders of Qualitative Disorders of ThinkingThinking
Quantitative disorders of thoughtQuantitative disorders of thought (content (content thought disorders):thought disorders):
Delusions: Delusions:
a)a)belief firmly held on inadequate grounds,belief firmly held on inadequate grounds,
b)b)not affected by rational argumentsnot affected by rational arguments
c)c)not a conventional beliefnot a conventional belief ObsessionsObsessions (obsessive thought) are recurrent (obsessive thought) are recurrent
persistent thoughts, impulses or images entering the persistent thoughts, impulses or images entering the mind despite the person's effort to exclude them. mind despite the person's effort to exclude them. Obsessive phenomena in acting (usual as senseless Obsessive phenomena in acting (usual as senseless rituals – cleaning, counting, dressing) are called rituals – cleaning, counting, dressing) are called compulsionscompulsions..
Qualitative Disorders of Qualitative Disorders of ThinkingThinking
Division of delusions:Division of delusions: according to onsetaccording to onset
a)a) primary (delusprimary (delusionion mood, perception) mood, perception)b)b)secondary (systematized)secondary (systematized)c)c) shared (folie a deux)shared (folie a deux)
according to themeaccording to themea)a) paranoid (persecutoryparanoid (persecutory) - d. of reference, d. of jealousy, d. of ) - d. of reference, d. of jealousy, d. of
control, d. concerning possession of thoughtcontrol, d. concerning possession of thoughtb)b)megalomanic (grandiose, expansive)megalomanic (grandiose, expansive) – d. of power, worth, – d. of power, worth,
noble origin, supernatural skills and strength, amorous d.noble origin, supernatural skills and strength, amorous d.c)c) depressive (micromanic, melancholic)depressive (micromanic, melancholic) – d. of guilt and – d. of guilt and
worthlessness, nihilistic d., hypochondriacal d.worthlessness, nihilistic d., hypochondriacal d.d)d)concerning the possession of thoughtsconcerning the possession of thoughts
thought insertionthought insertion thought withdrawalthought withdrawal thought broadcastingthought broadcasting
Disorders of MemoryDisorders of Memory Sensory storesSensory stores - retains sensory - retains sensory
information for 0.5 sec.information for 0.5 sec. Short - term memory (working memory)Short - term memory (working memory)
- for verbal and visual information, retained - for verbal and visual information, retained for 15-20 sec., low capacityfor 15-20 sec., low capacity
Long-term memoryLong-term memory – wide capacity and – wide capacity and more permanent storagemore permanent storage• declarative (explicit) memory – episodic (for declarative (explicit) memory – episodic (for
events) or semantic (for language and events) or semantic (for language and knowledge)knowledge)
• procedural memory – for motor artsprocedural memory – for motor arts• priming – unconscious memorypriming – unconscious memory• conditioning – classic or emotionalconditioning – classic or emotional
Disorders of MemoryDisorders of Memory
Disorders of memory:Disorders of memory: Amnesia – inability to recall past eventsAmnesia – inability to recall past events Jamais vu, déja vuJamais vu, déja vu Confabulation, amnesic disorientation, Korsakov’s Confabulation, amnesic disorientation, Korsakov’s
syndromesyndrome Pseudologia phantasticaPseudologia phantastica
HypomnesiaHypomnesia HypermnesiaHypermnesia
Disorders of AttentionDisorders of Attention ConcentrationConcentration CapacityCapacity TenacityTenacity IrritabilityIrritability VigilityVigility
Hypoprosexia (global, selective)Hypoprosexia (global, selective) HyperprosexiaHyperprosexia ParaprosexiaParaprosexia
Disorders of Mood (Emotions)Disorders of Mood (Emotions)
Normal affectNormal affect – brief and strong emotional – brief and strong emotional responseresponse
Normal moodNormal mood – subjective and for a longer – subjective and for a longer time lasting disposition to appear affects time lasting disposition to appear affects adequate to a surrounding situation and adequate to a surrounding situation and matters discussedmatters discussed
Higher emotionsHigher emotions::• intellectualintellectual• aestheticaesthetic• ethicethic• socialsocial
Disorders of Mood (Emotions)Disorders of Mood (Emotions)
Pathological affectPathological affect – very strong, abrupt affect with – very strong, abrupt affect with a short change of consciousness on its peaka short change of consciousness on its peak
Pathological moodPathological mood – two poles: – two poles:• manicmanic• depressivedepressive
PhobiaPhobia – persistent irrational fear and wish to avoid – persistent irrational fear and wish to avoid a specific situation, object, activity:a specific situation, object, activity:• agoraphobiaagoraphobia• claustrophobiaclaustrophobia• social phobiassocial phobias• hipsophobiahipsophobia• aichmophobiaaichmophobia• keraunophobiakeraunophobia
DepersonalizationDepersonalization – change of self-awareness, the – change of self-awareness, the person feels unreal,person feels unreal, unable to feel emotionunable to feel emotion
Disorders of Mood (Emotions)Disorders of Mood (Emotions) Pathological mood:Pathological mood:
• origin – based on pathological grounds, no psychological origin – based on pathological grounds, no psychological causecause
• duration – unusually long-lastingduration – unusually long-lasting• intensity – unusually strong, large changes in intensityintensity – unusually strong, large changes in intensity• impossibility to be changed by psychological meansimpossibility to be changed by psychological means
Pathological features of mood:Pathological features of mood:• euphoriaeuphoria• expansiveexpansive• exaltationexaltation• explosiveexplosive• maniamania• hypomaniahypomania• depressiondepression• apathy (anhedonia)apathy (anhedonia)• blunted, flattened affectblunted, flattened affect• emotional labilityemotional lability• helplesshelpless
IntelligenceIntelligence Disorders Disorders Intelligence:Intelligence:
• abstractabstract• practicalpractical• socialsocial
Intelligence quotient (IQ): Intelligence quotient (IQ):
IQ = (mental ageIQ = (mental age :: calendar age) x 100calendar age) x 100
Disorders of intellect:Disorders of intellect:• mental retardationmental retardation• dementiadementia
Motor DisordersMotor Disorders
quantitative::
• hypoagilityhypoagility• hyperagilityhyperagility• agitated behaviouragitated behaviour
qualitativequalitative::• mannerismsmannerisms• stereotypiesstereotypies• posturingposturing• waxy flexibilitywaxy flexibility• echopraxiaechopraxia• schizophrenic impulseschizophrenic impulse• negativismnegativism• short-circuit behaviourshort-circuit behaviour• automatismautomatism• agitationagitation• ticstics• abuliaabulia• compulsionscompulsions
Motor disordersMotor disorders occur frequently in mental occur frequently in mental disorders of all kinds, especially in catatonic disorders of all kinds, especially in catatonic schizophreniaschizophrenia..
Disorders of VolitionDisorders of Volition
Disorders of volitionDisorders of volition::• hypobuliahypobulia• abuliaabulia• hyperbuliahyperbulia
Disorders of PersonalityDisorders of Personality
Personality Personality means a complex of means a complex of persistent mental and physical traits of a persistent mental and physical traits of a personperson
Disturbances of personality:Disturbances of personality:• transformation of personalitytransformation of personality• appersonalizationappersonalization• multiple personality (alteration of personality)multiple personality (alteration of personality)• specific personality disorderspecific personality disorder• deprived personalitydeprived personality
Instruction to manufacturing Instruction to manufacturing (straight from the hell …)(straight from the hell …)
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