Signs and symptoms of mental

disorders

Naama Alyaseen
Psychiatrist must have
 1-capacity to collect data objectively,
accurately (by history taking +MSE)
 Organize the data in systemic
&balanced way.

 2-capacity for intuitive understanding of

each patient as an individual.
Psychiatrist can acquired skills
in examining patients

 Sound knowledge of how each

symptoms and signs is defined
 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
Signs and Symptoms in
Psychiatry
 Signs (objective findings)
restricted affect& psychomotor
retardation

 Symptoms
 (subjective experiences)
Psychopathology
 Phenomenology jasbers1963 (objective description of a conscious
abnormal state )

Delusion normal believe &obsession

 Psychodynamic psychopathology
Delusion repression &projection

 Experimental psychopathology. (observed changes of abnormal

phenomena)
 Studies of animal learning &behavioral response to frustration
&punishment.
The significance of individual
symptoms
 Hallucinations -----normal?

 Intense

 Persistent

 multiple
Primary and secondary
symptoms
 Temporal*

 Causal
idea of being followed by persecutors
could be reaction to hearing voices
Form and content of
symptoms
 Patients
 -1-when he is entirely alone----hear voice
calling him homosexual (form)(AUD.HAL)—
content--homo
 -2-hear voices that he is about to be
killed(aud.hal)but diff content
 -3-repeated intrusive thoughts that he is
homosexual ---realize it as untrue—same
content but different form?
Description of symptoms & signs
 Individual mental phenomena
 Consider the whole person
 Fulfills social roles (worker, spouse,
parent, friends, siblings) effect on other
healthy part of person
 Care for depressed child, schizophrenia
 Disorders 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 perception.
Pseudoillusions
 – distorted perception of objects which may
occur when the general level of sensory
stimulation is reduced(just
inside&outside)Tylor1981(imagened&percieve
d)P.H
 Illusions misperception of external stimuli

level of sensory stimulation

level of consciousness
Capgras delusion—delusion of double-P.SHIZ
Hallucination
 are percepts without any obvious
stimulus to the sense organs; the
patient is unable to distinguish it from
reality
Description of hallucinations
 1-according to complexity:
elementary bangs, whistles,
flashes
complex voices(phonemes),
music, faces, scenes.
 2-according to sensory modality

auditory
Visual Lilliputian
Olfactory (haptic)
somatic
3-according to special features
a-auditory: second person
third person
gedankenlautwerden speaks own thoughts

echo de la pensee

b-visual: extracampine
4-autoscopic hallucination (doppelganger)
Reflex hallucination—LSD-SCHIZ
Pseudohallucinations

 - patient can distinguish them from

reality.
 Jaspers1913 vivid mental image.
 Hare 1973 external persevering
without external correlate to the
experience.
 Taylor1981 imaged pseudo
perceived pseudo
Diagnostic association
 Finding of hallucination does not it self help
much in diagnosis but certain kind DO.
 Third person—homosexual—SCHIZ
 Derogatory—depression
 Voice—echo—SCHIZ
 Taste smell—infrequent (shiz,depression)
 Tactile&somatic hallucination?Diagnostic value.
 Sexual—schiz
 Insect---cocain&occacionaly schiz
 Disorders of Thinking
speech&writing

 Sort objects into category

 Thinking

 Cognitive functions
 Disorders of thinking:
 quantitative
 qualitative
 Quantitative Disorders of Thinking
Quantitative (formal) disorders of thinking:
 pressure of thought
 poverty of thought stream of thought
 thought blocking

 flight of ideas
 Perseveration dementia
 loosening of associations knight move (derailment) form of thoughts

 word salad (grammar)

 talking past the point (vorbeireden)

 Neologisms (limited education incorrect pronunciation private words)

 verbigeration
Disorders of Thinking

 1-particular kind of abnormal thoughts

delusion
obsession
 2-Disorder of stream of thoughts(speed and
pressure)
 3-disorder of form of thought (linking of
thoughts together)
 4-abnormal believe about the possession of
thoughts.
Thought disorder
 1-iability to give straight answer even to
simple Q .
 2-frequent change of
topic(derailment&knight move).
 3-abnormality of semantic syntactic
structure of speech.
 4-hardest to comprehend.
 5-dissociation of psychic functions.
 Concrete thinking Goldstein1944.

Loosening of association Cameron1938.

Overinclusion Payne&Friedlander 1962.

Less consistent Bannester(1962).

Qualitative Disorders of
Thinking
Over-valid idea (Wernicke 1900)
disorders of thought (content thought disorders):
 Delusions:

a) belief firmly held on inadequate grounds,

b) not affected by rational arguments

c) 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.
Description of delusion
 1-according to fixity:
 complete/partial
 2-according to onset:
 primary autochthonous/secondary
 3-other delusional experience:
 delusional mood/perception/memory
 4-according to theme:
 Persecutory/delusion of reference grandiose
/guilt,worthlesness/nehlestic/hypochondriacal/relegious/
sexual,amouros/control/
Delusion of possession of
 thought: insertion/withdrawal/broadcasting
 5-according to other features/shared delusion
 The causes of delusion
Freud1958

Delusion of perscuation:I don’t love him-I hate

him because he persecute me
Erotomania I don’t love him-I love her,
because she love me.
Delusion of jealousy :it is no I who loved the
man-she love him
Persecution---repressed homosexuality? or
projection
delusion
 Failure of logical reasoning (helmsly and
Garety1986).logical?
 Q/
 Can deluded patients reason logically
about matters unconnected with their
delusion????
Specific disturbances in
content of thought
 Poverty of content:
 Overvalued idea: delusion
 Preoccupation of thought: suicidal &
homicidal preoccupation
 Delusional moods, perception,
memories
 Delusion themes:
persecutory , reference, grandiose,
guilt, nihilistic, hypochondriacal,
religious, jealousy.
Specific disturbances in
content of thought (Cont.)
 Obsession:
 Compulsion:
Obsessions

 repetitive and constants thoughts, images,

or impulses that cause anxiety or distress
 thoughts, images, or impulses not about
real-life problems
 thoughts rumination doubts impulses
obsessional phobias.
 Compulsion (rituals).
 Obsessional slowness.
 Try to ignore or counter act thoughts,
images, or impulses
 thoughts, images, or impulses
“recognized as a product of one’s own
mind and not imposed from without”
Compulsions

 Repetitive behaviors or mental acts

person does in reaction to obsessions
 behaviors or mental acts done to
avoid or decrease distress
 behaviors or mental acts are clearly
excessive or not realistic
 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)
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
 Arachnophobia
 keraunophobia
 Acrophobia · Aerophobia · Agoraphobia · Agraphobia · Ailurophobia · Algophobia ·
Anthropophobia · Aphephobia · Apiphobia · Aquaphobia · Arachnophobia · Astraphobia ·
Autophobia · Aviatophobia · Aviophobia · Batrachophobia · Bathophobia · Biphobia ·
Brontophobia · Cainophobia · Cainotophobia · Cenophobia · Centophobia · Chemophobia ·
Chiroptophobia · Claustrophobia · Contreltophobia · Coulrophobia · Cynophobia ·
Dentophobia · Eisoptrophobia · Emetophobia · Entomophobia · Ephebiphobia ·
Equinophobia · Ergophobia · Erotophobia · Genophobia · Gephyrophobia · Gerascophobia
 · Gerontophobia · Glossophobia · Gymnophobia · Gynophobia · Hamaxophobia ·
Haphophobia · Hapnophobia · Haptephobia · Haptophobia · Heliophobia · Hemophobia ·
Heterophobia · Hexakosioihexekontahexaphobia · Hoplophobia · Ichthyophobia ·
Insectophobia · Keraunophobia · Kymophobia · Lipophobia · Monophobia · Murophobia ·
Musophobia · Mysophobia · Necrophobia · Neophobia · Nomophobia · Nosophobia ·
Nyctophobia · Ochophobia · Odontophobia · Ophidiophobia · Ornithophobia · Osmophobia ·
Panphobia · Paraskavedekatriaphobia · Pediaphobia · Pediophobia · Pedophobia ·
Phagophobia · Phasmophobia · Phonophobia · Photophobia · Psychophobia ·
Pteromechanophobia · Radiophobia · Ranidaphobia · Somniphobia · Spectrophobia ·
Suriphobia · Taphophobia · Technophobia · Tetraphobia · Thalassophobia · Tokophobia ·
Tonitrophobia · Trichophobia · Triskaidekaphobia · Trypanophobia · Xenophobia ·
Zoophobia
 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
Depersonalization – change of self-
awareness, the person feels unreal,
unable to feel emotion
Motor Disorders
Motor disorders occur frequently in mental
disorders of all kinds, especially in catatonic
schizophrenia.
 quantitative:
 qualitative:
 mannerisms
 stereotypes
 hypoagility  posturing
 waxy flexibility
 hyperagility  echopraxia
 agitated behaviour  negativism
 automatism
 tics
Soft neurological sign
 Stereognosis
 Graphasthesia
 Balance
 Proprioception
 Poor coordination
 Speech impairments.
 Hyperactive refluxes
 Impaired constructional and spatial ability.
 Clumsiness.
 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
 Quantitative changes of consciousness mean reduced
vigility (alertness):

 Somnolence

 Sopor—person can be aroused only by strong stimulation

 Clouding of consciousness
 Stupor—immobile—mute—unresponsive appear fully conscious
 Confusion—inability to think clearly(organic).

 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(cloudy) (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
Disorders of body image
 Phantom limb.
 Unilateral unawareness&neglect***.
 Hemisomatognosis :feel one limb is missing.
 Anosognosia: lack of awareness of disease,
blindness, amnesia– Korsakov
 Pain asympolia,feel pain not recognize it as
painfull.
 Autotopagnosia:inability to recognize name or
point on command to parts of the body.
 Reduplication state(sch,migrian,TLE)
 Disorders of Memory
 Sensory stores - retains sensory
information for 0.5 sec.
 Short - term memory (primary,working
memory) - for verbal and visual
information, retained for 15-20 sec., low
capacity
 Long-term memory
secondary memory

– wide capacity and more permanent storage

Procesed,stored according to verbal
characterstic,visual,meaning.
 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:
 Amnesia – inability to recall past events


Jamais vu("never seen ), déja vu (paramnesia)
 Confabulation, amnesic disorientation, Korsakov’s syndrome
 Pseudologia phantastica

 Hypomnesia(Abnormally poor memory )

 Hypermnesia
Abnormally strong memory of the past )
 Disorders of Attention
 Ability to focus on the matter in hand,
 Concentration—ability to maintain that focus.
 Depression, mania, anxiety, schizophrenia,
organic disorders
 Intelligence Disorders
 Intelligence:
 abstract
 practical
 social
 Intelligence quotient (IQ):
IQ = (mental age : calendar age) x 100
Theory of multiple intelligence
howard Gardner1983

 1-linguistic
 2-logical-mathematical
 3-spatial
 4-musical
 5-bodily-kinesthetic
 6-personal
Disorders of intellect:

 mental retardation
 dementia
Insight
 Awareness of one’s medical condition.
 It is not simply present or absent
(matter of degree).
 4 Question:
 1-is the patient aware of phenomena
that other people have
observe(unuasaualy active or elated).
 2-if so does he recognize that these
phenomena are abnormal.
 3-if he recognize the phenomena as
abnormal dose he consider that they
are caused by mental illness.
 4-if he accept that he is ill, dose he
think that he need treatment?