Lecture, 3 psychiatric nursing……practical Lecture objectives:- ( Summary )

At the end of this lecture the students will be aware of :

V-Disturbance of thinking (thought)

Sign and symptoms A- Disturbance in the form and process of thought

1- Loose of associations (Circumstantiality – Incoherence- Word salad).
2- Blocking of thoughts - 3. Flight of ideas - 4. Irrelevant answer - 5.Verbigration =Palilalia - 6. Echolalia - 7.Perseveration
8. Neologisms - 9. Concrete thinking - 10. Pressure of talk
B- Disturbance in the content of thought

of mental illness I. Poverty of content of thoughts

II. Preoccupation of thought
III. Delusions (Persecutory- reference – grandeur – control - guilt – poverty-nihilistic- infidelity (jealousy)- hypochondrical (somatic)-
withdrawal, insertion-broadcasting)
IV . Obsession and compulsive symptoms:

(2) a. Obsession

A. TICS
– b. Compulsions:
VI-Disturbance OF motor behavior
B. Repetitive behavior (Stereotypy- Waxy flexibility –Mannerisms- Catalepsy- Echopraxia- Automatic obedience – Negativism)
VII- Disturbance of insight (Partial insight - Lack of insight)
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
VIII - Disturbance of judgment (Impaired (poor) judgment ) -

A- Disturbance in the form and

V-Disturbance of process (organization)of
thinking (thought) thought

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

 Disturbance in the form and process of thought

Because it is not possible to directly perceive the patient thinking

processes, the clinician must recognize the symptoms of thought disorder 1- Loose of associations
based on the a patient’s speech, this allows the examiner to note the Association refers to the logical connection or
quality of the thought process, including its form, structure, organization, tightness between ideas.
flow, logic and associations.
-- Loosening of association can take several
forms:
Abnormalities of the thinking form and process include:-

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

a. Circumstantiality b. Incoherence
Give much unnecessary details and Is sever form of loosened association in which no any
explanation before getting to the point or logical connections between patient sentences (no
answering a question. meaning, no grammatical connection ) and thinking
generally is not understandable , and did not reach the
goal.
It most common seen in normal conversations,
hypomania, anxiety disorders, substances abuse It most common seen in schizophrenia
(alcohol) and obsessive compulsive disorders.

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
 Disturbance in the form and process of thought

c. Word salad 2- Blocking of thoughts

There is no connection between individual Stop of thinking process ( the speech suddenly stop), after brief pause,
words to form understandable sentences. patient not return to the previous topic, and unaware that a block occurred.
Patient indicated no recall of what was being said.
Most commonly seen in act anxiety and schizophrenia.
This is most common seen in schizophrenia, and
advanced dementia.

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

Disturbance in the form and process of thought Disturbance in the form and process of thought

3. Flight of ideas
Involves rapid speech , and jumping from one idea to another without logical connection or 4. Irrelevant answer
reaching the goal .
Patient with flight of ideas may use two words of similar sound (clang association). patient answer is not in harmony with question
Most seen in mania
for example, might deliver a 10-minute monologue during which he or she jumps from talking
asked.
about childhood, to a favourite advertisement , to a moment of distorted body image, to
political ideology, to favourite flower.

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
 Disturbance in the form and process of thought Disturbance in the form and process of thought

5. Verbigration ( also known as Palilalia)

Useless, meaningless repetition of specific words or
6- Echolalia
phrases ( pathological repetition of the last word Automatic repetition of phrases or words heard from another person or
said told to him
Most common in mood disorder, and schizophrenia Most common in catatonic and chronic schizophrenia

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

Disturbance in the form and process of thought Disturbance in the form and process of thought

7.Perseveration 8. Neologisms
Persistent response to a prior stimulus after new stimulus has been presented
(inability to make appropriate shifts in thinking). New words created by the patient usually by condensation of
several words .
Most common in catatonic and chronic schizophrenia and dementia. Most common in schizophrenia

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
 Disturbance in the form and process of thought
Disturbance in the form and process of thought

9. Concrete thinking
(Lack of abstraction ability) 10. Pressure of talk
Inability to generalize or abstracts and inability Rapid, accelerated speech
to recognize the meaning behind words
that is difficult to interrupt
Most common in schizophrenia and dementia

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing

Break 15 minutes

B- Disturbance in the
content of thought
Disturbance in the content of thought
I. Poverty of content of thoughts
Restriction in the amount of speech used
( or give little information)
II. Preoccupation of thought
Centering of thought content on a particular
idea associated with strong affective tone.
Types of delusion
According to the theme of delusions, the
most common types include:
Persecutory- reference – grandeur – control
guilt – poverty-nihilistic- infidelity (jealousy)
- hypochondrical (somatic)- withdrawal,
insertion-broadcasting
Disturbance in the content of thought
III. Delusions
False fixed beliefs, not consistent with patient’s cultural ,
education, background, and cannot be corrected by logic,
because they accepted by the patient as reality
-False beliefs …. The belief is not arrived at through normal
process of logical thinking and not shared with others.
- Fixed beliefs…. Cannot be corrected with reasoning
-Not consistent with patient’s cultural , education….is not
accepted by other members of the patient culture.
Delusions of persecution
False believe that one is being persecuted )
Are most commonly concerned with persons or
organizations that are thought to be trying to
inflect harm to the patient or the food is being
poisoned.
 Delusions of reference Delusions of grandiosity
False believe that the behavior or False believe of exaggerated self
remarks of other persons or events (e.g. importance and powerful
newspaper or television) refers to oneself. Occur in mania and in schizophrenia

Delusion of influence (delusion of Delusions of sin

control ( self blame or guilt)
False believe that one’s action, thoughts, or False believe that one is responsible for certain harm,
feelings are being controlled by others or sin or crime
agencies or external forces Are found most often in depressive illness
 Delusions of poverty
False believe that one lost everything
in life (money or possession).
Delusions of infidelity (jealousy)
False believe derived from
pathological jealousy i.e. delusions
that a loved one is unfaithful
Nihilistic delusion
False believe that the person or part of
his body or others or the world is not
existent or ending.
Are found most often in sever
depressive illness
Hypochondriacal (somatic) delusions
An exaggerated concern over one's health,
and the belief that one has certain illness
(cancer ) without having any real organic
pathology
 Thought withdrawal delusion
False believe that other people or forces are
removing ones thought from his mind
Thought insertion delusion
False believe that thoughts are being implanted in
one mind by other peoples or forces
Disturbance in the content of thought
IV . Obsession and compulsive symptoms:
These symptoms are more common than delusions
a. Obsession:
Pathological recurrent and persistent ideas, thoughts, or feelings
that can not be eliminated from consciousness by logical effort,
despite of their irrationality.
Most common themes of obsession can be grouped into:
1.Cleanliness(dirt and contamination)
2.Orderliness (symmetry and precision)
3. Doubt 4. Religion
Thought broadcasting delusion
Delusion that others being broadcasted into the
air can hear one’s thoughts.
Thought withdrawal, insertion, and broadcasting
occur more commonly in schizophrenia than any
other disorder.
b. Compulsions:
Are repetitive behaviors (action) performed in a
stereotyped (repetitive) way.
A compulsions usually associated with an obsession as if it
has the function of reducing distress caused by obsession
e.g. hand washing compulsion often follows
obsessional thoughts that the hands are
contaminated.
 VI-Disturbance OF motor behavior

VI-Disturbance OF A. TICS
Are irregular repeated movements
motor behavior involving a group of muscles e.g. rising
(conduct) of one’s shoulder, eye-blinking, nose-
Mainly observed among schizophrenic patients twitching, head-jerking.

VI-Disturbance OF motor behavior

B Repetitive behavior Mannerisms:

Stereotypy
Are repeated movement that are regular ….
(unlike tics) and not goal directed (without
purpose )….. (unlike mannerisms).
Patients or people show a repeated
small movements of an habitual kind
(normal), and goal directed , but are
either odd in appearance or out of
context, such as grimacing and gestures
...........SMRT objective
VI-Disturbance OF motor behavior
Waxy flexibility
The patients' body parts are modified like
a model of wax. e.g. the patient allows
himself to be placed ( by the examiner) into
uncomfortable position that then maintained
for along periods without apparent distress.
VI-Disturbance OF motor behavior
Echopraxia
Pathological imitation of
movements of one person by the
patient.
VI-Disturbance OF motor behavior
Catalepsy ( catatonic posturing)
The patient assuming (spontaneously) an
unusual, inappropriate or bizarre posture,
generally maintain for a long time such as
squatting for hours which will cause
discomfort to most people
VI-Disturbance OF motor behavior
Negativism
Motiveless resistance to all instruction :
➢ in motor sphere when he was asked to look up, he
looked down , and/or maintain a rigid position against
attempts to be move.
➢ in speech: when he was asked question, he didn't answer
➢ in visceral sphere: retention of saliva, urine or feces
 VI-Disturbance OF motor behavior

Automatic obedience VII- Disturbance

The performance of all commands
or suggestions of others in a robot – of insight
like fashion

VII- Disturbance of insight VII- Disturbance of insight

Insight Partial insight Awareness of being

is the ability of the patient to understand sick but blaming it on others, or on external
the true cause and meaning of situation . factors
Insight may also be defined as awareness Lack of insight Complete denial
of one’s mental condition. of illness
 VIII - Disturbance of judgment

Judgment
VIII - Disturbance of is the ability to assess a situation correctly and
act appropriately within that situation
judgment Impaired (poor) judgment The inability
of the person to grasp the meaning of a
situation and react to it properly

Thanks