general psychopathology

General PsychopathologyGeneral Psychopathology

Department of Psychiatry, First Faculty of Medicine, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Charles University and General University Hospital in

Prague Prague

Head: Prof. MUDr. Jiří Raboch, DrSc.Head: Prof. MUDr. Jiří Raboch, DrSc.

Basic Terms in PsychiatryBasic Terms in Psychiatry Psychiatry Psychiatry studies the causes of mental disorders, studies the causes of mental disorders,

gives their description, predicts their future course gives their description, predicts their future course and outcome, looks for prevention of their and outcome, looks for prevention of their appearance and presents the best ways of their appearance and presents the best ways of their treatmenttreatment

PsychopathologyPsychopathology describes symptoms of mental describes symptoms of mental disordersdisorders

Special psychiatrySpecial psychiatry is devoted to individual mental is devoted to individual mental diseasesdiseases

General psychiatryGeneral psychiatry studies psychopathological studies psychopathological phenomena, symptoms of abnormal states of mind:phenomena, symptoms of abnormal states of mind:

1. consciousness1. consciousness 5. mood 5. mood (emotions)(emotions)

2. perception2. perception 6. intelligence6. intelligence3. thinking3. thinking 7. 7. motormotor4. memory4. memory 8. personality8. personality

Disorders of ConsciousnessDisorders of Consciousness Consciousness Consciousness is awareness of the self is awareness of the self

and the environmentand the environment Disorders of consciousness:Disorders of consciousness:

• qualitativequalitative• quantitativequantitative

short-termshort-term long-termlong-term

Hypnosis Hypnosis – artificially incited change of – artificially incited change of consciousnessconsciousness

SyncopeSyncope – short-term unconsciousness– short-term unconsciousness

Disorders of ConsciousnessDisorders of Consciousness Quantitative changes of consciousnessQuantitative changes of consciousness mean mean

reduced vigility (alertness):reduced vigility (alertness):• somnolencesomnolence• soporsopor• comacoma

Qualitative changes of consciousnessQualitative changes of consciousness mean mean disturbed perception, thinking, affectivity, memory disturbed perception, thinking, affectivity, memory and consequent and consequent motor motor disordersdisorders::• delirium (confusional state)delirium (confusional state) – characterized by disorientation, – characterized by disorientation,

distorted perception, enhanced suggestibility, distorted perception, enhanced suggestibility, misinterpretations and mood disordersmisinterpretations and mood disorders

• obnubilation (twilight state)obnubilation (twilight state) – starts and ends abruptly, – starts and ends abruptly, amnesia is complete; the patient is disordered,amnesia is complete; the patient is disordered, his acting is his acting is aimless, sometimes aggressive, hard to understoodaimless, sometimes aggressive, hard to understood

stuporousstuporous vigilambulantvigilambulant deliriousdelirious Ganser syGanser sy

Disturbances of PerceptionDisturbances of Perception PerceptionPerception is a process of becoming aware of what is a process of becoming aware of what

is presented through the sense organsis presented through the sense organs ImageryImagery means an experience within the mind, means an experience within the mind,

usually without the sense of reality that is part of usually without the sense of reality that is part of realityreality

PseudoillusionsPseudoillusions – distorted perception of objects – distorted perception of objects which may occur when the general level of which may occur when the general level of sensory stimulation is reducedsensory stimulation is reduced

IllusionsIllusions are psychopathological phenomena; are psychopathological phenomena; they appear mainly in conditions of qualitative they appear mainly in conditions of qualitative disturbances of consciousness (missing insight)disturbances of consciousness (missing insight)

HallucinationHallucination are percepts without any obvious are percepts without any obvious stimulus to the sense organs; the patient is unable stimulus to the sense organs; the patient is unable to distinguish it from realityto distinguish it from reality

Disturbances of PerceptionDisturbances of PerceptionHallucinations:Hallucinations: auditory (acousma)auditory (acousma) visualvisual olfactoryolfactory gustatorygustatory tactile (or deep somatic)tactile (or deep somatic) extracampine, inadequateextracampine, inadequate intrapsychic intrapsychic (belong rather to disturbances of thinking)(belong rather to disturbances of thinking) hypnagogic and hypnopompic (hypnexagogic)hypnagogic and hypnopompic (hypnexagogic)

PseudohallucinationsPseudohallucinations - patient can distinguish - patient can distinguish them from realitythem from reality

Disorders of ThinkingDisorders of Thinking

ThinkingThinking

Cognitive functionsCognitive functions

Disorders of thinking:Disorders of thinking:• quantitativequantitative• qualitativequalitative

Quantitative Disorders of Quantitative Disorders of ThinkingThinking

Quantitative (formal) disorders of thinkingQuantitative (formal) disorders of thinking:: pressure of thoughtpressure of thought poverty of thoughtpoverty of thought thought blockingthought blocking flight of ideasflight of ideas perseverationperseveration loosening of associationsloosening of associations word salad - incoherent thinkingword salad - incoherent thinking neologismsneologisms verbigerationverbigeration

Qualitative Disorders of Qualitative Disorders of ThinkingThinking

Quantitative disorders of thoughtQuantitative disorders of thought (content (content thought disorders):thought disorders):

Delusions: Delusions:

a)a)belief firmly held on inadequate grounds,belief firmly held on inadequate grounds,

b)b)not affected by rational argumentsnot affected by rational arguments

c)c)not a conventional beliefnot a conventional belief ObsessionsObsessions (obsessive thought) are recurrent (obsessive thought) are recurrent

persistent thoughts, impulses or images entering the persistent thoughts, impulses or images entering the mind despite the person's effort to exclude them. mind despite the person's effort to exclude them. Obsessive phenomena in acting (usual as senseless Obsessive phenomena in acting (usual as senseless rituals – cleaning, counting, dressing) are called rituals – cleaning, counting, dressing) are called compulsionscompulsions..

Qualitative Disorders of Qualitative Disorders of ThinkingThinking

Division of delusions:Division of delusions: according to onsetaccording to onset

a)a) primary (delusprimary (delusionion mood, perception) mood, perception)b)b)secondary (systematized)secondary (systematized)c)c) shared (folie a deux)shared (folie a deux)

according to themeaccording to themea)a) paranoid (persecutoryparanoid (persecutory) - d. of reference, d. of jealousy, d. of ) - d. of reference, d. of jealousy, d. of

control, d. concerning possession of thoughtcontrol, d. concerning possession of thoughtb)b)megalomanic (grandiose, expansive)megalomanic (grandiose, expansive) – d. of power, worth, – d. of power, worth,

noble origin, supernatural skills and strength, amorous d.noble origin, supernatural skills and strength, amorous d.c)c) depressive (micromanic, melancholic)depressive (micromanic, melancholic) – d. of guilt and – d. of guilt and

worthlessness, nihilistic d., hypochondriacal d.worthlessness, nihilistic d., hypochondriacal d.d)d)concerning the possession of thoughtsconcerning the possession of thoughts

thought insertionthought insertion thought withdrawalthought withdrawal thought broadcastingthought broadcasting

Disorders of MemoryDisorders of Memory Sensory storesSensory stores - retains sensory - retains sensory

information for 0.5 sec.information for 0.5 sec. Short - term memory (working memory)Short - term memory (working memory)

- for verbal and visual information, retained - for verbal and visual information, retained for 15-20 sec., low capacityfor 15-20 sec., low capacity

Long-term memoryLong-term memory – wide capacity and – wide capacity and more permanent storagemore permanent storage• declarative (explicit) memory – episodic (for declarative (explicit) memory – episodic (for

events) or semantic (for language and events) or semantic (for language and knowledge)knowledge)

• procedural memory – for motor artsprocedural memory – for motor arts• priming – unconscious memorypriming – unconscious memory• conditioning – classic or emotionalconditioning – classic or emotional

Disorders of MemoryDisorders of Memory

Disorders of memory:Disorders of memory: Amnesia – inability to recall past eventsAmnesia – inability to recall past events Jamais vu, déja vuJamais vu, déja vu Confabulation, amnesic disorientation, Korsakov’s Confabulation, amnesic disorientation, Korsakov’s

syndromesyndrome Pseudologia phantasticaPseudologia phantastica

HypomnesiaHypomnesia HypermnesiaHypermnesia

Disorders of AttentionDisorders of Attention ConcentrationConcentration CapacityCapacity TenacityTenacity IrritabilityIrritability VigilityVigility

Hypoprosexia (global, selective)Hypoprosexia (global, selective) HyperprosexiaHyperprosexia ParaprosexiaParaprosexia

Disorders of Mood (Emotions)Disorders of Mood (Emotions)

Normal affectNormal affect – brief and strong emotional – brief and strong emotional responseresponse

Normal moodNormal mood – subjective and for a longer – subjective and for a longer time lasting disposition to appear affects time lasting disposition to appear affects adequate to a surrounding situation and adequate to a surrounding situation and matters discussedmatters discussed

Higher emotionsHigher emotions::• intellectualintellectual• aestheticaesthetic• ethicethic• socialsocial

Disorders of Mood (Emotions)Disorders of Mood (Emotions)

Pathological affectPathological affect – very strong, abrupt affect with – very strong, abrupt affect with a short change of consciousness on its peaka short change of consciousness on its peak

Pathological moodPathological mood – two poles: – two poles:• manicmanic• depressivedepressive

PhobiaPhobia – persistent irrational fear and wish to avoid – persistent irrational fear and wish to avoid a specific situation, object, activity:a specific situation, object, activity:• agoraphobiaagoraphobia• claustrophobiaclaustrophobia• social phobiassocial phobias• hipsophobiahipsophobia• aichmophobiaaichmophobia• keraunophobiakeraunophobia

DepersonalizationDepersonalization – change of self-awareness, the – change of self-awareness, the person feels unreal,person feels unreal, unable to feel emotionunable to feel emotion

Disorders of Mood (Emotions)Disorders of Mood (Emotions) Pathological mood:Pathological mood:

• origin – based on pathological grounds, no psychological origin – based on pathological grounds, no psychological causecause

• duration – unusually long-lastingduration – unusually long-lasting• intensity – unusually strong, large changes in intensityintensity – unusually strong, large changes in intensity• impossibility to be changed by psychological meansimpossibility to be changed by psychological means

Pathological features of mood:Pathological features of mood:• euphoriaeuphoria• expansiveexpansive• exaltationexaltation• explosiveexplosive• maniamania• hypomaniahypomania• depressiondepression• apathy (anhedonia)apathy (anhedonia)• blunted, flattened affectblunted, flattened affect• emotional labilityemotional lability• helplesshelpless

IntelligenceIntelligence Disorders Disorders Intelligence:Intelligence:

• abstractabstract• practicalpractical• socialsocial

Intelligence quotient (IQ): Intelligence quotient (IQ):

IQ = (mental ageIQ = (mental age :: calendar age) x 100calendar age) x 100

Disorders of intellect:Disorders of intellect:• mental retardationmental retardation• dementiadementia

Motor DisordersMotor Disorders

quantitative::

• hypoagilityhypoagility• hyperagilityhyperagility• agitated behaviouragitated behaviour

qualitativequalitative::• mannerismsmannerisms• stereotypiesstereotypies• posturingposturing• waxy flexibilitywaxy flexibility• echopraxiaechopraxia• schizophrenic impulseschizophrenic impulse• negativismnegativism• short-circuit behaviourshort-circuit behaviour• automatismautomatism• agitationagitation• ticstics• abuliaabulia• compulsionscompulsions

Motor disordersMotor disorders occur frequently in mental occur frequently in mental disorders of all kinds, especially in catatonic disorders of all kinds, especially in catatonic schizophreniaschizophrenia..

Disorders of VolitionDisorders of Volition

Disorders of volitionDisorders of volition::• hypobuliahypobulia• abuliaabulia• hyperbuliahyperbulia

Disorders of PersonalityDisorders of Personality

Personality Personality means a complex of means a complex of persistent mental and physical traits of a persistent mental and physical traits of a personperson

Disturbances of personality:Disturbances of personality:• transformation of personalitytransformation of personality• appersonalizationappersonalization• multiple personality (alteration of personality)multiple personality (alteration of personality)• specific personality disorderspecific personality disorder• deprived personalitydeprived personality

Multistable perceptionMultistable perception

Mental constructionMental construction

Instruction to manufacturing Instruction to manufacturing (straight from the hell …)(straight from the hell …)

general psychopathology

Health & Medicine