CHAPTER TWO:

GENERAL SYMTOMATOLOGY
Student learning objectives
At the end of the chapter the learner should be able to:
a. Define and describe different signs and symptoms of psychiatric disorders
b. Classify signs and symptoms as disorders of perception, thinking, speech, motor
activity, memory, orientation, mood/affect, consciousness, and
cognitive/intellectual functioning
c. Explain the relationship between different psychiatric symptoms
Introduction to general symptomatology
Symptoms are vital in diagnosis of psychiatric disorders. But diagnosis of a mental disorder

shouldn’t be made on the basis of an individual symptom – which might also be short-lived.

Therefore, for proper diagnosis symptoms should occur that are intense and persistent. A

syndrome (signs and symptoms portraying a recognizable pattern) should be established. So

identification of syndromes is of great importance as opposed to individual sign or symptom.

Many symptoms in psychiatry have type and content aspect. Psychiatric signs and symptoms fall

into groups referred to as systems of psychological functioning. These include:-

A. Perception
B. Thinking
C. Speech
D. Motor activity
E. Memory
F. Orientation
G. Consciousness
H. Cognitive (intellectual functioning)
I. Mood effect

Different psychiatric disorders may affect each of the above systems as discussed below:
A. Disorder of perception
 Perception is the process of becoming aware of what is presented through the sense organs. It

is response to stimuli from five senses or relating various sensory impressions with previous

experiences and knowledge. Imagery is the experience within the mind without usually the

sense of reality that is part of perception eg eidetic imagery is where visual image which is so

intense and detailed that it has “Photographic quality.” Unlike perceptions, imagery can be

called up and terminated by voluntary efforts. There are many disorders that may affect

perception:

i. Illusion
Misperceptions of external stimuli e.g. mistake a stick for a snake.
When occur:-
 When general level of sensory stimulation is reduced e.g. at dusk you perceive the
outline of a bush as that of a man.
 When level of consciousness is reduced e.g. acute organic syndrome.
 In strong affective states e.g. anxiety state when you look at a cloud and see it as an
angel coming for you.
 When attention is not focused on sensory modality.
 Depression.
May also occur in normal persons but are pathological if they persist or become excessive.
ii. Hallucinations
These are mental impressions of sensory vividness without adequate external stimuli. A

perception experienced in the absence of an external stimulus to the sense organs and with a

similar quality to a true perception (compare with imagery). Not restricted to the mentally ill.

Normal people may experience hallucinations especially when tired and may occur in healthy

people during the transition between sleep and waking. When it occurs while falling asleep –

hypnagogic hallucinations and while awakening – hypnopompic hallucinations.

Pseudo hallucinations – these are vivid mental images that lack the quality of representing

external reality and seem to be within the mind rather than in external space. They lack of

vividness of a perception.

Hallucinations occur in:-

 Severe affective disorder e.g. during strong feelings or conflicts which cannot be
controlled by ordinary coping/defense mechanisms e.g. self- approach, excessive fear/
intense religiosity etc.
 Schizophrenia
 Organic disorders e.g. lesions of the sensory centers.
 Toxic states e.g. alcohol intoxications
 Dissociative disorders
 Some times in healthy people as said above.
Hallucinations have two very important qualities i.e. experienced as a true perception not

imagery and it seems to come from the outside world (except for somatic hallucinations).

Experiences that possess one of these qualities, but not the other are pseudo hallucinations.

Types of Hallucinations
Grouped according to:-
 Complexity.
 Sensory organ affected.
Based on Complexity:
I) Elementary
Such experiences as bangs, whistles, flash of light.
II) Complex
Hearing voices or music, Seeing faces & scenes
Based on Sensory system affected
1) Auditory hallucinations
One hears voices which don’t exist. Voices may command one to do violent acts e.g. kill
or commit suicide. These may occur in depression.
Subtypes
a. Second person auditory hallucinations
Directly refers to the patient. “You” e.g. you are going to die.
b. Third Person auditory hallucinations
Uses “he” or “she” e.g. She is going to die, he is very sick
2. Tactile hallucinations (haptic hallucinations or somatic hallucinations)
These are sensations of being touched, pricked or strangled. They usually occur in

organic states e.g. marked cocaine toxicosis – called “cocaine bugs” and schizophrenia. A

subtype here is sexual hallucinations-special type of tactile hallucination. E.g. Male

schizophrenics may complain of erection & orgasm being forced into them. Female

schizophrenia –may have the sensation of being raped.

3. Visual hallucinations
This is seeing figured/images that are not present. It may occur in intense fear and
organic psychosis.
4. Gustatory hallucinations
These cause tastes that are often strange or unpleasant. One feels things in the mouth

which are actually not there. Occur in Schizophrenics and Major/ grandmal epilepsy.

5. Olfactory hallucinations (phantosmia)

These hallucinations involve smelling odors that do not exist. The odors are usually

unpleasant such as such as vomit, urine, feces, smoke or rotting flesh. This condition

occurs as a result of neurological damage in the olfactory system. Occurs in temporal

epilepsy, Depressive, Schizophrenics

6. General somatic hallucination

This refers to when a person experiences a feeling of their body being seriously hurt

through mutilation or disembowelment, for example patients have reported experiencing

animals trying to invade their bodies, such as snakes crawling into their stomach.
Unclassified
Reflex hallucinations
Where a stimulus in one sensory modality results in hallucinations in another e.g. sound

of music provokes visual hallucinations.

Perception and meaning

A percept has a meaning for the person who experiences it.

In some disorders an abnormal meaning may be associated with a normal percept – called

delusional perception. Percepts may also lose their meaning (agnosia).

iii. Depersonalization and Derealization

Are alterations in the perception of one’s reality
Depersonalization
It’s where one has the feeling of being outside themselves and observing their actions, feelings or

thoughts from a distance. They are detached from thoughts, feelings and body. It’s the change of

self-awareness that the person feels unreal.

Derealization
This is where one feels the world around them as being unreal. Familiar objects/places/persons

seem to have changed in shape and size.

NB
Depersonalization is directed towards self while derializations towards the outside world.

Occurs in depression, Anxiety states, Schizophrenics, Hysteria and in normal subjects

B. Disorders of thinking/thought disorders

Thinking is the most highly organized function of the brain. It combines experiences with

perceptions and knowledge which had been stored as memory. Thoughts are understood through

speech and writing. Hence disorders of thought are closely related to disorders of speech.

Subtypes
i) Disorders of sequence of thought/stream/progression of thought
It’s concerned with speed and amount of speech.
a. Perseveration of thought

This is the Psychopathological repetition of the same word or idea in response to the different

question. Eg a person who continues talking about a topic even when the conversation has

moved on to other things or when asked to draw a cat then several other objects, but continue to

draw a cat each time. It’s also considered a speech disorder common in organic states e.g.

Dementia and sometimes in schizophrenia.

b. Circumstantial thinking/ Circumstantiality.

Before getting to the point or answering the question the patient gets caught up in countless

details and explanations of no primary significance. There is an inclusion of many, unnecessary

trivial details which are not essential to the subject being discussed. Thinking proceeds slowly

with many unnecessary & trivial details but finally the goal is reached. Occur commonly in

Mania/hypomania, Organic mental states, Schizophrenics, Obsession personalities.

c. Pressure of thought/speech

This is the tendency to speak rapidly as if motivated by urgency. There is an unusual increase in

the rate or speed of conversation. They talk much faster than what is considered normal or

ordinary. They are compelled to think and in their thoughts seem to run away with them.
Commonly seen in mania, anxious patients, depressed patients, bipolar disorders & sometimes

schizophrenia.

d. Thought blocking

This is sudden interruption of speech by silence that may last a few seconds to minutes, in the

middle of a sentence without an explanation and thoughts switch off abruptly & sometimes a

new one totally unconnected with it takes over. Commonly occur in Schizophrenics and anxiety

states

e. Tangentiality/Tangential thinking

This occurs when the speaker goes off the topic and does not return to it. Same as

circumstantiality but the final goal is not reached as the patient loses track of the original idea.

f. Fragmented thinking/loosening of association.

There is lack of logical connection between parts of a train of thoughts (knights’ move thinking).

The patient's responses do not relate to the interviewer's questions and is not logically connected

to any preceding concepts. i.e We wanted to take the bus, but the airport took all the traffic. It is

a symptom of schizophrenia.

ii) Disorders of thought content

a. Delusions
These are unshakeable, usually false beliefs which are incompatible with one’s socio-cultural or

educational background, and they cannot be explained on the basis of reality. They are out of

keeping with person’s education and cultural background. Note that they are usually false, but

not always. The main feature is that it’s firmly held on inadequate grounds i.e. the belief is not
arrived at through the normal process of logical thinking. Its arrived at through abnormal thought

process. A delusion can be true or subsequently become true e.g. in pathological jealousy

(jealousy delusions) a man believes that his wife is unfaithful without any evidence- even if the

wife is actually unfaithful at the time, it’s still delusional.

NB:
Differentiate this from strongly held non delusional convictions/beliefs. Delusions arise from

internal morbid process e.g. strong feelings of fear, envy, anger, or inferiority which reduce the

capacity for critical thinking.

Superstition:
Someone e.g. witchdoctor forces you to believe something whereas delusions originate from the

persons without any compelling force. In delusions, there is usually absence of evidence

sufficient for a reasonable prudent man to draw such a conclusion as seen in delusion.

Types of delusions
A. Based on onset
Primary/autochthonous delusions

Appears suddenly and with full conviction but without any mental events leading up to it.

Beliefs arrive in the mind suddenly, fully formed and in a totally convincing form. They cannot

be understood as arising from other psychological phenomenon, ideas or events. Special primary

delusion may include delusional mood, delusional perception and delusional memory.

Secondary delusions
Derived from some preceding morbid/abnormal experience e.g. hallucinations, mood. Someone

who hears voices may come to belief that he is being followed or one who is profoundly

depressed may believe that people think he is worthless.

B. Based on: theme/content

i. Persecutory delusions/ paranoid

The individual feels threatened and believes that others intend harm or persecution toward him in

some way. Subjects believe that others are plotting against them and is the subject of

persecution. Common in Paranoid schizophrenia, severe depressives, Organic states and

abnormal personalities.

ii. Grandiose delusions (expansive delusions/delusions of grandeur).

Subject believes that he is some important person e.g. Jesus, Pope, President, Almighty God etc

or endowed with unusual abilities. May also think that he is related to some important people e.g.

MPS, royal family etc. Common in General paralysis of the insane (GPI) very classical in GPI,

Mania, and Schizophrenics

iii. Nihilistic delusions

One believes that they are dead & everything around them has stopped working. May also

believe that some portion of him is non-existence e.g. genitals doesn’t exist. Chiefly occurs in

severe depression.

iv. Religious delusions:

Obsessional believes that one is holier than others. Fanatics – concerned with guilty divine

punishment for small sins or special divine process.

v. Jealous delusions/infidelity delusions:

Belief that one’s partner is unfaithful. May lead to violence. Common in men.

vi. Sexual or amorous delusions:

Belief that she is loved by a man who has never spoken to her and who is inaccessible e.g. public

figure. Common in women.

vii. Paranoid delusions:

False belief that makes one over suspicious due to fear of harm.

viii. Delusion of reference:

Patient believes that people look at him, talk about him and that his surrounding has a special

significant for him. Belief that objects, events & people have significance to him e.g. remark on

TV. Common in Schizophrenics, Depressive states, Organic states

ix. Delusions of control/influence:

Individual believes that certain objects or persons have control over his or her behavior.
Common in schizophrenia.
x. Somatic delusions:
False idea about the functioning of an individual’s body e.g. one may believe that he is oldest
person on earth.
xi. Delusions of guilt:
One believes that he is very wicked, has committed a terrible sin and deserves punishment. The

unforgivable sin is usually that of fornication or masturbation. Common in depressions.

xii. Hypochondriacal delusions:

Patient believes that he has cancer, TB or any other dreadful disease. Common among the

elderly, Depressives, Schizophrenics, Abnormal personalities

May seek plastic surgery services if they think parts of body are abnormal e.g. nose.
 xiii. Delusion of poverty
One is convinced that he is utterly impoverished, despite documentary evidence to the contrary.
Rare symptom in depressives.

Other types of delusions

i. Double orientation:
Where delusions don’t influence patients feelings / actions e.g. in chronic schizophrenics.

ii. Shared delusions (“folie a deux”.):

As a rule, other people recognize delusions as false and argue with patients in an attempt to
correct them. Occasionally, a person who lives with a deluded patient comes to share their
delusional beliefs. The second person may stop believing when separated from the patient.

iii. Partial delusions

These are delusions characterized by less firm belief and may weaken as the amount of
conviction decreases.

b. Overvalued ideas

Defined as an isolated pre-occupying belief, neither delusional nor obsessional in nature, which

comes to dominate a person’s life for many years and may affect his actions. It is a false belief

contrary to the facts presented but in keeping with a person’s socio-cultural background e.g.

some denominations over-emphasize a small aspect of the Bible as if it’s the only requirement to

purity. A person whose mother or sister suffered from cancer may become pre-occupied with the

conviction that cancer is contagious.

A second definition is that it’s an isolated pre-occupying strongly held belief that dominates a

person’s life and may affect his actions but (unlike delusion) has been derived through normal
mental process e.g. a man whose parents developed cancer within a short time may be convinced

that cancer is contagious even though his doctor presented evidence to the contrary & may avoid

visiting a friend with cancer who has asked to see him. To differentiate a delusion & an

overruled idea, the interviewers retrospectively examine how the belief/ idea were formed.

iii) Disorders of possession of thought

Normally we experience our thoughts as belonging to us or there is a quality of “my-ness” of our

thoughts. Apart from this we feel in control of our thinking. Both the control and the possession

of thought can be disturbed by mental illness. Patients may be compelled to think his own

thoughts against his will or he may experience his thoughts as alienated from himself in some

way.

a. Obsessions
Recurrent, persistent thoughts, impulses or images that enter the mind despite the persons effort

to exclude them or Persistent and recurrent ideas, thoughts or impulses, wishes that cannot be

eliminated from consciousness by logic or reasoning. The defining characteristic is the subjective

sense of a (struggle) resistance against the intruding mental phenomenon. Resistance

distinguishes obsession and delusions where it’s absent.

Obsessions can also be defined as undesirable contents of consciousness which cannot be gotten

rid of, although when they occur they are judged as being senseless or at least as dominating and

persisting without cause. One feels ashamed to tell people about them. Regarded by the person as

untrue & occurring against the patients will. Obsessional thoughts can be about any topic but

commonly are centered on the following themes: - Rationale and unclear.

 Dirt or contamination e.g. of hands by bacteria.

 Aggressive actions e.g. that the person may harm another or speak obscenities.
  Orderliness - idea that things have to be arranged in a certain way.
 Illness – idea that a person may have a certain disease or get a certain disease e.g. cancer.
 Sex – thoughts or images of practices that the person finds disgusting.
 Religion – blasphemous thoughts, doubts about the fundamentals of belief etc.
Examples of obsessions
 Obsessional ruminations: - repeated themes of more complex nature e.g. ending of the
world.
 Obsessional thoughts – repeated & intrusive words/phrases usually upsetting to the
patient e.g. blasphemous phrases coming to a religious person.
 Obsessional doubts – repeated themes expressing uncertainty about previous actions e.g.
whether closed house before sleep or put off electricity.
Obsessions are common in: depression, obsessional Neurosis, organic states, schizophrenia, and
anxiety. Differentiate obsessions from:
 Ordinary preoccupation of healthy people.
 Intrusive concerns of anxious or depressed people.
 Recurring thoughts & images associated with disorders of sexual preference.
 Recurring thoughts & images associated with drug dependency
 Delusions

Patients with these non-obsession ideas do not regard them as unreasonable & do not resist them.

Obsessions are an essential feature of obsessive – compulsive disorder.

Obsessions are closely associated with compulsions / Compulsive rituals which are repeated,

stereotyped, and seemingly purposeful actions which the person feels compelled to carry out but

resists, recognizing that they are irrational.

They are not thoughts but abnormal actions usually closely associated with obsessions because

people act to fulfill unwanted urges arising from an obsession. Other times there is no connection

e.g. when checking position of objects is associated with aggressive ideas. Compulsions usually
produce an immediate lessening of distress associated with obsessional thoughts. Compulsions

can be of any kind but four are usually themes common:-

 Checking rituals – often concerned with safety e.g. door, gas, electricity
 Cleaning rituals – repeated hand washing or domestic cleaning.
 Counting rituals – counting to a particular number or counting in threes
 Dressing rituals – clothes set out & put on in a particular order.
Phobias
These are forms of obsessions. They are defined as persistent, excessive, irrational fears about a

real or imagined object, place or a situation. They are specific pathological fear reaction out of

proportion to the stimulus. It’s the fear that is not proportional to dangerousness of the object,

place, person etc. Could also be called obsessional phobias – which are obsessional thoughts

leading to anxiety and avoidance behavior. Examples of phobias include:

Zeusophobia – God

Dentophobia – dentist

Abluthophobia – bathing

Lachanophobia – vegetable

Clinophobia – going to bed

Arachnophobia – flying

Anuptaphobia - staying single

Motophobia – automobiles

Cyberphobia – computers

Algophobia – pain

Pathophobia – disease

Zoophobia – animals

Agoraphobia – fear of open spaces or outdoors. Its one of the commonest phobias.
Astraphobia – thunder & lightning

Gynenophobia – fear of women

Kakorrhaphiophobia – fear of failure

Hematophobia – blood

Cypridophobia – fear of venereal diseases

Nyctophobia – darkness

Mystophobia – dirt

Sitophobia – eating

Xenophobia – strangers

Pyrophobia – fire.

Social phobia: fear of eating, drinking, speaking, writing, blushing or vomiting in presence of

others.

Individuals tend to develop avoidance behavior towards the objects that they fear. This

interferes with individuals’ normal functioning e.g. hydrophobia, gynenophobia.

NB:

Anticipatory anxiety – when one feels anxious about the phobic stimulus on thinking about it.

b. Alienation of thought.
Patient experiences that his thoughts are under control of an outside agency or others are
participating in his thinking.
 Thought withdrawal - One experiences as if thoughts are taken away from his mind.
 Thought insertion - Thoughts experienced as being inserted into the patients mind.
 Thought broadcasting - Patient has the experience that everyone else is participating in
his thinking. All these forms of thought alienation are characteristic of schizophrenia.

C. Disorders of orientation
Orientation in three aspects i.e. time, person and place
Disorientation common in Organic mental disorders, Psychotic disorders e.g. schizophrenia.
D. Disorders of speech
Characteristics of speech include rate, volume, articulation and tone.

They are closely related to disorders of thinking as speech is frequently an accurate congruency

of thinking. Hence speech can be: - retarded, blocked, fragmented, incoherent, or accelerated.

There other speech disorders:

a. Echolalia
Repetition of interviewers words like a parrot. Common in schizophrenia, dementia & autistic
children (autism).
b. Neologism
A patient invents new words/phrases or gives new meaning to standard words.
c. Mutism
Absence of speech.
d. Clang association:
Speech directed by the sound of a word rather than its meaning i.e. choice of words is governed
by sound rather than their conceptual meaning e.g. “I am cold and bold” or “The gold has been
sold and sold”.
e. Word salad:
Group of words put together in random fashion without apparent logical connection.
f. Loosening of association:
The patient shifts ideas from one to the other without logical connection between them.
E. Disorders of motor activity
Its characterized by delays in motor milestones such as sitting, crawling. The level of motor

activity is closely related to the thought processes which also affects speech. Therefore, motor

activity, speech and thoughts are interlinked. Problems of motor activity are common in

schizophrenics except tics/habits spasms. Examples include

 Restlessness
 Inability to remain still. The person keeps on moving his body or part of it. When
associated with anxiety and worry it’s called agitation.
 Stereotypes
Repeated movements that are regular (unlike tics) and without obvious significance
(unlike mannerisms) e.g. rocking to and from
 Tics/habit spasms
Irregular involuntary repeated movements involving a group of muscles e.g. sideways
movement of the head or wetting ones lips
 Choreiform movements:
Brief involuntary movements which are coordinated but purposeless
 Mannerisms
Repeated movements that appear to have some functional significance e.g. saluting,
matching
 Dystonia
Muscle spasm – painful & may lead to contortions
 Posturing
This is the adoption of unusual bodily postures continuously for a long time. May have
symbolic meaning e.g. hands outstretched as if to be crucified or may not have any
meaning e.g. standing on one leg.
 Ambitendence
Alternate between opposite movements e.g. putting out the arm to shake hands, and then
withdrawing it, extending it again and so on.
 Echopraxia
The patient purposely imitates the movement of another person. Subject imitates all the
actions of the examiner. Common in schizophrenia and dementia.
 Negativism
An active striving against all external attempts to influence behavior e.g. the more the

examiner insists on Physical examination the greater the resistance.

Subjects do opposite of what is asked and actively resist efforts to persuade them to

comply.
  Compulsion/Compulsive ritual
Recurrent actions carried out to relieve the urgency of obsessive thoughts e.g. repetitive hand
washing in an attempt to relieve an obsession of dirty hands.
 Stupor
Patient lies or sits motionless and doesn’t reply to questions or if he does, he gives muttered
monosyllabic replies.
 Waxy flexibility/ flexibilitas cerea
The examiner encounters plastic resistance like the bending of a wax rod when moving a
patient body (or part of it) which is then maintained in an old position. Very common in
catatonic schizophrenia.

F. Disorders of mood/Affect

This is the most common symptoms of psychiatric disorders. They are typical in anxiety and

depressive disorder. But normal people may also experience them when in stress.

Mood:

Emotional state of some duration in which the total experience of the subject is completely

colored by the prevailing emotion. Emotion that the patient tells you he feels or is conveyed non-

verbally.

Affect:

This is the sudden accentuation of emotion of short duration and marked intensity, often

reflective of how patient’s mood appears to the examiner – ranges & amount of emotion express.

Usually these two terms are used synonymously to describe the general emotional state of a

person. Mood influences thought, speech and motor activity –changes in facial expression &
posture accompany mood change. E.g. in elated mood, one manifests with flight of ideas,

accelerated speech and restless in motor activity.

Appropriateness:
This is congruency with the subject of conversation – appropriate/not appropriate.

Anxiety (pathological anxiety)

This is an unpleasant affective state with the expectation, but not certainty of something

happening. It’s a feeling of apprehension that is out of proportion to the actual situation. Marked

anxiety is called fear & when acute called panic. Anxiety is not necessarily negative unless it’s

very high or very low.

Phobic anxiety: avoidance behavior relates to stimuli. It’s the tendency to avoid stimuli that

evokes anxiety. Anxiety is common in Anxiety disorders, substance abuse, organic states etc.

Euphoria/Elation
Euphoria:
This is mild unwarranted cheerfulness. If associated with a sense of bodily wellbeing it is called
eutonia.

Elation (pathological elation)

This is a pervasive rising of mood accompanied by excessive cheerfulness & even ecstasy. The

above terms usually used synonymously to mean a feeling or sense of well-being which is

exaggerated & inappropriate usually associated with psychomotor acceleration.

Common in: Mania/hypomania and Hypothalamic lesions

Depression (pathological depression)

These are feelings of sadness, hopelessness and worthlessness, usually accompanied by slowed

thinking, speech and motor activity. Suicidal ideation may be present. It’s a pervasive lowering

of mood accompanied by feeling of sadness, loss of ability to experience pleasure (anhedonia).

Mainly occur in depressive disorder & other psychiatric disorders.

Inappropriate/ incongruent affect

Patient shows insufficient or inadequate affect in relation to the situation e.g. smiling while

talking about death of a loved one i.e. emotional tone is out of harmony with the idea

thought/speech accompanying it. Common in depressives who smile while talking about their

inadequacies and in Schizophrenics

Flat affect/apathy/emotional indifference

This is the absence or near absence of any signs of affective expressions in relation to an event or

situation. Patients are usually unresponsive or indifferent.

Irritability
This is an ill-humored mood state. Patients are usually unhappy, miserable, angry, resentful and

irritable.

Common in epilepsy usually but can also occur in depressive states, paranoid mania.

Emotional ambivalence
This is the presence of strong overwhelming simultaneous opposite attitudes, feelings, ideas or

drives towards an object, person or goal (act). Eugen Bleuler coined this term and identified 3

types of Emotional ambivalence: Affective ambivalence, Intellectual, Ambivalence of will.

Usually common in schizophrenics.

Emotional liability & Emotional Incontinence

Emotional liability is when the patient has unstable emotional state and is easily moved to tears

e.g. in depressives while emotional incontinence occur when subjects burst into tears/laughter for

little or no reason. It’s usually weeping that’s common. Common in organic states e.g. course

brain disease, especially arteriosclerotic dementia.

G. Disorders of memory
Some characteristics of memory/brain are important to mention: Recognition – feeling of

familiarity which accompanies memory. Recall – bringing back specific information to

consciousness when desired. No information presented. Registration – add new item to the

memory bank. Retention – capacity to store information in our memory.

Disorders of memory may include

-Amnesia: Loss of memory which is common organic states/syndromes e.g. delirium/dementia,

anxiety states, trauma/epilepsy. Subtypes of amnesia include:

Anterograde amnesia: Loss of memory of occurring for events taking place after the incident

causing amnesia. Occur in people involved in accidents. Occur after a period of unconsciousness.

It’s the impairment of memory for events between end of complete unconsciousness & the

restoration of consciousness.

Retrograde amnesia: Loss of memory for events that occurred before the precipitating incident

loss of memory for events before the onset of unconsciousness e.g. after ECT or head injury

memory can be:-Immediate – within hours; Recent – within some months/ days/weeks; Past –

distant past.

-Confabulation: unconscious invention of experiences to cover gaps in memory to recent

events. Gaps in patient’s memory filled with fabrications of the patients which he/she
nevertheless accepts has facts. Reporting as “memories” of events that didn’t take place at the

time in question. Common in KorsaKoffs (Korsakov’s) psychosis (syndrome), Dementia,

Cerebral trauma, chronic schizophrenics, and Toxic confusion states e.g. alcoholics and

Pathological liars.

Jamais vu – this failure to recognize events that have been encountered before.

Déjàvu – Recognition of events as familiar when they have never been encountered

Both of these disorders occur in neurological disorders.

Amnesic syndrome: Differential impairment where memory of recent events is most affected &

semantic memory least affected.

Memory usually affected in:

 Depressive disorders – unhappy memories recalled more often than others.

 Organic disorders – Long term memory affected – memory of earlier events less affected

than recent events.

H. Disorders of consciousness
Consciousness is a state of awareness of one’s self and environment. It ranges from full

consciousness to coma. Some disorders that may affect consciousness may include:

- Distractibility: Attention is easily diverted by any sensory stimulus e.g. light voices.

- Inattention: Difficulty in getting a person’s attention. Note that attention is ability to

focus on an issue while concentration is the ability to maintain attention.

- Confusion – muddled thinking: Impaired comprehension, distortion and poor contact

with surroundings.
 - Clouding of consciousness – state of drowsiness. Incomplete reaction to stimuli,

impaired attention, concentration & memory, slow & muddled thinking.

- Delirium: Clouding of consciousness. Common in organic condition in which a person is

confirmed, experience delusions, and disorders of perception.

- Confessional state – muddled thinking associated with impaired consciousness, health,

illusions, delusions & anxiety.

- Stupor: Also falls under motor activity. State of reduced responsiveness. State of

reduced reactivity to stimuli & less than full awareness of the surroundings. Person mute,

immobile & unresponsive but appears conscious bears eyes are open & follow objects.

I. Disorders of Intelligence/Cognition

This is a state where the subject’s intellectual capacity is impaired. Abstract thinking and

comprehension can be assessed using a proverb e.g. A penny saved is a penny earned or people

in a glass homes shouldn’t throw stones. Some problems associated with intelligence/cognition

include:

- Dementia – permanent loss of intelligence due to a coarse brain disease

- Mental retardation – subnormal mental ability.

J. Disorder of attention & concentration

Attention is the ability to focus on the matter at hand while concentration is the ability to

maintain that focus. They both can be impaired in anxiety disorder, depressive, mania,

schizophrenia, organic disorders

k. Insight
Defined as correct awareness of one’s mental condition. It is not just absence or presence of

insight but a matter of degree. It’s described best by use of four criteria:

 Awareness of oneself as presenting phenomena that other people consider abnormal

e.g. being unusually active & elated.

 Recognition that these phenomena is abnormal

 Acceptance that these abnormal phenomena is caused by one’s own mental illness

e.g. rather than e.g. poison.

 Awareness that treatment is required.

Generally, Insight is lost to a greater extent in psychosis than in non-psychotic disorders.

Assessment of insight is extremely important in determining a patient’s likely cooperation with

treatment.

☺? Critical thinking activity/learning activity

Read more on symptomatology by explaining the meaning of the following terms as used in
psychiatry:
Verigeration, transactional analysis, thematic apperception test (TAT), territoriality, split

personality, sociodrama, scapegoating, Rorschach test, realty testing, overcompensation,

manipulation, different forms of mania e.g. dipsomania, kleptomania, nymphomania,

pyromania; labella indifference, iatrogenic illness Ganser syndrome-“nonsense syndrome

“/prison psychosis/”syndrome of approximate answers”, labile, Functional, folie a deux, fellatio,

existential psychotherapy ennui, ego-dystonic, fugue, constitution, castration complex , blotting

paper syndrome ,autistic thinking ,anaclitic, ataractic, abreaction.