General SymptomatologyGeneral Symptomatology by Prof. Dr. Elham Fayadby Prof. Dr. Elham Fayad

Objectives :Objectives :

At the end of the session the At the end of the session the student will be able to :-student will be able to :-

Explain General symptomatology Explain General symptomatology of psychiatric disorder .of psychiatric disorder .

Contents :Contents :

General symptomatology of psychiatric General symptomatology of psychiatric disorders .disorders .

a- Composition of mind a- Composition of mind

1- Disorders of Intellect .1- Disorders of Intellect .

2- Disorders of Affect.2- Disorders of Affect.

3- Disorders of Behaviour .3- Disorders of Behaviour .

I- Disorder of ThoughtI- Disorder of Thought

a- Formal thought disordera- Formal thought disorder

Clinical manifestations of formal thought Clinical manifestations of formal thought disorderdisorder

11 - -Concrete thinkingConcrete thinking-: -:

Concreteness versus abstractnessConcreteness versus abstractness

22 - -Autistic thinkingAutistic thinking

Autistic versus realisticAutistic versus realistic

Disorders of the stream of thinkingDisorders of the stream of thinking

11 - -TangentialityTangentiality

22 - -CircumstantiallyCircumstantially

33 - -Looseness of associationLooseness of association

44 - -Flight of ideasFlight of ideas

55 - -Clang associationClang association

66 - -Incoherence or word saladIncoherence or word salad

77 - -Pressure of speechPressure of speech

88 - -Poverty of speechPoverty of speech

CONT. STREAM OF THOUGHTCONT. STREAM OF THOUGHT

99 - -RetardationRetardation

1010 - -BlockingBlocking

1111 - -PreservationPreservation

1212 - -PalilaliaPalilalia

1313--EcholaliaEcholalia

1414 - -Irrelevant answerIrrelevant answer

1515 - -NeologismsNeologisms

C- Disorder of the content of C- Disorder of the content of thoughtsthoughts: :

It includes:

1 -Delusion

2 -Obsession

3 -Preoccupation

4 -Suicidal ideation

11 - -DelusionDelusion

Definition Definition : It is false fixed : It is false fixed believe, not consistent with believe, not consistent with patient’s educational and patient’s educational and cultural background, that cannot cultural background, that cannot be corrected by logic or reasonsbe corrected by logic or reasons

Categorization of delusions:

1 -Paranoid delusions . .

2 -Delusion of influence

3 -Depressive delusion .

4 -Hypochondria cal delusion

11 - -Paranoid delusionParanoid delusion: :

a- a- Delusion of grandeurDelusion of grandeur

b- Delusion of persecutionb- Delusion of persecution

c-c- Delusion of reference Delusion of reference

d- d- Erotic delusionErotic delusion

e-e- Delusion of jealousy Delusion of jealousy

f-f- Delusion of infidelity Delusion of infidelity

g- g- Litigious delusionLitigious delusion

22 - -Delusion of influence Delusion of influence (delusion of control) false (delusion of control) false

belief that one is being belief that one is being controlled by others controlled by others

or agencies or agencies..

33 - -Depressive delusionDepressive delusion

a-a- Delusion of self-blame, guilt or sin Delusion of self-blame, guilt or sin

b- b- Delusion of povertyDelusion of poverty

c- c- Nihilistic delusionNihilistic delusion

44 - -Hypochondria cal delusionHypochondria cal delusion

Patient has false belief that he Patient has false belief that he has physical disease e.g. has physical disease e.g.

cancer stomach ,that is not cancer stomach ,that is not based on real organic based on real organic

pathology.pathology.

22 - -Obsessive thoughtsObsessive thoughts

Obsessive thoughts are intrusive Obsessive thoughts are intrusive thoughts invading the conscious thoughts invading the conscious awareness against the awareness against the resistance of the person in an resistance of the person in an involuntary way that is fully involuntary way that is fully aware that they are aware that they are unnecessary and absurdunnecessary and absurd

II- Disturbance in perceptionII- Disturbance in perception

11 - -HallucinationsHallucinations.. 22 - -IllusionIllusion..

TYPESTYPES::Visual: Seeing things that are not thereVisual: Seeing things that are not there..

Auditory : Hearing voices when none are Auditory : Hearing voices when none are presentpresent..Olfactory : Smelling smells that do not existOlfactory : Smelling smells that do not exist..

Tactile : Feeling touch sensations in the absence Tactile : Feeling touch sensations in the absence of stimuliof stimuli..

Gustatory: Experiencing taste in the absence of Gustatory: Experiencing taste in the absence of stimulistimuli. .

III- Unreality statesIII- Unreality states

11 - -Depersonalisation : A phenomenon whereby a Depersonalisation : A phenomenon whereby a person experiences a sense of unrealityperson experiences a sense of unreality

or self -estrangementor self -estrangement. .

22 - -Derealization : The false perception by a Derealization : The false perception by a person that his or her environment has person that his or her environment has

changedchanged. .

Also they can be categorized under affect Also they can be categorized under affect and perceptionand perception. .

IV- Disorder of memoryIV- Disorder of memory

11 - -AmnesiaAmnesia types of amnesiatypes of amnesia: :

a-a- Anterograde amnesia :Anterograde amnesia : Loss of memory for Loss of memory for recent eventsrecent events..

b-b- Retrograde amnesia :Retrograde amnesia : Loss of memory for Loss of memory for remote eventsremote events. .

c-c- Total amnesia :Total amnesia : Loss of memory for recent and Loss of memory for recent and remote eventsremote events. .

d-d- Circumscribed amnesia :Circumscribed amnesia : Loss of memory for Loss of memory for limited timelimited time. .

22-- Par amnesia :Par amnesia : it denotes false recall it denotes false recall..a- Confabulation :a- Confabulation : Patient fills the gaps in his Patient fills the gaps in his

memory by fabricationmemory by fabrication. . b- Falsification :b- Falsification : Patient adds fraises details to a Patient adds fraises details to a

true memorytrue memory. . 33-- Hyperamnesia :Hyperamnesia : It’s excessive memory, the It’s excessive memory, the

patient mentions even unnecessary detailspatient mentions even unnecessary details..44-- Deja vu phenomena (already seen ) :Deja vu phenomena (already seen ) : in which in which

new situation is experienced as previouslynew situation is experienced as previously..55-- Jamais vu phenomena :Jamais vu phenomena : in which familiar in which familiar

situation is experienced as novelsituation is experienced as novel..

V- Orientation ,disorientationV- Orientation ,disorientation11 - -OrientationOrientation :: the ability to relate the self the ability to relate the self

correctly to time ,place and personcorrectly to time ,place and person..22 - -Disorientation :Disorientation : confusion and confusion and

impaired ability to identify time, place and impaired ability to identify time, place and personperson. .

VI- JudgementVI- Judgement: is the ability to assess a : is the ability to assess a situation correctly and act appropriately situation correctly and act appropriately within that situationwithin that situation..

VII - InsightVII - InsightIt is the ability to understand the objective It is the ability to understand the objective condition of his illnesscondition of his illness..

VIII- Attention and concentrationVIII- Attention and concentration It is the direction of the focus of awareness It is the direction of the focus of awareness and perception to a particular stimulusand perception to a particular stimulus..

* *Distractibility :Distractibility : inability to maintain inability to maintain attention, shifting from one area or topic to attention, shifting from one area or topic to

another with minimal provocationanother with minimal provocation. .

X- Disorder of affectX- Disorder of affect

a-a- Inappropriate affect Inappropriate affect : : (incongruity),it is a (incongruity),it is a disharmony of affect and ideationdisharmony of affect and ideation..

b- Pleasurable affectb- Pleasurable affect: :

11 - -EuphoriaEuphoria

22 - -ElationElation

33-- ExaltationExaltation

44-- EcstasyEcstasy

c- Depressive affectc- Depressive affect: : d- Inadequate affectd- Inadequate affect

11-- ApathyApathy 22 - -IndifferenceIndifference

e- Ambivalencee- Ambivalence

g- Anxiety .Apprehension, Fear and Phobiag- Anxiety .Apprehension, Fear and Phobia 11 - -Anxiety :A state of feeling, uneasiness , uncertaintyAnxiety :A state of feeling, uneasiness , uncertainty

22 - -Apprehension :-Apprehension :- Intense fear of any non-fearful Intense fear of any non-fearful

stimulusstimulus 33 - -Fear :Fear : A reaction to a specific dangerA reaction to a specific danger. .

44 Phobias :-Phobias :- An intense irrational fear of an object, An intense irrational fear of an object, situation or placesituation or place

XI- Disorder of behaviourXI- Disorder of behaviour

a-a- Hyperactivity :- Hyperactivity :- It includes It includes 11 - -AgitationAgitation

22-- ExcitementExcitement b-b- Psychomotor retardationPsychomotor retardation c-c- Repetitive activitiesRepetitive activities

11 - -StereotypyStereotypy 2- mannerism 2- mannerism 33 - -Preparation 4- Way flexibilityPreparation 4- Way flexibility

55 - -Catalepsy ( posturingCatalepsy ( posturing ) )

dd-- Echopraxia Echopraxia

e-e- Negativism Negativism

f-f- Automatic Obedience Automatic Obedience

g-g- ImpulsivenessImpulsiveness

h-h- Compulsion Compulsion