Psychopathology of mental disorders

Terminology of psychiatry

1. JINTO PHILIP ASST. PROFESSOR MSc in Psychiatric Nursing DEFINITION: MENTAL HEALTH, MENTAL ILLNESS, MENTAL HEALTH NURSING TERMINOLOGY OF PSYCHIATRY

2. MENTAL HEALTH “Mental health is a state of well-being in which each individual is able to recognize his or her own potential, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to the society” [WHO] DEFINITION: MENTAL HEALTH, MENTAL ILLNESS, MENTAL HEALTH NURSING TERMINOLOGY OF PSYCHIATRY

3. MENTAL ILLNESS “Mental illness is considered to be a clinically significant behavioral or psychological syndrome marked by the patient’s distress, disability or the risk of suffering disability or loss of freedom” [APA, 2000]

4. MENTAL HEALTH NURSING “ A specialized area of nursing practice, employing a wide range of explanatory theories of human behavior as its science and purposeful use of self as its art” [ANA,2000] Psychiatric nursing is an interpersonal process that promotes and maintains patient behavior that contribute to integrated functioning. The patient may be an individual, family, group, organization or community.

5. PSYCHOPATHOLOGY OF MENTAL DISORDERS “Psychopathology is a term which refer to either a study of mental illness or mental distress, or the manifestations of behaviors and experiences which may be indicative of mental illness or psychological impairment, such as abnormal, maladaptive behavior or mental activity”

6. Psyche- mind /social Pathos- traces disease Logos- study It refers to the study of the causes and nature of disease or abnormal behavior Signs and symptoms of mental illness

7. Signs are observations and objective findings elicited by the clinician Symptoms are the subjective experience described by the patient, often expressed as chief complaints such as depressed mood or lack of energy. Syndrome is a group of signs and symptoms that together make up a recognizable condition.

8. A neurosis is a chronic or recurrent nonpsychotic disorder characterized mainly by anxiety, which is experienced or expressed directly or is altered through defense mechanisms; it appears to be a symptom such as an obsession, a compulsion, a phobia or a sexual dysfunction. Symptoms are distressing to the individual and is recognized as unacceptable and alien, reality testing is grossly intact. Behavior does not actively violate gross social norms. no demonstrable organic etiology. NEUROSIS

9. Loss of reality testing and impairment in mental functioning-manifested by delusions, hallucinations, confusion and impaired memory. Severe impairment in social and personal functioning With gross impairment in reality testing, persons incorrectly evaluate the accuracy of their perceptions and thoughts and make incorrect inferences about external reality, even in the face of contrary evidence. PSYCHOSIS

10. DEVIATIONS FROM NORMAL BEHAVIOR Disturbances of consciousness Disorders of motor aspects of behavior Disorders of thinking Disorders of affect Disorders of perception Disorders of memory

11. CONSCIOUSNESS Consciousness: State of awareness Apperception is perception modified by a person’s own emotions and thoughts. Sensorium is a state of cognitive functioning of the special senses Disturbances of consciousness: Disorientation : disturbance of orientation in time, place and person

12. Disturbances of consciousness: ( contd ….) 2. Clouding of consciousness: incomplete clear mindedness with disturbances in perception and attitudes 3 . Stupor : Lack of reaction to and unawareness of surroundings 4. Delirium: bewildered, restless, confused, disoriented reaction association with fear and hallucinations. 5. Coma: Profound unconsciousness 6. Coma vigil : Coma in which patient appears to be awake with eyes open but cannot be aroused (also known as akinetic mutism)

13. Disturbances of consciousness: ( contd ….) 7. Twilight state: disturbed consciousness with hallucinations 8. Dreamlike state: consciousness disturbance and patient is not aware about the surroundings 9. Somnolence: abnormal drowsiness 10. Confusion: disturbance of consciousness in which reactions to environmental stimuli are inappropriate, manifested by disordered orientation in relation to time, place and person.

14. Disturbances of consciousness: ( contd ….) 11. Drowsiness: a state of impaired awareness associated with a desire or inclination to sleep. 12. Sundowning: syndrome in older persons that usually occurs at night and is characterized by drowsiness, confusion, ataxia, and falling as the result of being overly sedated with medications (sundowner’s syndrome)

15. B. Disturbances of attention: C. Disturbances in suggestibility:

16. DISORDERS OF MOTOR ACTIVITY Increased activity (Hyperactivity) Decreased activity (Psychomotor retardation) Stereotype position # catalepsy #catatonic stupor #catatonic rigidity #catatonic posturing #waxy flexibility contd ……

17. DISORDERS OF MOTOR ACTIVITY contd …. Stereotype movements #Mannerisms #Tics #Echopraxia Automatism Negativism

18. DISORDERS OF THOUGHT Form Flight of ideas Prolixity Loosening of association Circumstantiality Tangentiality Perseveration Thought blocking Word salad Clang associations Neologisms

19. DISORDERS OF THOUGHT Content Obsessions Compulsions Phobias Suicidal and homicidal ideas (ideas of hopelessness and worthlessness) Hypochondriacal symptoms Antisocial urges and impulses Thought insertion, withdrawal, broadcast

20. DISORDERS OF THOUGHT Thought disturbances Delusions Ideas of references and ideas of influence

21. DISORDERS OF MOOD/AFFECT PLEASURABLE AFFECT: Expansive mood, Euphoria, Elation, Ecstasy UNPLEASURABLE AFFECT: Dysphoric mood, sadness, anxiety, grief and mourning UNHEDONIA ALEXITHYMIA INAPPROPRIATE AFFECT

22. DISORDERS OF PERCEPTION Imperceptions Hypoesthesia Anesthesia Parasthesia Hyperesthesia Illusions Hallucinations De-personalization De-realization

23. HALLUCINATIONS Auditory Visual Olfactory Tactile Gustatory contd …. First person Second person Third person

24. HALLUCINATIONS Hypnogogic and hypnopompic Mood congruent and mood incongruent Command hallucinations Visceral hallucination Delusional zoopathy Functional hallucination contd ….

25. HALLUCINATIONS Reflex hallucinations or synaesthesia Extracampine hallucinations Autoscopy or phantom mirror image Negative autoscopy Internal autoscopy Pseudohallucinations

26. Perception = Hallucination Pseudohallucinations Fantasy = Imagery 1.Experience is concrete, tangible, objective, real ‘inner eye’ pictorial subjective 2.Location in outer objective space inner subjective space 3.Definition definite outlines, complete sound indefinite, incomplete only individual details 4.Vividness full, fresh, bright most elements are dim or neutral 5. Constancy retained evanescent

27. Perception = Hallucination Pseudohallucinations Fantasy = Imagery 6. Independence from volition Cannot be dismissed, recalled or changed at will Requires voluntary creation 7. Insight Has quality of perception-no distinction between perceptions and hallucinations Fantasy has quality of idea 8.Behavioral relevance Relevant to emotions, needs, actions Not relevant

28. Perception = Hallucination Pseudohallucinations Fantasy = Imagery 9. Sensory modality Could experience object in another modality Could not experience this object in another modality 10. Existence Object exists independent of observer Depends on observer for existence

29. DISORDERS OF MEMORY Hyperamnesia Amnesia Paramnesia Confabulation Complete Partial Circumscribed Retrograde Anterograde Déjà Vu Jamais Vu

30. THANK YOU - JINTO PHILIP