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psychegr. psukhein to breathe
psukhē breath, soul
The mind as the center of thought, emotion, and behavior, consciously or unconsciously adjusting or mediating the body's responses to the social
and physical environment
Definitive classification of disease must be based on aetiology
Pragmatic approach to classification that will best enable us to care for our patients,
communicate with other health professionals,carry out high-quality research
How should the mind be conceived?
What are the mind’s faculties, functions, or elements (if there are any)?
How can these be distinguished?
How can mental disorders be comprehended by application of these principles?
Manfred Spitzer
Psychopathology:Systematic study of abnormal experience, cognition and
behaviour
Study of the products of the disordered mind
The science and study of psychological and psychiatric symptoms
Description, delineation, differentiation of the morbid phenomena that constitute the subjective experience of
patients
empathy: gr. feeling oneself intoClinical instrument:
measuring another person’s subjective state
using the observer’s own capacity for emotional and cognitive experience as a yardstick
giving an account of the patient’s inner experience that the patient recognizes as his/her own
NOT sympathy: gr. feeling with
Mrs Jenkins complains that she is unhappy
descriptive psychopathology: elicit thoughts and actions without trying to explain them;
Observation: listless sagging of shoulders; tense gripping and wringing of her hands-> use in MSE
Phenomenology: ‘that horrible feeling of not really existing’; ‘not being able to feel any emotion’
-> use in ‘presenting complaint’, ‘HPC’, or succinctly in MSE
labelling: assigning universally recognized symptoms:anergia; psychomotor agitation; anhedonia; loss of emotional resonance;nihilistic preocupa tions -> use in the Mental State Examination
diagnosis: recognizing symptoms as part of a syndrome: depression (Using a classification system: DSM-IV, ICD-10
Uses of descriptive psychopathology
• Diagnostic: facilitates communication of the clinical features to other professionals
• Scientific: allows precise observations and deductions to be made
• Therapeutic: facilitates establishment of an empathic relationship
• Forensic: medico-legal evaluation is largely based on psychopathology
A appearance
B behaviour
C conversation
A affect
P perception
C cognition
(I insight, J judgement,R rapport)
A appearance
B behaviour
C conversation
A affect
P perception
C cognition
(I insight, J judgement,R rapport)
A appearance
B behaviour
C conversation
A affect
P perception
C cognition
(I insight, J judgement,R rapport)
Refraining from speechin full consciousness
Receptive dysphasias Expressive dysphasias
-Approximate answers (Ganser syndrome)
Content of thinking
Fixed false idea-Primary vs secondary delusions-Delusional system-Common themes: persecution, jealousy, love, grandiosity, ill health,guilt, nihilism, poverty, reference
A appearance
B behaviour
C conversation
A affect
P perception
C cognition
(I insight, J judgement,R rapport)
A appearance
B behaviour
C conversation
A affect
P perception
C cognition
(I insight, J judgement,R rapport)
A appearance
B behaviour
C conversation
A affect
P perception
C cognition
(I insight, J judgement,R rapport)
Mental illness is a myth, whose function it is to disguise and render more palatable the bitter pill of
moral conflict in human relationsThomas Szaz, 1970
We call people physically ill when their body functioning violates certain physiological and
anatomical norms; similarly we call people mentally ill when their personal conduct violates certain
ethical, political, and social normsThomas Szaz, 1970
Answers (?) -1
Operational classification systems:
Diagnostic and Statistical Manual of Mental Disorders (DSM)
International Statistical Classification of Diseases and Related Health Problems (ICD)
=> formalistic reductionism?
Answers (?)-2• Psychiatric endophenotypes (Gottesman,2003)=neurobiological
correlates of disorders– Genetically influenced– stable over time– Neurobiological component that contributes to the disorder– Genes influencing the endophenotype are also susceptibility genes for
the disorder– determined by fewer genes than the disorder– Not/marginally influenced by environment
Example: higher beta-activity in the EEG of alcoholics found in familiy members also. Linked with GABAa receptor
genes (Porjecz et al, 2002)
=> Naturalistic reductionism?
Psychopathology quiz
• Example question:– A man in his mid-30s with an established diagnosis
of chronic schizophrenia shows no emotional reactivity during the interview (doesn’t smile when a joke is made; doesn’t get animated when talking about his puppy dog; doesn’t look sad when talking about the death of his beloved mother last year). His affect can be described as…
Practising descriptive psychopathology
• written accounts of inner experience– literature (Sylvia Plath; Sarah Kane; Sebastian
Faulks; Elyn Saks– Patient’s notes/letters– TED talk Eilyn Saks
www.ted.com/talks/elyn_saks_seeing_mental_illness.html
– Patient encounters– Clinical meetings (handovers etc.)