1. Signs And Symptoms of
Mental Disorders
Fareed Minhas
Professor of Psychiatry
Head, Institute of Psychiatry
Rawalpindi Medical College
Rawalpindi
2. General Issues…
Psychopathology-study
of abnormal states of mind
Three approaches
Phenomenological- objective descriptions of
abnormal states entirely of conscious experiences
and observable behavior
Psychodynamic- explains causation of the
abnormal events by postulating unconscious mental
processes in addition to description
Experimental- relationships between abnormal
phenomena examined by inducing change in one
and observing impact on others
3. General Issues…(contd.)
Significance of individual symptomscharacteristic grouping of symptoms is
important.
Primary and Secondary Symptoms-
establishing a temporal relationship between
symptoms if possible.
Form and Content of Symptoms- eg. “form” of
a chair contains a seat, back and four legs whilst
“content” is wood and straw
4. Categorizing Disorders…
Disorders of perception
Disorders of thinking
Disorders of mood
Disorders of general behavior
Motor Signs and Symptoms
Disorders of Body Image
Disorders of Memory
Disorders of Consciousness
Disorders of Attention/Concentration
Disorders of Insight
5. Disorders of Perception
Perception is the process of becoming aware of what
is presented through the sense organs
Imagery is the experience within the mind (without
sense of reality ) which is a part of perception eg.
Eidetic imagery, pareidolia etc
Alterations in perception of intensity eg. mania or
depression and quality eg. Schizophrenia
Illusions are misperceptions of external stimuli eg.
Delirium, normal situations
6. Disorders of Perception (contd.)
Hallucination is a percept experienced in absence of
external stimulus to sense organ and with a similar
quality to a true percept
Auditory
Visual
Olfactory or gustatory
Somatic (tactile or deep)
Delusional Perception
Normal situations(hypnagogic/hypnopompic)
Pseudohallucinations are of a less intensity and the
person recognizes the absence of external correlates
7. [Description of Hallucinations]
According to complexity
Elementary
Complex
According to sensory modality
Auditory
Visual
Olfactory and gustatory
Somatic (tactile or deep)
According to special features
Auditory : second-person or third-person
Gedankenlautwerden
echo de la pensee
Visual : extracampine
Autoscopic hallucinations
8. Disorders of Thinking
TH O U GH T D ISO RD ERS
STREAM O F TH O U G H T
-Pressu re
- T h o u g h t b lo c k
FO R M O F TH O U G H T
- F lig h t o f id e a s
- P e r s e v e r a t io n
- L o o s e n in g o f a s s o c ia t io n
PARTICU LAR KIN D S
- D e lu s io n s
- O b s e s s io n s
9. Disorders of Thinking(contd.)
Pressure of thought- when ideas arise in unusual
variety and pass through the mind rapidly
Thought Block- sudden, striking and repeated
interruptions in speech when the patient describes an
abrupt emptying of the mind
Flight of ideas- thoughts/conversations move quickly
from one topic to another with understandable links eg.
Clang associations, punning, rhyming
Persevaration- persistent inappropriate repetition of
same thoughts
10. Disorders of Thinking(contd.)
Loosening of association- loss of normal structural
links such as:
Knight’s move or derailment
Word salad
Verbigeration
Talking past the point
Neologisms- use of self-invented words and phrases
to describe morbid experiences
Delusions – false, firm belief impervious to reasoning
and against the social and cultural norms
11. Disorders of Thinking(contd.)
According to theme :
Persecutory(paranoid) delusions
Delusions of reference
Grandiose(expansive) delusions
Delusions of guilt and worthlessness
Nihilistic
Hypochondriacal
Delusions of control
Sexual
Delusions concerning possession of thought:
thought insertion, thought withdrawal, thought
broadcast
12. Disorders of Thinking(contd.)
Other delusional experiences:
Delusional mood
Delusional perception
Delusional memory
Obsessions- recurrent persistent thoughts, impulses
or images that enter the mind despite the person’s
efforts to exclude them. Types maybe:
Thoughts
Ruminations
Doubts
Impulses
Phobias
13. Disorders of Thinking(contd.)
Compulsions- repetitive and seemingly purposeful
behaviors performed in a stereotyped way (compulsive
rituals) eg. Cleaning, counting, dressing and these may
lead to obsessional slowness
Obsessions are not always followed by
compulsions but compulsions always have
preceding obsessions associated with them
14. Disorders of Mood
Change in nature of mood- which can be towards
anxiety, depression, elation or anger
Abnormal fluctuations of mood- such as:
Apathy
Blunting or flattening of affect
Labile
Emotional incontinence
Incongruity of mood- for eg. A patient may laugh
when describing the death of his mother
15. Disorders of general behavior
Phobias- A phobia is a persistent irrational fear of a
specific object/activity/situation which the person
recognizes as his own and tries to avoid it at all
possible costs eg. Claustrophobia
Depersonalization- change of self-awareness such
that the person feels unreal
Derealization- objects around the person appear
unreal and people as seen as two-dimensional
cardboard figures
16. Motor Symptoms and Signs
Tics- irregular repeated movements involving a group
of muscles, eg. Raising of shoulders
Mannerisms- repeated movements seeming to have a
functional significance eg. Saluting
Stereotypies- repetitive regular movements having no
obvious functional significance eg. Rocking to and fro
Posturing- adoption of unusual body postures for long
periods of time
17. Motor Symptoms and Signs
Negativism- Patients doing completely opposite of
what is being asked and resisting persuasion
Echopraxia- immitation of interviewer’s movement
automatically even when asked not to do so
Ambitendence- Patients alternate between opposite
movements eg. Putting out an arm to shake hands then
withdrawing
Waxy flexibility- when patient’s limbs can be placed
in any position for long periods while muscle tone is
uniformly increased
18. Disorders of Body Image
Phantom Limb- continuing awareness of a part of body
that has been lost
Unilateral awareness and neglect- resulting from
parietal lobe lesions and in extreme forms patient may
neglect washing that particular side, puts on one shoe
etc
Hemisomatognosis- or hemidepersonalization
Anosognosia- lack of awareness of disease
Pain asymbolia- recognising a painful stimulus as
painless
19. Disorders of Body Image(contd.)
Autotopagnosia- inability to recognize, name or point
on command to parts of the body
Distorted awareness of size and shape- feelings
that a limb is becoming smaller, larger etc
Reduplication phenomenon- experience that part or
all of the body has doubled
Coenesthopatic states- localized distortions of body
awareness eg. Nose feels as if made of cotton wool
20. Disorders of Memory
Normal process:
Sensory stores Short-term Memory Long-term
Memory
Amnesia- Failure of memory
Anterograde
Retrograde
Confabulation- Patients have so much difficulty
remembering that they recall even those events that
never happened
21. Disorders of Consciousness
Consciousness- awareness of the self in relation to
environment. Level may vary from extreme alertness to
coma
Coma- Extreme of impaired consciousness
unresponsive to the strongest stimulus. 4 grades
Clouding of consciousness- All cognitive functions
are impaired
Stupor- Immobile, mute, unresponsive patient
appearing to be fully conscious
23. Disorders of
Attention/Concentration
Attention – is the ability to focus on the matter in
hand
Concentration – ability to maintain that focus
Latent Inhibition – the ability of a person to
recognize a previously irrelevant stimulus when it
becomes relevant. In disorders this process is slowed
down
24. Insight
TO CH ECK FO R
IN SIGHT
I s t h e p a t ie n t
aw a re o f th e p h e n om en a
o t h e r p e o p le h a v e
o b se rve d ?
D o e s h e r e c o g n is e
th at th e se p h en o m en a
are
a b n o r m a l?
I f a b n o r m a l, d o e s h e
c o n s id e r t h e m t o b e
r e s u lt in g f r o m a
m e n t a l illn e s s ?
I f h e is m e n t a lly
ill, d o e s h e t h in k h e
needs
tre atm en t?