Psychopathology (ZLA) v. 2020-11-261 Psychopathology (ZLA) Prof. MUDr. Tomáš Kašpárek, Ph.D. (Modified by MUDr. Elis Bartečků, Ph.D.) Department of Psychiatry, Faculty of Medicine, Masaryk University Psychopathology2 Learning outcomes —To learn the vocabulary – symptoms of mental illness —To learn the concepts of discrete psychological functions —To learn the description of major and most frequent symptoms Psychopathology3 Psychopathology —It is the study of abnormal cognititions, behaviour and experiences. —Types of psychopathology – Descriptive ● Definition and categorization of psychiatric symptoms ● Is basis the larger part of nomenclature of mental disorders → diagnostic criteria – Explanatory ● Explanation of symptoms according to theoretical models – Biological – Psychological Psychopathology4 Norm and pathology —Functional (Dysfunction) —Danger —Personal (Distress) – Subjective ego-dystonic experience – Significant change in habitual experience and behaviour – Does not need to be realised – recognized by peers —Cultural (Deviance) – Abnormalities considered deviant in individual’s cultural context – BUT! Non-conformity itself is not a sign of psychopathology Four D model Psychiatric symptoms —Typical presentations of mental disorders —Specific psychiatric symptoms – E.g. hallucinations, delusion, catatonia etc. Psychopathology5 Domains of psychopathology —From the didactic point of view, psychiatric symptoms can be divided into several groups according to mental functions. —These groups are to an certain extent artificial because symptoms usually appear in specific clusters spread accros more mental functions → syndromes —Only selected disorders of mental functions are included in this presentation Psychopathology6 Mental functions —Consciousness —Psychomotorics and behavior —Volition —Emotions —Perception —Thought —Attention —Memory —Intellect —Sleep —Instincts —Personality Psychopathology7 Consciousness Psychopathology8 Disturbances of consciousness —Do not appear as a part of clinical presentation of mental disorders. —According to ICD-10: – Somnolence – Stupor ●  In Czech psychopathology it is called sopor – Coma – Persistent vegetative state – Transient alteration of awareness Quantitative Qualitative —Delirium – “confusional state” – More details in the next slide —Obnubilation (blackout) – Manifest by an unconsctious action of the patient (the patient does not retain memory from this state) – Can appear during dissociative states Psychopathology9 Delirium —Transient cognitive disorder —Appears as a non-specific syndrome caused by various agents. —Core features: impairment of consciousness with attention deficit, rapid onset, fluctuating course. —Other phenomena may appear more prominent, but are not always present – Psychomotor changes (agitation) – Perceptual changes as illusions and hallucinations – Disorganized thought – Delusions – Disturbances of sleep – Emotional changes (irritability, flatness of emotions)... Psychopathology10 Psychomotorics and behavior Psychopathology11 Catatonia —mutism —passive negativism —catalepsy (passive induction of a posture held against gravity) —posturing (spontaneous and active maintenance of posture against gravity) —waxy flexibility (slight and even resistance to positioning by examiner) —stupor (no psychomotor activity) Akinetic Excited —agitation —active negativism —mannerism (odd caricature of normal movements) —stereotypies (repetitive, nonsensical movements) —grimacing —echolalia, echopraxia Malignant (Lethal) —Muscle rigidity → Rhabdomyolisis —Vegetative instability with hyperpyrexia —Disturbance of consciousness Psychopathology12 Emotions Psychopathology13 Emotions - terminology —Emotion – Complex state of “feeling” – Psychilogical, somatic and behavioral components —Affect – Short-term emotional state —Mood – Longer-term emotional state – Proness to emotionally react in certain direction Psychopathology14 Qualitative disturbance of emotions —Range – Flattening of emotions —Tenacity – Increased tenacity – Lability – Incontinence —Appropriateness – Incogruent emotions – Idiosyncrasy —Direction – Ambivalence —Disorder of higher emotions —Other – Phobias – Alexithymia Psychopathology15 Disturbances of affect —Uncontrolled affect – Subject is “carried away” by his or her emotions – No changes in consctiousness, no amnesia —Pathological affect – Intensive emotional reaction – Short period of qualitative disorder of consciousness (obnubilation) – Amnesia —Inhibition of affect (emotional blunting) Disturbance of affect —Agitation —Raptus Behavioral presentation —Affective (emotional) stupor – Stupor-like state associated with strong emotion Psychopathology16 Disturbance of moods —Manic mood —Euphoric mood —Moria (frivolity) Expansive moods —Depressive mood —Dysphoric mood —Anxious mood Depressive moods Psychopathology17 Perception Psychopathology18 Disturbances of perception —Distortions of a real stimulus Illusions —False perception in an absence of real perception – Sensoric ● Auditory – Verbal (commenting, imperative, contrary etc.) – More often in schizophrenia ● Visual – More often in organic disorders ● Tactile – Intrapsychic hallucinations ● On the threshold between disorders of perception and thoughts ● Thought echo, broadcasting, imputation / amputation Hallucinations Psychopathology19 Thinking Psychopathology20 Disorders of thinking —Quantitative (Speed of thinking) —Qualitative – Structure (Formal though disorders) – Content Psychopathology21 Disorders in speed of thinking —Increase – flight of thoughts: excessive speed of thinking manifested as extreme speed in speech (= logorrhoea) —Decrease – Slowing of the flow of associations, slowed and diminished verbal production (bradypsychism) – Blocking of thoughts - cessation of the flow of associations ( patient stops the verbal production without any recognisable impulse from surroundings) Psychopathology22 Disorders in structure of thinking —perseverative thinking – involuntary persistence of response to some question or topic, verbigeration - a meaningless repetition of specific word or phrase —circumstantiality – indirect speech that is delayed in a reaching the point, characterised by an overinclusion of details —tangentiality – patient never gets from desired point to desired goal —illogical (paralogical) thinking – thinking containing erroneaous conclusions or internal contradiction —neologism – new word created by the patient often by combining syllables or other words —incoherent thinking – thought that is not understandable – word salad: incoherent mixture of words and phrases Psychopathology23 Disorders in thought content: Delusions —False beliefs – inadequate/bizzare content – based on incorrect inference about external reality – not consistent with patient‘ s intelligence and cultural background – cannot be corrected by reasoning – influence on behaviour —Formation (development) – Delusionoal mood – feeling that something is wrong, different, unreal – Delusional perception – things have special meaning, perceived as significant – Making sense out of it = ”AHA”, delusion formation — Do not mistake with Overvalued idea: – An unreasonable and sustained belief that is maintained with less than delusional intensity Psychopathology24 Disorders in thought content: Delusions —delusion of self accusation – false interpretation of real past event resulting in feeling of guilt —hypochondriac delusion – false belief of having a fatal physical illness —nihilistic delusions – false feeling that self, others or the world is nonexistent or ending —delusions of failure – false belief that one is unable to do anything useful —delusion of poverty (ruin) – false belief that one lost all property Depressive —delusion of importance – exaggerated conception of one‘s importance —delusion of power, extrapotence – exaggerated conception of one‘s abilities/possibilities —delusion of identity – false belief of being the offspring of member of an important family Expansive (Delusions of grandeur) Psychopathology25 Disorders in thought content: Delusions —based on ideas of reference (false ideas that behaviour of others refers to a patient): —delusion of persecution – false belief that one is being persecuted —delusion of infidelity – false belief that one‘s lover is unfaithful —erotomanic delusion – false belief, that someone is deeply in love with them Paranoid —false feeling that one‘s will, thoughts, feelings, or movements are controlled by another agent – Delusions of control —Some of them can be categorized as hallucinations: – thought withdrawal / insertion ● false belief that one‘s thought are being removed from or implanted into one‘s mind by other people of forces – thought broadcasting ● false belief that one‘s thought can be heard by others – thought control ● false belief that one‘s thoughts are being controlled by other people of forces Delusions of control Psychopathology26 Disorders in thought content: Other —Persistence of an irresistible thought, repetitive thought —Ego-dystonic —Stereotypical, monotonous —Cannot be eliminated from consciousness by will —Associated with anxiety, interferes with directed behavior, attention —Do not mistake it with preoccupation of thought: – certain idea is in the center of thinking, is coming back, usually associated with a strong affective tone (date, money, success…) Psychopathology27 Memory Psychopathology28 “Life cycle” of a memory —Immediate memory – information stored for 15-20s —Short-term memory – consolidation of the memory trace – several minutes to 2 days – medial temporal structures —Long-term memory – formed trace – large cortical areas Psychopathology29 “Quantitative” disturbances of memory —Amnesia – short/long-term memory impairment in a state of normal consciousness – Type ● anterograde: failure to form new information ● retrograde: failure to recall old information – Appears in: organic disorder (head trauma, tumor etc.), dissociative disorders —Hypomnesia —Hypermnesia: – unusually vivid memory – Appears in: mania, posttraumatic stress disorder (intrusive memories), obsessive or paranoid personality traits Psychopathology30 “Qualitative” disturbances of memory —Paramnesias – retrospective falsification of memories during its recollection (awareness of recalled memory, failure to proper class time and situation of memory acquirement) —Confabulation – filling memory gaps with inaccurate information; frontal lobe and self-monitoring? —Deja vu – sensation of previously experienced situation when experiencing the first time —False awareness of memory – common in normality, increased in fatigue, intoxication, complex partial seizures Thank you for your attention