Psychopathology

Dr. Shafqat Huma

MBBS, FCPS(Psychiatry)
Fellowship in Addiction Psychiatry(USA)
 Disorder of thought

stream
formal Tangentiality content
Circumstantially
loose associations
Concrete
Flight of idea Delusion.
thinking
Clang association
word salad
Autistic Obsession
Pressured specchi
thinking
Poverty of speech
Retardation
Peroccuption.
Blocking
Preservation
Echolalia
Suicidal ideation.
Neologisms
 Formal thought disorder:

Concrete thinking: when the patient use literal

thinking with out understanding the implicit
meaning behind sentence &it is verse abstract

When his doctor used the phrase “we’re walking on eggshells,” the patient immediately
looked down around his feet and appeared puzzled by the empty floor around him.
 Autistic thinking: thinking that gratifies
unfulfilled desire but has no regard for
reality, egocentric (self -centred) fantasy.

Logical structures supporting a totally private view of reality. The pa

Example: The patient religiously avoids stepping on cracks in the pa
 Disorder of stream of thinking:

• Tangentiality:
• Occur when The speaker goes off the topic
and dos not return to the it.

eviation from the subject. This new thought is vaguely relevant t

 • Circumstantially:
• Before getting the point or answering the
question the patient gets caught up in
countless details and explanation.

ate from topic of conversation but remain vaguely related to orig

 • Loose association:
• Thinking haphazard , illogical and confused,
connection of thought is interrupted appear
mostly in schizophrenic disorder.

ds to be more severe form of tangentiality in which one statemen

 Example

“I went to the market. I should read that book. When did you
buy this dress? It's a lovely evening. I should go for a walk. I
feel like having a chocolate. I need to study for the
examination. That movie has received very good reviews”.
 • Flight of idea:
• Rapid jumping from one idea to another, the
connection b\t idea is through stimuli from last
idea or external stimuli.

Patient: My eating is okay. I once ate a lot of fish. Maybe I co

Clang association: meaningless rhyming of word

"You are very cute. A cute mute, who sings in a suit, while eating his fruit”.
 • Incoherence or word salad: mixture of
word and phrases that have no meaning.

Example: “It was shockingly not of the best quality I have known all

Pressured speech: Forceful energy heard in a manic

people frantic jumbled speech as he or she struggles to keep
pace with racing thought.
• Poverty of speech: the speech is brief.

Example: A depressed man offers no spontaneous commentary du

Retardation: refer to slow speech and prolonged

latent period before response.
 Blocking:
Sudden cessation of thought in the middle of
sentence & person is unable to continue her/his
train of thought.

Preservation : psychopathological repetition of the

same word or idea in response to the different
question

Example: Asked for the day, the patient says it’s Sunday. Subseque
Palilalia:
pathological repetition of the last word said.

Echolalia: repeating the speech of another

person.
Irrelevant answer:
answer that is not in harmony with question asked.

Neologisms:
word a person mack up that only have meaning for
the person.

"I need to study for the test; maybe I should form a study cohabitorum"
 Disorder of content of thought:
It includes:

Delusion. Obsession.
Preoccuption. Suicidal ideation.
 Delusion

Definition
It is false fixed belief not consistent with the patient’s
educational and cultural back ground that cannot be
corrected by logic or reasons.
 Paranod delusion:
it is an intense and strongly defended irrational
suspicious belief.

A-Delusion of grandeur: false belief that one is a very

powerful and important person.
B-Delusion of persecution: false belief that one is chased
by other.
C-Delusion of reference: false belief that the behavior of
other refers to one self (people in street, radio, news
paper are referring to him) .
D-Erotic delusion: false belief that there is a love
story between one self and famous person.
E-delusion of jealousy:
conviction that the spouse has some definite relation
with someone else.
f-delusion of infidelity:
false belief derives from pathological jealousy that
one lover is unfaithful (it is an extreme of the
jealousy delusion)
 delusion of influence (delusion of
control)

false belief that one is being

controlled by other or agencies.
 Depressive delusion:

A-delusion of self-blame, guilt or sin:

in which the patient that he is wicked, full of sins
and unfit to live with other people
(unworthiness).
B-delusion of poverty: false belief that he lost
everything in life.
C-Nihilistic delusion: false belief that a part of
this body doesn't exist or he doesn't exist(dead)
 Hypochondriacal delusion:

Patient has false belief that he has

physical disease e.g. cancer
stomach that is not based on real
organic pathology.
 Obsession:

Obsessions are thoughts or images that will

not go away. An obsession is intrusive and
normally seen as irrational, but the person
with OCD is not able to stop or ignore
these thoughts.
 Preoccupation:
Centring of thought content around
a particular idea associated with
strong affective tone.

Suicidal ideation:
It is the recurrent idea affecting the
individual to put an end by himself
to his own life
 Disturbance in perception:

Hallucination:
False perception for which no external
stimuli exist. Hallucination can have
an organic or a functional etiology.
 Visual: seeing
thing that are not
there.

Auditory: Gustatory:
hearing voice experiencing
when none are taste in the
present. absence of
stimuli.

Olfactory: Tactile: feeling

smelling smells touch sensation
that do not exist in the absent of
stimuli.
 illusion:
It is a false perception with an external
stimulus.
N.B. it may affect any of the special
senses ( auditory, olfactory….,etc)
1-hallucination: 2- illusion:
False perception for which It is a false perception
no external stimuli exist. with an external
Hallucination can have an
stimulus.
organic or a functional
etiology.
 Unreality states:

Depersonalisation: A phenomenon whereby a

person experience a sense of unreality or self –
estrangement.

Derealization: the false perception by a person

that his or her environment has changed also they
can be categorized under affect and perception.
 4-disorder of memory:

1-amnesia: is loss of memory and may be partial or complete.

1-Anterograde 3-Total amnesia:

amnesia:

type of amnesia:

2-Retrograde
amnesia : 4-Circumscribed
amnesia:
1-Anterograde amnesia: loss of memory for recent event.
2-retrograde amnesia : loss of memory for remote event.
3-Total amnesia: loss of memory for recent and remote
event.
4-Circumscribed amnesia: loss of memory for limited time.

2-par amnesia: it denotes false recall.

a-confabulation: b-falsification
patient fills the patient adds
gaps in his fraises details
memory by to a true
fabrication. memory.
3-hyperamnesia: it's excessive memory, the
patient mention even unnecessary details.

4-deja vu phenomena (already seen): in which

new situation is experienced as previously

5-jamais vu phenomena: in which familiar

situation is experienced as novel.
 6-judgment:

It is the ability to assess a situation correctly and act

appropriately within that situation.

7-insight:

It is the ability to under stand the objective

condition of his illness.
N.B. A patient with no insight will have poor
judgment towards his social , financial and
domestic problem.
 8-attention and concentration:

It Is the direction of the focus of awareness and

perception to a particular stimulus.

*distractibility: inability to maintain attention,

shifting from one area or topic to another with
minimal provocation.
 9-Disorder of consciousness:

Between conscious and unconscious there are various degree of

disturbed consciousness, some of them are:
1-confusion:
There is dimming or clouding of consciousness. All mental
processes are slow.

2-delirium:
There is clouding of consciousness .the mental function show
quantitative change:
a-intellect: Hallucination ,illusion and disorientation.
B-affect: fear and apprehension.
c-behavior: restlessness.
3-stupor: there is complete suppression of
motor activity, the patient doesn't respond to
any stimuli neither of external or internal.

4-twilight state: is state of restricted

consciousness including ideation perception
and association emotional state.

5-fugue: it involves memory loss, as does

psychogenic amnesia, but it also including
traveling away from home or from one's usual
work locale.
Therefore, fugue involves flight as well as
forgetfulness.
 10-disorder of affect:

A-inadequate
affect:

1-apathy :
it's the absence of
emotional experience
and expression.

2-indifference:
absence of both emotional but
experience is present.
(incongruity) it is a disharmony of
affect and ideation.
 c-Ambivalence:

the holding at the

same time of tow opposing emotions, attitudes,
ideas or wishes
toward the same person, situation
or object
 D-depressive
affect:
1-grief or
mourning:
it's feeling of
sadness
appropriate to
a real
loss.
2-depression:
it's
a psychopathological
feeling of
sadness.
 E-pleasurable
1-euphoria: affect:
it is a heightened feeling
of psychological well
being inappropriate to
apparent event.

2-elation:
it is feeling of happiness
with air
of confidence and
enjoyment
associative with increase
motor activity.
 F-anxiety,
apprehension
,fear and
phobia

1-Anxiety:
a state of feeling ,uneasiness ,uncertainty
or dread resulting from a real or perceived
threat whose actual source is unknown or unrecognized.
 1-free floating anxiety:
it is sever, generalized
and pervasive. Fear not
attached to any idea.

3-panic:
2-tension: sudden, overwhelming
unpleasant feeling anxiety of such
associated with intensity that it
physical Type of anxiety: produce
and psychological disorganization of the
tightness. personality
2-Apprehension:
intense fear of any non-fearful stimuli.
Fear of externals danger
e.g. car accident.

3-fear: A reaction to specific danger.

4-phopias: An intense irrational fear of

an object,
situation or place .the fear persist even
thought the
object of the fear is perfectly
harmless and the person is aware of
the irrationality.
 14-Disorder of behavior( conation):

a-hyperactivity:

1-Agitition:
2-Excitement:
it's some from of it include: it's sever form of
hyperactivity
hyperactivity, excessive
characterized by pacing
purposeless motor
and accompanied with
activity and the patient may
restlessness
destruct himself or other
B-Compulsion:

un controllable impulse to perform an act repetitively.

c-Repetitive activity:

1-stereotypy: 2-mannerism:
it is a monotonous repetition of it is a repeated movement,
certain movement with which isn't monotonous and
out purpose. keeping with the personality
character.

4-waxy flexibility:
it is the maintenance of imposed postures
however abnormal they may be
the absence of fatigue
in such cases is remarkable
(e.g. raising the heal of the patient from the
pillow or the arm up).
D - Echopraxia

imitating the movement of another person :.

E - Negativism

frequent opposition to suggestion, e.g.

a-in motor sphere when was asked to look up

he looked down.

b-in speech : when he asked question he

didn't answer.

c- retention of saliva, urine or feces.

f-Automatic obedience:

the performance of all simple commands in

a robot-like fashion may be present in catatonic.

G-Impulsiveness:
is an action that is sudden , abrupt , unplanned
and directed toward immediate gratification.

H-psychomotor retardation:

Extremely slow and different movement that in the

extremes can entail complete inactivity and incontinence