2 phenomenology

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Phenomenology

Dr. Mahmoud Bashtawi


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Definition

The study of events, either psychological or

physical.

In psychiatry, it involves the observation and categorization of

abnormal psychic events, the internal experiences of thepatient and his consequent behavior.

or what you call it Psychopathology ;the signs and symptoms

of psychiatry.


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Psychopathology

The study of phenomena of mental illness :

abnormal thoughts, feelings, perceptions and

cognitions. Descriptive psychopathology aims

to describe such phenomena. Psychodynamic

psychopathology aims to describe and

explain causes of abnormal mental

phenomena using psychoanalytic theories.


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Classification of signs and symptoms in

Psychiatry

Disorders of Perception

Disorders of Thinking

Disorders of Mood Disorders of Cognition


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Perception

the awareness of objects and interpretation

of sensoryinformation;i.e. awareness of what

is presented through the sense organs.

Imagery: A sensory experience over which the

subject has voluntary control and experiences

as taking place within the mind.
http://en.wikipedia.org/wiki/Sensory_systemhttp://en.wikipedia.org/wiki/Informationhttp://en.wikipedia.org/wiki/Informationhttp://en.wikipedia.org/wiki/Sensory_system


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illusion

Hallucination

Depersonalization

Derealization


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Illusions

Illusions

misperceptions of external stimuli

conditions more likely to occur:

reduced level of sensory stimulation (e.g. at dusk)

reduced level of consciousness (e.g. delirious pts.)

when attention is not focussed on the sensory modality

(e.g. in darkness)

when there is a strong affective state (e.g. stressed and

anxiety)


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Hallucinations

sensory perception without an objective stimulus but

with a similar quality to a true percept.

can be of all sensory modalities:

visual , auditory , somatic ,gustatory and olfactory


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Auditory hallucinations

Voices Single or multiple

Male or female

Known or unknown person

person 1st person: thought echo - hearing own thoughts spoken aloud.

2nd person: calling patient by you

3rd person: calling patient by he or she

Voices Commanding, running commentary or arguing with each other

Timing: day , night or all the time.

continuous or intermittent.

Theme: friendly or derogatory


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Hallucinations

Visual Hallucinations: commonly associated withorganicity.

Olfactory and gustatory hallucinations

often experienced together often unpleasant in nature

common in temporal lobe epilepsy

Somatic (tactile and deep)

tactile (haptic): touched, insect crawling under the skine.g. formication in cocaine abuse

deep sensation: e.g. viscera being pulled out, sexualstimulation, electric shock


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Hallucinations

Extracampine hallucinations:

perceiving a sensation from beyond the limits of the sense

organ

e.g. visions from outside visual field, hearing voices from far

away

Reflex hallucinations:

stimulus in one sensory modality causing a hallucination in a

different sensory modality

e.g. music causing visual hallucination (LSD abuse)

Hypnogogic and hypnopompic hallucinations

occurs at the point of falling to or waking from sleep

usually brief and elementary


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Depersonalization: a feeling that his body parts

are abnormal, unreal

e.g. my brain or my head becomes big until it fills the

room Derealization: a feeling that the external

environment is abnormal, unreal

Patient describe things in his surrounding that are

artificial and lifeless

both can occur in tiredness, TLE, depression etc.


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Thought disorders

Thought disorder(TD) or formal thoughtdisorder(FTD) occurs when an individual hasserious problems with thinking, feelings, and

behavior. Thinking : a goal directed flow of ideas initiated by a task leading to

a reality orientated conclusion

components of thinking:

Flow or ( stream ) of thought

Form of thought

content

possession


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Disorders of flow(stream) of thoughts

1-Preasure of thought: increase amount and

speed of speech; we can not interrupt or stop

the patient because he has many thoughts in

his mind (we see this in mania).


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Disorders of flow(stream) of thoughts

2-poverty of thoughts: the has very few

thoughts and pass slowly through his mind;

(we see this in depression).

3-Thought blocking: Sudden interruption of

the flow of thoughts in which the patient

experiences as his mind going blank or his

mind is empty(we see this in schizophrenia).


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Formal thought disorders

-loosening of association:There is a breakdown in thenormal structure of thinking in which ideas shift fromone subject to another in completely unrelated way.

- derailment: transition from one topic to another with

no logical connection between the two- flights of ideas: the patients thoughts move rapidly

from one idea to another, each idea being more orless meaningfully related to the preceding idea.characteristic of mania .

- perseveration: Giving a response beyond the point ofrelevance i.e. same answer to each question(stimulus)


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Formal thought disorders

-Word salad: severe form of derailment affecting the grammatical structure of

speech.

-Circumstantialities: going round and round before finally reaching the point.

- Tangentiality

Inability to have goal directed association of thoughts, he never gets from

points to desired goals.

-Echolalia

The patient repeats apart or the whole of what have been said to him

-neologism:

new words invited by the patient


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Disorders of content of thought

Delusion:

False fixed unshakeable belief, inappropriate to a persons

educational and social background.

Over-valued ideas:

ideas held with a lot of emotion (highly charged) but with

some degree of ambivalence and doubts about the belief.

Pre-occupation:

ideas which comes to mind, again and again and may preventthe patient from performing his day to day activities


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Classification of delusions

According to special features:

Systematised delusion:

chronic, presence of nucleus, well knitted, inter-connected,

layered and well-encapsulated.

Non-systematised delusion

Shared delusion:

folie a deux(two person, including patient)

folie a mass(> than two person)


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Themes of delusion

(According to theme)

Persecutory (paranoid):

others trying to inflict harm on him

Delusion of Reference:

idea that objects, events or people have a personalsignificance for patient e.g. TV programmes, news

Grandiose (expansive):

beliefs of exaggerated self-importance

e.g. wealth, special powers, beauty

Religious:

delusions with religious content

e.g. chosen to be prophet, communicating directly to God


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Themes of delusion

-De Clerambaults Syndrome

being lovedby a man who is inaccessible, high status, never

spoken before, unable to reveal his love for her

-Delusion of Jealousy:

common in men

delusion of unfaithfulness of spouse (infidelity)

spying, checking on spouse, examine for sexual

secretions


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Themes of delusion

Delusion of Guilt and Worthlessness:

e.g. minor past faults will be exposed, being sinful,

deserves to be punished

Nihilistic Delusion belief about non-existence

CotardsSyndrome: failures of bodily functions e.g.

bowels are rotting etc.

Hypochondriacal Delusions

belief of ill health despite contrary medical evidence


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Other disorders of thought Content

Obsessions: recurrent persistent thoughts, impulses or images that

enter the mind despite efforts to exclude them

subjective sense of struggle to resist them

recognized as his own

regarded as untrue and senseless

Compulsions:

repetitive, purposeful behaviours performed in astereotyped way, accompanied with subjective sense thatit must be carried out and an urge to resist

most common: cleaning, counting, dressing


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Disorders of thought possession

Thought Insertion:

delusion that some thoughts have been implanted by

outside agency

Thought Withdrawal: delusion that thoughts have taken out of his mind

Thought Broadcasting:

delusion that his unspoken thoughts are known to

other people


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Emotion

Affect: a feeling-tone that accompanies an idea; observed expression of emotion; may beinconsistent with patient's description of emotion

Appropriate affect

- Inappropriate affect:

- Restricted or constricted affect: reduction in intensity of feeling tone less severe thanblunted affect but clearly reduced

- Blunted affect: a disturbance in affect manifested by a severe reduction in theintensity of externalized feeling

tone

Flat affect: absence or near absence of any signs of affective expression; voicemonotonous, face immobile

Labile affect: rapid and abrupt changes in emotional feeling tone, unrelated toexternal stimuli


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Emotion

B. Mood: a pervasive and sustained emotion, subjectively experienced and reported by

the patient and observed by

others; examples

1. Euthymic mood: normal range of mood, implying absence of depressed or

elevated mood

2. Euphoria: intense feeling of well being

3. Elation: intense feeling of well being with exaggerated motor activity

5. Expansive mood: expression of one's feelings without restraint, frequently with anoverestimation of one's significance or importance


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Mood

6. Ecstasy: felling of intense rapture

7. Dysphoric mood: an unpleasant

mood

8. Anhedonia: loss of interest in andwithdrawal from all regular and pleasurable

activities, often associated with depression


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Other emotions

Anxiety: feeling of apprehension caused by anticipation of danger,which may be internal or external

2 Fear: anxiety caused by consciously recognized and realistic danger

3 Agitation: severe anxiety associated with motor restlessness

4 Panic: acute, episodic, intense attack of anxiety associated withoverwhelming feelings of dread and autonomic

discharge

5 Ambivalence: coexistence of two opposing impulses towardthe same thing in the same person at the same time


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Motor behavior

Echopraxia: pathological imitation of movements of one person byanother

Catatonia: motor anomalies (stupor or excitement) in some disorders

Catalepsy: general term for an immobile position that is constantlymaintained

Catatonic excitement: agitated, purposeless motor activity,uninfluenced by external stimuli

Catatonic stupor: markedly slowed motor activity, often to a point ofimmobility and seeming unawareness ofsurroundings


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Catatonic symptoms

catatonic stupor= markedly slowed motor activity,often to a point of immobility

catatonic excitement= agitated, purposeless motoractivity

catatonic posturing= voluntary assumption of aninappropriate or bizarre posture

echopraxia= pathological imitation of movements

stereotypy= repetitive fixed pattern of physical action

mannerism= habitual involuntary movement

command automatism= automatic following ofsuggestions

2 phenomenology

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