General Psychopathology: General Psychopathology Department of Psychiatry 1st Faculty of Medicine Charles University, Prague Head: Prof. MUDr. Jiří Raboch, DrSc.


Basic Terms in Psychiatry: Basic Terms in Psychiatry Psychiatry studies the causes of mental disorders, gives their description, predicts their future course and outcome, looks for prevention of their appearance and presents the best ways of their treatment Psychopathology describes symptoms of mental disorders Special psychiatry is devoted to individual mental diseases General psychiatry studies psychopathological phenomena, symptoms of abnormal states of mind: 1. consciousness 5. mood (emotions) 2. perception 6. intelligence 3. thinking 7. motor 4. memory 8. personality


Disorders of Consciousness: Disorders of Consciousness Consciousness is awareness of the self and the environment Disorders of consciousness: qualitative quantitative short-term long-term Hypnosis – artificially incited change of consciousness Syncope – short-term unconsciousness


Disorders of Consciousness: Disorders of Consciousness Quantitative changes of consciousness mean reduced vigility (alertness): somnolence sopor coma Qualitative changes of consciousness mean disturbed perception, thinking, affectivity, memory and consequent motor disorders: delirium (confusional state) – characterized by disorientation, distorted perception, enhanced suggestibility, misinterpretations and mood disorders obnubilation (twilight state) – starts and ends abruptly, amnesia is complete; the patient is disordered, his acting is aimless, sometimes aggressive, hard to understood stuporous vigilambulant delirious Ganser sy


Disturbances of Perception: Disturbances of Perception Perception is a process of becoming aware of what is presented through the sense organs Imagery means an experience within the mind, usually without the sense of reality that is part of reality Pseudoillusions – distorted perception of objects which may occur when the general level of sensory stimulation is reduced Illusions are psychopathological phenomena; they appear mainly in conditions of qualitative disturbances of consciousness (missing insight) Hallucination are percepts without any obvious stimulus to the sense organs; the patient is unable to distinguish it from reality


Disturbances of Perception: Disturbances of Perception Hallucinations: auditory (acousma) visual olfactory gustatory tactile (or deep somatic) extracampine, inadequate intrapsychic (belong rather to disturbances of thinking) hypnagogic and hypnopompic (hypnexagogic) Pseudohallucinations - patient can distinguish them from reality


Disorders of Thinking: Disorders of Thinking Thinking Cognitive functions Disorders of thinking: quantitative qualitative


Quantitative Disorders of Thinking: Quantitative Disorders of Thinking Quantitative (formal) disorders of thinking: pressure of thought poverty of thought thought blocking flight of ideas perseveration loosening of associations word salad - incoherent thinking neologisms verbigeration


Qualitative Disorders of Thinking: Qualitative Disorders of Thinking Quantitative disorders of thought (content thought disorders): Delusions: belief firmly held on inadequate grounds, not affected by rational arguments not a conventional belief Obsessions (obsessive thought) are recurrent persistent thoughts, impulses or images entering the mind despite the person's effort to exclude them. Obsessive phenomena in acting (usual as senseless rituals – cleaning, counting, dressing) are called compulsions.


Qualitative Disorders of Thinking: Qualitative Disorders of Thinking Division of delusions: according to onset primary (delusion mood, perception) secondary (systematized) shared (folie a deux) according to theme paranoid (persecutory) - d. of reference, d. of jealousy, d. of control, d. concerning possession of thought megalomanic (grandiose, expansive) – d. of power, worth, noble origin, supernatural skills and strength, amorous d. depressive (micromanic, melancholic) – d. of guilt and worthlessness, nihilistic d., hypochondriacal d. concerning the possession of thoughts thought insertion thought withdrawal thought broadcasting


Disorders of Memory: Disorders of Memory Sensory stores - retains sensory information for 0.5 sec. Short - term memory (working memory) - for verbal and visual information, retained for 15-20 sec., low capacity Long-term memory – wide capacity and more permanent storage declarative (explicit) memory – episodic (for events) or semantic (for language and knowledge) procedural memory – for motor arts priming – unconscious memory conditioning – classic or emotional


Disorders of Memory: Disorders of Memory Disorders of memory: Amnesia – inability to recall past events Jamais vu, déja vu Confabulation, amnesic disorientation, Korsakov’s syndrome Pseudologia phantastica Hypomnesia Hypermnesia


Disorders of Attention: Disorders of Attention Concentration Capacity Tenacity Irritability Vigility Hypoprosexia (global, selective) Hyperprosexia Paraprosexia


Disorders of Mood (Emotions): Disorders of Mood (Emotions) Normal affect – brief and strong emotional response Normal mood – subjective and for a longer time lasting disposition to appear affects adequate to a surrounding situation and matters discussed Higher emotions: intellectual aesthetic ethic social


Disorders of Mood (Emotions): Disorders of Mood (Emotions) Pathological affect – very strong, abrupt affect with a short change of consciousness on its peak Pathological mood – two poles: manic depressive Phobia – persistent irrational fear and wish to avoid a specific situation, object, activity: agoraphobia claustrophobia social phobias hipsophobia aichmophobia keraunophobia Depersonalization – change of self-awareness, the person feels unreal, unable to feel emotion


Disorders of Mood (Emotions): Disorders of Mood (Emotions) Pathological mood: origin – based on pathological grounds, no psychological cause duration – unusually long-lasting intensity – unusually strong, large changes in intensity impossibility to be changed by psychological means Pathological features of mood: euphoria expansive exaltation explosive mania hypomania depression apathy (anhedonia) blunted, flattened affect emotional lability helpless


Intelligence Disorders: Intelligence Disorders Intelligence: abstract practical social Intelligence quotient (IQ): IQ = (mental age : calendar age) x 100 Disorders of intellect: mental retardation dementia


Motor Disorders: Motor Disorders quantitative: hypoagility hyperagility agitated behaviour qualitative: mannerisms stereotypies posturing waxy flexibility echopraxia schizophrenic impulse negativism short-circuit behaviour automatism agitation tics abulia compulsions Motor disorders occur frequently in mental disorders of all kinds, especially in catatonic schizophrenia.


Disorders of Volition: Disorders of Volition Disorders of volition: hypobulia abulia hyperbulia


Disorders of Personality: Disorders of Personality Personality means a complex of persistent mental and physical traits of a person Disturbances of personality: transformation of personality appersonalization multiple personality (alteration of personality) specific personality disorder deprived personality