Symptomatology Chapter four 1

Symptomatology  Symptom What the patient narrates in related to illness  Objective refers to features of observe during an interview. N.B. The term is usually use when the psychiatrist wants to compare with the patient describing the symptoms. 2

Perception = Sensation + Meaningful Perception is the process of becoming aware of what is presented through the sense organs. Imagery is the awareness of a percept that has been generated within the mind Example- 3

Abnormalities of Perception 1) Illusion : illusion is misperception of external stimuli. It happens in an organic syndrome eg. Example : roap > snake 2 ) Hallucination - A hallucination is a percept that is experienced in the absence of an external stimulus to the corresponding sense organ. It differs from an illusion in being experienced as originating in the outside world or from within the person’s body. 4

Types of Hallucination according to sensory modalities Auditory Hallucination e.g Visual Hallucination e.g Olfactory Hallucination e.g Gustatory Hallucination e.g Somatic/Tactile Hallucination e.g

Diagnostic Associations Severe depressive disorder Severe manic disorder Schizophrenia Organic disorders Dissociate states 6

Thinking - Is very vital and extensive mental/psychological process - It covers two kinds of phenomenon: - 1) Disturbance of thoughts - 2) Disturbance of thinking process 7

1) Disturbance of thoughts  Delusion –  False believe,  Unshakeable and  Not Shared by the Community 8

2 )Disturbance of thinking process  Pressure of thought  Poverty of thought  Thought block  Perseveration  Flight of ideas  Loosening association – This denotes a loss of the normal structure of thinking. A) In Talking Past the Point (the patient seems always about to get to the end of the topic) B) Knight’s Move or Derailment (refers to a transition from one topic to another with no logical relationship) C) Verbigeration (is said to be present when speech is reduced to the senseless repetition of sounds, words or phrases) 9

Types of Delusion According to Theme 1) Delusion of Persecutory – Belief is being harassed and cheated 2) Delusion of Reference – Behavior of other refer to the patient 3) Delusion of Grandiose – Exaggerated conception of ones importance 4) Delusion of Guilt & Worthlessness – Blaming self without any reason of past 5) Delusion of Nihilistic – Non existing or ending 6) Delusion of Jealous – Belief unfaithful 7) Delusion of Amorous – Belief she is loved by higher class 8) Delusion of Control – Thought/ feeling controlled by others 9) Delusion of Thought Broadcasting – Unspoken thought are known to others 10) Delusion of Withdrawal & Insertion – Certain thought implanted by outside agency or withdrawn by other agency 11) Shared Delusion 12) Delusion of Religion - 10

Diagnostic Association Schizophrenia Delusional Disorders Severe Depressive Disorders Rarely in Manic Syndrome 11

Obsession Obsessions are recurrent persistent thoughts, impulses or images that enter into the mind despite the person efforts to exclude them. 12 Diagnostic Association - Obsessive Compulsive Disorder (OCD)

Phobia Phobia is a persistent irrational fear of and with to avoid the specific object, activity or situation 13 Diagnostic Association - Phobia Anxiety Disorder

Motor Symptoms and Sign Tics are irregular repeated movements involving a group of muscles Mannerisms are repeated movements that appear to have some functional significance Stereotypies are repeated movements that are regular and without obvious significance Catatonia is a state of increased muscle tone that affects extension and flexion Catelepsy is detected when a patient’s limbs can be placed in a position in which they remain for long periods while at the same time muscle tone is uniformly increased 14

Motor Symptoms and Sign ( Cont…) Posturing is the adaption of unusual bodily posture continuously for a long time. The posture may have a symbolic meaning. Grimacing denotes pouting of the lips to bring them closer to the nose. Negativism patients are said to show negativism when the do the opposite of what is asked. Echopraxia occurs when the patient imitates the interviewer’s movement automatically Migehen the patient’s limbs can be moved into any position with the slightest pressure Ambitendence the patients are said to exhibit ambitendence when they alternate between the arm to shake hands then withdrawing it, extending it again, - repeatedly 15

Disorders of Emotion Emotion is a complex inner feeling with psychic somatic and behavior components that related to affect and mood. - Affect : Transit emotion is called affect - Mood : A pervasive and sustained emotion subjectly experienced and reported by patient - Normal Mood : Euthymic mood 16

Abnormal Mood Dysphonic Mood Expansive Irritable Mood Elevated Mood Euphoric Mood Depressio n Mood Labile Mood 17

disturbance of Memory 18  Amnesia Failure of memory  Paramnesia Distortion of memory Definition of Memory: Memory is a function by which information stored In the brain and recall to consciousness

Stages of memory  Immediate Memory : concern the retention of information over a period in minute Example -  Recent Memory : concern events that have taken place in the last few days Example –  Long term Memory : concerns events that have occurred over longer period of time Example - 19

Disturbance of Recognition  Jamais vu: is the failure to recognize events that have encounter before.  Déjà vu : is the conviction that an event is repeating one that has not been experienced in the past when in fact it is novel.  Confabulation : is the confident recounting of quite false memory for the recent events [amnesia ]  Psychogenic Amnesia: is thought to result from an active process of repression which prevent the recall of memories that would otherwise evoke unpleasant emotions 20

Attention & Concentration  Definition : is the ability to focus on the matter in hand  Assessment : sever serial test 21 Insight : Defined as awareness of one’s own mental condition -Defense mechanism : unconscious intrapsychic processes that provide relief from emotional conflicts and anxiety.

Thank You 22