Symptomatology in mental disorders

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SYMPTOMATOLOGY IN

MENTAL DISORDERS

By:- Firoz QureshiDept. Psychiatric Nursing

Introduction

Mental illness in an individual causes lot of human suffering

The systematic study of cognition and behavior is called ‘psychopathology’.

Symptoms are the result of many forcesThe symptoms may be very bizarre but

have a cause and meaning.

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Various symptoms observed in mental illness are addressed under the following headings:

1. Disorders of motor aspects of behavior2. Disorders of perception3. Disorders of thinking4. Disturbances of affect5. Disturbances of attention6. Disorders of consciousness7. Disorders of orientation8. Disorders of memory

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Disorders of motor aspects of behavior

Motor disturbances are related to action or impulse toward action. It is called conation. These activities are related to attitude and feeling.Increased activity (over activity)Decreased activityRepetitious activities

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Stereotypy • Persistent and constant repetition of certain

activities and may be of position, movement of body or speech. Stereotypy is seen in the following forms.

Stereotypy position• Catalepsy A constantly maintained

immobility of position is known as catalepsy. It is frequently seen in Schizophrenia.

• Waxy –flexibility: In this patient may flex his extremities like wax in awkward position and remains in that position for long time.

• Stereotype Movement• Mannerisms: These are stereotyped

movements commonly seen in Schizophrenia. Ex: grimaces repeated gestures and peculiarities of gait etc.

• Stereotype Speech• Verbigeration: When meaningless word,

phrase or sentence may be repeated. It is called verbigeration.– Automatic Behaviour

• In this patient follows compulsively and automatically suggestions and requests. This is seen in two forms:

• Echolalia: patient repeats the words or phrases which are spoken in his presence.

• Echopraxia: the patient imitates the movement of others.

• 1.6. Negativism • It is a psychological defense reaction

manifested by opposition and resistance to what is suggested. This can be exhibited in different forms such as mutism, refusal of food and noncompliance with requests etc. Negativism provides gratification by the acting out of hostile, revengeful feelings towards significant persons.– Compulsions

• A morbid and often an

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Stereotypy Persistent and constant repetition of certain activities and may be of position, movement of body or speech. Stereotypy is seen in the following forms.a) Stereotypy position• Catalepsy: A constantly maintained

immobility of position is known as catalepsy. It is frequently seen in Schizophrenia.

• Waxy –flexibility: In this patient may flex his extremities like wax in awkward position and remains in that position for long time.

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Stereotype Movement• Mannerisms: These are stereotyped

movements commonly seen in Schizophrenia. Ex: grimaces repeated gestures and peculiarities of gait etc.

Stereotype Speech• Verbigeration: When meaningless word,

phrase or sentence may be repeated. It is called verbigeration.

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Automatic Behaviour• In this patient follows compulsively and

automatically suggestions and requests. This is seen in two forms:

Echolalia: patient repeats the words or phrases which are spoken in his presence.Echopraxia: the patient imitates the movement of others.

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1.6. Negativism • It is a psychological defense reaction

manifested by opposition and resistance to what is suggested.

• This can be exhibited in different forms such as mutism, refusal of food and noncompliance with requests etc. Negativism provides gratification by the acting out of hostile, revengeful feelings towards significant persons.

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1.7 Compulsions • A morbid and often an irresistible urge to

perform purposeless act repetiously is known as compulsion. Ex: touching an object twice or may take form of ritual.1.8. Violence

• Violence is an expression of aggressiveness in the form of murders, assaults, rape damaging self and others and suicide.

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1.9. Suicide • It means self-destruction. • People with suicidal ideation have sense of

lack of love and affection and deep sense of personal rejection.

• They also suffer from self-derogatory attitude, profound feelings of hopelessness and helplessness.

• The suicidal attempt is motivated by the wish for revenge or by wish-fulfilling fantasies of reunion in death.

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Disorders of perception• Disorders of perceptions are classified as

illusions and hallucinations. Illusions • Illusions are mistaken or misinterpretations

of sense impressions. Ex: patient perceives rope as a snake. Illusions occur due to individual emotional state, needs and fears.

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Hallucinations• Hallucination is a perception without object• Hallucinations should be looked upon as

mental products which, arising from within and not related to any external stimulus.

• They represent a breakthrough of preconscious or unconsciousness in the form of sensory images in response to psychological situations and needs.

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Types of Hallucinations

A. Auditory Hallucinations B. Visual Hallucinations C. Olfactory Hallucinations D. Gustatory HallucinationsE. Tactile HallucinationsF. Kinesthetic Hallucinations

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3. Disorders Of Thinking1.Disorders in the form of thought• Thinking is the product of stimulus and

response. • Stimuli for thought come from various sources.

In day dreaming thinking is directed by egocentric wishes and instinctual needs.

• In case of Schizophrenia, thinking is directed by unconscious factors. Ex: autistic thinking or drastic thinking.

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Disorders of progression of thought (Stream of thought)A. Flight of ideasB. RetardationC. PerseverationD. CircumstantialityE. IncoherenceF. TangentialityG. Blocking

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Disorders of content of thought• Overvalued or over determined ideas: When

an idea has strongest feeling tones it tends to dominate and we call it over valued idea. Overvalued idea becomes most important determinant of behavior. This is how delusion occurs.

• Delusions: The delusion is defined as common false beliefs, which are irrational, not shared by persons of same race, age and standard of education, which is held by conviction and which cannot be altered by logical arguments and which are persistent. 17

Types of Delusions A. Delusions of grandeurB. Delusions of Self-AccusationC. Delusions of persecutionD. Ideas of referenceE. Delusion of sin, guilt, Impoverishment and

illness

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Hypochondria: • In this patient shows exaggerated concern

over physical health. • In this anxiety is displaced from

unconscious mental sources to organs. • It occurs in people who have shown

previous tendency to evade the responsibilities of life through illness.

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Obsessions: • Thoughts that persistently push themselves

in to consciousness against the desire of the patient are known as obsessions.

• Obsession thoughts are strongly charged with the emotions of guilt or depression. Ex: patient keeps on asking why he was born. Obsession thoughts are closely related to compulsive acts.

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Phobias: • Allied to obsessive thoughts the patient has

fears of dirt, bacteria, cancer or of crowds.

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Disturbances of affect

• Affect is related to feeling which currently the person is having whereas mood is sustained feeling state of considerable duration.

• Affect serves as warning signal to refrain from a forbidden act. Affect influence our thoughts and ideas.

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Pleasurable affects• Euphoria • Elation • Exhalation • Ecstasy

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Depression

• It is an effective feeling tone of sadness.• It is the commonest type of complaint in

psychiatric patient. • It can vary from milder depressive

syndrome to deeper depression. • Grief: it is an effect of sadness due to loss

of a close relation, may be death of a person.

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Anxiety• It is a persistent feeling of dread,

apprehension and impending disaster. The patient is ignorant of its source. Following are the different states of anxiety.

A. Free-Floating anxiety B. Agitation C. TensionD. Panic

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In adequate Affect• This is emotional dulling or detachment in

the form of indifference, also called apathy. Patient does not feel pleasure or pain or any other sentiments.

• This absence of emotional responsiveness may cause out of touch with reality. It may appear as a protective, defensive reaction against painful perceptions.

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Inappropriateness of affect• It is a disharmony of affect. It is common

emotional disturbance, seen in Schizophrenia.Ambivalence • It means existence of contradictory feeling,

attitudes toward the same object or person. Both of these conflicting attitudes are faces of the same coin, while only one may be visible, the other is nevertheless present. Ex: feeling of love and hate towards the parents.

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Depersonalization

• It is an affective disorder in which feelings of unreality and a loss of one’s own identity are experienced.

• The unreality symptoms are of two kinds; a) feeling of changed personality b) a feeling that the outside world is unreal.

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Disturbances of attentionOrganism examines the external world for useful data is known as attention.Disordered attention• Fatigue toxic states and organic lesions

interfere and lower attention.Distractibility • The inability to hold attention for a sufficient

length of time is called distractibility. In Schizophrenia the degree of attention is greatly diminished. 29

Disorders of consciousness

Impairments in consciousness from least to the greatest are A. Confusion B. Clouding of C. DeliriumD. Dream state E. Stupor

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Disorders of orientation• The process by which one understands his

surroundings and locates himself in relation to it is known as orientation.

• If a person knows his position in reference to time, place and person, he is said to be oriented.

• Disorientation may occur in organic brain syndromes and in acute conflicts.

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Disorders of memoryThe function by which information is acquired and presented to consciousness and attention is stored, later same is recalled to consciousness is known as memory. It has three processes.• Registration: it means reception of the

mental impression• Retention: it means preservation of the

previous by acquired impression.• Recall: It means reproduction of the

impression. 32

Hypermnesia • It’s an exaggerated degree of retention and

recall. It occurs in mild manic states, paranoia and catatonia impressions with which strong emotions are attached.

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Amnesia• It means loss of memory or inability to

recall past experience. • It can occur in physiological disturbances of

neurons through chemical alterations or trauma. In psychogenic amnesia, recall is not present for psychogenic reasons.

The types of amnesia are• Anterograde amnesia: confined to recent

events and is progressive.• Retrograde amnesia: involves the past

events and is not progressive. 34

Paramnesia It is a falsification of memory as well as distortions of memory also serves as protection against intolerable anxiety. There are various types as follows:• Confabulation• Retrospect falsifications

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“Déjà vu”: • This is an experience of seeing with the

feeling that one has seen it before but does not know when and where.

• This is seen in Schizophrenia, Psychoneuroses, lesions of the temporal lobe including epilepsy and states of fatigue or intoxication.

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