PsychoPathology

Definition : psychiatry
• It is a branch of medicine that
deals with the diagnosis
,treatment and prevention of
mental illness .
 Definition : Psychiatric nursing
• It is a specialized area of nursing
practice , employing theories of human
behavior as it is a science , and the
purposeful use of self as it is an art , in
the diagnosis and treatment of human
responses to actual or potential mental
health problems .
( ANA1994 )
 SIGNS
&
SYMPTOMS OF
MENTAL ILLNESS
DISORDERS OF

PERCEPTION
• Perception is the
meaningful organization of
sensory data and their
interpretation in the light
of one’s past experience.
• Hyper aesthesia: Increased intensity of
sensations, seen in intense emotions and
hypochondriacal personalities.
In hyper aesthesia sounds appear louder,
colors brighter ,and pain unbearable .
• Illusions: Misperceptions or
misinterpretations of real external sensory
stimuli:
e.g. Shadows may be misperceived as
frightening figures., In a fading light rope is
misperceived as a snake .
• Hallucinations:
Perception in the absence of real
external stimuli; experienced as true
perception coming from the external
world (not within the mind).
e.g. Hearing a voice of someone when
actually nobody is speaking within the
hearing distance.
Types
Auditory hallucinations (voice,
sound, noise).
is a form of hallucination
that involves perceiving
sounds without auditory
stimulus.
Types of auditory hallucination:
•Second-person hallucinations: voice
speaking to the person addressing
him as “you”.
•Third-person hallucinations: voice
talking about the person as “he” or
“she”:
•Thought echo: hearing one’s own
thoughts spoken aloud.
• Visual hallucination
is the seeing of things that are
not there .
Olfactory hallucinations is the
phenomenon of smelling odors that are
not really present. The most common
odors are unpleasant smells such as
rotting flesh ,vomit, urine, feces, smoke,
or others

Gustatory hallucination is the

perception of taste without a
stimulus.
• Tactile hallucinations occurs when someone
feels a sensation on the body that is, in fact,
not present.

Tactile hallucination is the false perception of tactile

sensory input that creates a hallucinatory sensation
of physical contact with an imaginary object.

One subtype of tactile hallucination, formication, is

the sensation of insects crawling underneath the
skin and is frequently associated with prolonged
cocaine use.
• somatic hallucination

Somatic hallucinations refer to

sensations or perceptions
concerning body organs that have
no known medical cause or reason,
such as the notion that one's brain
is radioactive.
• Imperative hallucination: voices giving
instructions to patients, who may or may not
feel obliged to carry them out.

• ‘Thought echo’ : hearing one’s own thoughts

being spoken aloud; the voice may come from
inside or outside the head.

• Running commentary hallucinations: are

usually abusive and often talk about sexual
topics.
• Scenic hallucinations: hallucinations
in which whole scenes are
hallucinated like a cinema film; more
common in psychiatric disorders
associated with epilepsy.
• Lilliputian hallucinations:
A term used to denote a
hallucination featuring
miniature individuals, animals,
objects, or fantasy figures.
• Autoscopy (phantom mirror image): the
patient sees himself and knows that it is
he. Seen in normal subjects when they
are depressed or emotionally disturbed.
• ‘Negative autoscopy’: the patient looks
in the mirror and sees no image; in
organic states.
• Internal autoscopy: the subject sees his
own internal organs.
• Extracampine hallucinations: a
hallucination which is outside the limits
of the sensory field.
• Extracampine hallucinations are
hallucinations beyond the possible
sensory field.
• e.g., 'seeing' somebody standing behind
you is a visual extracampine hallucination
experience.
• Hypnagogic hallucinations:
hallucinations when falling asleep.

• Hypnopompic hallucinations:
hallucinations when waking from
sleep.
 ABNORMALITIES IN THINKING

• Autistic thinking is a form of
thought disturbance and is a term
used to refer to thinking not in
accordance with consensus reality
and emphasizes preoccupation with
inner experience.
 A. Abnormalities of Stream of 
Thought

• Flight of ideas: the thoughts 
follow each other rapidly and 
there is no general direction 
of thinking, seen in mania 
/excited schizophrenics.
• Flight of ideas
Flight of ideas describes excessive
speech at a rapid rate that
involves fragmented or unrelated
ideas. It is common in mania. It
has also been described
in schizophrenia and ADHD
• Pressure of thoughts: Rapid abundant 
varying thoughts associated with 
pressure of speech and flight of ideas.
• Poverty of thoughts: Few, slow, 
unvaried thoughts associated with 
poverty of speech.
• Thought block: Sudden cessation of 
thought flow with complete emptying of 
the mind not caused by an external 
influence.
 B. Abnormalities of Form of thought

• Formal thought disorder: 
              a synonym for the disorders of 
conceptual or abstract thinking 
which occur in schizophrenia and 
coarse brain disease.
Loosening of Association: (Loose Association) A
thought disorder in which series of ideas are
presented with loosely apparent or
completely in apparent logical connections.
A manifestation of a thought disorder whereby
the patient's responses do not relate to the
interviewer's questions, or one paragraph,
sentence, or phrase is not logically connected
to those that occur before or after.
Example: I sang out for my mother …… for this
to hell I went…how long is road …
Tangentiality: It is a form of derailment.
Wandering from the topic
and never returning to it or providing the
information requested.
e.g. In answer to the question "Where are
you from?", a response "My dog is from
England. They have good fish and chips
there. Fish breathe through gills."
• Derailment: direction of thought is lost and the
thought goes away from the intended theme .

Example:
• "The next day when I'd be going out you know, I
took control, like uh, I put bleach on my hair in
California.”
Neologism: completely new word or
phrase whose deviation cannot be
understood.
OR
is the name for a newly coined term, word,
or phrase that may be in the process of
entering common use but that has not yet been
accepted into mainstream language.
  C. Abnormal Thought
Content

• Overvalued Ideas: abnormal
beliefs ,unique to the individual
which dominates his life .
    Example: *A woman falsely believes herself
unusually unattractive.               
* A person with no computer science training might,
believe he is going to write the next great computer
program and fixate on this idea rather than
pursuing training in computer science or going to
work.
* A person who works at a company may rigidly
maintain the idea that he or she is the most
valuable member of the company, that he/she will
save the company from ruin, or that he/she will
soon be made president of the company.
• Delusions: Fixed false beliefs 
which are not shared by others 
,are out of keeping with one’s 
educational ,social and cultural 
background and are unshakable 
in the face of evidence to the 
contrary.
 Delusional Contents:
• Persecutory (paranoid) delusion: Delusion of 
being persecuted (cheated, mistreated, etc.)
• Grandiose delusion: Delusion of exaggerated 
self-importance, power or identity.
• Delusion of reference: Delusion that some 
events and others  behavior refer to oneself.
• “Idea of Reference”: misattribution of events 
as referring to oneself.
• Delusion of jealousy: Delusion that a 
loved person (wife/husband) is 
unfaithful (infidelity delusion)
•  Delusions of love (‘fantasy lover’,  
‘erotomania’): Delusion that 
someone, (usually inaccessible, high 
social class person) is deeply in love 
with the patient.
• Nihilistic delusion: Delusion of 
nonexistence of self, part of the body, 
belongings, others or the world.
• Delusion of self - accusation: Delusion 
that a patient has done something 
sinful, with excessive feeling of remorse 
and guilt.
• Delusion of influence: Delusion that 
person’s thoughts, actions, or feelings 
are controlled by outside forces.
• Passivity phenomena: person 
reports being made feel, made 
think or made act.
• Delusions of Replacement 
(Capgras Syndrome): a belief that 
important people in one's life 
have been replaced by impostors.
• Delusions can be either :
• Mood-Congruent Delusion – Delusional
content has association to mood:
- in depressed mood: delusion of
self - accusation.
- in elevated mood: grandiose delusion.
• Mood-Incongruent Delusions –
Delusional content has no association to
mood, e.g. patient with elevated mood
has delusion of thought insertion.
• Delusions can also be either:
• Systematized Delusion - Delusion
united by a single event or theme e.g.
delusion of jealousy/thematically well
connected with each other.
• Bizarre Delusion - Totally odd and
strange delusional belief, e.g.
delusion that person’s acts are
controlled by stars.
D. AbnormAlities of
Possession of
thought
• Obsessions:
–Repetitive ideas, images, feelings
or urges insistently entering
person’s mind despite resistance.
They are unwanted, distressful and
recognized as senseless and
irrational. Obsessions are
frequently followed by compelling
actions (compulsions).
• Common obsessional
Contents:
–dirt/contamination/cleaning
–orderliness
–doubts/checking/counting
–aggressive impulses/inappropriate
acts
–Ruminations: internal debates in
which arguments for and against even
the simplest everyday actions are
• Thought Alienation:
– Thought Insertion: Delusion that some of
person’s thoughts being put into the mind by an
external force (other people, certain agency).

– Thought Withdrawal: Delusion that some of

person’s thoughts being taken out of the mind.

– Thought Broadcasting: Delusion that others can

read or hear the person’s thoughts, as they are
broadcast over the air, radio or some other
unusual way.
• Dysmorphophobia:

a type of overvalued idea where

the patient believes one aspect of
his body is abnormal or
conspicuously deformed.
 ABNORMALITIES OF MOOD /EMOTION
• Feeling: a positive or negative reaction to
some experience
• Emotion: a stirred up state due to
physiological changes which occurs as a
response to some event and which tends to
maintain or abolish the causative event.
• Mood: the pervasive feeling tone which is
sustained (lasts for a length of time) and
colors the total experience of the person.
• Affect: is the outward objective
expression of the immediate cross-
sectional emotion at a given time.
• Euthymia: a normal mood state,
neither depressed nor manic.
• Cheerfulness: being in good spirits.
• Perplexity: a state of puzzled
bewilderment.
• Anxiety: feeling of apprehension
accompanied by autonomic
symptoms (such as muscles tension,
perspiration and tachycardia),
caused by anticipation of danger.
• Free-floating anxiety: diffuse,
unfocused anxiety, not attached to a
specific danger.
• Fear: anxiety caused by realistic
consciously recognized danger.
• Panic: acute, self-limiting,
episodic intense attack of anxiety
associated with overwhelming
dread and autonomic symptoms.
• Phobia: irrational exaggerated fear and
avoidance of a specific object, situation
or activity.
• Agoraphobia: patients rigidly avoids
situations in which it would be difficult
to obtain help.
• Social phobia - Intense and excessive
fear of being observed by other people
–Eg: eating or drinking in public or
talking to the other member of sex
• Specific phobia: irrational fear of a
specific object or stimulus.
Acrophobia : fear of heights
Arachnophobia : fear of spiders
Claustrophobia : fear of closed spaces
Gamophobia : fear of marriage
Hemophobia : fear of blood
Zoophobia : fear of animals
• Agitation: severe feeling of inner tension
associated with motor restlessness.
• Irritable mood: easily annoyed and
provoked to anger.
• Dysphoria: mixture feelings of sadness
and apprehension.
• Depressed mood: feeling of sadness,
pessimism and a sense of loneliness.
• Anhedonia: lack of pleasure in acts
which are normally pleasurable.
• Diurnal variation: a variation in the severity
of symptoms (mood) depending on the time
of the day
• Grief: sadness appropriate to a real loss (e.g.
death of a relative)
• Guilt: unpleasant emotion secondary to
doing what is perceived as wrong.
• Shame: unpleasant emotion secondary to
failure to live up to self-expectations.
• Perplexity: anxious mood with
bewilderment.
• Ambivalent Mood: coexistence of
two opposing emotional tones
towards the same object in the
same person at the same time.
• Alexithymia: inability to, or
difficulty in, expressing one’s own
emotions.
• Elevated Mood: a mood more
cheerful than usual .
• Elevated Mood:
– Euphoria (Stage I): mild elevation of mood in which
feeling of elevated mood with optimism and self-
satisfaction not keeping with ongoing events. Usually
seen in hypomania.
– Elation (stage II): (Moderate elevation of mood) - a
feeling of confidence and enjoyment, along with
increased PMA. –a feature of manic illness
– Exaltation (stage III): (severe elevation of
mod): intense elation with delusions of grandeur, seen
in severe mania.
– Ecstasy (Stage IV): (very severe elevation of mod):
a sense of extreme well-being associated with a feeling
of rapture, bliss and grace. typically seen in delirious
and stuporous mania .
• Expansive Mood: expression of euphoria with an
overestimation of self-importance.
• Grandiosity: feeling and thinking of great
importance (in identity or ability).
• Constricted Affect: significant reduction in the
normal emotional responses.
• Flat affect: absence of emotional expression.
• Apathy: lack of emotion, interest or concern,
associated with detachment.
• Labile Affect: rapid, abrupt changes in emotions in
the same setting, unrelated to external stimuli.
• La Belle Indifference: inappropriate
denial of expected affect and lack of
concern about physical disability (seen
in conversion disorders).
• Inappropriate Affect: disharmony
between emotions and the idea,
thought, or speech, accompanying it.
• Cyclothymia: There is cyclical mood
variation to a lesser degree than in
bipolar disorder.
 ABNORMALITIES OF SPEECH
• Echolalia: imitation of words or phrases
made by others.
• Verbigeration : repetition of words of
phases while unable to articulate the
next word in the sentence/senseless
repetition of same words or phrases
over and over again.
• Pressure of Speech: rapid, uninterrupted
speech that is increased in amount.
–Mutism: inability to speak.

–Elective Mutism: refusal to

speak in certain circumstances.

–Poverty of Speech: restricted

amount of speech.
–Stuttering (Stammering): frequent
repetition or prolongation of a sound
or syllable, leading to markedly
impaired speech fluency.
–Cluttering: dysrhythmic rapid and
jerky speech.
–Clang Associations
(Rhyming): association of word similar
in sound but not in meaning (e.g.
deep, keep, sleep)
– Punning: playing upon words, by using a
word of more than one meaning (e.g. ant,
aunt)
– Word Salad: incoherent mixture of words
and phrases.
– Dysphasia: impairment in producing or
understanding speech.
– Dysarthria: difficulty in articulation and
speech production.
– Sensory Aphasia: nonsensical fluent
speech due to lesion affecting Wernicke’s
–Motor Aphasia: impairment in the
ability to formulate fluent speech due
to lesion affecting Broca’s (motor)
area.
–Dysphonia: difficulty in voicing speech
clearly, due to dysfunction of vocal
cords or soft palate.
–Circumstanciality: over inclusion of
details delaying reaching the desired
 –Coprolalia: forced vocalization of
obscene words or phrases,
–Palilalia: is characterized by the
repetition of a word or phrase; i.e., the
subject continues to repeat a word or
phrase after once having said. It is
a perseveratory phenomenon.
–Alogia: lack of speech output.
• Mutism: complete absence of speech.
ABNORMALITIES OF MOTOR BEHAVIOUR
• Psychomotor Retardation: Slowed mental
and motor activities.
• Stupor: A state in which a person does not
react to the surroundings: (mute, immobile
and unresponsive).
• Catatonic Stupor: Stupor with rigid posturing.
• Psychomotor Agitation: Restlessness with
psychological tension. (Patient is not fully
aware of restlessness.)
• Catatonic Excitement: Marked
agitation, impulsivity and aggression
without external provocation.
• Chorea: sudden involuntary
movement of several muscle groups
with the resultant action appearing
like part of voluntary movement.
• Aggression: Verbal or physical hostile
behavior, with rage and anger.
• Akathisia: Inability to keep sitting
still, due to a compelling subjective
feeling of restlessness.

• Dyskinesia: Restless movement of

group of muscles (face, neck, hands).
• Dystonia: Painful severe muscle spasm.
• Torticollis: Contraction of neck muscles.
• Tics: Sudden repeated involuntary
muscle twisting. e.g. repeated blinking,
grimacing.
• Compulsions: Compelling repeated
irrational actions associated with
obsessions. e.g. repeated hand washing.
• Echopraxia: Imitative repetition of
movement of somebody.
• Stereotypies: Purposeless repetitive
involuntary movements. e.g. foot
tapping, thigh rocking.
• Mannerism: Odd goal-directed
movements. e.g. repeated hand
movement resembling a military
salute.
• Waxy Flexibility: Patient’s limbs may
be moved like wax, holding position
for long period of time before
returning to previous position.
• Cerea flexibilitas, meaning "waxy flexibility", refers
to people allowing themselves to be placed in
postures by others, and then maintaining those
postures for long periods even if they are obviously
uncomfortable. It is characterized by a patient's
movements having the feeling of a plastic
resistance, as if the person were made of wax. This
occurs in catatonic schizophrenia, and a person
suffering from this condition can have his limbs
placed in fixed positions as if the person were in
fact made from wax.
• Automatic obedience: the pt. carries
out every instruction regardless of
the consequences.
• Perseveration: is a senseless
repetition of a goal-directed action, a
particular response, such as a word,
phrase, or gesture which has already
served its purpose (beyond their
relevance).
• Dyspraxia; inability to carryout
complex motor tasks, although the
component motor movements are
preserved.
• Omega sign (Athanassio): the
occurrence of a fold like the Greek
letter omega in the forehead above
the root of the nose produced by the
excessive action of the corrugator
muscle; seen in depression.
• Ambitendency: a motor symptom of
schizophrenia in which there is an alternating
mixture of automatic obedience and
negativism.
• Mitgehen: The pt. moves his body in the
direction of the slightest pressure on the part
of the examiner. seen in catatonia
• Mitmachen (Co-operation): The body can be
put to any position without any resistance on
the part of the patient seen in catatonia.
• Trichotillomania: a condition
characterized by an overwhelming urge
to pluck out specific hairs.
• Pyromania: is an impulse control
disorder in which individuals repeatedly
fail to resist impulses to deliberately start
fires, in order to relieve tension or for
instant gratification.
• Dipsomania: uncontrollable craving for
alcohol or compulsive drinking of alcohol.
• Kleptomania: a disorder in which the
individual impulsively steals things other
than personal use or financial gain.
• Negativism: an apparently motiveless
resistance to all commands and attempts
to be moved or doing just the opposite.
 Collective Symptoms
• Positive symptoms: refers to presence of
delusions, disordered thoughts and speech, and
tactile, auditory, visual, olfactory and
gustatory hallucinations
• Negative symptoms : are deficits of normal
emotional responses or of other thought
processes, and respond poorly to medication
which includes flat or blunted affect and emotion,
poverty of speech (alogia), inability to experience
pleasure (anhedonia), lack of desire to form
relationships (asociality), and lack of motivation
(avolition).
• Biological symptoms (somatic
symptoms./melancholic
symptoms.): refers to changes in
sleep, appetite, libido, activity,
diurnal changes in mood, anhedonia,
early morning awakening, and
psychomotor agitation or
retardation.
• Psychotic symptoms: presence of
hallucinations and delusions.
• First Rank Symptoms of Schizophrenia (Kurt
Schneider)
– Audible thoughts (thought echo)
– Voices heard arguing
– Voices heard commenting on one's actions
– Somatic/thought passivity experiences (delusions of
control)
– Thought withdrawal
– Thought insertion - Thoughts are ascribed to other
people who intrude their thoughts upon the patient
– Thought broadcasting (also called thought diffusion)
– Delusional perception.
• Motor Symptoms of schizophrenia

• Catatonia
• Catalepsy
• Automatic obedience
• Negativism
• Ambitendency
• Mitgehen . Psychological pillow
• Mitmachen
• Mannerism
• Stereotypy
• Echopraxia
• In Capgras syndrome, the patient feels
that a person familiar to him, usually a
family member has been replaced by
an imposter.[1] This is a type
of delusion that can be experienced as
part of schizophrenia. Capgras Syndrome
and several other related disorders are
referred to as delusional
misidentification syndrome.