 Psychiatry: It is a branch of medicine

that deals with the diagnosis ,treatment

and prevention of mental illness .
 Psychiatric Nursing: It is a specialized
area of nursing practice , employing
theories of human behaviour as it is a
science , and the purposeful use of self
as it is an art , in the diagnosis and
treatment of human responses to actual
or potential mental health problems . (
ANA1994 )
 Perception is the meaningful organization of
sensory data and their interpretation in the light
of one’s past experience.
 Hyper aesthesia: Increased intensity of
sensations, seen in intense emotions and
hypochondriacal personalities. In hyper
aesthesia sounds appear louder, colours
brighter ,and pain unbearable .
 Illusions: Misperceptions or misinterpretations of
real external sensory stimuli: e.g. Shadows may
be misperceived as frightening figures., In a
fading light rope is misperceived as a snake .
 Hallucinations: Perception in the
absence of real external stimuli;
experienced as true perception coming
from the external world (not within the
mind). e.g. Hearing a voice of someone
when actually nobody is speaking within
the hearing distance.
 Auditory hallucinations (voice, sound,
noise). is a form of hallucination that
involves perceiving sounds without
auditory stimulus.
Types of auditory hallucination:
 Second-person hallucinations: voice
speaking to the person addressing him
as “you”.
 Third-person hallucinations: voice talking
about the person as “he” or “she”:
 Thought echo: hearing one’s own
thoughts spoken aloud.
 Visual hallucination: is the seeing of
things that are not there.
 Olfactory hallucinations is the
phenomenon of smelling odors that are
not really present. The most common
odors are unpleasant smells such as
rotting flesh ,vomit, urine, feces, smoke,
etc.
 Gustatory hallucination is the perception
of taste without a stimulus.
 Tactile hallucinations occurs when
someone feels a sensation on the body that
is, in fact, not present.
 Tactile hallucination is the false perception
of tactile sensory input that creates a
hallucinatory sensation of physical contact
with an imaginary object.
 One subtype of tactile hallucination,
formication, is the sensation of insects
crawling underneath the skin and is
frequently associated with prolonged
cocaine use.
 Somatic hallucination: Somatic hallucinations
refer to sensations or perceptions concerning
body organs that have no known medical
cause or reason, such as the notion that one's
brain is radioactive.
 Imperative hallucination: voices giving
instructions to patients, who may or may not
feel obliged to carry them out.
 ‘Thought echo’ : hearing one’s own thoughts
being spoken aloud; the voice may come from
inside or outside the head.
 Running commentary hallucinations: are
usually abusive and often talk about sexual
topics.
 Scenic hallucinations: hallucinations in
which whole scenes are hallucinated like
a cinema film; more common in
psychiatric disorders associated with
epilepsy.
 Lilliputian hallucinations: A term used to
denote a hallucination featuring
miniature individuals, animals, objects, or
fantasy figures.
 Autoscopy (phantom mirror image): the
patient sees himself and knows that it is
he. Seen in normal subjects when they
are depressed or emotionally disturbed.
 ‘Negative autoscopy’: the patient looks
in the mirror and sees no image; in
organic states.
 Internal autoscopy: the subject sees his
own internal organs.
 Extracampine hallucinations: a
hallucination which is outside the limits of
the sensory field.
 Extracampine hallucinations are
hallucinations beyond the possible
sensory field.
 e.g., 'seeing' somebody standing behind
you is a visual extracampine
hallucination experience.
 Hypnagogic hallucinations:
hallucinations when falling asleep.
 Hypnopompic hallucinations:
hallucinations when waking from sleep.
 Autistic thinking is a form of thought
disturbance and is a term used to refer
to thinking not in accordance with
consensus reality and emphasizes
preoccupation with inner experience.
Abnormalities of Stream of Thought
 Flight of ideas: the thoughts follow each
other rapidly and there is no general
direction of thinking, seen in mania
/excited schizophrenics. Flight of ideas
describes excessive speech at a rapid
rate that involves fragmented or
unrelated ideas. It is common in mania. It
has also been described in schizophrenia
and ADHD.
Abnormalities of Stream of Thought
 Pressure of thoughts: Rapid abundant
varying thoughts associated with
pressure of speech and flight of ideas.
 Poverty of thoughts: Few, slow, unvaried
thoughts associated with poverty of
speech.
 Thought block: Sudden cessation of
thought flow with complete emptying of
the mind not caused by an external
influence.
Abnormalities of Form of thought
 Formal thought disorder: a synonym for the disorders
of conceptual or abstract thinking which occur in
schizophrenia and coarse brain disease.
 Loosening of Association: (Loose Association) A
thought disorder in which series of ideas are
presented with loosely apparent or completely in
apparent logical connections. A manifestation of a
thought disorder whereby the patient's responses do
not relate to the interviewer's questions, or one
paragraph, sentence, or phrase is not logically
connected to those that occur before or after.
 Example: I sang out for my mother …… for this to hell I
went…how long is road …
 Tangentiality: It is a form of derailment.
Wandering from the topic and never
returning to it or providing the information
requested.
e.g. In answer to the question "Where are you
from?", a response "My dog is from England.
They have good fish and chips there. Fish
breathe through gills.“
 Derailment: direction of thought is lost and
the thought goes away from the intended
theme .
 Example: "The next day when I'd be going
out you know, I took control, like uh, I put
bleach on my hair in California.”
 Neologism: completely new word or
phrase whose deviation cannot be
understood. OR is the name for a newly
coined term, word, or phrase that may
be in the process of entering common
use but that has not yet been accepted
into mainstream language.
Abnormal Thought Content
 Overvalued Ideas: abnormal beliefs ,unique to
the individual which dominates his life .
 Example: *A woman falsely believes herself
unusually unattractive. * A person with no
computer science training might, believe he is
going to write the next great computer
program and fixate on this idea rather than
pursuing training in computer science or going
to work. * A person who works at a company
may rigidly maintain the idea that he or she is
the most valuable member of the company,
that he/she will save the company from ruin, or
that he/she will soon be made president of the
company.
 Delusions: Fixed false beliefs which are not
shared by others ,are out of keeping with one’s
educational ,social and cultural background
and are unshakable in the face of evidence to
the contrary.
 Delusional Contents:
 Persecutory (paranoid) delusion: Delusion of
being persecuted (cheated, mistreated, etc.)
 Grandiose delusion: Delusion of exaggerated
self-importance, power or identity.
 Delusion of reference: Delusion that some
events and others behavior refer to oneself.
 “Idea of Reference”: misattribution of events as
referring to oneself.
 Delusion of jealousy: Delusion that a loved person
(wife/husband) is unfaithful (infidelity delusion)
 Delusions of love (‘fantasy lover’, ‘erotomania’):
Delusion that someone, (usually inaccessible, high
social class person) is deeply in love with the patient.
 Nihilistic delusion: Delusion of nonexistence of self,
part of the body, belongings, others or the world.
 Delusion of self - accusation: Delusion that a patient
has done something sinful, with excessive feeling of
remorse and guilt.
 Delusion of influence: Delusion that person’s thoughts,
actions, or feelings are controlled by outside forces.
 Passivity phenomena: person reports being
made feel, made think or made act.
 Delusions of Replacement (Capgras
Syndrome): a belief that important people in
one's life have been replaced by impostors.
Delusions can be either :
 Mood-Congruent Delusion – Delusional content
has association to mood: - in depressed mood:
delusion of self - accusation. - in elevated
mood: grandiose delusion.
 Mood-Incongruent Delusions – Delusional
content has no association to mood, e.g.
patient with elevated mood has delusion of
thought insertion.
Delusions can also be either:
 Systematized Delusion – Delusion united
by a single event or theme e.g. delusion
of jealousy/thematically well connected
with each other.
 Bizarre Delusion - Totally odd and
strange delusional belief, e.g. delusion
that person’s acts are controlled by stars.
AbnormAlities of Possession of thought
 Obsessions: –Repetitive ideas, images, feelings or
urges insistently entering person’s mind despite
resistance. They are unwanted, distressful and
recognized as senseless and irrational. Obsessions
are frequently followed by compelling actions
(compulsions).
 Common obsessional Contents:
 –dirt/contamination/cleaning
 –orderliness
 –doubts/checking/counting
 –aggressive impulses/inappropriate acts
 –Ruminations: internal debates in which arguments for
and against even the simplest everyday actions are
Thought Alienation:
 Thought Insertion: Delusion that some of
person’s thoughts being put into the mind by
an external force (other people, certain
agency).
 Thought Withdrawal: Delusion that some of
person’s thoughts being taken out of the mind.
 Thought Broadcasting: Delusion that others can
read or hear the person’s thoughts, as they are
broadcast over the air, radio or some other
unusual way.
 Dysmorphophobia: a type of overvalued idea
where the patient believes one aspect of his
body is abnormal or conspicuously deformed.
 Feeling: a positive or negative reaction to some
experience
 Emotion: a stirred up state due to physiological
changes which occurs as a response to some event
and which tends to maintain or abolish the causative
event.
 Mood: the pervasive feeling tone which is sustained
(lasts for a length of time) and colors the total
experience of the person.
 Affect: is the outward objective expression of the
immediate cross sectional emotion at a given time.
 Euthymia: a normal mood state, neither depressed
nor manic.
 Cheerfulness: being in good spirits.
 Perplexity: a state of puzzled bewilderment.
 Anxiety: feeling of apprehension
accompanied by autonomic symptoms
(such as muscles tension, perspiration and
tachycardia), caused by anticipation of
danger.
 Free-floating anxiety: diffuse, unfocused
anxiety, not attached to a specific danger.
 Fear: anxiety caused by realistic
consciously recognized danger.
 Panic: acute, self-limiting, episodic intense
attack of anxiety associated with
overwhelming dread and autonomic
symptoms.
 Phobia: irrational exaggerated fear and
avoidance of a specific object, situation
or activity.
 Agoraphobia: patients rigidly avoids
situations in which it would be difficult to
obtain help.
 Social phobia - Intense and excessive
fear of being observed by other people
 Eg: eating or drinking in public or talking
to the other member of sex
 Specific phobia: irrational fear of a
specific object or stimulus.
 Acrophobia : fear of heights
 Arachnophobia : fear of spiders
 Claustrophobia : fear of closed spaces
 Gamophobia : fear of marriage
 Hemophobia : fear of blood
 Zoophobia : fear of animals
 Agitation: severe feeling of inner tension
associated with motor restlessness.
 Irritable mood: easily annoyed and
provoked to anger.
 Dysphoria: mixture feelings of sadness
and apprehension.
 Depressed mood: feeling of sadness,
pessimism and a sense of loneliness.
 Anhedonia: lack of pleasure in acts
which are normally pleasurable.
 Diurnal variation: a variation in the
severity of symptoms (mood) depending
on the time of the day
 Grief: sadness appropriate to a real loss
(e.g. death of a relative)
 Guilt: unpleasant emotion secondary to
doing what is perceived as wrong.
 Shame: unpleasant emotion secondary
to failure to live up to self-expectations.
 Perplexity: anxious mood with
bewilderment.
 Ambivalent Mood: coexistence of two
opposing emotional tones towards the
same object in the same person at the
same time.
 Alexithymia: inability to, or difficulty in,
expressing one’s own emotions.
 Elevated Mood: a mood more cheerful
than usual .
Elevated Mood:
 Euphoria (Stage I): mild elevation of mood in which
feeling of elevated mood with optimism and self
satisfaction not keeping with ongoing events. Usually
seen in hypomania.
 Elation (stage II): (Moderate elevation of mood) – a
feeling of confidence and enjoyment, along with
increased PMA. –a feature of manic illness
 Exaltation (stage III): (severe elevation of mood):
intense elation with delusions of grandeur, seen in
severe mania.
 Ecstasy (Stage IV): (very severe elevation of mod): a
sense of extreme well-being associated with a feeling
of rapture, bliss and grace. typically seen in delirious
and stuporous mania .
 Expansive Mood: expression of euphoria with
an
 overestimation of self-importance.
 • Grandiosity: feeling and thinking of great
 importance (in identity or ability).
 • Constricted Affect: significant reduction in the
 normal emotional responses.
 • Flat affect: absence of emotional expression.
 • Apathy: lack of emotion, interest or concern,
 associated with detachment.
 • Labile Affect: rapid, abrupt changes in
emotions in
 the same setting, unrelated to external stimuli.
 La Belle Indifference: inappropriate
 denial of expected affect and lack of
 concern about physical disability (seen
 in conversion disorders).
 • Inappropriate Affect: disharmony
 between emotions and the idea,
 thought, or speech, accompanying it.
 • Cyclothymia: There is cyclical mood
 variation to a lesser degree than in
 bipolar disorder.
 • Echolalia: imitation of words or phrases
 made by others.
 • Verbigeration : repetition of words of
 phases while unable to articulate the
 next word in the sentence/senseless
 repetition of same words or phrases
 over and over again.
 • Pressure of Speech: rapid,
uninterrupted
 speech that is increased in amount.
 Mutism: inability to speak.
 –Elective Mutism: refusal to
 speak in certain circumstances.
 –Poverty of Speech: restricted
 amount of speech.
 Stuttering (Stammering): frequent
 repetition or prolongation of a sound
 or syllable, leading to markedly
 impaired speech fluency.
 –Cluttering: dysrhythmic rapid and
 jerky speech.
 –Clang Associations
 (Rhyming): association of word similar
 in sound but not in meaning (e.g.
 deep, keep, sleep)
 Punning: playing upon words, by using a
 word of more than one meaning (e.g. ant,
 aunt)
 –Word Salad: incoherent mixture of words
 and phrases.
 –Dysphasia: impairment in producing or
 understanding speech.
 –Dysarthria: difficulty in articulation and
 speech production.
 –Sensory Aphasia: nonsensical fluent
 speech due to lesion affecting Wernicke’s
 (receptive) area.
 –Motor Aphasia: impairment in the
 ability to formulate fluent speech due
 to lesion affecting Broca’s (motor)
 area.
 –Dysphonia: difficulty in voicing speech
 clearly, due to dysfunction of vocal
 cords or soft palate.
 –Circumstanciality: over inclusion of
 details delaying reaching the desired
 goal.
 –Coprolalia: forced vocalization of
 obscene words or phrases,
 –Palilalia: is characterized by the
 repetition of a word or phrase; i.e., the
 subject continues to repeat a word or
 phrase after once having said. It is
 a perseveratory phenomenon.
 –Alogia: lack of speech output.
 • Mutism: complete absence of speech.
 Psychomotor Retardation: Slowed mental
 and motor activities.
 • Stupor: A state in which a person does not
 react to the surroundings: (mute, immobile
 and unresponsive).
 • Catatonic Stupor: Stupor with rigid
posturing.
 • Psychomotor Agitation: Restlessness with
 psychological tension. (Patient is not fully
 aware of restlessness.)
 Catatonic Excitement: Marked
 agitation, impulsivity and aggression
 without external provocation.
 • Chorea: sudden involuntary
 movement of several muscle groups
 with the resultant action appearing
 like part of voluntary movement.
 • Aggression: Verbal or physical hostile
 behavior, with rage and anger.
 Akathisia: Inability to keep sitting
 still, due to a compelling subjective
 feeling of restlessness.
 • Dyskinesia: Restless movement of
 group of muscles (face, neck, hands).
 Dystonia: Painful severe muscle spasm.
 • Torticollis: Contraction of neck muscles.
 • Tics: Sudden repeated involuntary
 muscle twisting. e.g. repeated blinking,
 grimacing.
 • Compulsions: Compelling repeated
 irrational actions associated with
 obsessions. e.g. repeated hand washing.
 Echopraxia: Imitative repetition of
 movement of somebody.
 • Stereotypies: Purposeless repetitive
 involuntary movements. e.g. foot
 tapping, thigh rocking.
 • Mannerism: Odd goal-directed
 movements. e.g. repeated hand
 movement resembling a military
 salute.
 Waxy Flexibility: Patient’s limbs may
 be moved like wax, holding position
 for long period of time before
 returning to previous position.
 Cerea flexibilitas, meaning "waxy flexibility", refers
 to people allowing themselves to be placed in
 postures by others, and then maintaining those
 postures for long periods even if they are obviously
 uncomfortable. It is characterized by a patient's
 movements having the feeling of a plastic
 resistance, as if the person were made of wax. This
 occurs in catatonic schizophrenia, and a person
 suffering from this condition can have his limbs
 placed in fixed positions as if the person were in
 fact made from wax.
 Automatic obedience: the pt. carries
 out every instruction regardless of
 the consequences.
 • Perseveration: is a senseless
 repetition of a goal-directed action, a
 particular response, such as a word,
 phrase, or gesture which has already
 served its purpose (beyond their
 relevance).
 Dyspraxia; inability to carryout
 complex motor tasks, although the
 component motor movements are
 preserved.
 • Omega sign (Athanassio): the
 occurrence of a fold like the Greek
 letter omega in the forehead above
 the root of the nose produced by the
 excessive action of the corrugator
 muscle; seen in depression.
 Ambitendency: a motor symptom of
 schizophrenia in which there is an alternating
 mixture of automatic obedience and
 negativism.
 • Mitgehen: The pt. moves his body in the
 direction of the slightest pressure on the part
 of the examiner. seen in catatonia
 • Mitmachen (Co-operation): The body can be
 put to any position without any resistance on
 the part of the patient seen in catatonia.
 Trichotillomania: a condition
 characterized by an overwhelming urge
 to pluck out specific hairs.
 • Pyromania: is an impulse control
 disorder in which individuals repeatedly
 fail to resist impulses to deliberately start
 fires, in order to relieve tension or for
 instant gratification.
 Dipsomania: uncontrollable craving for
 alcohol or compulsive drinking of
alcohol.
 • Kleptomania: a disorder in which the
 individual impulsively steals things other
 than personal use or financial gain.
 • Negativism: an apparently motiveless
 resistance to all commands and
attempts
 to be moved or doing just the opposite.
 Positive symptoms: refers to presence of
 delusions, disordered thoughts and speech, and
 tactile, auditory, visual, olfactory and
 gustatory hallucinations
 • Negative symptoms : are deficits of normal
 emotional responses or of other thought
 processes, and respond poorly to medication
 which includes flat or blunted affect and emotion,
 poverty of speech (alogia), inability to experience
 pleasure (anhedonia), lack of desire to form
 relationships (asociality), and lack of motivation
 (avolition).
 Biological symptoms (somatic
 symptoms./melancholic
 symptoms.): refers to changes in
 sleep, appetite, libido, activity,
 diurnal changes in mood, anhedonia,
 early morning awakening, and
 psychomotor agitation or
 retardation.
 • Psychotic symptoms: presence of
 hallucinations and delusions.
 First Rank Symptoms of Schizophrenia (Kurt
 Schneider)
 – Audible thoughts (thought echo)
 – Voices heard arguing
 – Voices heard commenting on one's actions
 – Somatic/thought passivity experiences (delusions of
 control)
 – Thought withdrawal
 – Thought insertion - Thoughts are ascribed to other
 people who intrude their thoughts upon the patient
 – Thought broadcasting (also called thought diffusion)
 – Delusional perception.
 Motor Symptoms of schizophrenia
 • Catatonia
 • Catalepsy
 • Automatic obedience
 • Negativism
 • Ambitendency
 • Mitgehen . Psychological pillow
 • Mitmachen
 • Mannerism
 • Stereotypy
 • Echopraxia
 In Capgras syndrome, the patient feels
 that a person familiar to him, usually a
 family member has been replaced by
 an imposter.[1] This is a type
 of delusion that can be experienced as
 part of schizophrenia. Capgras
Syndrome
 and several other related disorders are
 referred to as delusional
 misidentification syndrome.