2. King Saud University College of Nursing Supervised by\ Prof. Dr. Elham Fayad Presented by\ Ms. Mofida AL-barrak

3. Objectives At the end of this lectures the students will be able to: 1. Explain general symptomatology of psychiatric disorders.

4. 7/3/2016AL-barrak 20083 General symptomatology of psychiatric disorders. 1-Composition of mind 2-Types of Psychiatric Disorders a. Thought disorders b. Disorders of affect c. Disorders of behavior

5. It is essential for the students to know the important symptoms which are met with in psychiatry, & she should be clear as to the meaning of technical terms that are used to describe them. 7/3/2016AL-barrak 2oo84

6. What are the composition of the mind or components of personality? What are the composition of the mind or components of personality?

7. Intellect process Cognition process Or Thought process Affect Feeling Or Mood Behavior Process of thought  -Orientation  -Attention  Insight  Intelligence  Perception  Memory  Judgment  General knowledge

9. Three component are integrated in the normal person Intellect Behavior Affect

10. Three component are disintegrated like Schizophrenia patient (each one Split or separate from other) CognitionAffectBehavior

11. Thought disorder(Cognition)

12. 7/3/201611 I- Disorders of thought 1-Formal thought disorder2- Stream 3-Content of thoughts

13. 1.Formal thought disorder 1- Concrete thinking versus abstract Concrete Meaning behind sentences, thinking superficial Abstract General thinking, logical, 2- Autistic thinking versus realistic Autistic start with fantasy ending hallucinations.

14. II- Stream e.g. Mania It is excessive spontaneous talking but still perfectly coherent & logical Pressure of thought e.g. depression Slow speech & prolonged period before response Retardation

15. e.g. schizophrenia Poverty of speech e.g. mania *without reaching goals Flight of ideas Unnecessary details Circumstantialities Mixture of words & phrases that no meaning Incoherence word or word salad

16. Words of patient’s own making that only have meaning Neologisms Thinking is haphazard, illogical & confused e.g. schizophrenia Looseness of association Sudden stopped of the talk Blocking

17. Answer is not harmony with question asked Irrelevant answer Repetition of the last words in response to different question Perseveration Repeating the speech of anther person e.g. nurse said to the pt’s “tell me your name “pt’s responded “tell me your name” Echolalia

18. Stream Tangentially Circumstantially Looseness of association Flight of ideas Clang association Incoherence talks Pressure of speech Poverty of speech RetardationBlocking Preservation Palilalia Echolalia Irrelevant answer Neologisms

19. What are the different between flat of idea & circumstantially ? Flight of ideas not reach goal Circumstantialities reach goal

20. III- content 1. Delusion 2. Obsession 3. Preoccupation 4. Suicidal ideation

21. ***Delusion*** It is false fixed believe, not consistent with patient's educational & cultural background, that cannot be corrected by logical or reasons.

22. Types of delusion Systematized Delusions Un systematized delusion

23. Delusion 1. Paranoid delusion 2. Delusion of influence 3. Depressive delusion 4. Hypochondri acally delusion 5. Delusion of broad casting 6. Delusion of insertion 7. Delusion of withdrawal

24. **** I- Paranoid delusion**** Delusion of grandeurDelusion of persecutionDelusion of referenceErotic delusionDelusion of jealousy = suspicionDelusion of infidelityLitigious delusion

25. I- :Paranoid delusion It includes the following a- Delusion of grandeur False belief that one is a very powerful and important person, b- Delusion of persecution False belief that the patient is chased by others. c- Delusion of reference False belief in which the patient believes that every thing in the environment is refers to him (e.g. people in street, radio, and newspaper are referring to her)

26. d- Erotic delusion False belief that there is a love story between oneself & famous person. Suspicion = e- Delusion of jealousy Conviction that the husband has some definite relation with someone else. f- Delusion of infidelity False belief derives from pathological jealousy that one's lover is unfaithful (it is an extreme of the jealousy delusion) g- Litigious delusion Patient writes complaints and sends them to responsible person.

27. Multi choose questions All the statement are types of Paranoid delusion except one a. Delusion of grandeur b- Delusion of persecution c. Erotic delusion d. Nihilistic delusion

28. 2- Delusion of influence (delusion of control) False belief that one is being controlled by others or agencies.

29. 3. Depressive delusion Delusion of self- blame, guilt Delusion of poverty Nihilistic delusion

30. 3- Depressive delusion a. Delusion of self-blame, guilt In which the patient believes that she is wicked, full of sins and unfit to live with other people (unworthiness). b- Delusion of poverty False belief that the patient believes that she lost everything in life. c- Nihilistic delusion False belief that a part of her body doesn't exist or he doesn't exist (dead). 7/3/201629

31. 4-Hypochondriacal delusion Belief that Patient has physical disease e.g. cancer stomach, that is not based on real organic pathology. 7/3/201630

32. 5. Delusion of broad casting False belief that patient’s thought can be heard by other. 6. Delusion of insertion False belief that thought of other are being inserted in patient’s mind. 7. Delusion of withdrawal False belief that thoughts have been removed from patient’s mind by an outside agency.

33. Obsessive thoughts are intrusive thoughts invading the conscious awareness against the resistance of the person in an involuntary way that is fully aware that they are unnecessary and absurd. act compulsion II. Obsessive 7/3/201632

34. Example of obsession *Patient may have to remember & repeat the serial number of a bus-ticket he has (e.g. 815619) mental act *Patient wash his hands whenever he shakes them with any individual physical act

35. What are the different between Obsessive & delusions? What are the different between Obsessive & delusions? 7/3/201634 ObsessiveDelusion UnconsciousConsciences Fight against his or her ideas Fight about her ideas

36. 3. Preoccupation Centering of though content around a particular idea associated with strong affective tone. 4. Suicidal ideation It is a recurrent idea affecting the individual to put an end by herself to her own life. 7/3/201635

37. II-Disturbance in perception II-Disturbance in perception Hallucinations False perception for which no external stimuli exist. Visual: seeing things that are not there. Auditory: hearing voices when none are present. Olfactory: smells that do not exist Tactile: feeling touch sensations in the absence of stimuli. Gustatory: experiencing taste in the absence of stimuli. 7/3/201636

38. 2- Illusion 2- Illusion It is a false perception with an external stimulus What are the differentiae between hallucination & illusion? 7/3/201637

39. III unreality states 1- Depersonalizations is a nonspecific feeling or sense that a person has lost his identity or is unreal. when he looks in the mirror he feels himself changed, Derealization The false perception by a person that her environment has changed. Also they can be categorized under affect & perception. 7/3/201638

40. IV-Disorder of memory 1. Amnesia is loss of memory and may be partial or complete. e.g. psychotic patient’s 7/3/201639

41. The following are the different types of amnesia: The following are the different types of amnesia: Anterograde amnesiaRetrograde amnesia Total amnesia Circumscribed amnesia

42. Anterograde amnesia loss of memory for recent events. e.g. old age b-Retrograde amnesia Loss of memory for remote events. (Head injury) c- Total amnesia Loss of memory for recent and remote events. d- Circumscribed amnesia Loss of memory for limited time. (hysteria)

43. 2- Paramnesia it denotes false recall. ConfabulationFalsification

44. a- Confabulation Patient fills the gaps in his memory by fabrication. b- Falsification Patient adds fraises details to a true memory. 7/3/201643

45. 3- Hyperamnesia: It is excessive memory, the patient mentions even unnecessary details. 4- Déjà vu phenomena (already seen) In which new situation is experienced as previously. 5- Jamais vu phenomena In which familiar situation is experienced as novel (new). 7/3/201644

46. Orientation,disorientation Orientation The ability to relate the self correctly to time, place & person. e.g. Always found in organic patient (brain or old people suffering from Alzheimer ) Disorientation Confusion and impaired ability to identify time, place and person.

47. VI- Judgment It is the ability to assess a situation correctly and act appropriately within that situation. VII- Insight It is the ability to understand the objective condition of his illness. 7/3/201646

48. VIII- Attention and concentration It is the direction of the focus of awareness and perception to a particular stimulus. Distractibility: Inability to maintain attention, shifting from one area or topic to another with frustration)) minimal provocation. VIII- Attention and concentration It is the direction of the focus of awareness and perception to a particular stimulus. Distractibility: Inability to maintain attention, shifting from one area or topic to another with frustration)) minimal provocation. 7/3/201647

49. What are the differentiate between psychotic & neurosis? NeurosisPsychotic Insightlack insight ReversibleIrreversible e.g. anxiety & stresse.g. schizophrenia clinicalHospitalization

50. Disorder order affect = feeling = mood Inadequate affect Depressive affectPleasurable affect Inappropriate (Ambivalence)Incongruity or disharmony phobia & Anxiety, fear

51. Cont. Inadequate affect ApathyIndifferent Inappropriate affect Incongruity or disharmony Ambivalence

52. A - Inadequate Affect: 1- Apathy It's the absence of both emotional experience & expression. 2- Indifference It is the absence of emotional expression but experience is present.

53. What are the different between apathy & depression depressionApathy

54. B- Inappropriate Affect Incongruity ( disharmony ) thought satisfied (e.g. the patient feel happy while he believes that he is going to be killed by his enemies). C- Ambivalence The holding at the same time, two opposing emotions. (e.g. love & hate)

55. Depressive Affect: 1- Grief or Mourning: It's feeling of sadness associated to a real loss. 2- Depression: It's a psychopathological feeling of sadness when out of accord with the patient’s actual circumstances.

56. E- Pleasurable Affect: 1- Euphoria: It is a heightened feeling of well being inappropriate to apparent events. 2- Elation: It is feeling of happiness with air of confidence and enjoyment associated with increased motor activity. e.g. paranoid delusion 7/3/201655

57. Anxiety, apprehension, fear & phobia A state of apprehension, uncertainty or fear, resulting from the expectation of a realistic or imaginary threatening event or situation.

58. What are the different between anxiety & fear FearAnxiety Objectives feelingSubjective feeling Cognitive processEmotional process

59. Disorders of Behavior( conation ) a- Hyperactivity It includes:- 1- Agitation It's some form of hyperactivity characterized by pacing and accompanied with restlessness. 7/3/201658

60. 2- Excitement: It's sever form of hyperactivity excessive purposeless motor activity and the patient may destruct himself or others. b - Compulsion: Uncontrollable impulse to perform an act repetitively. 7/3/201659

61. c- Repetitive Activity 1- Stereotypy: It is a monotonous repetition of certain movement without purpose. 2- Mannerism: It is a repeated movement which isn't monotonous and keeping with the personality character. 7/3/201660

62. 3- Waxy Flexibility: It is the maintenance of imposed postures however abnormal they may be. The absence of fatigue in such cases is remarkable( e.g. raising the heal of the patient from the pillow, or the arm up). 7/3/201661

63. d- Echopraxia Imitating the movements of another person. e- Negativism the patient do the opposite order e.g. schizophrenia pt’s 7/3/201662

64. f- Automatic Obedience The patient do performance of all simple commands g- Impulsiveness Is an action that is sudden, abrupt, unplanned and directed toward immediate gratification (satisfaction). 7/3/201663

65. f- Psychomotor Retardation Extremely slow and different movement that in the extremes can entail complete inactivity and incontinence. 7/3/201664

66. 7/3/201665