Classification of Psychiatric

Disorders
Ruth Owusu-Antwi
Psychiatrist
Dept. of Psychiatry, SMS/KATH
 Where it all started from…
• As far back as 4000BC- the euphoric effect of the
poppy plant was described.
• 1808- Reil coined the term psychiatry.
• 1863: Kahlbaum introduced the term catatonia
• 1896- Emil Kraepelin separated psychiatric
conditions into “manic-depressive illness” and
“dementia praecox”
• Kurt Schneider: described first rank symptoms
• 1950: chlorpromazine synthesized
 WHAT IS MENTAL HEALTH?

• A state of wellbeing in which an individual is at

peace with himself and with his environment
and is able to withstand the stress that may
present to him or her from the family life,
occupational life, educational life and social
life and is able to contribute to his society.
 CLASSIFICATION

Mental/psychiatric disorders are classified but

not exclusively into
 organic mental disorders
 Substance misuse disorders
 the psychoses (eg. schizophrenia)
 Mood disorders( depression, BAD)
 Anxiety disorders( phobias)
 CLASSIFICATION
 Behavioural syndromes( anorexia, sleep
disorders
 Personality disorders
 Mental retardation
 behavioural disorders in children
 1. organic mental disorders
• Dementia
• Delirium
• Mental disorders due to brain damage,
dysfunction and physical diseases
 2. Substance misuse Disorders
• Mental and behavioural disorders due to
psychoactive substance abuse.
• Examples of these psychoactive substances
are
Alcohol tobacco
Opioids benzodiazepines
Cannabinoids solvents
Cocaine hallucinogens-LSD
 Substance Misuse Disorders
• Acute intoxication
• Harmful use
• Dependence syndrome
• Withdrawal state
• Substance induced psychosis
 3. The psychoses
These are disorders that have psychotic
symptoms. Psychotic symptoms refer to
•Hallucinations
•Delusions
•Grossly disorganized behaviour
 The psychoses
• EXAMPLES of conditions here are
• Schizophrenia
• Acute psychosis
• Delusional disorders
• Schizoaffective disorders
 4. Mood disorders
• Mood is defined as one’s feeling state over a
period or one’s prolonged emotional state as
opposed to affect which is one’s current
emotional state at a specific point in time.

• Examples of mood disorders are

Depression Mania
Bipolar Dysthymia
 5.Anxiety disorders
• These are stress related mental disorders
• Examples are
• Phobias
• Panic disorders
• OCD
• Acute stress reaction
• PTSD
• Dissociative disorders
 6. Behavioural syndromes
• Eating disorders- anorexia, bulimia
• Sleep disoders- insomnia, hypersomnia,
nightmares, night terrors, somnambulism,
• Sexual dysfunctions- excessive sexual
desire(nymphomania and satyriasis), Gender
identity disoders
• Egodystonic sexual orientation
• paraphilias
 7. Personality disoders
• Disoders of adult personality and behaviour
• Anti social
• Borderline
 8. Mental retardation
• Now referred to as learning disability. It’s a
condition of arrested or incomplete
development of the mind, characterised by
impairment of skills manifested in the
developmental period
• The process of growing and acquiring new
skills ( i.e. walking and grasping objects,
communicating, playing, interacting with
others)
• It is a complex process, determined by the
biological brain development, influenced in
part by the quality of interactions with others
(i.e. carers)
• Examples in each domain
– Motor (movement) skills
• Sitting up, walking, skipping
• Picking up objects, using a spoon, drawing

– Communication and speech

• Babbling (e.g. say ‘bababa’), pointing, using words

– Social interaction
• Smiling, waving goodbye, taking turns with others

– Play and learning

• Problem solving, exploring the environment, doing math
• Substantial difficulty/delay in skills across most
developmental domains:
• Motor (movement) skills
• Communication and speech
• Social interaction
• Play and learning
• There are different degrees of intellectual disability, ranging
from mild to profound
9. behavioural disorders in children

• Autism
• Enuresis
• ADHD
• Conduct disorders
 references
• Oxford textbook of psychiatry
• Kaplan and saddock texbook of psychiatry
• ICD-10
• Thank you

• Questions
• comments
Symptoms in
psychiatry
• The psychoses are characterized mainly by
abnormalities of perception and thoughts and
grossly disorganized behaviour.

• Perception is the process of becoming aware

of what is presented through the sense
organs. (note: sensation is reception of a
stimuli by the sense organ)
 Disorders of Perception
• Illusions
• Hallucinations
• Body image disorders
 illusion
• Illusions are misperceptions of external stimuli.

• They are most likely to occur when the general

level of sensory stimulation is reduced.

• Illusions are also more likely to occur when the

level of consciousness is reduced, for example in
an acute organic syndrome.
 Hallucination
Hallucination is a percept experienced in the
absence of an external stimulus to the sense
organs.

• A hallucination is experienced as originating

in the outside world (or within one’s own
body) and not within the mind like imagery.
 Types of hallucination

Hallucinations may be
• auditory,
• visual,
• gustatory, or
• olfactory,
•tactile or of deep sensation
Auditory hallucinations
• may be experienced as noises, music or voices.
Voices may be heard clearly or indistinctly; they
may seem to speak words, phrases or sentences
-Second person auditory hallucinations
- Third person hallucinations: they may
seem to address the patient, run commentary on
the patient or talk to one another referring to the
patient as “he” or “she”
- Echo de la pensée or simply thought echo:
Sometimes voices seem to speak patient’s own
thoughts as he thinks them or repeats them
immediately after he has thought them.
 Visual hallucinations
• may also be elementary or complex and may
appear normal or abnormal in size.
 Lilliputian: Visual hallucinations of dwarf
figures. they are visual hallucinations smaller
than the corresponding real precept.
 Extracampine visual hallucinations are
experienced as located outside the field of
vision, that is, behind the head.
• An autoscopic hallucination is the experience
of seeing one’s own body projected into
external space, usually in front of oneself, for
short periods. In clinical practice, this is a rare
phenomenon, mainly encountered in a small
minority of patents with temporal lobe
epilepsy or other organic brain disorders.

Olfactory and gustatory hallucinations

• are frequently experienced together, often as
unpleasant smells or tastes
Tactile hallucinations
Hallucinations of deep sensation

Reflex hallucination: Occasionally, a stimulus in

one sensory modality results in a hallucination in
other, eg. the sound of music may provoke visual
hallucinations. This experience, sometimes called
reflex hallucinations, may occur after taking drugs
such as LSD, or rarely, in schizophrenia.
Table 1.1 Description of hallucinations
• According to complexity
 Elementary
 Complex

• According to sensory modality

 Auditory
 Visual
 Olfactory and gustatory
 Somatic (tactile and deep)

• according to special features

 auditory: second person
 third person
 échode la pensée
 visual: extracampine
 Autoscopic hallucinations
 Reflex hallucinations
 DISORDERS OF THOUGHTS
• Form
• Stream
• Possession
• Content
• Control
Disorders of the form of thought
1.In flight of ideas the patient’s thoughts and
conversation move quickly from one topic to
another so that one train of thought is not
completed before another one appears. These
rapidly changing topics are understandable
because the links between them are normal. A
point that differentiates them from loosening
of associations.
The characteristics of flight of ideas are:
 using two words with a similar sound (clang associations)
 using the same word with a second meaning (punning),
 rhyming .
 Neologisms- patient uses words or phrases, invented by himself, often to
describe his morbid experiences
2. Perseveration is the persistent and
inappropriate repetition of the same
thoughts. In response to a series of simple
questions, the person may give the correct
answer to the first but continue to give the
same answer inappropriately to subsequent
questions. Perseveration occurs esp. in
dementia
3. Loosening of associations denotes a loss of
the normal structure of thinking. To the
interviewer this appears as muddled and
illogical conversation that cannot be clarified
by further enquiry. Loosening of associations
occurs more often in schizophrenia.
Loosening of associations can take several
forms.
4. Knight’s move or derailment refers to a
transition from one topic to another, either
between sentences or in mid-sentence, with
no logical relationship between the two topics
and no evidence of the forms of association
described under flight of ideas.
5. When this abnormality is extreme, it is called
word salad.
6. talking past the point. In this condition the
patient seems always about to get near to the
matter in hand but never quite reaches it.

7. Tangentiality: deviating from subject of

discussion.

8. Circumstantiality: beating about the bush

concerning the subject of discussion but
eventually landing on the right answer.
Disorders of the stream of thought
In disorders of the stream of thought both the
amount and speed of thoughts are changed
• pressure of thought (overspeed): when ideas
arise in unusual variety in abundance and pass
through the mind rapidly.
• poverty of thought (slow motion) when the
patient has only a few thoughts, which lack
variety and richness, and seem to move through
the mind slowly.
• thought blocking :when the stream of thought is
interrupted suddenly, this phenomenon usually
occur in schizophrenia.
Disorders of the possession of thoughts:
healthy people take for granted that their thoughts
are their own.
• In thought insertion patients believe that some
of their thoughts are not their own but have
been implanted by an outside agency.
• In thought withdrawal patients believe that their
thoughts have been taken out of their mind by
some outside agency, often their supposed
persecutors.
• In thought broadcasting, the patient believes
that his unspoken thoughts are known to other
people.
• All three are Schneider's first rank symptom.
Abnormality with the content of thought.

• Delusions
• Delusions
A disorder of the thought content and
it is an abnormal belief which is
firmly held in the face of
contradictory evidence and not
expected to be held on given the
person’s educational, cultural,
religious and social background; and
it is usually false.
• Persecutory delusions
often called paranoid delusions of persecution.
Persecutory delusions are most commonly
concerned with persons or organizations that
are thought to be trying to inflict harm on the
patient, damage his reputation, make him
insane, poison him
• Delusions of reference
are concerned with the idea that objects,
events, or people have a personal significance
for the patient: for example, an article read in
a newspaper or remark heard on television is
believed to be directed specifically to himself.
• Grandiose or expansive delusions are belief
of exaggerate self-importance. The patient
may think himself wealthy, endowed with
unusual abilities, or a special person.
Grandiosity of ability and identity or both.

• Delusions of guilt, hopelessness and

worthlessness are found most often in
depressive illness, and are therefore
sometimes called depressive delusions.
• Nihilistic delusions: Nihilistic delusions are
associated with extreme degrees of depressed
mood. concerns failures of bodily function (e.g.
that the bowels are blocked with putrefying
matter). The resulting clinical picture is called
Cotard’s syndrome after the French psychiatrist
who described it (Cotard 1882).

• Hypochondriacal delusions are concerned with

illness. The patient may believe wrongly, and in
the face of all medical evidence to the contrary,
that he is ill.
• Delusions of jealousy are more common
among men. Also called Othello syndrome.

• Sexual or amorous delusions: more frequent

among women. A woman with amorous
delusions believes that she is loved by a man
who is usually inaccessible, of higher social
status, someone to whom she has never even
spoken. It is the most prominent feature of a
syndrome called De Clerambault’s syndrome
• Delusions of control: also known as passivity
phenomenon. the patient who has a delusion
of control believes that his actions, impulses,
or thoughts are controlled by an outside
agency. It is a Schneider's first rank symptom
of schizophrenia.

Types:
• passivity of affect: forced by external agent to
feel emotions
• Passivity of impulse: forced by external agent
to desire to do things.

• Passivity of volition: forced by external agent

to perform actions

• Somatic passivity: forced by external agent to

experience bodily sensation
• In some psychiatric disorders an abnormal
meaning may be associated with a normal
percept. When this happens we speak of
delusional perception. attaching a new
significance to a familiar percept without any
reason. For example, a new arrangement of
object on a colleague’s desk may be
interpreted as a sign that the patient has been
chosen to do God’s work.
• Misinterpretation of a normal stimulus
 Motor symptoms and signs
Abnormalities of facial expression and posture are
mainly observed among schizophrenic patients.

• Tics are irregular repeated movements involving a

group of muscles, example side ways movement of the
head or the raising of one’s shoulder.
• Mannerisms are repeated movements that appear to
have some functional significance, example saluting.
• Stereotypies are repeated movements that are
regular (unlike tics) and without obvious significance
(unlike mannerisms); for example rocking to and fro.
• Posturing is the adoption of unusual bodily
postures continuously for a long time

• Patients are said to show negativism when

they do the opposite of what is asked of them.

• Echopraxia is the imitation of the

interviewer’s movement automatically even
when asked not to do so.
• Patients are said to exhibit ambitendence
when they alternate between opposite
movements eg. Putting out the arm to shake
hands, then withdrawing it, extending it again,
and so on

• Waxy Flexibility is detected when a patient’s

limbs can be placed in a position in which they
then remain for long periods. 
 HIGHLIGHTS
• Illusions are misperceptions of external stimuli
• Hallucination is a percept experienced in the
absence of an external stimulus to the sense
organs
• Delusional perception Misinterpretation of a
normal stimulus.
• Delusions are abnormal beliefs
• QUESTIONS?

• COOMENTS?
 References for further reading
• Oxford text book of psychiatry
• Oxford handbook of psychiatry
• Synopsis of psychiatry by Kaplan and sadock