General Psychopathology

Department of Psychiatry
Hawler Medical university
 Disorder of thought stream

• Disorders of thought Tempo

1.Flights of ideas
2.Inhibition or slowing of thinking
3.Circumstantiality

• Disorders of continuity of thinking

1.Perseveration
2.Thought blocking
 Flights of ideas

• In this case thoughts follows each other rapidly

• Chance connection, Speech is diverted by internal or external stimuli.

• The associations of the train of thought are determined by Chance relationship,

verbal association of all kinds, clang associations.

• Patient can go back to the main point

• Flights of idea occasionally seen in individuals with schizophrenia, organic states such
as lesions of hypothalamus.

• Acute mania can lead to complete incoherence.

"I own five cigars. I've been to Havana. I want to go on a holiday . Its too hot and
expensive “
Inhibition or slowing of thinking

• Train of thought is slowdown and the number of

ideas and mental images that presents themselves is
decreased leading to difficulties in making decisions,
lack of concentration, and the loss of clarity of
thinking.

• This is usually accompanied by diminished active

attention

• Events are poorly registered leading to patients

complaining of memory loss.
Circumstantiality

• In which the focus of a conversation drifts, but often

comes back to the point. unnecessary details and
irrelevant remarks cause a delay in getting to the point.

•  "What is your name?" "Well, sometimes when people ask me that, I have to think
about whether or not to answer, because some people think it's an odd name even
though I don't really think so , because my mum gave it to me and I think my dad
helped, but it's a good name in my opinion, I think it's a little weird to have the
same name as two of my other names, but the fact that I still like it.......... but
yeah, it's Gordon."
Disorder of thought stream

• Disorders of thought Tempo

1.Flights of ideas
2.Inhibition or slowing of thinking
3.Circumstantiality

• Disorders of continuity of thinking

1.Perseveration
2.Thought blocking
 Disorder of the continuity of thinking

1. Perseveration

2. Thought block.
Disorders of thought and speech

• Disorder of intelligence
• Stream of thought and possession of thought
• Obsessions and compulsions
• Disorders of the content and form of thinking.
Obsessions, compulsions and
disorders of the possession of thought

• An obsession, also termed rumination, is a thought that persists and dominates an

individual thinking despite the individual’s awareness that the thought is entirely
without a purpose.

• Compulsions are obsessional motor acts

• Appear against will

• Obsessional images
• Obsessional ideas
• Obsessional impulses
• Obsessional fears or phobias
OCD
Disorders of thought and speech

• Disorder of intelligence
• Stream of thought and possession of thought
• Obsessions and compulsions
• Disorders of the content and form of thinking.
Thought alienation

• In thought alienation the patient has the experience that their

thoughts are under control by an outside agency or others are
participating / accessing their thinking.

• Thought insertion
• Thought deprivation - withdrawal
• Thought broadcasting

• Thought alienations form an important component in the

diagnostic criteria for Schizophrenia.- First rank symptom
Disorders of thought content

• Delusion is defined as false, unshakable belief that is out of

keeping with the patient’s social and cultural background

• Primary delusions ---- Delusional mood

---- Delusional Perception
---- Sudden delusional ideas

• Acute Schizo ( primary delusions) ----Chronic ( secondary

Delusions)

• Secondary delusions can be understood as arising from other

morbid experiences.
Delusion - Content

• Delusion of persecution

• Delusion of infidelity

• Delusion of love (Erotomania) - de Clerambault syndrome

• Grandiose delusion

• Delusion of ill health - hypochondriacal

• Delusion of guilt

• Nihilistic delusion

• Delusion of poverty
Disorders of form of thinking

• The other term is” formal thought disorder “which is a disorder of

conceptual or abstract thinking

- Overinclusion (concept widening )

- Loosening of association ( derailment, Talking past the point, word
salad)
- Circumstantiality
- Neologism
- Metonyms (word approximation)
- Fusion
- Substitution
- Concrete thinking
Disorder of speech

• Stammering and Stuttering

- pauses, repetition , tics, grimacing .

• Mutisim : Elective , hysterical , a kinetic

• Talking past the point ( Vorbeireden)
• Neologism
• Word salad
• Aphasia (dysphasia)
Disorders of Memory

• Sensory memory ( registered memory for each sense) –

allow comparison with STM AND LTM – lasts few seconds

( selective attention )
Disorders of Memory

• Short term memory – Constant updating

- Rehearsal
- encoding

• Long term memory

--- Autobiographical memory
--- Flash bulb memory
Disorders of memory

On clinical grounds memory can be divided into

• Explicit or declarative or relational memory, which

is subdivided into Episodic memory for example,
going to the shops this morning,: and Semantic
memory for abstract facts such as” what is the
capital of Iraq”.
Disorders of memory

• Procedural memory ( Implicit memory) in which

there is no active awareness that the memory
been searched for.

• The process of remembering has four parts :

registration, retention, retrieval, and recall.
Memory impairment

• Amnesia: is defined as partial or total inability to

recall past experiences and events its due to organic
or psychogenic causes.

• Failure to recall may be due to decay , proactive and

retroactive interference.
Disorders of emotion

• A feeling can be defined as a positive or negative reaction to

some experienced events and it is this objective experience of
emotion.

• Emotion is a stirred-up state caused by physiological changes

occurring as a response to some event and tends to maintain or
abolish the causative event.

• Affect refers to short-lived emotion and it may not be

congruent with the mood. It is described as reactive,
constricted, blunt or flat.

• Mood is a pervasive and sustained emotion .

Types of Affect

• ” Blunted affect “ which is the loss of normal degree of

emotional sensitivity and sense of the appropriate response to
events, it’s one of the negatives symptoms of schizophrenia.

• “Incongruent affect “ refers to the objective impression that

the displayed affect is not consistent with the current thoughts
or actions, for example, laughing while discussing a traumatic
experience. Also seen in schizophrenia.
Affect

• ” Flat affect “, which is evident by a limitation in

the usual range of emotional response so that the
patient displays little emotional response in any
directions, although they expressed an amount in
the appropriate direction, unlike incongruity of
affect, which is not.

• “ lability of affect “ , is defined as rapid and abrupt

changes in emotion largely unrelated to external
stimuli. These shifts occur without warning. It can
be seen in absence of psychiatric disorder
 Morbid disorders of emotions

• Depressive illness

• Morbid anxiety

• Irritability : diminution in the stressor required to provoke

anger or physical violence

• Apathy: i.e. Lack of motivation seen in severe depression and

schizophrenia.

• Morbid euphoria and elation: seen in mania and hypomania

Disorders of the experience
of self

• Existence and activity of the self

• Being a unity at any given point in time
• Continuity of identity over a period of time
• Being separated from the environment
Disturbance of awareness
of self activity

• Depersonalisation : an unpleasant
subjective experience where the patient
feels as if they have become “unreal” its
seen in many psychiatric disorders as well
as in normal people

• Derealisation: the subjective feeling of

unreal environment
Disorders of consciousness

• Consciousness can be defined as a state of

awareness of the self and the environment.

• Attention, can be active when the subject focuses

their attention on some internal or external event,
or passive when the same event attracts the subject
attention without any conscious effort.

• Orientation is normally described in terms of time,

place and person .
Movement disorders
associated with antipsychotic use

• Acute akathesia: restlessness or inability to keep still.

• Chronic Akathesia

• Acute dystonia: involuntary to sustained muscle

contractions or spasm

• Tardive dyskinesia: repetitive, purposeless movements,

usually of the mouth, tongue and facial muscles.
Questions ?