Psychopathology

 The term psychopathology

is borrowed from Greek “psyche”-soul
“Pathos”-suffering
“Logos”-science
 Psychopathology
 is the description, interpretation, explanation
and classification of those, particular mental
phenomena that have, clinical meaning, i.e.,
whose perception, analysis and assessment a re
useful in diagnostic and therapeutic
management of persons with mental
disorders.
 For a psychiatrist a patient’s experiences and
ways of behavior are the same as observed
physical phenomena for a physicist
Difficulties in defining abnormality
 Psychopathology is characterized by subjective
discomfort
 Private feelings of pain, unhappiness, emotional
distress
 Can disturbance be without discomfort?
 Yes- manic episode
 Yet, lack of discomfort might reveal a problem
 Statistical abnormality
 Abnormality is defined on the basis of an
extreme score on some dimension, e.g. IQ,
anxiety, depression
 Design a test/scale to measure & identify the
person who deviated from the average
 It tells nothing about the meanings of deviations
from the norm
 Social nonconformity
 Abnormality is defined by a failure to conform
to social norms or the minimum standards for
social conduct
 Extreme non conformity could lead to destructive
or self-destructive behaviour
 Situational context
 Cultural relativity
Core Features of Disordered Behaviour

 Maladaptive: difficult to meet the demands of

day-to-day life

 Loss of ability to control thoughts, feelings

and behaviours adequately
 Thought disorder
 Any disturbance of thinking that affects
language, communication, or thought content;
characterized by a failure to follow semantic
and syntactic rules that is inconsistent with the
person's education, intelligence, or cultural
background
Disturbance of thought
 Form
 Flight of ideas
 Loosening of association
 Derailment
 Tangentiality
 Circumstantiality
 Flight of ideas

1. Rapid shift from one to another

2. Understandable link with no logical
connection
3. The determining tendency is decided by
rhyme, pun, distraction, clanging
 Sample of speech
 They thought I was in the kitchen , cooking a hen , no
, looking at the bedroom, big one ,palatial , I am the
great, lamp there it is , going to catch fire, get the fire
brigade, scream ,beam, seem
 Birmingham, Kingstanding; see the king he’s
standing, king, king, sing, sing, bird on the wing,
wing, wing on the bird, bird, turd, turd’
 Loosening of association
 Lack of logical connection between sequence
of thoughts
 Replies are hard to follow
 Sometimes knight’s move thinking (odd
tangential association between ideas)
 Sample of speech
 I don’t know. I might be thrown out. Benito
Mussolini actually came alive out in waiting room. I
figured it out. There was a picture in the book. If its
not my mother, it could have been Hitler. What if that
was one of his armed guards? Mussolini was hanging
from a tree. Thank you for letting me reason it out.
Oh that’s another thing that I wanted to talk about is
being brain washed. I didn’t buy the Beatles tape; I
never did
 Others
 Perseveration
Persistent and inappropriate repetition of the same response
beyond the point of relevance

 Derailment
Total break in the chain of association between the meaning of
thoughts
 Tangentiality
Oblique, digressive, or even irrelevant manner of speech in
which the central idea is not communicated
 Neologism
Coining of a new word or using a new word in a idiosyncratic
manner
 Samples of speech
 What is your name ?
John
 Where have you come from?
John
 Can you state your age?
John
 Samples
What city are u from?
“That’s a hard question to answer. Becoz my parents…..
I was born in Iowa, But I Know that I am white
instead of Black, So apparently I came from the
North Somewhere, And I don’t know where, You
Know, I don’t know whether I am Irish or
Scandinavian”
 Samples
 Did you enjoy college?

 “I really enjoyed some communities, I Tried it, And

the, And the next day when I would be going out, I
took control, I put bleach in my hair, in California.”
 Samples
 I heard you were late for your morning group session.
 I am having a rough day. I woke up late. My alarm
clock has been working poorly. Then it took forever
for me to brush my teeth becoz I couldn’t find my
tooth paste. I started talking to my roommate and I
lost track of time. I got to the bus stop in time to see
the bus pulling away. I caught the next bus and talked
to a man from INDIA ………..
 Stream

1. Pressure of thought/speech

2. Poverty of thought

3. Thought block
 Thought content
 Delusions
 Overvalued ideas
 Obsessions
 Thought alienation
 Delusions
 False belief, based on incorrect inference
about external reality, that is firmly held
despite objective and obvious contradictory
proof or evidence and despite the fact that
other members of the culture do not share the
belief.
 Delusional themes
 Delusion of persecution-being harmed
 Delusion of grandeur-self importance
 Delusion of reference-special significance
given to neutral stimulus
 Delusions of guilt - Pathological guilt over
innocent errors
 Delusional themes
 Nihilistic delusions-non existence
 Delusion of love
 Delusion of jealousy-infidelity
 Delusion of control
 Thought insertion, withdrawal and broadcast
 Primary vs secondary delusion
 A primary delusion occurs suddenly which arises de
novo
 Secondary delusions arise in response to other
abnormality or experience
Examples
Delusion of guilt in Depression
Delusion secondary to hallucinations
Factors involved in the formation of
delusion
 Disorder of brain functioning
 Personality
 Affect
 Perceptual disorders
 Cognitive deficits
 Overvalued idea
An isolated, preoccupying strongly held belief
which has come to unreasonably dominate the life
and may affect his or her actions
Examples: paranoid state, morbid jealousy,
body image disturbances
 Obsessions and compulsions
 Obsession
Recurrent persistent unwanted ideas or
impulses or images
Recognized by the individual as his or her own
Resisted at the expense of mounting anxiety
At times the anxiety may be relieved by performing
certain acts referred to as compulsions
 Obsessional themes
 Dirt and contamination
 Aggression
 Religion
 Sex
 Orderliness
 Disease
 Compulsions
 Repeated ,stereotyped acts that the person is
compelled to carry out but resists recognizing the act
as irrational

 Most of the compulsions follow obsessions

 Examples : cleaning rituals, checking rituals

 Perception
 Conscious awareness of elements in the
environment by the mental processing of
sensory stimuli; sometimes used in a broader
sense to refer to the mental process by which
all kinds of data, intellectual, emotional, and
sensory, are meaningfully organized.
 Abnormalities of perception
Sensory distortions – A real object is perceived in a distorted
way
 Change in intensity
 Example : Drug induced states
 Change in Quality
 Example :Food tastes differently or colored vision
 Change in spatial form
 Example: micropsia and macropsia
 Perceptual abnormalities
Sensory deceptions: A new perception occurs in the
presence or absence of external stimulus.

Imagery
Occurs within mind that lack sense of reality
Can be initiated and terminated at will

 Illusion
 Misperception of an external stimulus
Factors involved in the formation of
illusion
 Clouding of sensorium

 Reduction in the level of sensory stimulation

 Intense state of emotion

 Lack of attention

 A young woman describes looking up into the clouds

and seeing an image of her fiancé
 Hallucination
 Perception experienced in the absence of external
stimulus
 The percept is experienced as a true perception
 Arises in the external objective space

 Can hallucination occur in healthy people?

Hallucinations in normal individuals
 Hypnagogic hallucination
occurs while falling asleep

 Hypnopompic hallucination
occurs while waking

 Intense emotion
 Fatigue
 Suggestibility
 Functional hallucination vs reflex
hallucination
 Functional hallucination
Experiencing a hallucination while experiencing a
normal percept in the same modality
 “I hear the voice of my long dead father, as if he were talking to me now, when I
hear water running from the bath tap.”

 Reflex hallucination
A real percept in one modality triggers hallucination
in another modality
“I hear the voice of my long dead father, as if he were talking
to me now, if/after I hear water running from the bath tap.”
 Hallucinations
 Auditory
 Visual
 Tactile
 Olfactory
 Gustatory
 Auditory hallucinations
 Thought Echo: hearing ones thought spoken
aloud
 Second person: voices talking to the person
 Third person: voices discussing, arguing..
 Command hallucinations
 Running commentary
 Mood -Affect
 MOOD-Pervasive and sustained feeling tone
that is experienced internally and that, in the
extreme, can markedly influence virtually all
aspects of a person's behavior and perception
of the world. Distinguished from affect, the
external expression of the internal feeling tone.
Depression
 Pervasive lowering of mood accompanied by
feelings of sadness and a loss of ability to
experience pleasure
Elation of mood
 Excessive cheerfulness
 Can progress to ecstasy
 Abnormalities in the variability of
mood
 Reduced eg blunt,flat,rescricted
 Increased eg lability,exapansive
 Emotional incontinence
 Incongruity/inappropriateness of affect
Mood and thinking do not correspond to each other
 Disorders of self
Depersonalisation
 Experience of being unreal, detached and unable to
feel emotion

Derealisation
 Similar experience related to environment
 Motor signs and symptoms
 Negativism
An apparently motiveless resistance to all instructions
or attempts to be moved
 Posturing
Voluntary assumption of bizarre and abnormal postures
 Mutism
absence of speech without impairment in consciousness
 Waxy flexibility
Maintenance of limbs and body in externally imposed
positions
 Motor signs and symptoms
 Echolalia
Purposeless repetition of words/phrases spoken by the
examiner
 Echopraxia
Purposeless repetition of the body movements of the
examiner
 Stupor
Marked decrease in reactivity to the environment and in
spontaneous movements and activity
 Excitement
Apparently purposeless increased motor activity not
influenced by external stimuli
 Abnormalities of memory
 Anterograde amnesia
Period between the event and the resumption of
continuous memory
 Retrograde amnesia
Period of amnesia between an event and the last
continuous memory
 Déjà vu
A sense that events experienced for the first time
have been encountered before
 Abnormalities of memory
 Jamais vu
Failure to recognise events that have been
encountered before
 Confabulation
Describing plausibly false memories for a period for
which the patient is amnesic
 Abnormalities of consciousness
 Clouding of consciousness
 A state of drowsiness with incomplete reaction to
stimuli

 Stupor
 Absence of response and movement along with
mutism. Consciousness may be preserved
 Insight
 Patient’s awareness of morbid nature of the
experience
 Assessed by
Awareness of the nature of individual symptoms
Whether they believe they are ill
Whether they think the illness is physical or
mental
Whether they think they need treatment
 Judgement
 Mental act of comparing or evaluating choices
within the framework of a given set of values for
the purpose of electing a course of action.
 If the course of action chosen is consonant with reality or
with mature adult standards of behavior, judgment is said
to be intact or normal; judgment is said to be impaired if
the chosen course of action is frankly maladaptive,
results from impulsive decisions based on the need for
immediate gratification, or is otherwise not consistent
with reality as measured by mature adult standards
Thank you