2 phenomenology
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Phenomenology
Dr. Mahmoud Bashtawi
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Definition
The study of events, either psychological or
physical.
In psychiatry, it involves the observation and categorization of
abnormal psychic events, the internal experiences of thepatient and his consequent behavior.
or what you call it Psychopathology ;the signs and symptoms
of psychiatry.
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Psychopathology
The study of phenomena of mental illness :
abnormal thoughts, feelings, perceptions and
cognitions. Descriptive psychopathology aims
to describe such phenomena. Psychodynamic
psychopathology aims to describe and
explain causes of abnormal mental
phenomena using psychoanalytic theories.
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Classification of signs and symptoms in
Psychiatry
Disorders of Perception
Disorders of Thinking
Disorders of Mood Disorders of Cognition
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Perception
the awareness of objects and interpretation
of sensoryinformation;i.e. awareness of what
is presented through the sense organs.
Imagery: A sensory experience over which the
subject has voluntary control and experiences
as taking place within the mind.
http://en.wikipedia.org/wiki/Sensory_systemhttp://en.wikipedia.org/wiki/Informationhttp://en.wikipedia.org/wiki/Informationhttp://en.wikipedia.org/wiki/Sensory_system -
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Disorders of Perception
illusion
Hallucination
Depersonalization
Derealization
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Illusions
Illusions
misperceptions of external stimuli
conditions more likely to occur:
reduced level of sensory stimulation (e.g. at dusk)
reduced level of consciousness (e.g. delirious pts.)
when attention is not focussed on the sensory modality
(e.g. in darkness)
when there is a strong affective state (e.g. stressed and
anxiety)
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Hallucinations
sensory perception without an objective stimulus but
with a similar quality to a true percept.
can be of all sensory modalities:
visual , auditory , somatic ,gustatory and olfactory
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Auditory hallucinations
Voices Single or multiple
Male or female
Known or unknown person
person 1st person: thought echo - hearing own thoughts spoken aloud.
2nd person: calling patient by you
3rd person: calling patient by he or she
Voices Commanding, running commentary or arguing with each other
Timing: day , night or all the time.
continuous or intermittent.
Theme: friendly or derogatory
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Hallucinations
Visual Hallucinations: commonly associated withorganicity.
Olfactory and gustatory hallucinations
often experienced together often unpleasant in nature
common in temporal lobe epilepsy
Somatic (tactile and deep)
tactile (haptic): touched, insect crawling under the skine.g. formication in cocaine abuse
deep sensation: e.g. viscera being pulled out, sexualstimulation, electric shock
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Hallucinations
Extracampine hallucinations:
perceiving a sensation from beyond the limits of the sense
organ
e.g. visions from outside visual field, hearing voices from far
away
Reflex hallucinations:
stimulus in one sensory modality causing a hallucination in a
different sensory modality
e.g. music causing visual hallucination (LSD abuse)
Hypnogogic and hypnopompic hallucinations
occurs at the point of falling to or waking from sleep
usually brief and elementary
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Disorders of Perception
Depersonalization: a feeling that his body parts
are abnormal, unreal
e.g. my brain or my head becomes big until it fills the
room Derealization: a feeling that the external
environment is abnormal, unreal
Patient describe things in his surrounding that are
artificial and lifeless
both can occur in tiredness, TLE, depression etc.
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Thought disorders
Thought disorder(TD) or formal thoughtdisorder(FTD) occurs when an individual hasserious problems with thinking, feelings, and
behavior. Thinking : a goal directed flow of ideas initiated by a task leading to
a reality orientated conclusion
components of thinking:
Flow or ( stream ) of thought
Form of thought
content
possession
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Disorders of flow(stream) of thoughts
1-Preasure of thought: increase amount and
speed of speech; we can not interrupt or stop
the patient because he has many thoughts in
his mind (we see this in mania).
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Disorders of flow(stream) of thoughts
2-poverty of thoughts: the has very few
thoughts and pass slowly through his mind;
(we see this in depression).
3-Thought blocking: Sudden interruption of
the flow of thoughts in which the patient
experiences as his mind going blank or his
mind is empty(we see this in schizophrenia).
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Formal thought disorders
-loosening of association:There is a breakdown in thenormal structure of thinking in which ideas shift fromone subject to another in completely unrelated way.
- derailment: transition from one topic to another with
no logical connection between the two- flights of ideas: the patients thoughts move rapidly
from one idea to another, each idea being more orless meaningfully related to the preceding idea.characteristic of mania .
- perseveration: Giving a response beyond the point ofrelevance i.e. same answer to each question(stimulus)
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Formal thought disorders
-Word salad: severe form of derailment affecting the grammatical structure of
speech.
-Circumstantialities: going round and round before finally reaching the point.
- Tangentiality
Inability to have goal directed association of thoughts, he never gets from
points to desired goals.
-Echolalia
The patient repeats apart or the whole of what have been said to him
-neologism:
new words invited by the patient
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Disorders of content of thought
Delusion:
False fixed unshakeable belief, inappropriate to a persons
educational and social background.
Over-valued ideas:
ideas held with a lot of emotion (highly charged) but with
some degree of ambivalence and doubts about the belief.
Pre-occupation:
ideas which comes to mind, again and again and may preventthe patient from performing his day to day activities
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Classification of delusions
According to special features:
Systematised delusion:
chronic, presence of nucleus, well knitted, inter-connected,
layered and well-encapsulated.
Non-systematised delusion
Shared delusion:
folie a deux(two person, including patient)
folie a mass(> than two person)
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Themes of delusion
(According to theme)
Persecutory (paranoid):
others trying to inflict harm on him
Delusion of Reference:
idea that objects, events or people have a personalsignificance for patient e.g. TV programmes, news
Grandiose (expansive):
beliefs of exaggerated self-importance
e.g. wealth, special powers, beauty
Religious:
delusions with religious content
e.g. chosen to be prophet, communicating directly to God
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Themes of delusion
-De Clerambaults Syndrome
being lovedby a man who is inaccessible, high status, never
spoken before, unable to reveal his love for her
-Delusion of Jealousy:
common in men
delusion of unfaithfulness of spouse (infidelity)
spying, checking on spouse, examine for sexual
secretions
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Themes of delusion
Delusion of Guilt and Worthlessness:
e.g. minor past faults will be exposed, being sinful,
deserves to be punished
Nihilistic Delusion belief about non-existence
CotardsSyndrome: failures of bodily functions e.g.
bowels are rotting etc.
Hypochondriacal Delusions
belief of ill health despite contrary medical evidence
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Other disorders of thought Content
Obsessions: recurrent persistent thoughts, impulses or images that
enter the mind despite efforts to exclude them
subjective sense of struggle to resist them
recognized as his own
regarded as untrue and senseless
Compulsions:
repetitive, purposeful behaviours performed in astereotyped way, accompanied with subjective sense thatit must be carried out and an urge to resist
most common: cleaning, counting, dressing
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Disorders of thought possession
Thought Insertion:
delusion that some thoughts have been implanted by
outside agency
Thought Withdrawal: delusion that thoughts have taken out of his mind
Thought Broadcasting:
delusion that his unspoken thoughts are known to
other people
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Emotion
Affect: a feeling-tone that accompanies an idea; observed expression of emotion; may beinconsistent with patient's description of emotion
Appropriate affect
- Inappropriate affect:
- Restricted or constricted affect: reduction in intensity of feeling tone less severe thanblunted affect but clearly reduced
- Blunted affect: a disturbance in affect manifested by a severe reduction in theintensity of externalized feeling
tone
Flat affect: absence or near absence of any signs of affective expression; voicemonotonous, face immobile
Labile affect: rapid and abrupt changes in emotional feeling tone, unrelated toexternal stimuli
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Emotion
B. Mood: a pervasive and sustained emotion, subjectively experienced and reported by
the patient and observed by
others; examples
1. Euthymic mood: normal range of mood, implying absence of depressed or
elevated mood
2. Euphoria: intense feeling of well being
3. Elation: intense feeling of well being with exaggerated motor activity
5. Expansive mood: expression of one's feelings without restraint, frequently with anoverestimation of one's significance or importance
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Mood
6. Ecstasy: felling of intense rapture
7. Dysphoric mood: an unpleasant
mood
8. Anhedonia: loss of interest in andwithdrawal from all regular and pleasurable
activities, often associated with depression
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Other emotions
Anxiety: feeling of apprehension caused by anticipation of danger,which may be internal or external
2 Fear: anxiety caused by consciously recognized and realistic danger
3 Agitation: severe anxiety associated with motor restlessness
4 Panic: acute, episodic, intense attack of anxiety associated withoverwhelming feelings of dread and autonomic
discharge
5 Ambivalence: coexistence of two opposing impulses towardthe same thing in the same person at the same time
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Motor behavior
Echopraxia: pathological imitation of movements of one person byanother
Catatonia: motor anomalies (stupor or excitement) in some disorders
Catalepsy: general term for an immobile position that is constantlymaintained
Catatonic excitement: agitated, purposeless motor activity,uninfluenced by external stimuli
Catatonic stupor: markedly slowed motor activity, often to a point ofimmobility and seeming unawareness ofsurroundings
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Catatonic symptoms
catatonic stupor= markedly slowed motor activity,often to a point of immobility
catatonic excitement= agitated, purposeless motoractivity
catatonic posturing= voluntary assumption of aninappropriate or bizarre posture
echopraxia= pathological imitation of movements
stereotypy= repetitive fixed pattern of physical action
mannerism= habitual involuntary movement
command automatism= automatic following ofsuggestions