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Sign and Symptoms

Sign and Symptoms

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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

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 . gives their description. predicts their future course and outcome.Basic Terms in Psychiatry    Psychiatry studies the causes of mental disorders.

General psychiatry studies  psychopathological phenomena. motor 4. personality . consciousness 5. mood (emotions) 2. intelligence 3. symptoms of abnormal states of mind: 1. memory 8. perception 6. thinking 7.

Signs and Symptoms in Psychiatry Signs (objective findings) restricted affect& psychomotor retardation   Symptoms  (subjective experiences) .

(observed changes of abnormal phenomena) Studies of animal learning &behavioral response to frustration &punishment. .Psychopathology  Phenomenology jasbers1963 (objective description of a conscious abnormal state ) normal believe &obsession Delusion  Psychodynamic psychopathology Delusion repression &projection   Experimental psychopathology.

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 .

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? .Form and content of symptoms     Patients -1-when he is entirely alone----hear voice calling him homosexual (form)(AUD.

spouse. schizophrenia . parent. friends. siblings) effect on other healthy part of person Care for depressed child.Description of symptoms & signs     Individual mental phenomena Consider the whole person Fulfills social roles (worker.

  .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.

.

SHIZ  .H  Illusions misperception of external stimuli level of sensory stimulation level of consciousness Capgras delusion delusion of double-P.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.

.

the patient is unable to distinguish it from reality .Hallucination  are percepts without any obvious stimulus to the sense organs.

Description of hallucinations
1-according to complexity: bangs, whistles, elementary 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 echo de la pensee speaks own thoughts

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

Sexual schiz Insect---cocain&occacionaly schiz .depression) Tactile&somatic hallucination?Diagnostic value.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.

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) word salad (grammar) talking past the point (vorbeireden) form of thoughts     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. .

3-abnormality of semantic syntactic structure of speech. 2-frequent change of topic(derailment&knight move). .Thought disorder      1-iability to give straight answer even to simple Q . 4-hardest to comprehend. 5-dissociation of psychic functions.

Bannester(1962). Cameron1938. Concrete thinking Goldstein1944. Loosening of association Overinclusion Less consistent Payne&Friedlander 1962. .

b) not affected by rational arguments c) not a conventional belief  Obsessions (obsessive thought) are recurrent persistent thoughts. Obsessive phenomena in acting (usual as senseless rituals cleaning.Qualitative Disorders of Thinking Over-valid idea (Wernicke 1900) disorders of thought (content thought disorders):  Delusions: a) belief firmly held on inadequate grounds. impulses or images entering the mind despite the person's effort to exclude them. dressing) are called compulsions. counting. .

worthlesness/nehlestic/hypochondriacal/relegiou s/sexual.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.amouros/control/ Delusion of possession of thought: insertion/withdrawal/broadcasting 5-according to other features/shared delusion .

Delusion of jealousy :it is no I who loved the man-she love him Persecution---repressed homosexuality? or projection . because she love me.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.

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 .

reference. nihilistic. perception. memories Delusion themes: persecutory . religious. . hypochondriacal. guilt. grandiose.  Delusional moods. jealousy.

.

Specific disturbances in content of thought (Cont.)   Obsession: Compulsion: .

images. images. or impulses not about real-life problems thoughts rumination doubts impulses obsessional phobias. Compulsion (rituals). .Obsessions      repetitive and constants thoughts. Obsessional slowness. or impulses that cause anxiety or distress thoughts.

  Try to ignore or counter act thoughts. images. or impulses recognized as a product of one s own mind and not imposed from without . or impulses thoughts. images.

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. object. activity:       agoraphobia claustrophobia social phobias hipsophobia Arachnophobia keraunophobia . 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.

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 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 .

no psychological cause duration unusually long-lasting intensity unusually strong. large changes in intensity impossibility to be changed by psychological means .Disorders of Mood (Emotions)  Pathological mood:     origin based on pathological grounds.

flattened affect emotional lability helpless .Pathological features of mood:            euphoria expansive exaltation explosive mania hypomania depression apathy (anhedonia) blunted.

the person feels unreal. unable to feel emotion .Depersonalization change of selfawareness.

schizophrenia.  qualitative:  quantitative:  mannerisms  hypoagility  stereotypes  posturing  hyperagility  waxy flexibility  agitated behaviour  echopraxia    negativism automatism tics .Motor Disorders Motor disorders occur frequently in mental disorders of all kinds. especially in catatonic schizophrenia.

Hyperactive refluxes Impaired constructional and spatial ability. . Clumsiness.Soft neurological sign          Stereognosis Graphasthesia Balance Proprioception Poor coordination Speech impairments.

Disorders of Consciousness  Consciousness is awareness of the self and the environment Disorders of consciousness:  qualitative  quantitative  short-term  long-term   Hypnosis consciousness artificially incited change of short-term unconsciousness  Syncope .

coma      .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).

hard to understood     stuporous vigilambulant delirious Ganser sy . Qualitative changes of consciousness mean disturbed perception. misinterpretations and mood disorders Obnubilation(cloudy) (twilight state) starts and ends abruptly. thinking. affectivity. sometimes aggressive. the patient is disordered. enhanced suggestibility. his acting is aimless. distorted perception. memory and consequent motor disorders:   delirium (confusional state) characterized by disorientation. amnesia is complete.

Unilateral unawareness&neglect***.feel pain not recognize it as painfull. Reduplication state(sch. blindness.Disorders of body image        Phantom limb. Autotopagnosia:inability to recognize name or point on command to parts of the body. Anosognosia: lack of awareness of disease.TLE) .migrian. Hemisomatognosis :feel one limb is missing. amnesia Korsakov Pain asympolia.

low capacity .for verbal and visual information.5 sec.working memory) ..term memory (primary. retained for 15-20 sec.retains sensory information for 0.Disorders of Memory   Sensory stores . Short .

meaning.visual.     declarative (explicit) memory episodic (for events) or semantic (for language and knowledge) procedural memory for motor arts priming unconscious memory conditioning classic or emotional .Long-term memory secondary memory wide capacity and more permanent storage Procesed.stored according to verbal characterstic.

déja vu (paramnesia) Confabulation. Korsakov s syndrome Pseudologia phantastica Hypomnesia(Abnormally poor memory ) Hypermnesia Abnormally strong memory of the past )   .Disorders of Memory Disorders of memory:  Amnesia inability to recall past events    Jamais vu("never seen ). amnesic disorientation.

Concentration ability to maintain that focus. organic disorders . anxiety.Disorders of Attention   Ability to focus on the matter in hand.  Depression. mania. schizophrenia.

Intelligence Disorders  Intelligence:    abstract practical social IQ = (mental age : calendar age) x 100  Intelligence quotient (IQ): .

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 .

4 Question: 1-is the patient aware of phenomena that other people have observe(unuasaualy active or elated). .Insight     Awareness of one s medical condition. It is not simply present or absent (matter of degree).

3-if he recognize the phenomena as abnormal dose he consider that they are caused by mental illness.   2-if so does he recognize that these phenomena are abnormal. dose he think that he need treatment? . 4-if he accept that he is ill.

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