This is the study of abnormal states of mind. It is an attempt to understand the disease process of
the mind in terms of signs and symptoms including their causes and how they develop
Two main schools of thought regarding it
1) Dynamic/psychoanalytic2) Clinical/descriptive- puts emphasis on phenomenology ie understanding of mental
phenomenon in terms of signs and symptoms
It is the objective description of abnormal states of mind. It is concerned with the conscious
experiences and observable behaviors and defines the essential qualities of morbid mental
experiences. It includes
Emotion- feeling or response to sensory input from external environment or mental images
*Mood- sustained and pervasive inward subjective feelings. The emotional state subjectively
experienced by the patient. Its influenced by the patient experiences, expectations and presence
of disease. It may be altered by use of psychoactive substances like alcohol and opiates.
Examples of variations in mood include
1) Euthymic mood- is the normal mood
2) Depressed mood- pathological feeling of sadness/low
3) Dyshoric- unpleasant mood/foul
4) Irritable- easily angered, offended
5) Elevated- cheerful, happy mood
6) Euphoric- intense elation of mood
7) Labile- rapid changes in emotions
8) Anhedonia- loss of intense or inability to enjoy previously pleasurable activities
9) Apathy- blunted emotions associated with loss of energy and drive
*Affect- its somatic and behavioral changes i.e. the outward expression of the emotion
Irritable, Labile, appropriate, inappropriate
Blunted- reduction in intensity of outward expression
Flat- no outward signs to express the feelings
DISTURBANCE IN THOUGHT- content, form, alienation/control
A) Disorders of content- delusions, over valued ideas, obssessions etc
*Delusion- a false unshakable belief based on incorrect inference about external reality(firmly
sustained) not consistent with a persons intelligence or cultural belief, cannot be corrected by
reasoning.(the belief is not one ordinarily acceptable by other members of the persons culture or
sub culture eg its not an article of religious faith)
1) Grandiose delusion- inflated self worth, power, knowledge, identity or special relationship to a
deity or famous person
2) Bizzare- involves a phenomenon that the person’s culture would regard as totally implausible
3)Delusional jealousy/infidelity- that one’s sexual partner is unfaithful. *Orthello syndrome
4)Erotomania- that another person usually of higher status is in love with the individual. W>m
5) Persecutory- the central theme is that one(or someone to whom one is close) is being attacked,
harrassed, cheated, persecuted or conspired against. May take legal action or act in defence
6) Somatic- main content pertains to appearance or functioning of one’s body. involves function
of body eg brain is rotten/melting, no stomach,
7) Hypochondriac- belief in one’s illness contraty to medical evidence
8)Nihilistic- extreme pessimism eg that self/others or world is non existent or coming to an end
9)Reference- behavior of others refer to himself , usually of negative nature, connection with
ideas of reference
*Overvalued ideas- false beliefs but less firmly held (shakable) and can be reasoned. They can
occur in normal persons undergoing stressful experiences
*Obsessions - Pathological persistence of an irresistible thought or feeling that cannot be
eliminated from the mind easily. Patient recognizes these as his own thoughts but he cannot get
rid of them e.g. in OCD
B) Disorders of form- flow and structure thoughts
1) Neologism- new words created by a patient or a normal word used to mean a different thing
2) Word salad- several words put together with no clear meaning
3) Echolalia- repetition of words or phrases said by another person tend to be repetitive and
persistent, at times mocking
4) Derailment- gradually deviates in flow of thought without blocking
5) Circumstantial- indirect speech that is delayed in reaching the point but eventually gets from
original point to desired goal. Has over inclusion of details
6) Flight of ideas- rapid thought manifested by fast verbalization and shifting of ideas which tend
to be connected to one another
7) Loosening of association- flow of thought in which ideas shift from one subject to another in a
completely unrelated way. When severe, speech may become incoherent
8) Thought block- sudden interruption in the stream of thoughts before an idea or thought is
10) Clang association- association of words similar in sound but not in meaning. The words have
no logical connection
11) Irrelevant answers- not in harmony with question asked i.e. apparent ignore or not attend to
C) Disorders of alienation/control-The thoughts are controlled by outside forces
1) Thought withdrawal- other people or forces or agents remove one’s thoughts from the mind
2) Insertion- other people or forces are putting thoughts into one’s mind against their wish
3) Broadcasting- one’s thoughts are made known to others without being talked out by the one
4) Thought echo
1) Pressure of speech- talks a lot and rapidly and it may be difficult to follow the speech eg in
2) Poverty- scanty speech eg in psychomotor retardation or depression. Monosyllabic replies
3) Alogia- inability to speak because of mental deficiency or dementia
4) Coprophasia- involuntary use of vulgar or obscene language eg in scz, tourettes disorder
5) Stuttering- frequent repetition or prolongation of a sound or syllable leading to markedly
impaired speech fluency
Perception- process of transferring physical stimulation into psychological information. Mental
process by which sensory stimuli are brought to awareness
Hallucinations vs illusions
*Illusions- arise from false interpretation of stimulus (could be a result of fantasy, intense
emotion, lack of perceptual clarity or disease)
*Hallucination- false sensory perception not associated with real stimulus. It may be in any of
the 5 sensory modalities- vision, touch, taste, smell, sound
1)Visual hallucination-occurs commonly in medical disorders affecting CNS but also in some
psychotic patients
2)Tactile- include false perception of touch(haptic), surface sensation as in amputated
limb(phantom limb) or even crawling sensations on or under the skin(formication). Occurs in
substance abuse as well as other mental illnesses.
3)Olfactory- false smell. Medical conditions mostly
4)Gustatory- false taste. Medical conditions
3 and 4 occur in medical conditions affecting CNS eg epilepsy and other mental illnesses eg
depression, scz
5)Auditory- hears voice/sound without any stimulus. The voices may include animal sounds,
music, conversations between people or with the patient. They could be familiar or unfamiliar to
the patient and could also be derogatory or pleasant. Common in psychotic disorders like scz,
mania, psychotic depression.
Third person auditory hallucination- voices talk among themselves about the patient
Second person- voices talk directly to the patient
Commentary voices-talk/describe what the patient is doing/thinking
Hallucinations may be mood congruent ie consistent with prevailing mood or also incongruent
*Depersonalisation- vs- *Derealization-
Externally observable abnormal behaviors that depict psyche eg motivations, impulses, drive,
instincts, wishes. It may be observed in all forms of mental illness and include;
1)Cataplexy- sudden temporary loss of muscle tone eg in scz, narcolepsy
2)Catalepsy- an immobile position that is constantly maintained for a long time ,
3) Catatonic excitement- purposeless motor over activity which sets on suddenly eg in scz
4) Catatonic stupor- marked slowed motor activity often to the point of immobility ie seeming
unawareness of surrrounding
4) Echopraxia- imitation of one’s movements by another person
5) Mannerism-habitual involuntary movts and attitudes
6) Akathisia- subjective feeling of restlessness and need to keep on moving eg in adverse effects
of antipsychotics
7)Chorea- random and involuntary quick jerking purposeless movements
8) Compulsion- an uncontrollable urge to perform an act repeatedly
Attention- ability to direct one’s activity
Concentration- amount of attention exerted in focusing on certain portions of an experience
Att and conc may be impaired in dissociative states, anxiety states, depressed patients etc
1) Distractability- inability to concentrate ie attention is easily diverted to other activities that are
irrelevant eg in manic states
2) Trance- a dream like state when attention is focused on one thing and the person seems
oblivious of his surrounding eg in hypnosis and dissociative disorders and in ecstatic religious
3) Selective inattention- in which one blocks away from consciousness things that generate
4) Hypervigilance- excessive attention is concentrated on a stimuli. Often secondary to paranoid
and delusional state
Memory-function by which information stored in brain is recalled to consciousness vs
Orientation- normal state of oneself and one’s surrounding in terms of time, place and person
Most affected in medical illness that affect brain eg dementia and other degenerative disorders
Para amnesias- falsification of memory by distortion of recall. may occur in some patients
going thro stressful life experiences eg terminal illness, bereavement, after alcohol abuse eg
Confabulation- unconcious filling of gaps in memory by imagined or untrue experiences that a
person believes but that have no basis in fact
Déjà vu- illusions of visual recognition in which a new situation is incorrectly regarded as a
repetition of previous memory
Jamais vu- false feeling of unfamiliarity with a real situation that a person has experienced
Amnesia- partial or total inability to recall past experiences
Retrograde amnesia-amnesia of events occurring before a point in time
Anterograde amnesia- amnesia of events occurring after a point in time
C- astate of awareness of the self and the environment. Its disturbance are often associated with
apparent brain pathology eg trauma, epilepsy, narcolepsy, CNS infections, tumours. Altered
states of consciousness include
1) Coma- deep/profound unconsciousness
2) Stupor- lack of response and unawareness of surrounding
3) Delirium- dream like change in consciousness often accompanied by an impaired reality
testing. Patient may be anxious, restless, confused, hallucinations
4) Drowsiness- state of impaired awareness associated with a desire or inclination to sleep
5) Somnolence- abnormal drowsiness