Psychiatry Phenomenology Flashcards
Psychopathology
Study of abnormal states of mind
Phenomenology
Words to provide an objective description of abnormal states of mind
Disorders of perception
Can be sensory distortions, or sensory deceptions
Sensory distortions
Changes in intensity - eg colourful vision in mania, B+W in depression
Changes in quality
Changes in spatial form
Distortions of experience of time (physical/personal time)
Sensory deceptions
Illusions
Hallucinations
Affect
Outward expression of person’s internal emotions
Blunting of affect
Objective absence of normal emotional responses, without evidence of depression or psychomotor retardation
Flattening of affect
Severe form of blunting, nearly no emotional expression
Incongruity of affect
Expressed mood is not consistent with current scenario, eg laughing at funeral
Hallucinations
False perception without an external stimulus
Source is ‘within’ but subject reacts as if they are true perceptions coming from ‘without’
Can be auditory, visual, olfactory, gustatory, tactile
Hallucinations - 2nd person auditory
Eg “YOU are a bad person, YOU are the next messiah, YOU’RE going to die”
Hallucinations - 3rd person auditory
Running commentary, voices discussing/commenting
Visual hallucinations
Elementary - flashes of light
Fully organised - visions of people, animals
Can be seen in organic states, eg delirium
More common in acute organic states with clouding of consciousness than in functional psychosis
Functional hallucination
Auditory stimulus causes a hallucination
Reflex hallucination
Stimulus in one sensory modality produces a sensory experience in another
Extracampine hallucination
Hallucination that is outside the limits of the sensory field, eg hears voices talking in Paris when they are in Sydney
Hypnagogic hallucination
Occur when subject is falling asleep
Hypnopompic hallucination
Occur when subject is waking up
Pseudo-hallucinations
Hallucination that is recognised as unreal
Delusion
Unshakeable false belief that is out of keep with patient’s social and cultural background (bizarre and without logical reasoning)
Thought disorder
Disturbance of the organisation / expression of thought. Can be disorders of:
Stream of thoughts
Possession of thoughts
Content of thoughts
Form of thought
Disorders of stream of thought
Disorder of the constant movt / appearance of thoughts in the consciousness. Can be:
Disorders of tempo (flight of ideas, inhibition / slowness of thinking, circumstantiality)
Disorders of continuity of thought (perseveration, thought blocking)
Flight of ideas
Thoughts follow each other rapidly, associations of thoughts less relevant but some connection, goal is NOT reached
Inhibition / slowness of thinking
…
Circumstantiality
Inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.
Perseveration
Repetition of a word, theme or action beyond point of relevance or appropriateness
Thought block
Sudden interruption on train of thought, leaving a blank
Disorder of possession of thought
Sense of loss of control or personal possession of thinking. Can be:
Obsessions / compulsions
Thought alienation (insertion, withdrawal, broadcasting)
Thought alienation
Thoughts are not of their own control
Thought insertion
Feeling as if your thoughts are not your own, but rather belong to someone else and have been inserted into your mind
Thought withdrawal
Person believes someone has taken thoughts from their mind
Thought broadcasting
Person believes their thoughts are audible, being said aloud by someone else, eg on TV
Disorder of content of thought
Disorder in what pt is thinking - delusions
Delusion
False, unshakable belief that is out of keeping with the pt’s social and cultural background
Primary delusion
Arises out of the blue, not from any morbid phenomena, not preceded by any other idea/event
3 types: delusional mood, delusional perception, sudden delusional idea
Delusional mood
Global, diffuse, ominous feeling of something impending - pt knows something is going on that concerns them, but does not know what it is
Delusional perception
Delusion that is triggered by real stimulus (eg traffic light changes = being monitored by the govt), idea of reference??
Sudden delusional idea
Delusion appears fully formed in person’s mind
Secondary delusions
Arising from some other morbid experience, eg hallucinations, another delusion, mood
Content of delusions eg
Persecutory - pt believes they are being persecuted, despite lack of evidence
Infidelity - believing partner is cheating
Love - pt convinced some person is in love with them
Grandiosity - false belief about one’s greatness, eg immortal
Guilt - pt believes they are bad/evil
Nihilistic - pt denies existence of body, mind, loved ones and world around them
Poverty - convinced they are impoverished, believe that destitution is facing them and their family
Disorders of form of thought
Disorder in the flow of ideas, eg
Loosening of association
Loosening of association
Lack of logical association between succeeding thoughts, giving rise to incoherent speech. Impossible to follow pt’s train of thought (knight’s move thinking/derailment)
Dissociative amnesia
Sudden amnesia that occurs during periods of extreme trauma, can last for hrs/days
Anhedonia
Inability to experience pleasure from activities usually found enjoyable
Apathy
Emotional indifference with a sense of futility - may manifest as lack of motivation
Overvalued idea
False / exaggerated belief but held with less rigidity than a delusion (less bizarre and with plausible reasoning)
Illusion
Misperception of a real external stimulus
Concrete thinking
Lack of abstract ideas
Tangential thinking
Less relevant associations at a normal speed, goal is NOT reached
Clang association
Saying words based on sound>logic, eg rhyming
Neologisms
Making up new words
Confabulation
Creation of fake memory to fill in gaps
Alogia / poverty of speech
Reduced speech inferring poor thinking
Thought echo
Hearing own thoughts after thinking them
Somatic passivity
Belief that one’s thoughts / actions are influenced or controlled by external agent
Made Act/Feeling/Drive
Action/feeling/impulse forced upon them by someone else
Belle indifference
Surprising lack of concern / denial of apparently severe functional disability
Conversion
Development of features suggestive of physical illness but are due to psychiatric illness (no organic cause, psychiatric abnormality manifesting as physical symptoms)
Dissociation
Separation of unpleasant emotions and memories from conscious awareness (eg unconscious defence mechanism)
Derealisation
Feels the world has become unreal / lifeless / grey
Depersonalisation
Feeling detached from one’s own body, eg observing your own actions from a distance rather than experiencing them
Catatonia
State of increased muscle tone at rest, abolished by voluntary activities
‘badly-toned’ behavioural state characterised by mutism, posturing, negativism, rigidity echolalia. Mainly caused by mania (50%) and other mood disorders, includes subtypes: retarded, excited, malignant…
Waxy flexibility
When pt’s limbs moved, feels like wax or lead pipe, and remain in position in which they are left
Rare in catatonic schizophrenia and structural brain disease
Logoclonia
Repetition of the last syllable of a word
Echolalia
Repeating other people’s speech
Echopraxia
Repeating other people’s actions
Negativism
Motiveless resistance to movt
Palilalia
Repetition of a word over and again with increasing frequency
Verbigeration
Repetition of one or several strings of fragmented words, often in monotonous tone
