Symptomatology and signs of

mental illness
E.J Dausen
 Learning outcomes
• At the end of this session the learners will be
able to;
1. Identify the symptomatology of different
mental disorders.
 Case scenario.
25 years old female brought to emergency
department by her family because they were
concerned about her behavioral changes over the
last week. Her husband report that she has
become hype-religious and talkative, has
pressured speech, jumping from one idea to
another to the extent that they cant understand
her speech. She is laughing all the time,
sometimes singing or reading the Bible loudly.
• She was energetic with decreased need for sleep.
She claimed she had special abilities more than
any other people, so she left her work and spend
much money on buying unnecessary objects.
• Regarding this case can you comment about:
1. Mood?
2. Speech?
3. Thinking ?
4. Motor activity ?
5. Insight ?
 1. Disorders of perception.
• Perception involves reception of information
from sensory organs, recognition, processing and
re- organization of the information into memory
and a subsequent response relating to the
information received.
• sensory stimuli are given a meaning.
Common disorders are;
1. Hallucinations.
2. Illusion.
3. Depersonalization and derealization
 Hallucinations
Are perception in absence of external physical
stimuli. “To wonder”
Can occur in normal conditions such as:
• hypnagogic
• hypnompopic
• Physical stimulation. E.g Flashes
 Classification of hallucinations
according to complexity
1. Elementary
unformed: flashes of light, undefined shapes,
non specific sounds.
1. Simple-
1 analyzer: auditory hallucination, where by pt
hears only speeches.)
1. Complex
sophisticated and meaningful stimuli. more then
1 analyzers: patient see and hear fell and fell the
object.)
 Classification of hallucination
according to sensory modalities
1. Auditory
2. Visual
3. Gustatory
4. Tactile
5. Olfactory
6. visceral
Types of hallucination
1. Auditory hallucinations.
most common eg schizophrenia
Varieties of auditory hallucinations
a) 2nd person
Voices talking to a patient, commands or
addressing the pt.
b) 3rd person
voices talking about the patient, eg commenting on
his thoughts or actions.
c) echo de pensee,
voices repeating patients thought,
Auditory hallucination
 Hallucination cont..
2. Visual hallucinations
- common in organic mental disorder.
3. Tactile hallucinations
False perception of touch eg phantom limb,
crawling sensation eg cocaine intoxication or
withdrawal.
Common in hebephrenic schizophrenia.
4. Olfactory/gustatory hallucinations
• phantosmia (unreal detection),
• parosmia (loss)
common in
• Epilepsy
• head trauma
• viral infections
• TL seizures
• Alzheimer's disease
• migraine.
5. Somatic hallucinations/Visceral.
False sensation of things occurring in the body
mostly visceral.eg complain that snake is
wondering in the abdomen, burning pain in the
brain.
Mostly in schizophrenia.
 Cont…
6. Extracampine hallucination
Occur outside the limits of sensory field including visual
field and range of audibility. Feeling of somebody
being near.
7. Kinesthetic hallucination
Involves the sense of bodily movement
(e.g. a person believes that his elbow joint is rotating
involuntarily but no such evidence in physical
examination
8. Cenesthetic hallucination
altered state in a body organ without corresponding
receptors to explain its physiology.
9. Autoscopy hallucination
seeing one's "self" or "double". Imitates his own
movement as if stands on the mirror.
10. Alcoholic hallucination
Occur in alcohol dependence
It is well-localised, derogatory and in second person
11. Lilliputian hallucination
Object appear reduced in size, microptic
Lilliputian hallucination
 ILLUSION
An Illusion is an involuntary false perceptions or
misinterpretations of environmental stimuli.
Description of common illusions:
Complete illusion
• the brain’s tendency to fill the gap of missing part
of the object and is banished by attention
Affective illusion – occurs in depressed/manic state.
• Affected by emotional experience, fear or dread,
eg; running in the dark with fear, can lead to
illusion.
• Auditory and optic illusions.
Pareidolic illusion
• imagery persists even when the subject looks
at a real object in the external environment
(e.g. seeing a woman’s face when looking at
the cloud).
• increased by attention.
Macropsia
• illusion of exaggeration in size
Micropsia
• illusion of reduction in size
 Depersonalization and Derealization
• Disturbed perception of oneself or the
surrounding environment.
1. Depersonalization: the person perceive himself,
his body or part of his body is different, unreal
or unfamiliar.
2. Derealization: the person perceive the external
world, object or people are different, strange or
unreal.
Both may occur in normal person during stress,
anxiety disorder, mood disorders, schizophrenia and
organic disorders.
 2. Disorders of thoughts
• They are classified into:
1. Disorders of form of thoughts.
2. Disorders of stream of thoughts.
3. Disorders of contents of thoughts.
 Disorders of form of thoughts.
• Abnormalities in the logical structure and
association of thoughts.
• They lead to failure in producing coherent and
logically connected meanings.
• Usually occur in psychotic disorders and in
organic mental disorders.
Disorders of form of thought cont..
• Commonest types
1. Loose association:
loosening between ideas rather than words or
group of word. Pt move from one idea to an
unrelated one in the same sentence.
2. Incoherence:
thoughts and words run together without
logical or grammatical rules or connection. Pt
is not understandable.
3. Word salad:
speech becomes haphazardly mixing of words
and phrases.
4. Neologism:
new words/language created by patient,
complete jargon of words, foreign languages
5. Verbigeration;
spontaneous repetition of specific words or
phrases without motivation.
6. Thought Preservation:
pt repeat the same response despite changing
of stimuli, same answer-different question.
7. Clang association:
words goes on according to their tone, sound or
rhyme but not according to meaning.
8. Irrelevant answer:
response not related to stimulus, ans not in
harmony to qn asked
9. Derailment:
gradual or sudden deviation in train of thoughts
without blocking.
Run off the rails. Its is equivalent to loose
association but the speak semi-related ideas.
10. Echolalia:
repetition of words or phrases of one person by
another.
 Disorders of the stream of thoughts
• These are abnormalities in the process of
thinking include its speed, association and
goal directed sequence.
1. Flight of ideas:
extremely hurried speech in which pt jumps
from one idea to another.
2.Circumstantiality:
Pt delay in reaching the point of aim. Provide
unnecessary details bt get to the goal.
 Cont…
3. Thought block:
abrupt interruption train of thought before a
thought or idea is finished.
4. Pressure of thought:
accelerated thoughts
5. Retardation of thought;
Slow speech and prolonged latent period before
response.
Disorders of the contents of thoughts.
• These are abnormalities in the ideas or beliefs
contained in the thought.
• They include
1. Delusions.
2. Obsessions.
 Delusions
• These are false fixed belief/Ideas.
• It is based on incorrect inferences about
reality.
• It is not consistent with the patient cultural
background.
• It can not be corrected b logic or reasoning.
 Delutions……
Delusions may be;
a) Fixed (with full conviction)or shakable
(lacking full conviction )
b) Systematized(united or centered on a single
idea) or mal-systematized ( disconnected or
shift from one theme to another)
c) Bizarre; with very strange or absurd content.
Delusions and hallucinations occurs in
psychotic disorders such as;
• Schizophrenia.
• Delusional disorder.
• Psychotic mood disorder.
• Some organic or subs related mental disorder.
 Types of delusions
1. Delusion of persecution;
believes people are harassing them, chasing or
spying or trying to kill them.
2. Delusion of grandeur;
believes has more power, wealth, smart or has
relationship with someone important.
3. Delusion of reference;
believes behavior of others refers to himself,
events, objects, or other person have a particular
and unusual significance eg people talking abt him
on tv.
4. Delusion of guilty or self accusation.
 Cont,..
5. Nihilistic delution;
denies the existence of an organ or the whole
person.
6. Hypochondriacally delusion;
believes has a serious illness despite of absence of
medical evidence.
7. Delusion of infidelity/jealous;
believes ones spouse is unfaithful despite of no
supporting evidence.
8. Erotomania delusion;
delusion of love; the belief that someone usually
inaccessible is in love with the pt.
 Cont..
9. Delusion of influence
believes is under influence of others.
10. Delusion of control
thought are being controlled by external forces.
 Delusion concerning possession of
thoughts include:
• Thought insertion;
believes thoughts are implanted in the brain by
external forces
• Thought withdrawal;
believes that his thoughts are taken out of his
mind
• Thought broadcasting
convinced that his thoughts are available to
others and may be the radio or tv
 Obsession and compulsion
• Obsessions
Are recurrent, persistent thoughts, impulses or
image that can not be eliminated from
consciousness by logic or reasoning although
the person is aware that they are unreasonable,
absurd (ego dystonic)
• Compulsion;
repetition of actions results from obsessive
thoughts. Eg, obsession of dirt leads to
compulsion washing. Ex; cleaning ritual,
checking, security.
 3. Disorders of speech
1. Volubility:
increase in the amount of speech
2. Poverty of speech:
speech is scanty
3. Stuttering and stammering:
used synonyms “disaffluent speech disorder”.
Where by the normal flow of speech is
disrupted.
 Cont…
4. hurried speech:
Rapid utterance of coherent directed speech.
5. Monotonous speech:
A speech lacking resonance and emotional
inflection.
6. Dysarthria:
Disorder of articulation, can be organic as in post-
stroke and slurred speech in drug intoxication.
8. Mutism:
pt cant speak any words. Occur in conversion
disorder, catatonia and neurological diseases.
 Cont…

• Logoclonia.
This refers to spastic repetition of syllables.
occurs in people with autism, schizophrenia,
Alzheimer’s disease and Parkinson disease.
• Logorrhoea;
refers to excessive verbal production
7. Aphasia:
Inability to comprehend or formulate language caused
by brain damage from stroke, neurodegenerative
diseases or trauma.
a) Motor aphasia (expressive)/broca:
white matter aphasia, pt can comprehend speech,
respond by writing, but can’t speak
b) Sensory aphasia(receptive)/warnicke’s:
pt can speak, read and write but can’t comprehend
language with repeating words.
 Aphasia cont..
c) Nominal aphasia:
Inability to recall names but can describe them.
d) Trans-cortical:
can communicate fluently with no obvious
meaning
e) Global aphasia:
affect receptive and expressive language. Speak
few words with neologism
 4. Disorders of emotions
• Emotion is a complex feeling state with
psychic, somatic and behavioral components
• Clinical study is concerned with two main
aspects.
1. Mood:
Subjective aspect of emotion.
2. Affect:
Objective
 Disorders of mood
Pleasant mood
• Cheerfulness:
Used for happiness or gladness
• Elation
Elevated mood, an exaggerated apparent cheerfulness
• Euphoria;
Generalized feeling of wellbeing associated with physical
health.
• Exaltation,
Elation with some sense of grandeur.
• Ecstasy,
Extreme sense of euphoria usually involving an
experience of mystic self-transcendence, trance-like state.
 Disorders of mood…cont..
Unpleasant mood
1. Depressed mood,
2. Dysphoric mood
3. Irritable mood, easily annoyed and provoked
to anger
4. Anger
 Disorders of affect
• Constricted/restricted affect.
mild reduction of affect
• Blunted affect.
decreased ability to express emotion
• Apathy;
loss of emotion/lack of feelings
• Indifference;
“la belle indifference’’ feel happy despite of
disability.
• Inappropriate affect (incongruity),
disharmony btn emotional experience with the
situation.
• Ambivalence;
coexisting of two opposing emotions at the
same time.
• Lability;
Emotional change from one extreme to the
other with no obvious cause. Laughing and
weeping. “emotional incontinence”
 5. Disorders of motor behavior
• Psychomotor retardation:
Diminished motor activity, occur in depression
• Agitation;
Moving around, moving his limbs, head, wrinkling
his fingers and cannot stay some time in one place.
• Excitement:
occurs in mania and schizophrenia
• Stereotypy;
monotonous repetition ex; touching the nose.
 CONT…
• Mannerism;
Repeated movements without cessation, are
keeping together with the thoughts
• Perseveration:
Repetition of the same movement inspite of the
patient’s desire to make the new one.
(Ex: pt continue to put the spoon in the plate and
up to his mouth, even after the plate gets empty)
• Lack of volition;
Lack of initiation and reduction of spontaneous
movements , no desire or to perform an acts.
 CONT…
Catatonic symptoms
• Catalepsy;
Refers to rigidity of the body, trance, loss of
sensation and consciousness.
• Catatonic posturing;
acquiring inappropriate bizarre posture.
• Catatonic rigidity;
assuming a rigid (but normal posture) and
holding it against all effort to change it.
• Waxy flexibility;
Pt is modeled in any position induced by
examiner maintaining such posture beyond
physiological fatigue
• Catatonic stupor;
marked retardation of motor activity to the
point of immobility.
• Catatonic excitement;
Extreme degree of motor hyperactivity, intense,
not related to provoking stimulus
• Negativism;
The patient does exactly the opposite of what is
asked to do.
• Automatic obedience;
pt readily and exactly respond to orders, regardless
of their odd content.
• Echolalia;
Repeat the same words or the last word the
examiner utter.
• Echopraxia;
repeat the movement of another person.
 6. Disorders of memory
• Memory is psychological fx by which the
information stored in the brain is later recalled
to consciousness.
Four levels of memory
1.Immediate memory 0.5sec
2. STM; 15-20 sec
3.Recent past memory; 5min
4.Remote(LTM); long lasting
Storage
 Disorders of memory.
1. Amnesia;
Failure to recall/recognize information.
a) Anterograde;
Inability to recall events occurred after an event. Ex
concussion
b) Retrograde;
Inability to recall events before the onset of
disturbance.
c) Circumscribed(amnestic gap).
Failure to recall events is limited to specific time
when the painful event was experienced
2. Hypermnesia;
Abnormal pronounced memory, remembers in
details,
Common in hypomania.
3. Par amnesia;
Falsification or distortion of recalled memory
a) Confabulation;
Filling amnestic gap with fabricated events.
occur in alcoholics.
 Cont..

b) Retrospective falsification.
unintended distortion of memory, includes
omissions, additions and biased reorganization of
memory to fit the present goal.
c) Jamais vu;
• illusion of unfamiliarity. It occurs in TLE and
exhaustion.
d) Déjà vu;
• illusion of familiarity.
 7. Disorders of attention
• Attention,
ability to focus on certain relevant task
• Concentration,
ability to maintain that focus.
Disorder of attention
1. Distractibility;
failure to maintain attention to one subject. Ex. mania
and hypomania
2. Selective inattention,
attention is heightened to specific target neglecting
others
3. Hypervigilance (hyperprosexia),
heightened attention that occur in mania and hypomania
 8. Disorders of orientation
• Orientation is awareness of time, place and
person.
• Disorientation : disturbed orientation to time,
place or persons. It is usually related to
disturbed consciousness.
• Double orientation; confuse btn a real
situation and event. Ex, hosp in mars
 9. Disorders of consciousness
• Consciousness is the general state of awareness
of the self and the environment.
Common disorders of consciousness are:
1. Lethargy, drowsy, less aware, less interested with
environment
2. Clouding of Consciousness (fog state): slighlt
wake.
3. Stupor-deep sleep; waken up with loud sound or
harsh touch
4. Coma, deep unconsciousness; pt cant not be
awakened
5. Dream-like state (oneroid or twilight state):
 Cont..
6. Somnolence; pt sleeping, cant stay awake, if
awaken can follow directions
7. Confusion; easily distracted, sometimes
disoriented
8. Somnambulism. Sleep walking

N.B.: Most symptoms indicating disturbances in

consciousness, orientation, memory, and attention
highly suggest an "Organic Mental Disorder".
 10. Disorders of judgment
• Judgment is the ability to assess a situation rationally and
to act appropriately within that situation.
• Judgment has several aspects (cultural, social, moral, etc...
• In psychiatry, insight refers to the patient's conscious
recognition of his condition, i.e., awareness that;
1. Disturbed or ill
2. The illness is psychiatric in nature
3. Seek professional help
4. Cooperate with the offered treatment
Full or partial awareness of these aspects indicates the degree
of his insight.
 Summary
Presence of symptoms is not a definite proof
that there’s mental disorder. Symptoms are
considered pathological if;
1. It is cultural incongruent
2. Incompressible
3. Occupation or social dysfunction
 Reference
• Psychiatric nursing 5th edition by Wilson-
Kneisl.
• Mental health nursing (nurse patient journey)
by Verner Elizabeth Carson- Elizabeth Nolan
Arnold.
• Accessibility: university library