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Chapter 1 Signs and Symptoms

of Mental Disorders

济宁医学院精神医学系

李功迎

副教授 医学博士
Contents
• 1. Introduction
• 2. Some Concepts of Psychopathology
• 3. Description of Symptoms and Signs
3.1 Disorders of Perception
3.2 Disorders of Thinking
3.3 Disorders of Mood
3.4 Depersonalization and Derealization
3.5 Motor Symptoms and Signs
3.6 Disorders of Memory
3.7 Disorders of Consciousness
3.8 Insight
心理现 象
• 从人的共同性来看 心理过 程
: 程 和对事 物的认 识有 关, 感觉、 知觉 、记 忆、思 维、
认知过
: 注意
和对 事物的 态度 有关, 情绪和 情感
情感过 程 和作出 决定有 关

意志过 程 个性

• 从人的差异性来看
个性倾 向性 : 需要、 动机 、兴趣 、理
: 理特 征:
个性心 想能力、 气质 、性格
个性自 我调 节系统 : 在认识 方面包 括有 自我认 识、自我 分
析、 自我 观念和 自我 评价等 ;在 情感方 面包 括自我体验 、自
尊、 自信 、自豪 等内 容;在 意志 行动方 面包 括有自 我监 督、
自我 命令 、自我 控制 等。三 方面 紧密联 系, 构成 自我调 节系
统。
感觉

知觉

正 认知 过程 记忆

的 思维
心 情感 过程
理 注意


意志 过程
感知觉
思维
注意
认知障 碍 记忆
智能
精 情绪 和情 感障碍 定向力

自知力

状 意志 行为 障碍

意识障 碍
Introduction
• Psychiatry can be practised only if the
psychiatrist develops two distinct capacities.
• One is the capacity to collect clinical data
objectively and accurately by history taking
and examination of mental state
• The other is the capacity for intuitive
understanding of each patient as an
individual
Introduction
• Both capacities can be developed by
accumulating experience of talking to
patients, and by learning from the guidance
and example of more experienced
psychiatrists.
• The psychiatrist can acquire skill in
examining patients only if he has a sound
knowledge of how each symptom and sign is
defined. Without such knowledge, he is liable
to misclassify phenomena and make
inaccurate diagnoses.
Introduction
• Signs and symptoms form the two major
categories of clinical phenomena.
• Symptoms are subjectively experienced
disturbances that are not necessarily
observable by others.
• Signs are abnormalities that are observable by
an examiner, including those that are easily
evident in the course of a routine encounter
with the patient as well as those elicited only
through specific physical, mental status, or
laboratory examinations
• But in psychiatry the line between symptoms
and signs is often more blurred than in
general medicine.
Contents
• 1. Introduction
• 2. Some Concepts of Psychopathology
• 3. Description of Symptoms and Signs
3.1 Disorders of Perception
3.2 Disorders of Thinking
3.3 Disorders of Mood
3.4 Depersonalization and Derealization
3.5 Motor Symptoms and Signs
3.6 Disorders of Memory
3.7 Disorders of Consciousness
3.8 Insight
Some Concepts of Psychopathology

• Psychopathology
• The study of abnormal states of mind ( 异常精神
状态 ) is known as psychopathology
• phenomenoiogical psychopathology
• concerned with the objective description of
abnormal states of mind
• It aims to elucidate the basic data of psychiatry
by defining the essential qualities of morbid
mental experiences and by understanding what
the patient is experiencing. It is entirely
concerned with conscious experiences and
observable behavior
Some Concepts of Psychopathology
• psychodynamic psychopathology
 originates in psychoanalytical investigations
 it goes beyond description and seeks to
explain the causes of abnormal mental events,
particularly by postulating unconscious
mental processes
 For example: persecutory delusions
seeks to explain the occurrence of persecutory
delusions in terms of unconscious mechanisms
such as repression and projection
Some Concepts of Psychopathology

• experimental psychopathology
 Hypotheses are formulated to explain
the observed changes, and then
tested in further experiments
 For example: anxiety ; Depression
Some Concepts of Psychopathology
• The significance of individual symptoms
 It is often mistaken to conclude that a person
has a mental disorder on the evidence of an
individual symptom
 Even hallucinations ; sometimes
experienced transiently by healthy people.
 Should consider it’s intense and
persistent
 It is the characteristic grouping of
symptoms into a syndrome that is
important
Some Concepts of Psychopathology
• Primary and secondary symptoms
 with more than one meaning
 The first is temporal
 The second is causal
 It is preferable to use the terms primary and
secondary in the temporal sense because this
sense does not require an inference about
causal mechanisms
 When cannot give a clear account of the
chronological development , it is only possible to
conjecture whether one symptom could be a
reaction to another, for example whether the
fixed idea of being followed by persecutors could
be a reaction to hearting voices.
Some Concepts of Psychopathology
• The form and content of symptoms
 it is usual to distinguish between form
and content
 For example: homosexual (in book P4)
Contents
• 1. Introduction
• 2. Some Concepts of Psychopathology
• 3. Description of Symptoms and Signs
3.1 Disorders of Perception
3.2 Disorders of Thinking
3.3 Disorders of Mood
3.4 Depersonalization and Derealization
3.5 Motor Symptoms and Signs
3.6 Disorders of Memory
3.7 Disorders of Consciousness
3.8 Insight
3.1 Disorders of Perception
• Illusions
 Illusions are misperceptions of external
stimuli
 to occur when the general level of
sensory stimulation is reduced
 Thus at dusk a common illusion is to
misperceive the outline of a bush as that
of a man.
Illusions

 to occur when the level of


consciousness is reduced
 for example in an acute organic
syndrome. Thus a delirious patient may
mistake inanimate objects for people
when the level of illumination is
normal, though he is more likely to do
so if the room is badly lit.
Illusions

 to occur when attention is not focused


on the sensory modality or when there
is a strong affective state (eg.
frightened )
 for example in a dark lane a frightened
person is more likely to misperceive
the outline of a bush as that of an
attacker.
感知觉 障碍
1 、感觉障碍:感觉过敏, 感觉减退,内感性不适,
2 、知觉障碍:
• 错觉:对客观事物歪曲的知觉 幻觉:没有现实刺激作用
于感觉器官时出现的知觉体验,是一种虚幻的知觉。
Disorders of Perception
• Hallucinations
 A hallucination is a percept experienced in the
absence of an external stimulus to the sense organs
and with a similar quality to a true percept
 Hallucinations are not restricted to the mentally ill. A
few normal people experience them :
 Hallucinations also occur in healthy people during the
transition between sleep and waking; they are called
hypnagogic if experienced while falling asleep and
hypnopompic if experienced during awakening.




Disorders of Perception
• Pseudohallucinations (假性 幻觉)
 has two meanings
 lack the quality of representing external reality and
seem to be within the mind rather than in external
space. However, unlike ordinary imagery, they
cannot be changed substantially by an effort of will.
 The second meaning is the experience of
perceiving something as in the external world, while
recognizing that there is no external correlate to the
experience 感觉体验似乎源于外界,但显得不真实
Disorders of Perception
• Types of hallucination (幻觉的 类型)
• 1. According to complexity
• Elementary( 要素性 或原 始性 )
• Complex
• 2. According to sensory modality
• Auditory
• Visual
• Olfactory and gustatory
• Somatic [tactile and deep)
• 3. According to special features
• (a) Auditory: second-person
• third-person
• Gedankenlautwerden( 思维鸣响 )
• echo de la pensde (思维 回响)
• (b) Visual: extracampine (域外幻 觉)
• 4. Autoscopic hallucinations (自视性 幻觉)
Type of hallucinations
• Auditory hallucinations may be experienced as
noise, music, or voices. (Hallucinatory 'voices‘ are
occasionally called phonemes.) Voices may be
heard clearly or indistinctly, they may seem to
speak words, phrases, or sentences, and they may
seem to address the patient directly (second-
person hallucinations) or talk to one another
referring to the patient as 'he' or 'she' (third-person
hallucinations). Sometimes voices seem to
anticipate what the patient thinks a few moments
later, or Speak his own thoughts as he thinks
them, or repeat them immediately after he has
thought of them.
Type of hallucinations
• Visual hallucinations may also be
elementary or complex. They may appear
normal or abnormal in size; if the latter, they
are more often smaller than the
corresponding real percept. Visual
hallucinations of dwarf figures are
sometimes called lilliputian. Extracampine
visual hallucinations are experienced as
located outside the field of vision, i.e. behind
the head.
Type of hallucinations
• Olfactory and gustatory hallucinations are
frequently experienced together, often as
unpleasant smells or tastes.
Type of hallucinations
• Tactile hallucinations, sometimes called haptic
hallucinations, may be experienced as sensations of
being touched, pricked, or strangled. They may also
be felt as movements just below the skin which the
patient may attribute to insects, worms, or other
small creatures burrowing through the tissues.
Hallucinations of deep sensation may occur as
feelings of the viscera being pulled upon or
distended, or of sexual stimulation or electric
shocks.




• 思维化声和思维鸣响:病人思考时体验到
自己的思想同时变成了言语声,自己和他
人均能听到。病人若觉得此种声音来自心
灵之中或脑内为思维化声,若觉得声音来
自外界则为思维鸣响。

• 思维回响
Disorders of Perception
• Types of hallucination (幻觉 的类型)
 Functional hallucination
 Reflex hallucination
 hypnagogic hallucination
 hypnopompic hallucination
 Psychosensory disturbance( 感知 综合障
碍)
各种感 觉模

均可出 现幻

• 真性幻 觉
• 假性幻 觉
• 功能性 幻

• 反射性 幻

感知综合障碍:对客观事物能感知,但对某些 个别属性如
大小、形状、颜色、距离、空间位置等产生错误的感知。
?‘









• 天目位 于鼻根 上印 堂的位 置, 从印堂 进去 两寸
,有一 个象松 果一 样的东 西, 现代医 学称 之为
松果体 ,有人 研究 认为, 松果 体内有 退化 了的
视网膜 ,具有 呈像 能力。 天眼 功练成 后, 两眉
中间的 天目激 活开 通了, 闭上 眼睛, 额前 就能
出现屏 幕状的 东西 而呈像 。开 天目是 激动 人心
的,能 看到常 人看 不到的 不可 思议的 东西 。

• 照佛家 的说法 ,就 是色界 天的 眼根超 越了 大地


的远近 ,时间 的过 去和未 来, 一切现 象都 能明
见。

“ 开天 耳”
Diagnostic associations
(幻觉的诊断价值)
• Hallucinations may occur in severe affective
disorders, schizophrenia, organic disorders
and dissociative states, and at times among
healthy people
• Therefore the finding of hallucinations does
not itself help much in diagnosis. However,
certain kinds of hallucination do have
important implications for diagnosis
• Both the form and content of auditory
hallucinations can help in diagnosis
Diagnostic associations
(幻觉的诊断价值)
• third-person hallucinations : are
associated particularly with schizophrenia
• Second-person hallucinations :
contents: depression ; schizophrenia
• Voices which anticipate, echo, or repeat the
patient's thoughts also suggest
schizophrenia.
• Visual hallucinations may occur in hysteria,
severe affective disorders, and
schizophrenia, but they should always raise
the possibility of an organic disorder
Diagnostic associations
(幻觉的诊断价值)
• Hallucinations of taste and smell : may
occur in schizophrenia or severe depressive
disorders, but they should also suggest
temporal lobe epilepsy or irritation of the
olfactory bulb or pathways by a tumour
• Tactile and somatic hallucinations
:hallucinatory sensations of sexual
intercourse suggest schizophrenia ;
The sensation of insects moving under the
skin occurs in people who abuse cocaine
and occasionally among schizophrenics
Disorders of Thinking
Four separate groups of phenomena Particular
1. kinds of abnormal thoughts
Delusions
Obsessions
2. Disorders of the stream of thought (speed
and pressure) (思维进程障碍,速度与紧迫)
3. Disorder of the form of thought (linking of
thoughts together)
4. Abnormal beliefs about the possession of
thoughts (思维据有的异常信念)
思维障碍分类(国内)
• 思维联想障碍 : 联想的速度、数量、结构、自主性
(思维速度障碍)
• 思维形式和逻辑障碍:
• 思维控制障碍:
• 思维内容障碍:
思维障 碍的 种类
• 思维速度障碍: 如思维过程 的速度加快 或缓
慢。
• 思维形式障碍: 联想障碍, 如联想的结 构缺
乏目的性,思维 松弛,思考 的过程不符 合逻
辑等。
• 思维控制障碍: 妄想所致, 患者感到自 己的
思维不属于自己 ,感觉自己 的思维在受 外力
所控制而不受自 己的意志所 控制。
• 思维内容障碍: 妄想或类妄 想,强迫性 观念
等。
思维障 碍在 心理学 上的分 类
• 概括过程障碍: 主要是以患 者的概括能 力下
降和概括过程错 误为表现。
• 思维动力障碍: 以思维速度 和推理的稳 定性
的改变为主要的 表现。
• 思维动机成分的 障碍: 以思维的过程失 去目
的性和指向性为 主要的表现 。
• 思维内容的障碍 :如妄想 ,类妄想等 。
Disorders of the stream of thought
• Both the amount and the speed of thoughts are
changed.
• At one extreme there is pressure of thought,
when ideas arise in unusual variety and
abundance and pass through the mind rapidly
(思维紧迫)
• At the other extreme there is poverty, of
thought, when the patient has only a few
thoughts, which lack variety and richness, and
seem to move through the mind slowly (思维贫
乏) .
• The experience of pressure occurs in mania;
that of poverty occurs in depressive disorders.
Both may be experienced in schizophrenia.
Disorders of the stream of thought

• Thought blocking :The stream of thought


can also be interrupted suddenly--a
phenomenon which the patient
experiences as his mind going blank, and
which an observer notices as a sudden
interruption in the flow of conversation
• Strongly suggests schizophrenia
Disorders of the form of thought
• Can be divided into three subgroups
• Flight of ideas, perseveration, and loosening of
associations
• Flight of ideas : the patient's thoughts and
conversation move quickly from one topic to another so
that one train of thought is not completed before another
appears.
• using two words with a similar sound (clang
associations) or the same word with a second meaning
(punning)
• understandable ; the links are normal ;it differentiates
them from loosening of associations
• Flight of ideas is characteristic of mania.
Disorders of the form of thought
• Perseveration is the persistent and
inappropriate repetition of the same thoughts
• in response to a series of simple questions,
the person may give the correct answer to
the first but continue to give the same
answer inappropriately to subsequent
questions
• occurs in dementia but is not confined to this
condition.
• 持续言语 (perserveration) :持续言语 属思维活动 形式障碍。 持续言
语与病理 性赘述比较类 似,但持续 言语的特点 不仅是粘 滞,而是在
某一概念 上停止不前。 病人单调地 重复某一概 念,或对 于某些不同
的问题材 ,总是用第一 次回答问题 的话来回答 其他问题 。如我们问
一个癫痫 性精神病病人 :“你来几 天了”病人 答日:“ 一天”又问
“来干什 么?你今年几 岁了?你家 住什么样地 方?”等 问题时,病
人均答日 :“一天”。 这类症状主 要见于癫痫 性精神病 、脑器质性
疾病伴发 的精神病。
• 重复言语 ( verbigeration ) :重复言语也 属于思维活 动形式障 碍
,它指病 人常常重复他 所说一句话 的最末几个 字或词, 此时病人能
意识到这 样做是不必要 的,但自己 却不能克服 ,也不因 当时的环境
而发生变 化。如有一病 人说:“我 是一个学生 ,学生、 学生、学生
、学生、 学生……”。 多见于脑器 质性精神病 、癫痫性 精神病。
• 刻板言语 ( stereotypy of speech ):刻板 言语也属思 维活动形式
的障碍, 指病人机械地 刻板地重复 某一无意义 的词或句 子。如一病
人说:“ 我是学生、我 是学生、我 是学生…… ”。这类 症状也多常
见于精神 分裂症。
•   模仿 言语 (echolaia) :模仿 言语同样属 于思维活动形 式障碍,它 指
病人模仿 周围其他人的 话,周围人 说什么,病 人就就说 什么。如医
生问病人 :“你叫什么 名子”病人 就回答:“ 你叫什么 名字?”医
Disorders of the form of thought
• Loosening of associations denotes a
loss of the normal structure of thinking
paragraph; phase
• Splitting of thought
it disrupts in the connections between
sentences
• word salad
phrases
Disorders of the form of thought
• Neologisms (语词 新作)
the patient uses words or phrases,
invented by himself, often to describe his
morbid experiences
“ 女男”表示结婚 ;“淡”: “女人是
水,男人是火, 淡字是一个 水,两个火
,两个火的力量 大于一水, 所以妻子应
该怕丈夫”
Neologisms occur most often in chronic
schizophrenia.
二、思维 障碍
• 1 、思维形式障碍:
• 思维奔逸,思维迟缓,思维贫乏

• 思维散漫、思维破裂,病理性赘
述,
• 思维中断,思维插入,思维化声

• 思维扩散,象征性思维,语词新
作,
Particular kinds of abnormal thoughts
• Delusions
• Definition:A delusion is a belief that is firmly held on
inadequate grounds, is not affected by rational
argument or evidence to the contrary, and is not a
conventional belief that the person might be
expected to hold given his educational and cultural
background.
• Feature :
1. The hallmark of the delusion is that it is firmly held
on inadequate grounds
2. It is held with such conviction that it cannot be
altered by evidence to the contrary.
3. it is not falsity that determines whether the belief is
delusional, but the nature of the mental processes
that led up to the belief ( 推理过程决定是否是妄想 )
Descriptions of delusions
• 1. According to fixity'
Complete
• Partial
• 2. According to onset
• Primary
• Secondary
• 3. Other delusional experiences
• Delusional mood
• Delusional perception
• Delusional memory
• 4. According to theme
• Persecutory {paranoid}
• Delusions of reference
• Grandiose {expansive)
• Delusions of guilt and worthlessness
• Nihilistic
• Hypochondriacal
• Religious
• Jealous
• Sexual or amorous
• Delusions of control
• Delusions concerning possession of thought
• Thought insertion
• Thought withdrawal
• Thought broadcasting
• 5. According to other features
• Shared delusions
Delusions
• Primary, Secondary delusions , Shared
delusions
• Primary delusion: is one that appears suddenly
and with full conviction but without any mental
events leading up to it.
• The belief arrives in the mind suddenly, fully
formed, and in a totally convincing form
• start with an idea; a delusional mood or a
delusional perception
• are given considerable weight in the diagnosis
of schizophrenia
Delusions
• Primary, Secondary
delusions , Shared delusions
• Secondary delusions can be
understood as derived from some
preceding morbid experience. The
latter may be of several kinds: a
hallucination ; a mood; or an existing
delusion (P13)
• systematized (P13)
Delusions
• Primary, Secondary delusions , Shared
delusions
• Shared delusions: a person who lives with a
deluded patient comes to share his delusional
beliefs. This condition is known as shared
delusions. Although the second person's
delusional conviction is as strong as the former's
while the couple remain together, it often
recedes quickly when they are separated.
Delusions
• Delusional moods, perceptions, and memories
• As a rule, delusion an emotional response and
interprets his environment in a new way
• Occasionally the order is reversed
• Delusional moods: often a feeling of anxiety with the
foreboding that some sinister event is about to take place,
and the delusion follows
• Delusional perceptions: the first change may be attaching a
new significance to a familiar percept without any
reason.(P14)
• Delusional memories: some delusions concern past rather
than present events, and are known as delusional memories
• (P14)
Delusional themes
• Persecutory delusions :are most commonly
concerned with persons or organizations that are
thought to be trying to inflict harm on the patient,
damage his reputation, make him insane, or
poison him.
• Such delusions are common but of little help in
diagnosis, for they can occur in organic states,
schizophrenia, and severe affective disorders.
However, the patient's attitude to the delusion
may point to the diagnosis
Delusional themes
• Delusions of reference : are
concerned with the idea that objects,
events, or people have a personal
significance for the patient;
• For example: an article read in a
newspaper or a remark heard on
television
• Idea of reference
Delusional themes
• Grandiose or expansive delusions are
beliefs of exaggerated self-importance.
The patient may think himself wealthy,
endowed with unusual abilities, or a
special person. Such ideas occur in
mania and in schizophrenia.
Delusional themes
• Delusions of guilt and worthlessness are
found most often in depressive illness,
and therefore are sometimes called
depressive delusions. Typical themes are
that a minor infringement( 违反、 侵害 ) of
the law in the past will be discovered and
bring shame upon the patient, or that his
sinfulness will lead to divine
retribution (报应) on his family.
Delusional themes
• nihilistic delusions are beliefs about the
non-existence of some person or thing, but
their meaning is extended to include
pessimistic ideas that the patient's career is
finished, that he is about to die, that he has
no money, or that the world is doomed.
• bodily function (e.g. that the bowels are
blocked with putrefying matter) often
accompany nihilistic delusions
• Cotard's syndrome
• depression
Delusional themes
• Hypochondriacal delusions are
concerned with illness. The patient may
believe wrongly, and in the face of all
medical evidence to the contrary, that he
is ill.
• more common in the elderly ; cancer or
venereal disease
Delusional themes
• Delusions of jealousy :are concerned with
doubts about the spouse's fidelity.
• they may lead to dangerously aggressive
behaviour towards the person thought to be
unfaithful. Special care is needed if the
patient follows the spouse to spy on her,
examines her clothes for marks of semen,
or searches her handbag for letters.
• Not all jealous ideas are delusions; less
intense jealous preoccupations are common
Delusional themes
• Sexual or amorous delusions: A woman
with amorous delusions believes that
she is loved by a man who is usually
inaccessible, of higher social status, and
to whom she has never even spoken.
• frequent among women.
他爱我!他在考验我
Delusional themes
• Delusions of control: believes that his
actions, impulses, or thoughts are
controlled by an outside agency.
• for example that his arms are moved
into the position of crucifixion not
because he willed them to do so, but
because an outside force brought it
about
• strongly suggests schizophrenia
Delusions concerning the
possession of thoughts:
• healthy people take it for granted that their
thoughts are their own. They also assume
that thoughts are private experiences that
can be known to other people only if spoken
aloud, or revealed by facial expression,
gesture, or action.
• Delusions of thought insertion
• Delusions of thought withdrawal
• Delusions of thought broadcasting
• Differ from obsession?





Obsessional and compulsive symptoms
• Obsessional and compulsive symptoms
• Obsessions are recurrent persistent thoughts,
impulses, or images that enter the mind despite
the person's efforts to exclude them.
• The characteristic feature is the subjective sense
of a struggle—the patient resisting the obsession
which nevertheless intrudes into his awareness.
• The presence of resistance is important ; it
distinguishes obsessions from delusions
• Compulsions are repetitive and seemingly
purposeful behaviours, performed in a
stereotyped way
• A compulsion has the function of reducing the
distress caused by the obsession
Obsessional and compulsive symptoms

• 1. Obsessions: thoughts
• ruminations
• doubts
• impulses
• obsessional phobias
• 2. Compulsions (rituals)
• 3. Obsessional slowness




Contents
• 1. Introduction
• 2. Some Concepts of Psychopathology
• 3. Description of Symptoms and Signs
3.1 Disorders of Perception
3.2 Disorders of Thinking
3.3 Disorders of Mood
3.4 Depersonalization and Derealization
3.5 Motor Symptoms and Signs
3.6 Disorders of Memory
3.7 Disorders of Consciousness
3.8 Insight
Disorders of Mood
• Emotional state--mood and affect
• In mental disorder, mood may be abnormal in
three ways: its nature may be altered, it may
fluctuate more or less than usual, and it may be
inconsistent with the patient's thoughts or
actions or with current events.
• 情感性 质的改 变: 高涨、 低落 、焦虑 、恐 惧
• 情感稳 定性的 改变 :不稳 、淡 漠、易 激惹 性
• 情感协 调性的 改变 :情感 倒错 、情感 幼稚
Disorders of Mood
• Changes in the nature of mood can be
towards anxiety, depression, elation, or
anger
• Abnormal fluctuation of mood : affect
is described as blunted or flattened ;
apathy ; affect labile
• Incongruity of mood (or affect)
Disorders of Mood
• Clinical association:
• mood (affective) disorders (depression
and elation) and of anxiety disorders
• also common in other neuroses, organic
disorders, and schizophrenia.
Disorders of Mood
• Anxiety
• anxiety is characterized by intense negative
affect, associated with an undefined threat to
one's physical or psychological self
• Anxiety is additionally characterized by somatic,
cognitive, behavioral, and perceptual symptoms.
• The somatic symptoms of anxiety are legion and
often dominate the subjective symptoms: a
partial list includes twitching, tremors, hot and
cold flashes, sweating, palpitations, chest
tightness, difficulty swallowing, nausea,
diarrhea, dry mouth, and decreased libido.
Disorders of Mood
• Cognitively, anxiety is characterized by
hypervigilance, poor concentration,
subjective confusion, fears of losing control
or of going crazy, and catastrophic thinking.
• Behavioral symptoms include fearful
expressions, withdrawal, irritability,
immobility, and hyperventilation.
• Perceptual disturbances, including
depersonalization, derealization, and
hyperesthesia
Contents
• 1. Introduction
• 2. Some Concepts of Psychopathology
• 3. Description of Symptoms and Signs
3.1 Disorders of Perception
3.2 Disorders of Thinking
3.3 Disorders of Mood
3.4 Depersonalization and Derealization
3.5 Motor Symptoms and Signs
3.6 Disorders of Memory
3.7 Disorders of Consciousness
3.8 Insight
Motor Symptoms and Signs
• Hyperbulia
• Hypobulia
• Abulia
• Abnormalities of social behaviour, facial
expression, and posture occur frequently in
mental illness of all kinds
• Tics (抽 动) are irregular repeated
movements involving a group of muscles, for
example sideways movement of the head or
the raising of one shoulder



退
Motor Symptoms and Signs

• Mannerisms (作 态) are repeated


movements that appear to have some
functional significance, for example saluting
• Stereotypies (刻 板动作 ) are repeated
movements that are regular {unlike tics} and
without obvious significance (unlike
mannerisms), for example rocking to and fro.
• Posturing (刻 板姿势 ) is the adoption of
unusual bodily postures continuously for a
long time.


Motor Symptoms and Signs
• negativism (违拗症 ) when they do the
opposite of what is asked and actively resist
efforts to persuade them to comply.
• Echopraxia (模仿动作) is the imitation of the
interviewer's movement automatically even
when asked not to do so.
• ambitendence (矛盾意向) when they
alternate between opposite movements, for
example putting out the arm to shake hands,
then withdrawing it, extending it again, and so
on.
• Waxy flexibility (蜡样屈曲) is detected
when a patient's limbs can be placed in a
position in which they then remain for long
periods
Insight
• Insight may be defined as awareness of one's
own medical condition
• to consider four separate questions
• First, is the patient aware of phenomena that
other people have observed ?
• Second, if so, does he recognize that these
phenomena are abnormal ?
• Third, if he recognizes the phenomena as
abnormal, does he consider that they are
caused by mental illness, as opposed to
• Fourth, if he accepts that he is ill, does he
think that he needs treatment?
十一、自知力

自知力
:对自己
精神疾病
的认识和
判断能力。
思维障碍
• 2 、思维内容障碍 :
• 妄想:一种病理性的歪曲信念。其内容
事实不符,没有客观现实基础,但患者坚
信不移;妄想具有个人独特性,其内容均
涉及患者本人,因文化背景和个人经历而
有所差异。
• 原发性妄想—继发性妄想
• 系统性妄想—非系统性妄想
按妄想内容归类,常见的妄想种类有:

• 1 、被害妄想, 2 、关系妄想,
• 3 、物理影响妄想, 4 、夸大妄想,
• 5 、罪恶妄想, 6 、疑病妄想,
• 7 、钟情妄想, 8 、嫉妒妄想,
• 9 、被洞悉感,
注意障碍
• 1 、注意增强
• 2 、注意涣散
• 3 、注意减退
• 4 、注意转移
• 5 、注意狭窄
记忆障碍
• 1 、遗忘:顺行性遗忘、逆行性遗忘、
• 界限性遗忘
• 2 、错构
• 3 、虚构
五、智能障碍

1 、精神发育迟滞
2 、痴呆
3 、假性痴呆
六、定向力障碍
• 1 、时间 2 、地点 3 、人物
七、情感障碍
• 1 、情感性质改变:情感高涨,情感低
落,焦虑,恐惧,
• 2 、情感波动性改变:情感不稳,情感
淡漠, 易激惹,
• 3 、情感协调性改变:情感倒错,情感
幼稚
八、意志活动障碍

1 、意志增强 2 、意志
减退 3 、意志缺乏
4 、犹豫不决






九、动作行为障碍

1 、精神运动性兴奋:协调性;不协调

2 、精神运动性抑制:木僵;蜡样屈曲
;缄默;违拗;
3 、刻板动作;
4 、模仿动作;
5 、作态