Psychopathology Flashcards
Thought disorders
Thought form - are the thought being formed appropriately
Cannot be assessed by behavior alone; will require the patient to speak.
Insight can be maintained
The stream and flow of thoughts may also be commented on
Thought content - what is being thought about ?
A subjects behaviour could indicate abnormal thought content
If delusions are present insight cannot be maintained
Formal thought disorder
When thought form is disorganized to a qualifiable degree, for example loosening of associations, word salad, tangentiality etc.
Formal thought disorder implies psychosis
Can be seen in organic syndromes
Paralogia: Formal thought disorder due to abnormal elements added to normal thought form. E.g tangentiality or flight of ideas
Alogia: Formal thought disorder due to elements lost from normal thought form. E.g thought block or retardation of thoughts
Classifying thought form
Mania is associated with:
-Clang associations - thoughts are linked through their sounds via punning or rhyming. Usually through first syllables in schizophrenia. Usually through end syllables in mania
-Flight of ideas: Succession of thoughts is rapid
Direction and association between each thought is present but hard to follow
Clang associations may be noticed
Schizophrenia is associated with:
- Derailment (Loosening of association)
(marked by frequent interruptions in thought and jumping from one idea to another unrelated or indirectly related idea)
It is a thought disorder characterized by discourse consisting of a sequence of unrelated or only remotely related ideas. The frame of reference often changes from one sentence to the next
Retardation of thinking implies depression. Flow of thoughts is noticeably slowed but remain goal directed. May be accompanied by latency of response and prolonged pauses.
Circumstantiality:
Slow progress of thoughts with unnecessary digressions but will return to the point
Can be associated with tempoalr lobe epilepsy/obsessional personalities
Tangentiality: Subjects thought progression never reaches the point
Over-inclusive thinking - concepts that are only remotely important in the subjects thought processes
Perseveration: Thought processes cannot move beyond the initial concept - associated with clouded consciousness - pathogonomic of organic brain disease. Can be demonstrated through repeated motor tasks
Vorbeireden - Talking past the point. FTD
Voirbeigehen- going past the point. Associated with ganser syndrome
Ganser syndrome: A dissociative syndrome of prisoners providing approximate nonsensical answers to simple questions implying they know the answer is correct. It can be associated with clouding of consciousness with disorientation.
Classifying thought disorder
Delusions: False unshakeable belief that is out of keeping with a subjects social and cultural background
Egosyntonic: in keeping and acceptable with the individuals hopes and goals
Mood congruent: Delusions with themes that are consistent with a persons mood states.
Obsessions: recurrent intrusive, unwanted and unpleasant thoughts
Overvalued ideas: a false belief that preoccupies a person’s life but is not held with unshakeable intensity of delusions and often has some reality base.
Associated with paranoid personality disorder, body dysmorphia and anorexia nervosa.
Primary delusions: Their cause cannot be reduced to other mental experiences
Contemporary psychiatry considers primary delusions as arising without identifiable precipitating event.
Tend to be associated with acute stages of psychosis.
4 types of primary delusions:
Delusional perceptions: A normal perception that is given a delusional meaning (usually self referential). This is the only first rank symptom that is a delusion
Delusional mood: A salient sense that something odd and significant is going on. Associated with early stages of psychosis,
Delusional memory: A false memory often bizarre is reported as having occurred and being remebered. Or a true memory is given a delusional significance.
Autochtonous delusions - ‘out of the blue’ occuring in a sudden moment of delusional knowledge.
Secondary delusions
Arise from abnormal experiences, that is, after an auditory hallucination.
Persecutory delusions: the subject believes they are in imminent danger or harm is intended to them from a specific source. Persecutory is recognized as the most common delusional content
Morbid jealousy - belief that a partner is being unfaithful
Cotards delusion: Subject believes they are dead. Associated with severe depression and schizophrenia
Couvade syndrome: Conversion syndrome of pregnancy by husband during wifes pregnancy
Pseudocyesis: Female subject experiencing symptoms of pregnancy with negative pregnancy test
Delusion of infestation: Ekboms syndrome. Belief that macroscopic parasites are present on the skin
Delusion of reference: Belief that a coincidence or observed event is of speicific personal reference to the self
Ideas of reference: A subjective sense that others are taking specific notice of oneself. Associated with paranoid personality disorder
Thought alienation: A subjects thoughts are expereined as being influenced by an external agency
Passivity pheneomenon - Thought insertion, thought withdrawl and thought broadcasting. They are characterized by the belief that one’s thoughts or actions are influenced or controlled by an external agent
Scheider’s first rank symptoms
A symptoms cluster - one or more symptoms sugegsts a diagnosis of schizophrenia. If organic illness is rule out.
Three hallucinations:
Thought echo: Thoughts are heard out loud after they have been experienced
Third person auditory hallucination - Talking about the subject
Running commentary on subjects actions
Three made phenomena
Made affect: mood/affect controlled by external agency
Mood volition: actions are controlled by external agency
Mood impulses: Subjects drive or desires are controlled by external agency
Three thought phenomena
Thought withdrawal by external agency
Thought insertion by external agency
Thought broadcasting/diffusion
Two isolated symptoms
Delusional perception
Somatic passivity: body sensation are under control by external agency
Disorders of speech
Speech may be classified as:
Pressured = rapid, without pauses and uninterruptible
Stilted= overpolite and excessively formal quality
Receptive dysphasia
Primary sensory dysphasia (Wernicke) impaired understanding of spoken word but able to speak fluently .
Pure word deafness - impaired understanding of speech with intact speech, reading and writing. Lesions in dominant temporal lobe
Pure word blindness - impaired reading comprehension with normal speech, writing and understanding of spoken word
Conduction dysphasia - repetition of speech and writing is impared but comprehension alone or expression alone are intact
Expressive dysphasia
Primary motor dysphasia (brocas) impaired production of speech and writing with intact comprehension
Pure word dumbness - difficulty in producing motor speech with intact comprehension and writing
Pure agraphia - isolated inability to write
stuttering and stammering
Mutism
Legoclonia - senseless repetition of syllables
Echolalaia - senseless repetition of words or phrases, associated with dementia and mental retardation
Verbigeration - stereotypes and meaningless repitition of words or syllables.
