Psychopathology

Dr. Mohsen Taraif

Consultant
Psychiatrist
Psychopathology
Study of abnormal mental phenomena and
abnormal behavior
Psychopathology

Psychopathol
ogy

Dynamic Descriptive
pathology Experimental
( Phenomenolo pathology
(Analytic) gy)
Mental state Examination
General appearance and behavior and motor system
Mood and Affect
Speech and language
Thought process/ Content
Perceptual function
Cognitive function
o Arousal state
o Orientation
o Attention and concentration
o Memory
Judgment , abstract thinking and general information
Intelligence
Insight
General Appearance and
Behavior and Motor
system
Body built
Manner
Posture
Gesture/ Facial expression/ body language
Self hygiene
Dressing
Social behaviour
Eye contact
General appearance and
behaviour and motor
system
Abnormal movement :
Gait abnormalities
Ataxic gait
Spastic gait
Wide-based gait
Hesitant gait ( huntington disease )
Festination ( parkinson )
Tremors
Static
Intention
Abnormal eye movements
Choreic movement : sudden jerky movement of the
limbs
Athetosis: slow writhing movement ( snake like)
Tics: repetitive movements of small facial muscles
 General appearance and
behaviour and motor
system
Extrapyramidal signs: e.g. tremors, rigidity
Steriotypy: automatic repetition of mundane
movements e.g. tapping, grooming, gesturing ,
rocking , self biting , head banging
Mannerism: odd movement e.g. tiptoe walking,
hopping, odd robotic speech, making gun shooting
hand movement
Catatonic features
catalepsy and posturing
Psychological pillow
Waxy flexibility
Automatic obedience
Ambitendency
General appearance and
behaviour and motor
system
Dyskinesias: involuntary, repetitive and sometimes
distorted movement of muscle groups not due to tremors
Acute : e.g. oral, buccal, puckering, peri-oral tremors, shoulder
shrugging
Tardive- typically result from prolonged exposure to anti-
psychotic drugs
Dystonias: sudden prolonged muscle spasm
Apraxias
Kinesthetic
Ideo motor
Dressing
Construction
Compulsions and other preservative actions: compulsions
are repetitive often ritualistic actions commonly driven by
obsession like checking and washing.
Mood and Affect
Mood: the prevailing emotional state.
Affect: outward expression of the mood
Objective range changeability- lability
Types of emotions
o Happy
o Sad
o Anger/ frustration
o Excitement/ Ecstasy
o Bored
o Fear
o Anxious
o Disgust
o surprise
Mood and Affect
Pervasive emotional states
o Panics
o Severe anxiety
o Depression
o Mania ( Elation- Euphoria)
o Irritability
o Ecstacy
o Pathological anger
o Pathological laughing and crying and emotional
incontinence
Speech and language
Stuttering/ stammering: In stammering the normal flow of
speech is interrupted by pauses and the interjection of repeated
words or parts of words while stuttering is difficulty in uttering
speech sounds at the beginning of words
Phonation
o Dysphonia
o Hoarseness
Articulation
o Dysarthria
o Stacato
Quantity : increased in mania ( pressured speech), decreased in
depression ( poverty of speech and thought )
Rate: paucity of speech and mutism
Tone: modulation- monotonus, loud and dramatic
Volume
Pitch
Speech and language
Aphasia Motor ( non fluent )
Central transcortical motor
transcortical sensory
Receptive ( fluent )
Neologism: using new words that do not convey meaning
Paraphrasia: imprecise use of words
Literal paraphrasia e.g. glob ( for glove )
Verbal paraphrasia e.g. writer for pen
Echolalia: repetition of words spoken by others
Steriotypical speech: verbigeration
palilala

logoclonia
Perseveration of speech: the patient repeats phrases and sentences
beyond the point of conversation
Talking past the point ( Vorbeireden):the patient appears to
understand the question but to deliberately give wrong answer.
Thought process/ Content
Types of thinking:
o Logical
o Imaginative
o Fantasy
Thought process/ Content
Thought
disturbance

Process Content
(Form)

Obsessions
1. Circumstantial Delusions
2. Tangatiality Phobias
3. Loss of Overvalued ideas
association Non-delusional abnormal thought:
suicidal, homicidal, culturally
deviant ideas
* Thought content
Overvalued-ideas
Beliefs that are plausible may contain a kernel of truth and
may be accepted by others, however it intrudes into the
foreground of thought at the expense of other considerations.
Obsessions
Repeated thought or ideas or images, impulse, silly or
inappropriate, the patient knows they are products of his mind.
Try to control, resistance cause anxiety
Phobias:
Irrational and exaggerated fear that cause avoidance and
suffering
Types:
o Animal
o Simple
o Situational
o Social
* Thought content
Delusions: false, fixed ( unshakable) beliefs that cannot
be changed by logic or arguments and they are out of
keeping with person background, culture and
education
Primary: Delusional atmosphere
Delusional perception
Delusional memory
Secondary: secondary to abnormal mental
phenomenon
Thought content
Delusion of control
(passivity delusion)

Thought Alienation

Persecutory
its content Paranoid
Based on
Delusion Grandiosity
Delusion of
Types of misidentification

Erotomania
Erotic Delusions
Delusion of jealousy

Nihilistic
Delusions
Types of delusion based
on the content
Delusion of Misidentification
Capgras: a relative spouse or familiar person is believed replaced by
a similar looking impostor ( most common form)
Reverse capgras: the patient believes others think he is an imposter
( rare)
Fregoli: unfamiliar persons are thought to be well known to the
patient
Intermetamorphosis: familiar persons are believed to be swapping
identities while maintaining the same appearance
Delusional companions: Inanimate objects are believed to be living
companions (when transient this is normal in childhood, always
abnormal in adults)
Passivity delusions: experiences of control and alienation are
defined as passivity delusion because the sufferer feels helpless
during the experience either being controlled by an outside force
or inhabited by another person thought
Nihlistic delusion: are beliefs of being dead or having no brain o
nerves or chest
Perceptual Function

Hypersthesia
Hyposthesia
Synesthesia
Dysmegalopsia
Dysmorphopsia
Perceptual function

Elementary

Complex
Misperception of a
stimulus

1st person auditory

hallucination
2nd person auditory
Perceptual function
Hallucination: perception without a stimulus
Specific types of hallucination
o Hypnogogic and hypnopompic hallucination
o Extracampine hallucination
o Functional hallucination
o Reflex hallucination
o Experiential hallucination
o Panoramic hallucination
o Lilliputian hallucination
o Peduncular hallucination
o Autoscopic hallucination
o Musical hallucination
o Thought echo
Cognitive function
Level of arousal
Increased arousal
decreased arousal (clouding of consciousness)
stupor
Orientation
Time, place, person
Attention and concentration
concentration: Serial 7s, Days of the week backward
Attention:
Memory short
Intermediate
Long
Types of memory:
Semantic (declarative)
Episodic
Procedural