Psychopathology

Psychopathology

Appearance and behaviour IMPORTANT FOR MENTAL STATUS EXAMINATION go according to that ASEPTIC - learn that MHE history and examination first

1. General appearance

=> •A Self Neglect (dress, goom, hygiene) * alcoholism • drug addiction • dementia • schizophrenia B Weightloss (build/demenour) • Physical disorder • psychological disorder • social problems C Apparent age?

2. Facial Expression

> Depression - vertical furrows, tearful, looks down, corner of mouth inverted. sighing > Anxiety - hortizontal furrows, eyes wide open, mouth open, facial muscle tense > Parkinsonian

3. Posture and gait

- depressed sit forwards and looks down. Anxious biting finger nails, clinging to chair

4. Movement

>Stupor - pschomotor retardation like a statue >Tics - Irregular, repeated movements of group of muscles >Choreiform - Irregular, repeated movements of group of muscles >Dystonia - Muscle spasm , painful - can be due to meds like antipsychotics

5. 5ocial Behaviour

>Disinhibited >Impending violence - clench fist, abgry and hostile

Behaviour

Appropriate or not , motor activity - Motor retardation, motor restlessness, agitation

Eye contact

Accessibility – Readily accessible, Poorly accessible

Attitude towards examiner and examination

Co-operative

relaxed

anxious and tensed up

Reticent

Suspicious

Irritable

Hostile

Threatning

over familiar

Disinhibited

over confident

over-bearing,indifferent,apathetic

6. SpeecA

Quality (actually asessing thoughts)a – relevant , coherent, loosening of association, vague, i3cdiosyncratic thinking, flight of ideas

7. Mood

Mood vs affect A. Subjective Mood - how are you feeling tod B. Objective Mood > Nature – depression/ elation/ anger/anxiety/ suspicion/ perplexed > Constancy – emotional lability/ emotional incontinence (cant control)/ (wont have lot) / flattening (wont show) > Congruity – congruous (inline with thoughts) / incongruous (not in line -pscizophrenia and organic conditions like dementia) >intensity Nature. Intensity. Constancy. Congruity with affect/situation.

Any suicidal ideation or homicidal idealation.

8. Thoughts

* Accessed using speech, writing and Art(chidren)

A. Abnormalaties of stream >pressure of thought ( a lot) >Poverty of thought(little) >blocking of though (dam in schizophrenia) B. Abnormalaties of form (formal thought disorders) >flight of ideas (usually in pressure of thoughts) (assessed using speech topics = mania) >loosening of associations (disconnected = cant understand despite langauge = incoherent) (knights move) >perseveration (same thought always = same answer for all questions) = organic brain disease like dementia Linea vs tangential vs circumferential C. Abnormalaties of content >delusions >overvalued ideas >obsessions

>Preoccupations

¨Worries

>Suicidal ideas and intentions (and homicidal etc) >Phoobias

C1 Delusions (4 conditions)

>belief usually false >firmly held on inadequate grounds >not amenable to reasoning >not shared by the sociocultural background A Primary delusions occurs suddenly without any other abnormalh mental event leading to it (without any other psychopathology without hallucinations, illusions, memory impairment)

Delusion perception, idea, memory, mood

g indications of schizophrenia)

> delusional mood - patient feels that

something sinister is

happening concerning

him, but unable to say

what it is

> sudden delusional idea - A patient may suddenly develop

the unshakable conviction that

he is changing sex

> delusional perception - A patient may suddenly be convinced he is a

homosexual when he sees the traffic lights turn red as

he approach it. Normal perception is given a delusional interpretation

B Secondary delusions

(mostly seen in practice because its a late presentation)

arise from some previous

abnormal idea or

experience

> hallucination

> mood

> another delusion (usual)

Delusional system or systemisized delusion - network of

inter-related

delusions

reference = everyone is talking about me

grandios = big shot

guilt = feeling guilty for something not done (depression)

nihilistic = nothing. hypochondrical = something pathological in body

dysmorphohobic = fear of change in own body like nose, ear, hair

jealosy (morbid jealousy) = partner is unfaithful. Very common in sri lankan.

sexual = sex has change.

religious = deviating from sociocultural

control = controlled by someone, chipped inside brain

pocession of thoughts = someone control though

Thought withdrawal,

thought insertion = inserted though computer

thought broadcasting = thought known in village

hallcination?

interviewer has to decide 3 things: 1 Is the belief true? 2 How strongly are the beliefs held? 3 Are the beliefs culturally determined? (otherwise not thqat much of a delusion)

c2 OVERVALUED IDEA: (one step before delusion) because of its emotional significance takes precedence over other ideas eg: emotional over famil members have cancer, they also think they have strongly cancer

C3 OBSESSIONS: (7 characteristics of an obsession) repetitive your own thoughts intrusive resistance

distressing

dysfunctional

useless or purposeless

Types of obsessions: thoughts ruminations(collection of thoughts) doubts images impulses

phobias

and then nonsense

Themes of obsessions> dirt & contamination aggressive actions orderliness disease sex religion Compulsions: Behavioural rituals: washing cleaning checking counting dressing nonsense Mental rituals: (occult obsession) phrases, reassurance (3rd party needs to resolve)

9. PERCEPTIONS:

process of becoming aware of what is presented to the body through the sense organs >Illusions >Hallucinations (frequently asked at exams)

>depersoanlization and derealization. > Passitivity experiences.

Illusions => (misinterpret) Misperception of a real external stimulus Common when : sensory impairment (common in the night) inattention impaired consciousness (delirium) emotional arousal Hallucinations => Perception experienced in the absence of an external stimulus (illusion you have a stimuli) (hallucination not0 Modalatities => auditory visual smell taste tactile deep sensation Diagnostic Associations: Visual => organic disorders (delirum, alcohol withdrwa, drug withdrawal) 2nd person auditory => mood disorders schizophrenia => 3rd person Auditory. Running Commentry. Thought Echo (hearing your own thought aloud)

10 Cognition

A CONSCIOUSNESS: > clouding of consciousness (delirium, organisc states, siwthdrawal and alcoholic states) > stupor (disassociative, schizophrenia, depression) > confusion (delirium) B ORIENTATION: > time > place > person C ATTENTION & CONCENTRATION: > serial 7s test (subtract 7 from 100) 9repeat days of the week or months backward) D Memory > Assessment assessment of immediate memory - digit span test (hold 5 items) assessment of recent memory - name & address test / 5 item recall assessment of long-term memory – recall personal events / public events (weddings, birthdays, when is the inpedence day) (important for exams) >Disorders 1. retrograde amnesia: Loss of memory for events before the onset of unconsciousness 2 anterograde amnesia: Loss of memory for events between the ending of complete unconsciousness & the restoration of full consciousness

(ECT, head injuries)

3 Confabulation :

reporting as memories of events

that did not take place to fill the

gaps in memory

E LANGUAGE: function tests

naming

verbal instructions (take piece of paper, fold it and place on the table)

written instruction (written instruction)

writing a sentence Dysarthria, dysphasia, comprehension, writing, naming objects

F VISUOSPATIAL : functioning tests

copy simple line figures