College of Nursing

NUR 415 Clinical

Psychiatric Mental Health Nursing

General Symptomatology of Mental Illness

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Objectives

At the end of the session the students will be able to:

• Explain general symptomatology of psychiatric disorder

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Aspects of mental functioning

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 Outline
I- Disorder of thought
II-Disturbance in perception
III unreality states
IV-Disorder of memory
V-Orientation / Disorientation
VI- Judgment
VII- insight
VIII- Attention and concentration
IX- Disorder of consciousness
X- Disorder of affect
XI- Disorder of behavior
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 I- Disorder of thought

Formal Stream Content

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 I- Disorder of thought
A. Formal thought disorder

1. Concrete thinking:
Described when using the literal thinking, without understanding the meaning
behind sentences.
concrete versus abstract
• Concrete Thinking superficial,
• Abstract General thinking, logical,

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I- Disorder of thought
A. Formal thought disorder

2. Autistic thinking:
Thinking that gratifies unfulfilled desires but has no regard for reality,
egocentric (self-centered) fantasy.

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I- Disorder of thought
B. Disorder of the stream of thinking:

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 I- Disorder of thought
B. Disorder of the stream of thinking:

1- Tangentially 
Tangential thinking occurs when someone moves from thought to thought but never
seems to get to the main point.
2– Circumstantially
Before getting to the point or answering a question, the person gets caught up in
countless details & explanations.
• Question: "What is your name?"
• Response: "Well, sometimes when people ask me, I have to think about whether or
not I will answer because some people think it's an odd name even though I don’t
really because my mom gave it to me and I think my dad helped but it's as good a
name as any in my opinion, but yeah it's Tom."
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 I- Disorder of thought
B. Disorder of the stream of thinking:

The next day when I’d be going out you

3- Looseness of association
know, um I did some changes like uh, I
put, um, bleach on my hair in, in my
room. My roommate was from UK and
she was going to the junior college. And
we lived in the hotel so she wanted to
put it, um, peroxide on my hair…"

Thinking is haphazard, illogical, and confused. Connections in thought are

interrupted. Seen mostly in schizophrenic disorders.
4- Flight of ideas 
Rapid jumping from one idea to another. The connection ideas are
through stimuli from last idea or external stimuli.

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 I- Disorder of thought
B. Disorder of the stream of thinking:

5- Clang association They are

Hat-Bat-Rat-
The meaningless rhyming of words. Sat -.
6- Incoherence talks (word salad)
A mixture of words and phrases that have no meaning. makes it impossible to
understand the individual’s thought process.
7- Pressure of speech
Forceful energy hard in a manic individual's frantic, jumbled speech as she
struggles to keep pace with racing thoughts.

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 I- Disorder of thought
B. Disorder of the stream of thinking:

8- Poverty of speech 
Speech that is brief and uncommunicative.
9- Retardation
Refers to slow speech and prolonged latent period before response. 
10- Blocking
Sudden cessation of a thought in the middle of a sentence.

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 I- Disorder of thought
B. Disorder of the stream of thinking:

11- Preservation  
Psychopathological repetition of the same word or idea in response to different
questions.  1- I am fine.
1-how are you? 2- I am fine.
2-How old are you?
3-are you studying?.
3- I am fine.

12- Palilalia
It is the pathological repetition of the last word said.  
My name is Saud,
Saud, Saud.

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 I- Disorder of thought
B. Disorder of the stream of thinking:

13- Echolalia What is What is

your your
Repeating the speech of another person. name?…. name?….

14- Irrelevant answer

Answer that is not in harmony with question asked.

15- Neologisms 
Words a person makes up that only have meaning for the person herself.
 
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 I- Disorder of thought
C. Disorder in the content of thoughts

C. Disorder of the content of thoughts

Suicidal
Delusion Obsession Preoccupation
ideation

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 I- Disorder of thought
C. Disorder in the content of thoughts
1- Delusion

It is false fixed believe, not consistent with patient's educational & cultural
background, that cannot be corrected by logical or reasons.
As regards systematization: Delusions could be divided into:-
 
Systematized delusions
(Well knit) when they form a coherent system and appear to be logical.
E.g.
Paranoid delusions
Unsystematized delusions:
 Group of delusions that are not related to each other or they are
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Another categorization of delusions:

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 I- Disorder of thought C. Disorder in the content of thoughts
1- Delusion
1.1 Paranoid delusion:

It is an intense and strongly defended irrational suspicious belief.

It includes the following:
a- Delusion of grandeur
False belief that one is a very powerful and important person,
b- Delusion of persecution 
False belief that the patient is chased by others.

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 I- Disorder of thought
C. Disorder in the content of thoughts
1- Delusion
1.1 Paranoid delusion:

c- Delusion of reference
False belief that the behavior of other refers to oneself (e.g. people in street,
radio, and newspaper are referring to her)
d- Erotic delusion
False belief that there is a love story between oneself & famous person.

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 I- Disorder of thought
C. Disorder in the content of thoughts
1- Delusion
1.1 Paranoid delusion:

e- Delusion of jealousy
Conviction that the husband has some definite relation with someone
else.
f- Delusion of infidelity
False belief derives from pathological jealousy that one's lover is
unfaithful (it is an extreme of the jealousy delusion)
g- Litigious delusion
Patient writes complaints and sends them to responsible person.
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I- Disorder of thought
C. Disorder in the content of thoughts
1- Delusion
1.2. Delusion of influence (delusion of control)

• False belief that one is being controlled by others or agencies.

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 I- Disorder of thought
C. Disorder in the content of thoughts
1- Delusion
1.3. Depressive delusion

a- Delusion of self-blame, guilt

In which the patient believes that she is wicked, full of sins and unfit to with
other people (unworthiness).
b- Delusion of poverty
False belief that the patient believes that she lost everything in life.
c- Nihilistic delusion
False belief that a part of her body doesn't exist or he doesn't exist (dead).
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I- Disorder of thought
C. Disorder in the content of thoughts
1- Delusion
1.4. hypochondriacal delusion
• False belief that Patient has physical disease e.g. cancer stomach,
that is not based on real organic pathology.

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 I- Disorder of thought
C. Disorder in the content of thoughts
2- Obsessive thoughts

• Obsessive thoughts are intrusive thoughts invading the conscious

awareness against the resistance of the person in an involuntary way
that is fully aware that they are unnecessary and absurd.

• N.B. The difference between delusion and obsession is that the latter is
more absurd and the patient is aware of the absurdity and resists it
most of the time.

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I- Disorder of thought
C. Disorder in the content of thoughts
3- Suicidal ideation

• It is a recurrent idea affecting the individual to put an end by herself

to her own life.
 

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 II-Disturbance in perception
1- Hallucinations
 
False perception for which no external stimuli exist. Hallucinations can have an organic or
a functional etiology.

Visual: seeing things that are not there.

Auditory: hearing voices when none are present.
Olfactory: smells that do not exist
Tactile: feeling touch sensations in the absence of stimuli.
Gustatory: experiencing taste in the absence of stimuli.
 
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 II-Disturbance in perception
2- Illusion

 
It is a false perception with an external stimulus
N.B. it may affect any of the special senses (auditory. Olfactory, etc……)
 

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 III unreality states

 
1- Depersonalizations
A phenomenon where by a person experiences a sense of unreality or
self-estrangement.
 
2- Derealization
The false perception by a person that her environment has changed. Also
they can be categorized under affect & perception

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 IV-Disorder of memory

1- Amnesia 
Is loss of memory and may be partial or complete.
The following are the different types of amnesia:
a- Anterograde amnesia loss of memory for recent events.
b- Retrograde amnesia Loss of memory for remote events.
c- Total amnesia Loss of memory for recent and remote events.
d- Circumscribed amnesia Loss of memory for limited time. (Amnesic gap
hysteria)

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 IV-Disorder of memory (cont.)

2- Déjà vu phenomena (already seen)

In which new situation is experienced as previously seen.
 
3- Jamais vu phenomena
In which familiar situation is experienced as novel and never seen.
 

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 V-Orientation / Disorientation

Orientation
Disorientation
the ability to relate the self
confusion and impaired ability to
.correctly to time, place & person
identify time, place & person.

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VI- Judgment
It is the ability to assess a situation correctly and act appropriately within
that situation.
 

VII- Insight
 
It is the ability to understand the objective condition of his illness.
N.B. A patient with no insight will have poor judgment towards her social,
financial and domestic problems.
 
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 VIII- Attention and concentration

  
• Distractibility:
Is a disorder of attention in which the patient gives attention to every
passing stimulus (e.g. someone coughing, door open or a bird flying) it is
prominent in manic states.
 
 

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 IX- Disorder of consciousness

 
1- Confusion:
There is dimming or clouding of consciousness. All mental processes are slow.

2- Delirium:
a. Intellect: hallucination, illusion and disorientation
 
b. Affect: shows emotional disturbances, particularly fear.
 
c- Behaviors: restlessness.

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IX- Disorder of consciousness

3- Stupor:
There is complete suppression of motor activity, the patient doesn’t
respond to any stimuli either external or internal.
 
4- Twilight state:  
Is a state of restricted consciousness including ideation perception &
associated emotional state.
 

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 X- Disorder of affect
 
 
a. Inappropriate affect (incongruity), it is a disharmony of affect and ideation.
 
b- Pleasurable affect:-
 
1- Euphoria: it is a heightened feeling of psychological well being inappropriate to apparent events.

2- Elation‫عجب‬: it is feeling happiness with air of confidence and enjoyment associated with
increased motor activity.

3- Exaltation: it is intense elation with feelings of grandeur and sarcasm.

 
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 X- Disorder of affect(cont.)
c- Depressive affect:

1- Grief or mourning:
It is feeling of sadness appropriate to a real loss.

2- Depression: it is a psychopathological feeling of sadness.

 
d- Inadequate affect:
 
1- Apathy: it is the absence of both emotional experience and expression.
 
2- Indifference: it is the absence of emotional expression but experience is present.

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X- Disorder of affect(cont.)
e- Ambivalence:
 
The holding, of two opposing emotions, attitudes, ideas, or wish
toward the same person, situation or object at the same time.
 
I heat you
I love you

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 XI- Disorder of behavior

Hyperactive Hypoactive Repetitive

activity

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XI- Disorder of behavior

A- Hyperactivity it includes:

1. Agitation It is some form of hyperactivity characterized by pacing

and accompanied with restlessness.
 
2. excitement: - It is sever form of hyperactivity excessive purposeless
motor activity and the person may destruct her self or others.

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 XI- Disorder of behavior(cont.)

b- Psychomotor retardation: Extremely slow and different movement that in the

extremes can entail complete inactivity and incontinence.
 
c- Repetitive activities
(1) Stereotypy: -
It is a monotonous repetition of certain speech or movement without purpose but have
meaning to the patient in movement.
 
(2) Mannerism: -
it is repeated movement which may continue for hour or days without cessation and
keeping with the personality (e.g. a patient with paranoia salutes repeatedly in a
grandiose manner) 41
 XI- Disorder of behavior

(3)Waxy flexibility
Is the maintenance of imposed postures however abnormal they may be
(e.g. raising the head of the person from the pillow, or the arm up). The
absence of fatigue

(4) Catalepsy (posturing)

It is sustained immobility. The person initiates the position by himself

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 XI- Disorder of behavior

d. Echopraxia:
Imitating the movements of another person.
e – Negativism:
Frequent opposition to suggestion, e.g.
a- In motor sphere when he was asked to look up, he looked down.
b - In speech: when he asked question, he didn’t answer.
c - in visceral sphere: retention of saliva, urine or faeces.
 

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 XI- Disorder of behavior

f - Automatic obedience:
The performance of all simple commands in a robot-like fashion, may be present in
catatonia
 
g- Impulsiveness
Impulsiveness is an action that is sudden, abrupt, unplanned, & directed toward
immediate gratification.
 
h- Compulsion
Uncontrollable impulse to perform an act repetitively.
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