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Symptomatology

Chapter four

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Symptomatology

Symptom What the patient narrates in related to illness

Objective refers to features of observe during an interview.

N.B. The term is usually use when the psychiatrist wants to compare with the patient describing the symptoms.

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Perception = Sensation + Meaningful

Perception is the process of becoming aware of what is presented through the sense organs.

Imagery is the awareness of a percept that has been generated within the mind

Example-

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Abnormalities of Perception

1) Illusion : illusion is misperception of external stimuli. It happens in an organic syndrome eg.

Example : roap > snake

2 ) Hallucination

- A hallucination is a percept that is experienced in the absence of an external stimulus to the corresponding sense organ. It differs from an illusion in being experienced as originating in the outside world or from within the person’s body.

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Types of Hallucination according to sensory modalities

Auditory Hallucination e.g ----------

Visual Hallucination e.g ----------

Olfactory Hallucination e.g ----------

Gustatory Hallucination e.g ----------

Somatic/Tactile Hallucination e.g

----------

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Diagnostic Associations

Severe depressive

disorder

Severe manic disorder

SchizophreniaOrganic disorders

Dissociate states

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Thinking

- Is very vital and extensive mental/psychological process

- It covers two kinds of phenomenon:

- 1) Disturbance of thoughts

- 2) Disturbance of thinking process

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1) Disturbance of thoughts

Delusion – False believe, Unshakeable and Not Shared by the Community

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2 )Disturbance of thinking process

Pressure of thought Poverty of thought Thought block Perseveration Flight of ideas Loosening association – This denotes a loss of the normal

structure of thinking.

A) In Talking Past the Point (the patient seems always about to get to the end of the topic)

B) Knight’s Move or Derailment (refers to a transition from one topic to another with no logical relationship)

C) Verbigeration (is said to be present when speech is reduced to the senseless repetition of sounds, words or phrases)

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Types of Delusion According to Theme

1) Delusion of Persecutory – Belief is being harassed and cheated

2) Delusion of Reference – Behavior of other refer to the patient

3) Delusion of Grandiose – Exaggerated conception of ones importance

4) Delusion of Guilt & Worthlessness – Blaming self without any reason of past

5) Delusion of Nihilistic – Non existing or ending

6) Delusion of Jealous – Belief unfaithful

7) Delusion of Amorous – Belief she is loved by higher class

8) Delusion of Control – Thought/ feeling controlled by others

9) Delusion of Thought Broadcasting – Unspoken thought are known to others

10) Delusion of Withdrawal & Insertion – Certain thought implanted by outside agency or withdrawn by other agency

11) Shared Delusion

12) Delusion of Religion -

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Diagnostic Association

Schizophrenia

Delusional Disorders

Severe Depressive Disorders

Rarely in Manic

Syndrome

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Obsession

Obsessions are recurrent persistent thoughts, impulses or images that enter into the mind despite the person efforts to exclude them.

Diagnostic Association

- Obsessive Compulsive Disorder (OCD)

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Phobia

Phobia is a persistent irrational fear of and with to avoid the specific object, activity or situation

Diagnostic Association - Phobia Anxiety Disorder

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Motor Symptoms and Sign

Tics are irregular repeated movements involving a group of

muscles

Mannerisms are repeated movements that appear to have

some functional significance

Stereotypies are repeated movements that are regular and

without obvious significance

Catatonia is a state of increased muscle tone that affects extension

and flexion

Catelepsy is detected when a patient’s limbs can be placed in a position in which they remain for

long periods while at the same time muscle tone is uniformly increased

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Motor Symptoms and Sign (Cont…)

Posturing is the adaption of unusual bodily posture continuously for a long

time. The posture may have a symbolic meaning.

Grimacing denotes pouting of the lips to bring them closer to the nose.

Negativism patients are said to show negativism when the do the opposite of

what is asked.

Echopraxia occurs when the patient imitates the interviewer’s movement

automatically

Migehen the patient’s limbs can be moved into any position with the slightest

pressure

Ambitendence the patients are said to exhibit ambitendence when they alternate

between the arm to shake hands then withdrawing it, extending it again, -

repeatedly

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Disorders of Emotion

Emotion is a complex inner feeling with psychic somatic and behavior components that related to affect and mood.

- Affect : Transit emotion is called affect - Mood : A pervasive and sustained

emotion subjectly experienced and reported by patient

- Normal Mood : Euthymic mood

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Abnormal Mood

Dysphonic Mood

Expansive

Irritable Mood

Elevated Mood

Euphoric Mood

Depression Mood

Labile Mood

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disturbance of Memory

Amnesia Failure of memory

Paramnesia Distortion of memory

Definition of Memory:

Memory is a function by which information stored In the brain and recall to consciousness

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Stages of memory

Immediate Memory : concern the retention of information over a period in minuteExample -

Recent Memory : concern events that have taken place in the last few daysExample –

Long term Memory : concerns events that have occurred over longer period of time

Example -

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Disturbance of Recognition

Jamais vu: is the failure to recognize events that have encounter before.

Déjà vu : is the conviction that an event is repeating one that has not been experienced in the past when in fact it is novel.

Confabulation : is the confident recounting of quite false

memory for the recent events [amnesia]

Psychogenic Amnesia: is thought to result from an active process of repression which prevent the recall of memories that would otherwise evoke unpleasant emotions

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Attention & Concentration

Definition : is the ability to focus on the matter in hand

Assessment : sever serial test Insight : Defined as awareness of one’s own mental condition

-Defense mechanism : unconscious intrapsychic processes that provide relief from emotional conflicts and anxiety.

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Thank You