Introduction To Psychopathology
Introduction To Psychopathology
Introduction To Psychopathology
Dr Oliver Schubert
psyche gr. psukhein to breathe psukh 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
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 minds 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
Traditional distinctions:
Organic syndromes vs. functional syndromes psychosis vs .neurosis
Psychopathology:
Systematic study of abnormal experience, cognition and behaviour Study of the products of the disordered mind
psychodynamic explanatory behavioural etc. psychopathology observation (appearance, behaviour) descriptive phenomenology (empathic assessment of subjective experience)
empathy: gr. feeling oneself into Clinical instrument: measuring another persons subjective state using the observers own capacity for emotional and cognitive experience as a yardstick giving an account of the patients inner experience that the patient recognizes as his/her own
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
ICD-10
A appearance
Mental processes
motor acts
speech
Consciousness
Experience of self
B behaviour
thinking
C conversation
Emotion
A affect
Perception
P perception
Attention
Memory
A appearance
Mental processes
motor acts
speech
Consciousness
Experience of self
B behaviour
thinking
C conversation
Emotion
A affect
Perception
P perception
Orinetation, Atten-tion
Memory
Static tremor Tortocollis Abnormal induced movements: Disorders of non Echopraxia, adaptive echolalia movements Perseveration Gegenhalten Negativism
Disorders of posture
Abnormal complex patterns of behaviour Subjective motor disorders: Alinenation of motor acts
Stupor excitement
Made actions
consciousness
Rise of the threshold for incoming stimuli thinking shows excessive displacement, condensation, misuse of symbols Hallucinations frequent Misinterpretations (threats)
Lowering of consciousness
Apathy general slowing Perseveration No hallucinations or delusions Awareness narrowed down to a few ideas often slight bemusement Relatively well ordered behaviours twilight state
Restricition of consciousness
A appearance
Mental processes
motor acts
speech
Consciousness
Experience of self
B behaviour
thinking
C conversation
Emotion
A affect
Perception
P perception
Attention
Memory
Thought/Speech
Stammering stuttering
speech
Speech confusions
Schizophasia/word salad
Pressured speech
neologisms
(Vorbeireden)
Stream of thought
Form of thinking
thinking
Possession of thought
Content of thinking
Stream of thought
Thought tempo
Continuity of thought
Transitory thinking
Formal thinking
Drivelling thinking
mixing Muddling Grammar and syntax disturbed Similar to speech disorder :schizophasia/word salad
Desultory thinking
Possession of thought
Obsessions/ compulsions
Thought alienation
Thoughts are under the control of an outside agency Others can participate in ones thinking
Thought insertion Thought deprivation/withdrawal Thought broadcasting
Acceptable, comprehensible idea pursued beyond the bounds of reason Content of thinking
Overvalued ideas
takes precedence over all other ideas Maintains precedence over long period of time Less fixed than delusions Tends to be based in reality (to a degree)
Delusions
Fixed false idea - Primary vs secondary delusions - Delusional system - Common themes: persecution, jealousy, love, grandiosity, ill health, guilt, nihilism, poverty, reference
A appearance
Mental processes
motor acts
speech
Consciousness
Experience of self
B behaviour
thinking
C conversation
Emotion
A affect
Perception
P perception
Attention
Memory
Pervasive and sustained emotion Coloring the persons perception of the world Descriptions:
mood
affect
present emotional responsiveness inferred from body language, facial expression, behaviour Congruent or incongruent with mood Descriptions: Normal range constricted/restricted blunt flat
Resulting from events Lie within cultural and social norms Grief reactions Stress reactions No functional incapacity
Adjustment disorders with disturbance of mood (ICD 10) Resulting from events Understandable but excessive (in relation to norms) Prolonged functional impairment anxiety=fear for no adequate reason Anxious foreboding Depressed mood
sufferer is usually unaware of abnormal expression incongruity of affect Inadequacy/blunting of affect Emotional constriction/flattening Labiility of affect Affective incontinence
Very different from average normal reaction Sufferer aware of abnormalitty Culturally colourend Dissociation of affect The Smiling depressive belle indifference Perplexity=tentative, bewildered, puzzled
Can be triggered by stessful events, but do not resolve with removal of the stressor Morbid depression Anhedonia Somatization Loss of emotional resonance Diurnal mood variation Morbid anxiety/agitation Apathy Irritability Mania/hypomania Irritability Extreme cheerfulness Elation Euphoria overactivity
A appearance
Mental processes
motor acts
speech
Consciousness
Experience of self
B behaviour
thinking
C conversation
Emotion
A affect
Perception
P perception
Attention
Memory
Sensory distortions
intensity quality spatial form (dysmegalopsia) body parts (hyperhyposchemazia) Experience of time
Disorders of perception
Illusions
Real perceived stimulus + mental image = false perception Completion illusions Affect illusions pareidolia
Sensory deceptions
Hallucinations
Perception without an object
Hallucinatory syndromes
Individual senses
Auditory Elementary voices Imperative/command hallucinations Running commentary Gedankenlautwerden echo de la pensee
Visual
Functional hallucinations Reflex hallucinations (synaesthesia) Extracampine hallucinations Autoscopy/mirror image Hypnagoggic.hypnopompnic hallucinations Organic hallucinations (Charles Bonnet syndrome, phantom limb) small animals (delirium) scenes (epilepsy)
Touch (tactile)
Formication (small animals crawling over the body/undet the skin
Gustatory, olfactory,visceral
A appearance
Mental processes
motor acts
speech
Consciousness
Experience of self
B behaviour
thinking
C conversation
Emotion
A affect
Perception
P perception
Memory
Hyperamnesia
Paramnesiasdistortions of memory
Dissociative amnesia Fugue/wandering stat Katathymic amnesia/motivated forgetting Amnesias Organic amnesias Acute brain disease Loss of Anterograde anmne memory Retrograde amnesia Subacute brain disease Amnestic state/amnestic syndrome (e.g.Korsakoffs) Distortions of recall Chronic coarse brain Retrospecitve falsification disease False memory Source amnesia Screen memory Confabulation Pseudologia fantastica (pathological lying) Munchhausens syndrome Vorbeireden or approximate answers (Ganser syndrome) Distortions of recognition Dj vu, jamais vu
Psychopathology of personality
Mental illness is a myth, whose function it is to disguise and render more palatable the bitter pill of moral conflict in human relations
Thomas 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 norms
Thomas Szaz, 1970
Stigma
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?
Answers (?)-3
User movement Person-centered care Recovery approach
Psychopathology quiz
Example question:
A man in his mid-30s with an established diagnosis of chronic schizophrenia shows no emotional reactivity during the interview (doesnt smile when a joke is made; doesnt get animated when talking about his puppy dog; doesnt look sad when talking about the death of his beloved mother last year). His affect can be described as