Introduction

PSYCHOPATHOLOGY
Dr. M.E. Mukrim
MBBS, MSc HPE, Clinical MD SMSB
Consultant Psychiatrist
Assistant Professor of Psychiatry
 Objectives

By the end of this lecture the students will be acquainted with;

 Principles of psychopathological -targeted

interviewing.
 Observations of the General Appearance and
Movements.
 Disturbances of Speech and Thinking.
 Disturbances of Emotions and Mood.
 Disturbances of Perception.
 Disturbances of Cognitive Functions.
 The Insight.
 Observation of

General Appearance & Behavior
• Consciousness
• Facial expression
• The dressing style and fashion.
• Hygiene and self care.
• Eye to eye contact.
• Cooperation in conversation.
• Level of motor activity & Abnormal
movements
• inappropriate or disorganized behaviors
• Catatonic behaviors
 Catatonic Movements


• Catalepsy: Passive induction of a posture held against
gravity.
• Posturing: Spontaneous and active maintenance of a
posture against gravity .
• Waxy flexibility: Slight, even resistance to positioning by
examiner.
• Negativism: Opposition or no response to instruction or
advice.
• Stupor: no psychomotor activity
• Mutism: no or very little verbal response
• Psychomotor agitation: Excessive motor activity associated
with a feeling of inner tension
 Catatonic Movements

• Mannerism: odd, circumstantial caricature of normal

actions.
• Stereotypy: Repetitive, abnormally frequent, none-goal
directed movements.
• Echolalia: senseless repetition by the pt of interviewer
words or phrase (echoing).
• Echopraxia: Mimicking the movements of another.
• Grimace (grimacing): Odd and inappropriate facial
expressions unrelated to situation.
 Disorders of Speech
Speech is the motor counter part of thinking
• Pressured speech: increased in the amount of
spontaneous speech.
• Flight of ideas: jumping from one topic to an
others abruptly.
• Poverty of speech: restriction in amount of speech.
• Mutism: No, or very little, verbal response (in the
absence of known aphasia).
• Monotonous Speech
 Disorders of Speech
• Loss of Association: unconnected ideas shifted from
topic to an other
• Word Salad: incoherent , mixture of word and phrase.
• Neologism: new word created by the pt.
• Circumstantiality: mention of unnecessary detail before
communicating the central idea.
• Tangentiality: as before but central idea is not
communicated
• Perseveration: Pathological repetition of same response
to different stimuli or repetition of specific word.
 Disorders of Emotions
• Mood: A pervasive and sustained emotion that colors the
perception of the world (Climate) e.g. Depression, elation,
anger, and anxiety.
• Affect: The subjective and immediate experience of
emotion (more fluctuating changes in emotion) (Weather).
Types of mood include;
• Euthymic: Mood in the "normal" range, which implies the
absence of depressed or elevated mood
• Dysphoric: An unpleasant mood, such as sadness (low
mood), anxiety.
 Disorders of Emotions
• Elevated: An exaggerated feeling of well-being, or
euphoria or elation. A person with elevated mood may
describe feeling "high," "ecstatic," "on top of the world," o
r "up in the clouds
• Expansive: Lack of restraint in expressing one's feelings,
frequently with an overvaluation of one's significance or
importance.
• Irritable: Easily annoyed and provoked to anger
 Disorders of Emotions
Disturbances in Affect include:
• Restricted or constricted: Mild reduction in the range and
intensity of emotional expression
• blunted: Significant reduction in the intensity of emotional
expression.
• Flat : Absence or near absence of any sign of affective
expression.
• Inappropriate : Discordance between affective expression
and the content of speech or ideation.
• Labile: Abnormal variability in affect with repeated, rapid,
and abrupt shifts in affective expression.
 Disorders of Emotions

• Anhedonia: deficits in the capacity to feel pleasure and

take interest in things.
• Bereavement: The state of having lost through death of
someone with whom one has had a close relationship.
This state includes a range of grief and mourning
responses.
 Disorders of Emotions
• Anxiety: The apprehensive anticipation of future danger
or misfortune accompanied by a feeling of worry,
distress, and/or somatic symptoms of tension. The
focus of anticipated danger may be internal or external
• Fear: An emotional response to perceived imminent
threat or danger associated with urges to flee or fight.
• Mood-congruent psychotic features: Delusions or
hallucinations whose content is entirely consistent with
the typical themes of a depressed or manic mood.
• Mood-incongruent psychotic features: Delusions or
hallucinations whose content is not consistent with the
typical themes of a depressed or manic mood.
 Disorders of Thinking
• Delusion: A false and fixed beliefs that are not amenable to
change in light of conflicting evidence or evidence to the
contrary and not keeping with patient culture or
educational background.
• Overvalued idea: false or unreasonable believe or idea but
held in less intensity than delusion.
• Delusions are divided to:
- Non bizarre delusion
- Bizarre delusion: if it is clearly implausible and not
understandable to same-culture peers and do not derive
from ordinary life experiences..
 Disorders of Thinking
Delusions are subdivided based on their content into;
• Delusional jealousy: A delusion that one's wife or partner
is unfaithful sexually.
• Erotomanic: A delusion that another person, usually of
higher status, is in love with the individual.
• Grandiose: A delusion of inflated worth, power,
knowledge, identity, or special relationship to a deity or
famous person.
• Persecutory: A delusion in which the central theme is
that one (or someone to whom one is close) is being
attacked, harassed, cheated, persecuted, or conspired
against.
• Somatic: A delusion whose main content pertains to the
appearance or functioning of one's body.
 Disorders of Thinking
• Delusion of controlled: A delusion in which feelings,
impulses, thoughts, or actions are experienced as being
under the control of some external force rather than being
under one's own control.
• Delusion of reference: belief that certain gestures,
comments, environmental cues, and so forth are directed
at oneself .
• Thought broadcasting: A delusion that one's thoughts are
being broadcast out loud so that they can be perceived by
others.
• Thought withdrawal: a delusion that ones own thoughts
are being removed from ones mind
• Thought insertion: A delusion that thoughts are being
implanted into one's mind.
 Disorders of Thinking

• Ideas of reference: The feeling that causal incidents and

external events have a particular and unusual meaning
that is specific to the person. An idea of reference is to
be distinguished from a delusion of reference, in which
there is a belief that is held with delusional conviction.
 Disorders of Perception

• Hallucinations
• Illusions
• Derealization
• Depersonalization
 Hallucinations
• Abnormal perception without external stimuli
• Types are based on sensory modalities (Auditory, Visual,
Gustatory,…etc.).
• Auditory hallucinations: either elementary or complex.
• True auditory hallucinations are: (coming From out side
space, not under voluntary control, in clear sensorium
and persistence).
• Types of Auditory Hallucinations include:
• 2nd person auditory hallucination: one or more voice
spoken to the patient in the second person as either
orders or abusive remarks.
 Hallucinations
• 3rd person auditory hallucination: two or more voices
speak about the person in the third persons .
• Commentary auditory hallucination : give a running
commentary on the patient’s actions.
• Mood Congruent: with content that consist with the
mood.
• Mood Incongruent: with content that is not consistent
with depressed or manic mood
 Hallucinations
• Visual hallucination: are associated with organic
disorders of the brain and with drug and alcohol
intoxication and withdrawal. They are very rarely seen in
psychotic illness
• Olfactory and gustatory hallucinations:
Hallucination primarily involving smell and taste
occur in a wide range of mental disorders.
Olfactory hallucinations occur in epileptic auras, in
depressive illnesses and schizophrenia.
• Tactile hallucination:
Hallucination primarily involving the sense of touch
 Hallucinations
• Hypnagogic/hypnopompic hallucinations: are transient
false perceptions which occur on falling asleep
(hypnagogic) or on waking (hypnopompic).
• Illusion:
misinterpretation of external stimuli.
• Derealization:
Sensation of changed reality or that one's surroundings
have altered.
• Depersonalization:
Sensation of unreality concerning oneself.
 Disorders of Cognitive Functions
1.Consciousness: state of awareness , with response to
external stimuli
• Clouding of consciousness: conscious between fully
consciousness and coma
• Confusion: disturbance of consciousness manifested
by disorientation in time, place and person
• Stupor: subjects reactivity is reduced to minimum.
• Coma: complete loss of consciousness.
2. Orientation: state of awareness of oneself and ones
surrounding in terms of time , place and person
3. Attention: ability to focus on a matter on a hand
4. Concentration: ability to maintain this focusing
• Distractibility : inability to concentrate.
 Disorders of Cognitive Functions

5. Memory: function by which information stored in the

brain is recalled.
• Amnesia : partial or total inability to recall past
experience
• Confabulation: unconscious filling of gaps in memory by
imagine or untrue experience.
• Déjà vu: illusion of visual recognition in which a new
situation is incorrectly regard as a repetition of a
previous memory.
• Jamais vu: false feeling of unfamiliarity with a real
situation one has expereinced.
 Disorders of Cognitive Functions
6. Intelligence: the ability to understand, recalls, mobilizes
and constructively integrates previous learning in meeting
new situation.
a/ mental retardation: lack of intelligence to a degree in
which there is interference with social and vocational
performance.
b/dementia :organic and global deterioration of
intellectual functioning without clouding of consciousness.
c/ pseudodementia: clinical features resembling a
dementia most of them caused by depression
7. Judgement: cognitive process in which evaluation or
assessment and decision making are involved
 cont
8. General Information
9. Abstractability of Thinking: ability to grasp the essential
of a whole.
Concrete thinking: characterize by actual thing, event and
immediate experience rather than by abstractions.
* Insight: attitude towards illness, the degree of awareness
of the pt about whether he consider himself as mentally
ill and whether in need of psychiatric treatment or not.
Thank You