04/04/1438
Mental State Examination
(Brain stethoscope)
Mental State Examination
(Brain stethoscope)
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Sensorium & cognitive functions
Level of consciousness
Orientation
Attention
Concentration
Memory
Knowledge
Intelligence
Capacity for abstract thinking
• Perception
o Disorders of sensory input
(hallucinations and illusions)
o Altered bodily experiences
(depersonalization and derealization)
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Thinking
Speech
Thought content
Thought form
Suicidal or homicidal ideation
Insight & judgment
• Feeling
o Affect
o Mood
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Behavior
Appearance
Agitation or retardation
Cooperation
04/04/1438
Mental State Examination
(Brain stethoscope)
• ABC STAMP LICKER
• Appearance
• Behavior
• Cooperation
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Speech
Thought
Affect
Mood
Perception
Level of Consciousness
Insight & judgment
Cognitive functions
Knowledge
Endings (suicidal or
homicidal)
• Reliability
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Mental State Examination
(Brain stethoscope)
!! ﺣﺎﺟﺔ ﺑﺑﻼش ﻛدة
• “Free” Parameters
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Level of consciousness
Appearance
Behavior
Cooperation
Reliability
Affect
Thought form
04/04/1438
Mental State Examination
(Brain stethoscope)
• Parameters “to ask”
!! ﺷﺧﻠل ﻋﺷﺎن ﺗﻌدي
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Orientation
Cognitive Functions
Suicidal/homicidal
Knowledge
Perception
Mood
Thought content
Mental State Examination
(Brain stethoscope)
• Take the opportunity when the chance arises in
the interview to ask about MSE.
• Take notes of key points that allow a smooth
transition back to these items,
just remember to ask about them later.
• Ask about the areas that remained unexamined
at the end of interview.
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04/04/1438
Integration between Hx & MSE
Psychiatric History
Identifying Data & CO
MSE component
Appearance
Behavior
Orientation
Level of consciousness
Integration between Hx & MSE
Psychiatric History
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MSE component
History of present illness
Cooperation
(5-10 minutes) of unstructured
speech using open-ended questions
and other facilitation techniques
Thought form
Thought content (what concerns
the patient)
04/04/1438
Integration between Hx & MSE
Psychiatric History
MSE component
Exploration of symptoms from HPI
Affect
More focused assessment using
closed-ended questions to get specific
data.
Mood
Suicidal/Homicidal ideation
Cognitive testing (concentration)
Integration between Hx & MSE
Psychiatric History
Direct testing of other MSE
components
MSE component
General knowledge
Perception
Unexamined areas
Insight & judgment
Formal cognitive testing
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04/04/1438
Mental State Examination
(Brain stethoscope)
• ABC STAMP LICKER
• Appearance
• Behavior
• Cooperation
Speech
Thought
Affect
Mood
Perception
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Level of Consciousness
Insight & judgment
Cognitive functions
Knowledge
Endings (suicidal or
homicidal)
• Reliability
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Appearance
• Not just an accurate record, but to convey to others as
closely as possible what it was like to see the persons.
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7.
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Gender & cultural background
Actual & apparent age
Attire
Grooming & hygiene
Body habitus
Physical abnormalities
Jewelry & cosmetics
Other features (tattoos, body piercing, scars,..etc)
04/04/1438
Appearance
Gender & cultural background
Appearance
Actual & Apparent Age
• Appears his or her stated age
• Appears younger / older than the stated age.
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04/04/1438
Appearance
Actual & Apparent Age
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Appears his or her stated age
Appears younger / older than the stated age.
Factors:
Serious & prolonger physical illness.
Exposure to elements / homeless
Substance abuse
Chronic or sever psychiatric disorder.
Appearance
Attire
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How patients are dressed.
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How they presented
themselves for the
interview.
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Reflection of many factors
(socioeconomic, occupation,
self-esteem, …etc)
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Circumstances of interview
(inpatient & outpatient)
04/04/1438
Appearance
Grooming & Hygiene
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Hair, facial hair, skin
condition, nails, body
odor, oral hygiene,
clothing
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Disheveled ﺷﻛﻠﮫ ﻛﻠﮫ ﻣﺑﮭدل
Unkempt , ﺷﻌره ﻣﻧﻛوش
ﺳﺎﯾب دﻗﻧﮫ
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Immaculately >> neatly >>
adequately >> poorly
groomed
Appearance
Grooming & Hygiene
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OCD >> Skin damage
OCD, narcissistic >> details
Delusional disorder >> less grooming
Chronic illness >> neglected
04/04/1438
Appearance
Body Habitus
• Patient’s built & body type
ھزﯾل • Ectomorphic >> Thin or slight
ﻗوي • Mesomorphic >> muscular
ﺑدﯾن -ﺑﻛرش • Endomorphic >> Heavy
• Truncal obesity, wasting of limbs, acsitis.
Appearance
Physical Abnormalities
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ﻓﯾﮫ ﺑﻌض اﻷﻣور ﺗﺑدو ﺣﺳﺎﺳﺔ ﻟﻛﻧﮭﺎ ﻣﮭﻣﺔ و ﻣﺣﺗﺎج أﻋرف ﻣﻧك ﺑﻌض
اﻟﻣﻌﻠوﻣﺎت ﺑﺧﺻوﺻﮭﺎ.
•
إﻋﺎﻗﺔ إﯾدﯾك اﺗوﻟدت ﺑﯾﮭﺎ و ﻻ ﺣﺻﻠت ﺑﻌد ﻛدة؟
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إﯾﮫ اﻟﺻﻌوﺑﺎت اﻟﻠﻲ واﺟﮭﺗك ﻣﻌﺎھﺎ ﻋﻠﻰ ﻣدار ﻛﺑراﻧك؟
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ده ﺣﺻل إزاي؟
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اﻟﻣوﺿوع ده ﺑﯾﺻﻌب ﻋﻠﯾك إﯾﮫ أو ﺑﯾﻌوﻗك ﻋن ﺣﺎﺟﺎت ﻣﻌﯾﻧﺔ ﻋﺎوز ﺗﻌﻣﻠﮭﺎ؟
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و ﺑﺗﻌﻣل إﯾﮫ ﻣﻊ ده؟
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04/04/1438
Appearance
Jewelry & cosmetics
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How patients see
themselves, what they
consider important
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Psychotic >> bizarre make-up
Personality D >> lavish
Schizophrenic & delusional >>
amulets
Appearance
Tattoos
• و ﻋﺎﻣل رﺳوﻣﺎت و ﺣرﻛﺎت !! ده إﯾﮫ ده؟
• ﻣﻌﻧﺎه إﯾﮫ؟ ﺑﻘﺎﻟك ﻛﺗﯾر ﻋﺎﻣﻠﮫ؟
!!• و إﺷﻣﻌﻧﻰ ﺳوﺳن ﺑﻘﻰ؟
• ﺣﺎوﻟت ﻗﺑل ﻛدة ﺗﺷﯾﻠﮫ أو ﺣﺳﯾت إﻧك ﻋﺎوز ﺗﺷﯾﻠﮫ؟ ﻟﯾﮫ؟
ﻋﻣﻠت إﯾﮫ و ﺷﯾﻠﺗﮫ إزاي؟
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04/04/1438
Appearance
Sample
• Ms. S.D.’s appearance was that of a woman
who looks her stated age and is dressed in
mismatched clothes consisting of a suit
jacket and hiking boots.
• Mr. Ahmed appears older than his stated age
dressed in a housecoat and slippers. He is
thin, has odor of poor hygiene and has old
scars visible on his left wrist and forearm
Behavior
• General
• Specific
• Agitation
• Hyperactivity
• PM retardation
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Increased
Decreased
WNL
Concious voluntary mov.
Unconcious voluntary mov.
Involuntary mov.
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Akathisia
Automatism
Catatonia
Choreoathetoid
Compulsions
Dystonia
EPS
Tardive dyskinesia
Tics
Tremors
-ve symptoms
04/04/1438
Behavior
Agitation
• Restlessness >>> sense of
tension
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Hand wringing
Finger tapping
Fidgeting
Foot tapping
Rhythmic leg movement
Frequent shifts in posture
Frequent shifts in focus of
attention
Behavior
Hyperactivity
• ↑ level of physical energy.
• Absence of inner tension.
• Usually goal directed.
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04/04/1438
Behavior
Psychomotor retardation
• ↓ voluntary and
involuntary movements.
• ↓ Initiation >>execution
>>completion
• Exclusion:
o Indecisiveness
o Poor concentration
o Depression >> retarded
depression
o Schizophrenia >> -ve
symptoms
o Medication side effects >>
antipsychotics
o Catatonia
o Dementia
o General medical conditions
Behavior
Akathisia
• Side effect of psychiatric
medication
• Neuroleptic induced
• Pt moves their legs
rhythmically
• Get up and walk around the
room
• Rocking >> fidgeting >> pacing
>> feel forced to keep moving
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04/04/1438
Behavior
Automatisms
• Involuntary movements
• Simple to complex
• Common with epileptic
seizures (partial complex)
• Occur during altered state of
consciousness
• Pt may be partially aware of
surroundings
Lip smacking
Uttering words
Fumbling with clothing
Eye blinking or staring
Behavior
Catatonia
• WRENCHES
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Weird movements
Rigidity
Echopraxia
Negativism
Catalepsy
High level of motor activity
Echolalia
Stupor
Demo
04/04/1438
Behavior
choreoathetoid movements
Behavior
Compulsions
• Unwanted act (egodystonic)
• Patient has insight towards them.
• Purposeful or semi-purposeful.
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Performed to ↓ anxiety.
Performed consciously
Stereotyped (repeated)
Ritualized (same way )
Usually linked to obsessions.
04/04/1438
Behavior
Dystonia
• Involuntary increase in muscle
tone.
• Sustained torsion or
contraction of muscles
• Requires immediate
intervention
• Lead to non compliance
Occulogyric crisis
Torticollis
Opisthotonos
laryngospasm
Behavior
EPS
• Dystonic reaction (hours to days)
• Akathisia (hours to weeks)
• Bradykinesia or akinesia (days to
weeks)
• Rigidity (days to weeks)
• Tremors (weeks to months)
• Pisa and rabbit syndrome
(months to years)
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04/04/1438
Behavior
tardive dyskinesia
• Involuntary movement.
• Prolonged use of neuroleptics.
• Delayed onset
• Facial & oral 75%
• Extremities 50%
• Trunk 25%
Behavior
Tics
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Involuntary
Sudden
Rapid
Recurrent
Non rhythmic
Stereotyped
Irresistible
Movements or vocalizations
04/04/1438
Behavior
Tremors
• Regular
• Rhythmic
• Oscillations
• Some part of the body
• Causes:
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Stress induced (anxiety D)
Strong emotions
Fatigue
Hypothermia
Nueroleptics, TCAs, SSRIs
Behavior
Sample
• She refused seating and speaking only if she
was allowed to walk around the room. She
rummaged through her purse at the beginning
of interview and wrote several lists of reminders
of time
• He sat in an immobile position with his hands at
his sides and his head slumped forward on his
chest. He mad no spontaneous movement
during the interview.
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04/04/1438
إﻋﻼن ﻏﯿﺮ ﻣﺪﻓﻮع اﻷﺟﺮ
Cooperation & reliability
• Cooperation: quantity of information given.
• Reliability: quality of data obtained.
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6.
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Eye contact
Attitude
Attentiveness
Level of consciousness
Affect
Secondary gain
04/04/1438
Cooperation & Reliability
eye contact
• Universal indicator that someone
is interested.
• Continued eye contact indicates
cooperativeness.
• Continuous >> good >>
intermittent >> fleeting >> absent
Cooperation & Reliability
Attitude
• Cooperative:
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Obsequious ﻣﺟﺎﻣل ﺑﺈﻓراط
Effusive ﻣﻧﻔﺗﺢ اﻟﻘﻠب
Seductive ﻣﻐوي
Flattering ﻣداھن
Charming ﻓﺎﺗن
Over-inclusive ﺗﻔﺎﺻﯾل- ﺷﻣوﻟﻲ
Controlling ﻣﺳﯾطر
• Uncooperative
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Hostile ﻋﻧﯾف
Defensive دﻓﺎﻋﻲ
Suspicious ﺷﻛﺎك
Guarded ﺣذر
Antagonistic ﻣﻌﺎدي- ﻣﺧﺎﺻم
Critical ﻧﻘدي
Childish طﻔوﻟﻲ
Regressed ﻧﻛص
Sullen ﻣﺗﺟﮭم
Withdrawn اﻧﻌزاﻟﻲ
04/04/1438
Cooperation & Reliability
attentiveness
• Inattentive
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BPD >> get bored
Mania >> distractible
Delirium >> drifting
OCD >> rituals & anxiety
Psychosis >> Hs & Ds
• ↓A en on span
• Being preoccupied
• ↓ LOC
• Distraction by activity in
interview
• Sudden shifts in affect or
mood.
Cooperation & Reliability
Level of Consciousness LOC
• Degree of alertness
• Level of arousal
• Important to be included
early in interview
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04/04/1438
Cooperation & Reliability
Affect
• Observable quality of
emotional state
• Mood & Affect
• Moment to moment
variability of visible
emotions.
• Range of reactions to
questions.
Cooperation & Reliability
2ry gain
• Actual or external advantage
from being ill
• Being relieved of occupational
responsibility
• Obtaining prescription
medication
• Avoiding military service
• Gaining in personal relationships
• Postponing exams
• Transfer out of jail
• Shelter or food
• Financial gain
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04/04/1438
Cooperation & Reliability
Sample
• She was superficially cooperative and said she’d
talk as long as she could make her lists and if
the interview didn’t last for more then 10
minutes. She was considered reliable, but
biased towards minimizing the details of her
activities.
• He was uncooperative and he said he wanted to
be left alone. The information he shared didn’t
seem to be reliable.
Speech
speech
language
Though
process
Speech: verbal expressions
(words, phrases &
sentences)
Language: communication of
ideas (speech, posture,
expressions, actions
{semantics & articulation}
Though process: the way ideas
are produced
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04/04/1438
Speech
• Comprehension: tested
by ability to follow simple
to complex request.
• Amount
• Repetition: tested by
simple and complex
phrases.
• Articulation
• Pitch
• Modulation
• Naming: tested by
common and uncommon
objects
Speech
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Accent: terms describe cultural and
regional differences in
pronunciation.
Spontaneity: degree of
engagement in interview.
Latency: time interval to answer
questions
• Rhythm:
Stuttering اﻟﺗﻌﻠﺛم – اﻟﺗﻣﺗﻣﺔ
Hard to say 1st sound of word
Cluttering ﻣﺷوش – ﻣﻠﺧﺑط
Bursts of rapid speech containing
errors
Scanning ﻣﺳﺢ ﺑطﻲء
Irregular pauses “scanned”
Inflection اﻟﺗواء – اﻧﺛﻧﺎء – ﺗﻐﯾر ﻓﻲ ﻣﻘﺎم
اﻟﺻوت
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04/04/1438
Speech
Sample
• Her speech was loud, rapid and pressured, but
remained understandable and had proper
syntax. Prosody was exaggerated regardless of
the content.
• His speech was fluent and syntactically correct.
There was latency of several seconds before
replying to questions. He spoke in a
monotonous manner with no variability or
prosody.
Thought form and process
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The way ideas are organized
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How patient communicates
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Degree of connection between ideas and flow of
thought
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Assessed through (speech, language, written
materials and behavior)
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Better to be assessed via open ended questions
04/04/1438
Thought form and process
• Goal Directed, succinct reply gets to the point
Question
The path the patient takes to
answer the question
Answer
Goal
Thought form and process
• Circumstantial thought
Question
Answer
Goal
contains excessive amount of details,
but finally reach the point
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04/04/1438
Thought form and process
• Tangential thought
Answer
Goal
Question
Replies are approximately right,
but not exact
Thought form and process
• اﺷﺗرﯾت ﻋرﺑﯾﺗك ﻣﻧﯾن؟
tangential
circumstantial
أﻧﺎ ﻛﻧت راﺟﻊ ﻓﻲ ﻣرة ﻣن
ﻋرﺑﯾﺗﻲ 4ﺳﻠﻧدر ,و
اﻟﺷﻐل و اﻟﻣواﺻﻼت ﻛﺎﻧت
اﺳﺗﮭﻼﻛﮭﺎ ﻟﻠﺑﻧزﯾن ﻣﻌﻘول ,
ﺑﺗﺳﺎﻋدﻧﻲ ﻛﺗﯾر ﻓﻲ اﻟﺳﻔر ﻷن زﺣﻣﺔ و ﺣﺻﻠت ﺧﻧﺎﻗﺎت ﻛﺗﯾر
ﺷﻐﻠﻲ ﺑﯾﺧﻠﯾﻧﻲ أﺳﺎﻓر ﻛﺗﯾر و ﻓﻘﻠت ھوا أﻧﺎ ﻟﯾﮫ زاﻧﻖ ﻧﻔﺳﻲ
أﻧﺎ ﻛﻣﺎن ﺳﺎﻛن ﺟﻧب اﻟطرﯾﻖ ﻋﻠﻰ اﻟﻣواﺻﻼت ,طب ﻣﺎ
اﺷﺗري ﻋرﺑﯾﺔ ,ﻓﺷوﻓت ﻣﻌﺎﯾﺎ
اﻟﺳرﯾﻊ ﻓﺳﮭل ﻟﯾﺎ اﻟﺣرﻛﺔ و
ﻋﺎﻣل ﺑﻘﻰ ﺟراج ﺻﻐﯾر ﺗﺣت ﻓﻠوس ﻗد إﯾﮫ و رﺣت
اﻟﻣﻌرض اﻟﻠﻲ ﻓﻲ وﺳط اﻟﺑﻠد
اﻟﺑﯾت ﺑﺎﺣطﮭﺎ ﻓﯾﮫ.
و اﺷﺗرﯾﺗﮭﺎ.
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04/04/1438
Thought form and process
Thought form and process
• Flight of ideas
Question
Answer
Goal
Non-goal directed speech
Changes topic frequently
Often prompted by a word in a previous sentence
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04/04/1438
Thought form and process
• ﺗﻌرف إﯾﮫ اﻷﻓﻼم اﻟﺟدﯾدة ﻓﻲ اﻟﺳوق؟
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أﻧﺎ ﻣﺎﻟﯾش ﻓﻲ اﻟﺳﻧﯾﻣﺎ و ﻻ اﻟﺗﻠﯾﻔزﯾون ,
ﺗﻠﯾﻔزﯾون اﻟﺑﯾت ﺑﺎظ و ﺑﻌﺗﮫ ﯾﺗﺻﻠﺢ ﻋﻧد اﻟﻣﮭﻧدس ,
ﻛﻠﯾﺔ اﻟﮭﻧدﺳﺔ ﺻﻌﺑﺔ و ﺑﺗﺣﺗﺎج ﻣﺟﮭود و ﻗوة ,
أﻧﺎ ﻻزم أﻟﻌب رﯾﺎﺿﺔ ﻛل ﯾوم اﻟﺻﺑﺢ ﻷن دي ﺣﺎﺟﺔ ﻣﮭﻣﺔ ﻟﻠﺟﺳم,
أﻧﺎ ﺑﺎﺣﺎﻓظ ﻋﻠﻰ ﻧﻔﺳﻲ ﻣن أي ﺣﺎﺟﺔ ﺗﺄذﯾﻧﻲ ,
ﻣن ﯾوﻣﯾن ﻓﯾﮫ ﻧﺣﻠﺔ ﻗرﺻﺗﻧﻲ ﻓﻲ ﺻﺑﺎﻋﻲ ,
أﻧﺎ ﺑﺣب آﻛل اﻟﻌﺳل و ﺑﺎﺧد ﻣﻌﻠﻘﺔ ﻛل ﯾوم ع اﻟﻔطﺎر ,
اﻟﻔطﺎر ده أھم وﺟﺑﺔ ﻓﻲ اﻟﯾوم ,
زي اﻟﻧﮭﺎردة ﻣن 5ﺳﻧﯾن ﺑﻧﺗﻲ ﻧﺟﺣت ﻓﻲ اﻹﺑﺗداﺋﯾﺔ.
Thought form and process
• ﺗﻌرف إﯾﮫ اﻷﻓﻼم اﻟﺟدﯾدة ﻓﻲ اﻟﺳوق؟
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أﻧﺎ ﻣﺎﻟﯾش ﻓﻲ اﻟﺳﻧﯾﻣﺎ و ﻻ اﻟﺗﻠﯾﻔزﯾون ,
ﺗﻠﯾﻔزﯾون اﻟﺑﯾت ﺑﺎظ و ﺑﻌﺗﮫ ﯾﺗﺻﻠﺢ ﻋﻧد اﻟﻣﮭﻧدس ,
ﻛﻠﯾﺔ اﻟﮭﻧدﺳﺔ ﺻﻌﺑﺔ و ﺑﺗﺣﺗﺎج ﻣﺟﮭود و ﻗوة ,
أﻧﺎ ﻻزم أﻟﻌب رﯾﺎﺿﺔ ﻛل ﯾوم اﻟﺻﺑﺢ ﻷن دي ﺣﺎﺟﺔ ﻣﮭﻣﺔ ﻟﻠﺟﺳم,
أﻧﺎ ﺑﺎﺣﺎﻓظ ﻋﻠﻰ ﻧﻔﺳﻲ ﻣن أي ﺣﺎﺟﺔ ﺗﺄذﯾﻧﻲ ,
ﻣن ﯾوﻣﯾن ﻓﯾﮫ ﻧﺣﻠﺔ ﻗرﺻﺗﻧﻲ ﻓﻲ ﺻﺑﺎﻋﻲ ,
أﻧﺎ ﺑﺣب آﻛل اﻟﻌﺳل و ﺑﺎﺧد ﻣﻌﻠﻘﺔ ﻛل ﯾوم ع اﻟﻔطﺎر ,
اﻟﻔطﺎر ده أھم وﺟﺑﺔ ﻓﻲ اﻟﯾوم,
زي اﻟﻧﮭﺎردة ﻣن 5ﺳﻧﯾن ﺑﻧﺗﻲ ﻧﺟﺣت ﻓﻲ اﻹﺑﺗداﺋﯾﺔ.
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04/04/1438
Thought form and process
• Flight of ideas
Thought form and process
• Rambling ﺗﺧرﯾف – ﺗﺷﺗت
ﺑس ﻣﺎﻟﮭﺎش دﻋوة ﺑﺎﻟﻣوﺿوع... ﻛل ﻣﺟﻣوﻋﺔ ﺟﻣل ﻛوﯾﺳﺔ
Answer
Goal
Question
Clusters of related sentences
Sentences are goal directed
Loosely associated statements
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04/04/1438
Thought form and process
• Loose Associations
• No logical connections between the sentences
أﻧﺎ ﻣﺎﻟﯾش ﻓﻲ اﻟﺳﻧﯾﻣﺎ و ﻻ اﻟﺗﻠﯾﻔزﯾون ,
ﻛﻠﯾﺔ اﻟﮭﻧدﺳﺔ ﺻﻌﺑﺔ و ﺑﺗﺣﺗﺎج ﻣﺟﮭود و ﻗوة ,
أﻧﺎ ﺑﺎﺣﺎﻓظ ﻋﻠﻰ ﻧﻔﺳﻲ ﻣن أي ﺣﺎﺟﺔ ﺗﺄذﯾﻧﻲ ,
أﻧﺎ ﺑﺣب آﻛل اﻟﻌﺳل و ﺑﺎﺧد ﻣﻌﻠﻘﺔ ﻛل ﯾوم ع اﻟﻔطﺎر ,
زي اﻟﻧﮭﺎردة ﻣن 5ﺳﻧﯾن ﺑﻧﺗﻲ ﻧﺟﺣت ﻓﻲ اﻹﺑﺗداﺋﯾﺔ.
Thought form and process
Answer
Goal
Question
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04/04/1438
Thought form and process
• Thought Blocking:
Having an idea removed from consciousness or losing one’s train
of thought.
• Thought Derailment:
Speech begins again after an episode of thought blocking.
After few seconds, but on a different topic.
• اﻟﻣواﺻﻼت ﻛﺎﻧت ﺳﮭﻠﺔ و اﻧﺗﺎ ﺟﺎي؟
ﻣوﺳم اﻟﺻﯾف ﺑﻘﻰ و ﻓﯾﮫ ﻧﺎس, ﻛﺎﻧت ﻣﻌﻘوﻟﺔ ﺑس زﺣﻣﺔ أوي, • ﯾﻌﻧﻲ
. أﻧﺎ ﻻزم أﺑﻌت اﻟﺗﻘرﯾر اﻟﻧﮭﺎردة ﺑﺎﻟﻠﯾل......... ﻛﺗﯾرة ﺟﺎﯾﺔ ﻋﺷﺎن
Thought form and process
• Fragmentation اﻟﺗﻛﺳﯾر
• Words are intact / phrases are disconnected
... اﻷﻏﻧﯾﺔ اﻟﻠﻲ ﻛﺎﻧت... راﺣم اﻟﻧﮭﺎردة.... ﻓﯾن اﻟـ... أﻧﺎ ﻋﺎﯾز
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04/04/1438
Thought form and process
• Verbigeration (palilalia) ﺛرﺛرة ھزﯾﺎﻧﯾﺔ
• Repetition of words and phrases
إﻧﺗﺎ ﺟﺎي ﻣﻊ ﻣﯾن؟
ﻣﻊ... ﻣﻊ.. ﺟﺎي ﻣﻊ...... ﻣﻊ.. ﻣﻊ.. أﻧﺎ ﺟﺎي ﻣﻊ
Thought form and process
• Jargon ﻟﮭﺟﺔ ﻏرﯾﺑﺔ
• Syntax is intact / speech is meaningless
و اﻟدراﺳﺔ ﻓﻲ اﻟﻣدرﺳﺔ ﻛﺎﻧت ﻛوﯾﺳﺔ؟
ﻓﻲ أﯾﺎم اﻟﻌرﺑﯾﺔ, ﻣﺑﺎديء ﻋﺷﺎن ﺗروح, اﻟﺷﻔﺎﻓﯾﺔ ﻣﺣﺗﺎﺟﺔ ﺗﺑﻘﻰ
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04/04/1438
Thought form and process
• Word salad
• Words are intact / all syntax is lost
• Extreme form of loose associations
• Words have no connection
أﺧﺑﺎر اﻟﺷﻐل إﯾﮫ؟
إﻣﺗﻰ.. ﻣش.. ﻷ.. ﻓﯾن.. ﻟﻛن.. ﻛﺎن.. ﻣﻣم
Thought form and process
other disorders
• Punning (اﻟﺗﻼﻋب ﺑﺎﻟﻛﻠﻣﺎت )اﻟﺗورﯾﺔ
• Double meanings or similar sounding-words
ﺟﮫ اﻟدﻛﺗور __ ﺟدك طور
اﻟﺳﻼم ﻋﻠﯾك __ اﻟﺳﺎم ﻋﻠﯾك
ﻓﻣﺎ ﺑﺎل ﺷوﻗﻲ اﻟﯾوم أﺻﺑﺢ ﺑﺎردا... ﯾﻘوﻟون أن اﻟﺷوق ﻧﺎر و ﻟوﻋﺔ
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04/04/1438
Thought form and process
other disorders
•
•
•
•
Clang associations (اﻟرﻧﺔ )اﻟوزن و اﻟﻘﺎﻓﯾﺔ
Based on sound not syntax.
Rhythming the last word in a sentence.
Most commonly seen in mania
و ﻧﺎﻛل.. زي اﻟﻌﺻﺎﻓﯾر.. • ھﻧﻘﻌد ﺷوﯾﺔ ﻧﺎﻛل ﻟﻘﻣﺔ و ﻧطﯾر
و ﻧﺷرب ﻋﺻﯾر.. ﻓطﯾر
إﻓﯾﮭﺎت ﻧﻔس اﻟوزن و اﻟﻘﺎﻓﯾﺔ
Thought form and process
other disorders
• Echolalia اﻟﺻدى
• Automatic repetition of
interviewer’s speech
• ﻋﻧدك ﻛﺎم ﺳﻧﺔ؟
• ﻛﺎم ﺳﻧﺔ
45
• Perseveration اﻟﻣﺣﺎﻓظﺔ
• Automatic repetition of
a verbal response
despite changing
questions
04/04/1438
Thought form and process
other disorders
• Neologismﺗﻌﺑﯾر ﺟدﯾد
• Important to ask about neologism to
understand …. Don’t miss it
Thought form and process
Sample
• Connections were generally logical. On 2
occasions she was unable to repeat
questions posed to her or to relate
connection between them and what she was
saying.
• Intermittent loosening of associations with
periods of rambling when asked open ended
questions
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04/04/1438
Thought Content
• Delusions:
Paranoid
Grandiose
Jealous
Erotomanic
Somatic
Passivity & control
•
•
•
•
47
Overvalued ideas
Obsessions
Phobias
Thoughts of harm
04/04/1438
Thought Content
Delusions
• What is it?
• How to ask ?
• Parameters in asking?
• Commenting in MSE
Thought Content
Delusions
• Fixed False Belief
• Inconsistent with cultural
norms
• Inappropriate for person’s
level of education
• Not altered by proofs
• Preoccupies pt’s thought
• Not resisted by pt.
• Ranges from implausible to
impossible
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Open questions
• ﻓﻲ اﻟﻔﺗرة اﻷﺧﯾرة ھل ﻓﯾﮫ أي ﺣﺎﺟﺎت
ﺑﺗﺣﺻﻠك ﺣﺎﺳﺳﮭﺎ ﻏرﯾﺑﺔ أو ﻏﯾر ﻣﻌﺗﺎدة
أو ﻣﺣﯾراك أو ﻣﺛﻼ ﻣش ﻻﻗﯾﻠﮭﺎ ﺗﻔﺳﯾر؟
• إﯾﮫ أﻛﺗر ﺣﺎﺟﺔ ﺷﺎﻏﻠﺔ ﺗﻔﻛﯾرك ﻓﻲ اﻟوﻗت
اﻟﺣﺎﻟﻲ؟
• اﻟﻠﻲ ﺣواﻟﯾك ﺑﯾﻌﺎرﺿوك ﻛﺗﯾر؟ أو ﻣﺎ
ً ﺑﯾواﻓﻘوش ﻋﻠﻰ وﺟﮭﺔ ﻧظرك؟ أو ﻣﺛﻼ
ﺑﯾﺣﺳوا إﻧﮭﺎ ﺣﺎﺟﺎت ﻣﺳﺗﺑﻌدة ﻣﺛﻼ ً أو
ﻣﺳﺗﺣﯾﻠﺔ؟
04/04/1438
Thought Content
Delusions
Delusions of persecution
• ﺗﻌﺎﻣﻼﺗك ﻣﻊ اﻟﻧﺎس أﺧﺑﺎرھﺎ إﯾﮫ؟ ﻣرﺗﺎح ﻓﻲ اﻟﺗﻌﺎﻣل ﻋﻣوﻣﺎ ً و ﻻ ﻓﯾﮫ ﺣﺎﺟﺔ ﻣﺿﺎﯾﻘﺎك؟
• ھل ﻣﻣﻛن ﺗﺑﻘﻰ ﺣﺎﺳس إﻧك .......
ﻣش ﻣرﺗﺎح أو إﻧﮫ ﻣﺛﻼ اﻟﻧﺎس ﺑﺗﺑص ﻋﻠﯾك؟
أو ﻣﺛﻼ ﺑﯾﺗﻛﻠﻣوا ﻋﻠﯾك ﻣن ورا ﺿﮭرك؟
أو ﻣرﻛزﯾن أوي ﻣﻊ أي ﺣﺎﺟﺔ اﻧﺗﺎ ﺑﺗﻌﻣﻠﮭﺎ؟
ھل ﺣﺳﯾت ﻗﺑل ﻛدة إﻧﮫ ﻓﯾﮫ ﺣد ﻋﺎوز ﯾﺄذﯾك أو ﻣﺳﺗﻘﺻدك؟
ھل ﻣﻣﻛن ﯾﻛون ﻓﯾﮫ ﺣد ﻋﺎوز ﯾﺑوظﻠك ﺣﯾﺎﺗك؟
ﻣﻣﻛن ﯾﻛون ﻣﺛﻼ ﺣد ﻋﺎوز ﯾﺄذﯾك ﺑﺄي طرﯾﻘﺔ؟
ھل ﻣﺛﻼ ﻣﻣﻛن ﯾﻛون ﺣد ﺑﯾراﻗﺑك؟
Thought Content
Delusions
Delusions of Reference
• ھل اﻟﻧﺎس ﺑﺗﻠﻘﺢ ﻋﻠﯾك ﺑﺎﻟﻛﻼم أو ﺑﺗرﻣﯾﻠك ﻛﻌوب أو ﺑﺗﺗﻛﻠم ﻋﻠﯾك ﻣن ﺗﺣت
ﻟﺗﺣت؟
• ﺑﺗﺗﻔرج ﻋﻠﻰ اﻟﺗﻠﯾﻔزﯾون /اﻟرادﯾو /ﺑﺗﻘرا ﺟراﯾد ؟ ﺑﺗﺗﺎﺑﻊ إﯾﮫ؟ طب ﻣﻣﻛن ﻣﺛﻼ
ﺗﺣس إﻧﮫ اﻟﻠﻲ ﺑﯾﺗﻘﺎل ﻓﻲ اﻟﺗﻠﯾﻔزﯾون ده ﺑﯾﺗﻘﺎﻟﻠك إﻧﺗﺎ أو ﺑﯾﺗﻛﻠم ﻋﻠﯾك؟
ھل ﻣﻣﻛن ﺗﻼﻗﻲ رﺳﺎﯾل ﻣﺗوﺟﮭﮫ ﻟﯾك ﻣن اﻟﺗﻠﯾﻔزﯾون /اﻟرادﯾو /اﻟﺟراﯾد؟
طب ھل ﻣﻣﻛن ﺗﻼﻗﻲ اﻟﺗﻠﯾﻔزﯾون ﺑﯾﺗﻛﻠم ﻋن ﺣﺎﺟﺎت أو أﻋﻣﺎل إﻧﺗﺎ ﻋﻣﻠﺗﮭﺎ؟
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04/04/1438
Thought Content
Delusions
Delusions of control or passivity
• ھل ﻓﯾﮫ ﺣد ﺑﯾﺣﺎول ﯾﺳﯾطر ﻋﻠﯾك أو ﯾﺗﺣﻛم ﻓﯾك؟
• ﺣﺎﺳس إﻧﮫ ﻓﯾﮫ ﻗوة أﻛﺑر ﻣﻧك ھﯾﺎ اﻟﻠﻲ ﺑﺗﺳﯾطر ﻋﻠﯾك؟
• ھل ﻣﻣﻛن ﺗﺣس إﻧك زي اﻹﻧﺳﺎن اﻵﻟﻲ ...ﻣﺎﻟﻛش ﺳﯾطرة ﻋﻠﻰ ﻧﻔﺳك ﺧﺎﻟص؟
• ھل ﺑﯾﺟﺑروك ﺗﻔﻛر أو ﺗﻘول أو ﺗﻌﻣل أي ﺣﺎﺟﺔ؟
• ھل ﺑﯾﻐﯾروا أو ﺑﯾﺄﺛروا ﻋﻠﻰ إﺣﺳﺎﺳك ﺑﻧﻔﺳك؟
Thought Content
Delusions
Delusions of Grandiosity
• ﺑﺗﺣس إﯾﮫ ﻟﻣﺎ ﺗﻘﺎرن ﻧﻔﺳك ﺑﺣد؟
• ھل ﻋﻧدك أي ﻗدرات أو ﻣزاﯾﺎ ﻏﯾر ﻋﺎدﯾﺔ ,أو ﺣﺎﺟﺎت إﻧﺗﺎ ﺑس اﻟﻠﻲ ﺗﻌرف ﺗﻌﻣﻠﮭﺎ؟
• ﻋﻧدك ﻗدرات ﺧﺎرﻗﺔ أو ﻗوة ﻏﯾر ﻋﺎدﯾﺔ؟
• ھل ﻓﯾﮫ ﻣﮭﻣﺔ ﻣﻣﯾزة أو ﺣﺎﺟﺔ ﻣﮭﻣﺔ ﺑﺗﻌﻣﻠﮭﺎ ﻓﻲ ﺣﯾﺎﺗك؟
• ﻓﯾﮫ ھدف ﺳﺎﻣﻲ إﻧﺗﺎ ﻋﺎﯾش ﻋﻠﺷﺎﻧﮫ؟
• إﻧﺗﺎ ﺷﺧص ﻣﻌروف أو ﻣﺷﮭور؟ أو ﻣﻧﺗﻣﻲ ﻟﮭﯾﺋﺔ ﻣﮭﻣﺔ أو ﻣﻌروﻓﺔ؟
50
04/04/1438
Thought Content
Delusions
Delusions of guilt
• ھل ﺑﺗﻠوم ﻧﻔﺳك ﻋﻠﻰ ﺣﺎﺟﺔ ﻣﻌﯾﻧﺔ؟ أو ﺷﺎﯾف إﻧك إﻧﺗﺎ اﻟﻣﺳﺋول ﻋن أي
ﺣﺎﺟﺔ وﺣﺷﺔ ﺑﺗﺣﺻل؟
• ﻧدﻣﺎن ﻋﻠﻰ أي ﺣﺎﺟﺔ؟
• ھل ﻋﻧدك إﺣﺳﺎس ﺑﺎﻟذﻧب ﻣن ﺟواك ,ﻛﺄﻧك ﻣﺛﻼ ارﺗﻛﺑت ﺟرﯾﻣﺔ أو
ﻋﻣﻠت أي ﺣﺎﺟﺔ ﻏﻠط؟
• ھل ﺣﺎﺳس إﻧك ﺗﺳﺗﺣﻖ ﺗﻌﯾش ﻣ ُﻌ َﺎﻗ َب؟
Thought Content
Delusions
Nihilistic delusions
• ﺷﺎﯾف اﻟﻣﺳﺗﻘﺑل إزاي؟ إﺣﺳﺎﺳك إﯾﮫ ﻧﺎﺣﯾﺔ اﻟﻣﺳﺗﻘﺑل؟
• ھل ﺣﺎﺳس إﻧﮫ ﻓﯾﮫ ﺣﺎﺟﺔ ﻣرﻋﺑﺔ أو ﺧطﯾرة ﺣﺻﻠﺗﻠك أو
ھﺗﺣﺻﻠك؟
• ﺣﺎﺳس إﻧك ﻣﺗت ﻗﺑل ﻛدة؟
• ھل ﻓﯾﮫ ﺟزء ﻣن ﺟﺳﻣك ﻣﺎت أو اﺗﺷﺎل ﻣﻧك؟
51
04/04/1438
Thought Content
Delusions
Religious delusions
• ھل ﺑﺗﺣس إﻧك ﻗرﯾب ﻟرﺑﻧﺎ أوي ...رﺑﻧﺎ ﻣﻣﯾزك و ﻣﻘرﺑك ﻟﮫ؟
• رﺑﻧﺎ ﺑﯾﻛﻠﻣك؟ ﺑﯾﺗواﺻل ﻣﻌﺎك؟
Thought Content
Delusions
Hypochondrial delusions
• أﺧﺑﺎر ﺻﺣﺗك إﯾﮫ؟
• ﻋﻧدك أي ﻗﻠﻖ ﺑﺧﺻوص أي ﺣﺎﺟﺔ ﻓﻲ ﺻﺣﺗك أو ﺟﺳﻣك؟
• ﺑﺗﻘﻠﻖ إﻧﮫ ﯾﻛون ﻋﻧدك /ﯾﺟﯾﻠك ﺗﻌب ﻣﻌﯾن أو ﻣرض ﺧطﯾر؟
52
04/04/1438
Thought Content
Delusions
Delusions of jealousy
• ﻣراﺗك ﻋﺎﯾﺷﺔ ﻣﻌﺎك ﻣش ﻛدة؟
• ﻋﻼﻗﺗك ﻣﻊ ﻣراﺗك أﺧﺑﺎرھﺎ إﯾﮫ؟ ھل ﻣﺳﺗﻘرﯾن و ﻻ ﻣﺛﻼ ﻓﯾﮫ
ﻣﺷﺎﻛل أو اﻟﻌﻼﻗﺔ ﻣﺗوﺗرة؟
• إﻧﺗﺎ ﺑﺗﺣﺑﮭﺎ و ﻣﺧﻠص ﻟﮭﺎ ؟ ھل ﻣراﺗك ﺗﺑﺎدﻟك اﻟوﻓﺎء /اﻹﺧﻼص /
اﻟﺣب؟
Thought Content
Delusions
Delusions of thought broadcasting
• ھل ﺣﺎﺳس ﺑﺧﺻوﺻﯾﺔ ﻷﻓﻛﺎرك و ﻻ ﺳﮭل إﻧﮫ اﻟﻧﺎس ﺗﻌرف
إﻧﺗﺎ ﺑﺗﻔﻛر ﻓﻲ إﯾﮫ؟
• اﻟﻧﺎس ﺗﻌرف ﺗﻘرا أﻓﻛﺎرك؟
• ھل أﻓﻛﺎرك ﺑﺗﺗذاع ﻣﺛﻼ ﻓﺎﻟﻧﺎس ﺑﺗﻌرف اﻧﺗﺎ ﺑﺗﻔﻛر ﻓﻲ إﯾﮫ؟
53
04/04/1438
Thought Content
Delusions
Delusions of thought insertion
• ھل اﻷﻓﻛﺎر ﺑﺗﺗﺣط ﻓﻲ دﻣﺎﻏك و اﻧﺗﺎ ﻋﺎرف إﻧﮭﺎ ﻣش ﺑﺗﺎﻋﺗك؟
• طب اﻧﺗﺎ ﺑﺗﻌرف إﻧﮭﺎ ﻣش ﺑﺗﺎﻋﺗك إزاي؟
• ﺟﺎﯾﺔ ﻣﻧﯾن؟
Thought Content
Delusions
Delusions of thought withdrawal
• ھل ﻣﻣﻛن ﺗﺣس إﻧﮫ أﻓﻛﺎرك ﺑﺗﺗﺷﺎل ﻣن دﻣﺎﻏك ...ﻛﺄن ﺣد أو ﻗوة
ﻣﺎ ﺑﺗﺣذﻓﮭم ﻣن دﻣﺎﻏك؟
• ھل اﻷﻓﻛﺎر ﺑﺗﺧﺗﻔﻲ أو ﺑﺗﺗﺎﺧد ﻣن دﻣﺎﻏك؟
• طب ﺑﻌد ﻣﺎ ده ﺑﯾﺣﺻل ﺑﺗﺣس ﻣﺛﻼ إﻧﮫ دﻣﺎﻏك ﻓﺎﺿﯾﺔ؟
• ﻣﻣﻛن ﺗدﯾﻧﻲ ﻣﺛﺎل ..
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Thought Content
Delusions
•
•
•
•
•
Yes I have :D :D
Assess degree of conviction
Explanation
Effects
Coping
• طب ﺗﻔﺗﻛر ﻟﯾﮫ ده ﺑﯾﺣﺻل؟ ﻣﯾن
ﺑﯾﻌﻣل ﻛدة؟
• و ﻟﯾﮫ ﺑﯾﻌﻣﻠوا ﻛدة؟ إزاي ﺑﯾﻌﻣﻠوا ﻛدة؟
اﻧﺗﺎ ﺑﺗﺗﻌﺎﻣل ﻣﻊ.. • أﻛﯾد ده ﻣﺄﺛر ﻋﻠﯾك
ده إزاي؟
• Onset
• Fixity
• ﺑدأت ﺗﺣس ده ﻓﺟﺄة و ﻻ ﻛﺎن ﻓﯾﮫ
ﻣﻘدﻣﺎت؟
• إﯾﮫ اﻟﻠﻲ ﺧﻼك ﻣﺗﺄﻛد ﻣن ﺗﻔﺳﯾرك ده؟
• ھل ﺟﮫ ﻋﻠﯾك أي وﻗت ﺣﺳﯾت إﻧﮫ ﯾﻣﻛن
و ﻟو ﻣرة واﺣدة؟.. ﯾﻛون ده ﻣش ﺻﺢ
إﻣﺗﻰ؟ ﻟﯾﮫ؟ إﯾﮫ اﻟﻠﻲ ﺣﺻل؟
• ھل ﺣﺻل و ﻗﻠﻘت ﻣرة ﻣﺛﻼ إﻧﮫ ﯾﻛون ده
ﺣﺎﺟﺎت ﻓﻲ دﻣﺎﻏك إﻧﺗﺎ ﺑس؟
Thought Content
Delusions
• Mood congruence:
• Manic episode >> themes of
power, brilliance, wealthy.
• Depression >> themes of
death, failure,
worthlessness,hopelessness
• Mood incongruence:
• Manic episode >> themes of
nihilism, poverty
• Depression >> themes of
grandeur, omnipotence
55
•
•
•
•
Egosyntonic:
Not distressing to pt.
Not disturbing.
Accepted as reality.
• Paranoid >> persecution
04/04/1438
Thought Content
overvalued ideas
• Less firm
• Content often doesn’t make
sense.
• Magical thinking
• Superstitious thinking
Thought Content
Obsessions
• Thoughts, impulses or
images:
Recurrent
Persistent
Unwanted (egodystonic)
Not able to be controlled
Product of patient’s own
mind
• Irrational and doesn’t make
sense
•
•
•
•
•
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Thought Content
Obsessions
• ھل ﻓﯾﮫ أﻓﻛﺎر ﻣﻌﯾﻧﺔ ﺑﺗﺟﯾﻠك ﺑﺎﺳﺗﻣرار
و ﻣش ﻗﺎدر ﺗوﻗﻔﮭﺎ؟
• اﻷﻓﻛﺎر دي ﺟﺎﯾﺔ ﻣﻧﯾن؟ إﯾﮫ اﻟﻠﻲ ﺑﯾﺣﺻل
ﯾﺧﻠﯾﮭﺎ ﺗﯾﺟﻲ؟
• ھل ﺣﺎﺳس إﻧك ﻣﺟﺑر ﺗﻔﻛر ﻓﻲ
ﺣﺎﺟﺎت ﻣﻌﯾﻧﺔ ﻏﺻب ﻋﻧك و اﻧﺗﺎ
ﻣش ﻋﺎوز؟
• طب ﺑﺗﻌﻣل إﯾﮫ ﻟﻣﺎ ﺗﺟﯾﻠك اﻷﻓﻛﺎر دي؟
• اﻷﻓﻛﺎر دي ﺑﺗزﻋﺟك أو ﺑﺗوﺗرك ﻣﺛﻼ؟
• طب اﻷﻓﻛﺎر دي ﺑﺗﺟﯾﻠك ﻛل ﻗد إﯾﮫ؟
• ﺑﺗﺣﺎول ﺗﻌﻣل أي ﺣﺎﺟﺔ ﺗوﻗف ﺑﯾﮭﺎ
اﻷﻓﻛﺎر دي؟
• ﺣﺎﺳس اﻷﻓﻛﺎر دي ﺑﺗﺎﻋﺗك و ﻻ أﻛﻧﮭﺎ
ﺑﺗﺗﺣط ﻓﻲ دﻣﺎﻏك ﻣن ﻗوة ﺧﺎرﺟﯾﺔ؟
• طب إﯾﮫ اﻟﻠﻲ ﺑﯾﺣﺻل ﻟﻣﺎ ﺑﺗﺣﺎول ﺗوﻗﻔﮭﺎ؟
Thought Content
Obsessions / compulsive acts
• ھل ﻻﺣظت ﻧﻔﺳك ﻗﺑل ﻛدة ﺑﺗﺎﺧد
وﻗت طوﯾل ﺗﻌﻣل ﻓﯾﮫ ﻧﻔس اﻟﺣﺎﺟﺔ و
ﺗﻛررھﺎ ﻛﺗﯾر ﺣﺗﻰ ﻟو اﻧﺗﺎ ﻋﺎرف إﻧك
ﻋﻣﻠﺗﮭﺎ ﻛوﯾس؟ ﻣﺛﻼ ......
• ﺑﺗﻘﻌد ﺗﺄﻛد ﻋﻠﻰ اﻟﺣﺎﺟﺎت ﺣﺗﻰ ﻟو ﻋﺎرف
إﻧك ﻋﻣﻠﺗﮭﺎ ..أﻧﺑوﺑﺔ اﻟﺑوﺗﺎﺟﺎز ,اﻟﺗرﺑﺎس
,اﻷﺑواب ,ﻣﻔﺎﺗﯾﺢ اﻟﻧور ......
• ھل ﻟﯾك أي طﻘوس ﻣﻌﯾﻧﺔ ﻓﻲ أي ﺷﻲء؟
• ﺑﺗﺎﺧد وﻗت طوﯾل ﻓﻲ ﻧﺿﺎﻓﺗك
اﻟﺷﺧﺻﯾﺔ؟ ﯾﻌﻧﻲ ﻣﺛﻼ ﺗﻘﻌد ﺗﻐﺳل
إﯾدﯾك ﻛﺗﯾر ﻟﺣد ﻣﺎ ﺗﺗﺄﻛد إﻧﮭﺎ ﻧﺿﯾﻔﺔ
ﺗﻣﺎﻣﺎ ً
• ﺻﻌب ﻋﻠﯾك ﺗﺎﺧد ﻗرارات ...ﺣﺗﻰ ﻟو
ﻓﻲ ﺣﺎﺟﺎت ﺑﺳﯾطﺔ؟
• اﻧﺗﺎ ﻣﻧدﻓﻊ ﻓﻲ ﺗﺻرﻓﺎﺗك؟
• ھل ﻣﺛﻼ ﺗﻌرﺿك ﻷي ﺟراﺛﯾم
ﺑﯾﻘﻠﻘك؟
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Thought Content
Obsessions / compulsive acts
• Rituals
Thought Content
Phobias
• Marked and persistent fears
• Egodystonic
• Clearly circumscribed
• Accompanied by sense of
anxiety upon exposure or
thought of exposure
• Cause distress
• Of generally benign objects
58
• Animal type (cats)
• Situational (bridges,
tunnels)
• People (social phobia)
• Surroundings (water,
heights)
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Thought Content
Phobias
• ھل ﺑﯾﻌدي ﻋﻠﯾك وﻗت ﺗﺑﻘﻰ ﻓﯾﮫ ﻗﻠﻘﺎن أو
ﺧﺎﯾف أو ﻣذﻋور أو ﻣرﻋوب؟ إزاي؟
• ﻓﯾﮫ ﺣﺎﺟﺔ ﺑﺗﺧوﻓك ...ﺣﺎﺟﺔ ﻣﻌﯾﻧﺔ
ﺑﺗﻌﻣﻠﮭﺎ أو ﺣد أو ﻣﻛﺎن أو ﻣﻧﺎﺳﺑﺔ أو أي
ﻓﻛرة ﺑﺗﺟﯾﺑﻠك إﺣﺳﺎس ﺧوف أو ﻗﻠﻖ؟
• ﺑﺗﺣس إﻧﮫ ﻣﻣﻛن ﺣﺎﺟﺔ ﻣﻔزﻋﺔ ﺗﺣﺻل؟
• ﺑﻘﺎﻟك ﻗد إﯾﮫ ﻋﻧدك اﻹﺣﺳﺎس ده؟
• ده ﻣﺄﺛر ﻋﻠﻰ ﺣﯾﺎﺗك أو ﺑﯾﻌطﻠك ﻓﻲ أي
ﺣﺎﺟﺔ؟
• ھل ﺑﺗﺧرج ﻋن ﺷﻌورك ﻛﺗﯾر أو ﺑﺗﺣس
إﻧك ﻣﺷدود أوﻋﻠﻰ آﺧرك و ﻣش
ﻣﺳﺗﺣﻣل أي ﺣﺎﺟﺔ ﺗﺣﺻل؟
• ﺑﺗﻘﻠﻖ ﻋﻠﻰ /ﻣن ﺣﺎﺟﺎت ﺑﺳﯾطﺔ؟
• أﺧﺑﺎر ﻧوﻣك إﯾﮫ؟ ﺳﮭل ﻋﻠﯾك ﺗﻧﺎم؟
• ﺑﯾﺟﯾﻠك إﺣﺳﺎس إﻧك ﻋﻠﻰ ﺣﺎﻓﺔ ﺣﺎﺟﺔ ﻣﺎ؟
• ھل ﻣﻣﻛن ﺗﺧﺎف ﺗﻧﺎم ﻋﻠﺷﺎن ﻋﺎرف إﻧك
ھﺗﺣﻠم ﺑﺣﺎﺟﺔ وﺣﺷﺔ؟
Thought Content
thoughts of harm to self or others
Precipitants
Lethality of method
Antidepressants
Isolation
Note written
•
•
•
•
•
• Family history
• Organic conditions
• Relationship difficulties
• Akathisia
• SOS MADE PLAIN FOR A DR
• Sex
• Occupation
• Stress
Mental illness
Age
Drug abuse
Effects of medications
•
•
•
•
)• Dates (anniversary reactions
• Repeated attempts
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Thought content
Sample
• Content of her thoughts had to do with her
plans to start a senior management in 500
companies of her choice after graduation.
• His thought content involved delusions of
persecution and being infested
Perception
• Hallucinations
• Illusions
• Disturbances of self & environment
Depersonalization and derealization
• Disturbance of the quality or size
Micropsia, macropsia, dysmegalopsia
• Disturbance in the intensity of perception
Hyperacusis, visual hyperaethesia
• Disturbances of experience
Déjà vu , Jamais vu
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Perception
Hallucinations
• No actual stimulus
• The most sever perceptual
disorder
• Occur in all sensory modalities
• Simple or complex
• Spontaneous
•
•
•
•
•
Sight >> visual
Sound >> auditory
Smell >> olfactory
Taste >> gustatory
Touch >> somatic
ھل ﺑﺗﺣس ﺑﺄي ﺣﺎﺟﺔ ﻏرﯾﺑﺔ ﻣن ﺣواﻟﯾك؟
ﻓﯾﮫ ﺣﺎﺟﺎت ﺑﺗﺣﺻل ﻣﺣﯾراك؟
ھل ﻣﻣﻛن ﺗﺳﻣﻊ ﺻوت ﺣد ﺑﯾﻧﺎدي ﻋﻠﯾك ﺑره
اﻷوﺿﺔ؟
ﻣﻣﻛن ﺗﺳﻣﻊ ﺣد ﺑﯾﻛﻠﻣك و ﺗﺑص ﻣﺎﺗﻼﻗﯾش
ﺣد؟
ﺑﺗﺣس إﻧك ﺷﺎﯾف ﺣﺎﺟﺔ اﻟﻠﻲ ﺣواﻟﯾك ﻣش
ﺷﺎﯾﻔﯾﻧﮭﺎ؟
•
•
•
•
•
• Internal experiences attributed
to external stimulus.
Perception
Auditory Hallucinations
• ﻓﯾﮫ ﺳؤال روﺗﯾﻧﻲ ﺑﻧﺳﺄﻟﮫ ﻟﻠﻛل
ھل ﺣﺻل ﻗﺑل.أﺣب أﺳﺄﻟﮭوﻟك
ﻛدة و ﺳﻣﻌت ﻓﻲ ودﻧك أﺻوات
• Cardinal symptom of schizophrenia. أو دوﺷﺔ ﻣن ﻏﯾر ﻣﺎ ﯾﻛون ﻓﯾﮫ ﺣد
• +ve symptom of schizophrenia.
ﺗﺎﻧﻲ ﺳﺎﻣﻌﮫ أو ﻣن ﻏﯾر ﻣﺎ ﯾﻛون
ﻓﯾﮫ ﺣد ﻣوﺟود ﻣﻌﺎك؟
• Most common type in psychotic D.
• Patients are usually able to describe
their “voices”.
• ﻛﻧت ﻗﻠﺗﻠﻲ إﻧﮫ اﻟﻔﺗرة اﻷﺧﯾرة ﻓﯾﮫ
أﺻوات ﺑﺗﺳﻣﻌﮭﺎ و اﻧﺗﺎ ﻟوﺣدك و
• Aware of gender of the voice.
ﻋﺎوز... ﻣﻔﯾش ﺣد ﻣﻌﺎك ﺑﯾﻛﻠﻣك
أﻋرف ﻣﻧك ﺷوﯾﺔ ﻣﻌﻠوﻣﺎت
• Command H, critical, derogatory &
.ﺑﺧﺻوﺻﮭﺎ
insulting.
• Diminished by antipsychotics.
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Perception
Auditory Hallucinations
• Elementary
• ھل ﺑﺗﺳﻣﻊ دوﺷﺔ ﺷﺑﮫ اﻟﺧﺑط أو ﻣﺛﻼ
ﻣوﺳﯾﻘﻰ؟
• ﺷﺑﮫ إﯾﮫ؟ ﻣﻣﻛن ﺗوﺻﻔﮭﺎﻟﻲ؟
• ھل ﻣﺛﻼ ﺷﺑﮫ اﻟدﻧدﻧﺔ و ﻻ ﺷﺑﮫ اﻟوﺷوﺷﺔ؟
• ﺑﺗﻣﯾز أي ﻛﻠﻣﺎت ﻣﻧﮭﺎ؟
Perception
Auditory Hallucinations
• Second person
• ﻣﻣﻛن ﺗدﯾﻧﻲ ﻣﺛﺎل اﻟﺻوت ﺑﯾﻘوﻟك إﯾﮫ؟
• اﻟﺻوت ده ﻣﻣﯾز ﻟﯾك؟ ﺻوت ﺣد اﻧﺗﺎ
ﻋﺎرﻓﮫ؟
• ﺑﯾﻘوﻟوﻟك ﺗﻌﻣل إﯾﮫ أو ﺗﺗﺻرف إزاي؟
ﻣﻣﻛن ﺗدﯾﻧﻲ ﻣﺛﺎل؟
• ﺑﯾﺄﻣروك ﺑﺣﺎﺟﺔ؟ و اﻧﺗﺎ ﺑﺗﻧﻔذ؟
• ھل ﻣﻣﻛن ﯾﺑﻘﻰ ﻓﯾﮫ ﺣوار ﺑﯾﻧك و ﺑﯾن
اﻟﺻوت ﯾﻌﻧﻲ ﺗﻛﻠﻣﮫ و ﯾرد ﻋﻠﯾك؟ و ﻻ
ھوا ﺛﺎﺑت ﻣﺑﯾﺗﻐﯾرش؟
• ﻛﺎم ﺻوت ﺑﯾﻛﻠﻣوك؟
• أﺻوات رﺟﺎﻟﺔ و ﻻ ﺳﺗﺎت و ﻻ أطﻔﺎل؟
• ﺑﯾﻛﻠﻣوك اﻧﺗﺎ ﻣﺑﺎﺷرة و ﻻ ﺑﯾﺗﻛﻠﻣوا ﻋﻠﯾك
ﻣﻊ ﺑﻌض؟
• ﺑﺗﺳﻣﻊ إﺳﻣك ﺑﯾﺗﻧده؟
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Perception
Auditory Hallucinations
• Third person
• ﺑﺗﺳﻣﻊ أﻛﺛر ﻣن ﺻوت ﻓﻲ وﻗت واﺣد؟
• ﺑﺗﺳﻣﻌﮭم ﻣﺛﻼ ﯾﻘوﻟوا ھوا أو ھﯾﺎ؟
• طب ﺑﯾﻘوﻟوا إﯾﮫ؟
• ﯾﻌﻧﻲ ﻣﺛﻼ ﺑﯾﻌﻠﻘوا ﻋﻠﯾك أو ﻋﻠﻰ
ﺗﺻرﻓﺎﺗك أو ﺑﯾوﺟﮭوك ﺗﻌﻣل إﯾﮫ أو
ﺗﺗﺻرف إزاي؟
• ﺑﯾﻌﻠﻘوا ﻋﻠﻰ أﻓﻛﺎرك أو ﻣﺛﻼ ﻋﻠﻰ ﺣﺎﺟﺔ
ﺑﺗﻘراھﺎ؟
Perception
Auditory Hallucinations
• Hypnagogic/ Hypnapompic
Hallucinations
Go sleepو اﺻﺣﻰ ﻋﻠﻰ ﺻوت اﻟﺑﻣب
• إﻣﺗﻰ ﺑﺗﺳﻣﻊ اﻷﺻوات؟ ﺑﺗﻛون
ﺻﺎﺣﻲ ﺗﻣﺎﻣﺎ و ﻓﺎﯾﻖ ﻟﻣﺎ ﺑﺗﺳﻣﻌﮭم؟
• اﻷﺻوات دي ﺑﺗﻘﻠﻖ ﻣﻧﺎﻣك؟
• ﺑﺗﺳﻣﻌﮭم ﻓﻲ أوﻗﺎت ﻣﻌﯾﻧﺔ ...ﻣﺛﻼ و
اﻧﺗﺎ داﺧل ﺗﻧﺎم أو و اﻧﺗﺎ ﻟﺳﺔ ﺻﺎﺣﻲ؟
?• True Hallucinations
• ﺗﻔﺗﻛر اﻷﺻوات دي ﺟﺎﯾﺔ ﻣﻧﯾن؟
• ﺑﺗﺳﻣﻌﮭم ﻓﻲ دﻣﺎﻏك و ﻻ ﻓﻲ ودﻧك؟
• اﻟﺻوت ﺟﺎي ﻣن ﺟوة دﻣﺎﻏك و ﻻ ﻣن
ﺑرة دﻣﺎﻏك؟
• ﺑﺗﺳﻣﻌﮭم ﺑوﺿوح زي ﻣﺎﻧﺗﺎ ﺳﺎﻣﻌﻧﻲ
دﻟوﻗﺗﻲ؟
• ﺗﻘدر ﺗﺧﻠﯾﮭم ﯾﺑﺗدو أو ﯾوﻗﻔوا؟
• ﺑﺗﺣﺳﮭم ﺣﻘﯾﻘﯾﯾن و ﻻ ﻣﺟرد أﺻوات؟
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Perception
Hallucinations
• Visual
• Next most common in
psych.D
• Most common to be with
auditory H than being
alone.
• Isolated >> suspect
organicity.
• Simple to complex.
• Brief ; just a Vision or
involved like having a visit
from president.
• ھل ﻣﻣﻛن ﺗﺷوف ﺣﺎﺟﺔ ﺑﺎﻗﻲ اﻟﻧﺎس ﻣش
ﺷﺎﯾﻔﯾﻧﮭﺎ؟
• ﺑﺗﺷوف إﯾﮫ؟
• ﺑﺗﺷوﻓﮭﺎ ﻓﻲ أوﻗﺎت ﻣﻌﯾﻧﺔ؟ ﻛﺎم ﻣرة؟
• ﺑﺗﺷوﻓﮭﺎ ﻓﻲ ﻋﯾﻧك ﻗداﻣك و ﻻ ﺻورة ﻓﻲ
دﻣﺎﻏك؟
ھل ﻛﻧت ﻧﻌﺳﺎن ﺷوﯾﺔ ﻟﻣﺎ ده ﺣﺻل؟
•
ﻛﻧت ﺻﺎﺣﻲ و ﻓﺎﯾﻖ ﻟﻣﺎ ﺷﻔت ده؟
•
Perception
Hallucinations
• Olfactoty
•
•
•
•
Less common
Need medical investigations
epilepsy
Burning rubber, rotting
garbage, strong body odor.
• ھل ﻓﯾﮫ ﺣﺎﺟﺔ ﻏرﯾﺑﺔ ﻓﻲ ﺗذوﻗك أو ﻓﻲ
اﻟﺷم ؟
• ﺑﺗﻼﺣظ أي رواﯾﺢ ﻏرﯾﺑﺔ اﻟﻠﻲ ﺣواﻟﯾك
ﻣش ﻣﺗﺿﺎﯾﻘﯾن ﻣﻧﮭﺎ؟
• إﯾﮫ اﻟرواﯾﺢ دي؟ ﺷﺑﮫ إﯾﮫ؟
• طب ﻋﻧدك أي ﺗﻔﺳﯾر ﻟوﺟودھﺎ أو دورت
وراھﺎ؟
• ده اﺗﻛرر ﻛﺗﯾر و ﻻ ﻣرة و ﺧﻼص؟
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Perception
• Illusions:
Misperception of existing
stimuli
• Micropsia
• Macropsia
• Dysmegalopsia
Perception
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• Depersonalization:
Change in perception of self.
• Déjà vu: (already seen)
Feeling familiarity to situations
that are novel
• Derealization:
Change in perception of
external world.
• Jamais vu: (never seen)
Familiar situations , but pt feel
he hasn’t ever experienced
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Perception
Sample
• She denies any perceptual problems.
• He described perceptual abnormalities in the
form of tactile H. (beetles crawling on his
skin). He is also harassed by voice of old
merchant.
إﻋﻼن ﻏﯿﺮ ﻣﺪﻓﻮع اﻷﺟﺮ
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Affect & Mood
Affect
• Type / quality
• Range / variability
• Degree / intensity
• Stability / reactivity
• Appropriateness
• Congruence
mood,
appearance,
Behavior.
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Affect
• Type / quality :
Predominant emotion
expressed
•
•
•
•
•
•
Happiness
Sadness
Shame
Surprise
Anger
fear
• Range / variability:
Extent to which emotions vary
• Narrow , restricted
• Wide, expanded
Affect
• Degree / intensity:
• Low
Flattened, constricted,
detached
• Normal
Appropriate, responsive
• High
Exaggerated, dramatic
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• Stability / reactivity
Duration of affective
response.
Affect shifts during
interview.
Shifts are sustained for few
moments.
↓Change >> fixed or immobile
↑Change & rapid >> labile
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Affect
• Appropriateness:
• Congruence:
• Matching bet. Visible
emotions & thought
content.
• Mood
• ﺑﯾﺿﺣك و ھوا ﺑﯾﺗﻛﻠم ﻋن ﻣوت أﺑوه
• Inappropriate
• Behavior
• Appearance
• اﻷب ﻛﺎن ﺑﯾﺿرﺑﮫ و ﯾﻌذﺑﮫ
• appropriate
Affect
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Mood
Quality / type
Reactivity
Intensity
Stability / duration
•
•
•
•
• ﺣﺎﺳس ﺑﻧﻔﺳك إزاي؟
• أﺧﺑﺎر ﻣزاﺟك إﯾﮫ؟
• ﻟو ھﺗﻘﯾم إﺣﺳﺎﺳك ﺑﻧﻔﺳك ﻣن 1ﻟـ
10ﺗدﯾﻠﮫ ﻛﺎم ) 10ﯾﻌﻧﻲ طﺑﯾﻌﻲ ,و
1ﯾﻌﻧﻲ ﻣﻛﺗﺋب(؟
Mood
quality / type
• Depressed mood:
ﻣﻐﻣوم Blue
ﻣﺎﻟﯾش ﻟزﻣﺔ Worthless
ﻣذﻧب Guilty
ﺑﺎﺋس Miserable- gloomy
ﻓﺎﺿﻲ ﻣن ﺟواﯾﺎ Hollow
ﻛﺋﯾب Glum
ﻣﻛروب Morose
اﻟدﻧﯾﺎ ﺳودا ﻓﻲ ﻋﻧﯾﺎ Somber
•
•
•
•
•
•
•
•
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Mood
quality / type
• Euphoric mood:
Up ﻣزاﺟﻲ ﻋﺎﻟﻲ
Flying ﺣﺎﺳس إﻧﻲ طﺎﯾر
Jovial ﻣﻧﺷرح
Omnipotent أﻗدر ﻋﻠﻰ أي ﺣﺎﺟﺔ
– ﺧﺎرق
• On top of the world أﺣﺳن ﻣن
أﺣﺳن ﺣد
•
•
•
•
Mood
quality / type
• Angry / irritable mood:
•
•
•
•
•
•
•
71
Annoyed ﻣﺗﺿﺎﯾﻖ
Miffed ﻣﻣﺗﻌض
Pissed off ﻣﺳﺗﺎء
Seething ﻣﺣﺗدم
Cranky ﺣﺎد اﻟطﺑﻊ
Bellicose ﺷرس
Easily provoked ﯾﺳﮭل اﺳﺗﺛﺎرﺗﮫ
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Mood
quality / type
• Anxious mood:
•
•
•
•
•
Tense ﻋﻠﻰ آﺧري
Fearful ﺧﺎﯾف
On edge روﺣﻲ ﻓﻲ ﻣﻧﺎﺧﯾري
Worried ﻗﻠﻘﺎن
Nervous ﻋﺻﺑﻲ
Mood
• Reactivity:
• The degree to which mood
is altered by external
factors.
• Intensity:
• Degree to which mood is
expressed.
• Stability:
• Duration of time the mood
disturbances exists without
variation
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Insight assessment
Insight assessment
• Having awareness of one’s
illness
• A form of self-knowledge
which includes not only
information on problems,
but also an understanding
of their effect on the way in
which the self interacts with
the world. ( Markova 1992)
73
1. Awareness of having an
illness.
2. Understanding of the
factors contributing to
illness.
3. Understanding that signs
& symptoms are part of
disease process.
4. Awareness that one’s
illness impacts on other
people and society at
large.
5. Acknowledgement of the
need for treatment
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Insight assessment
•
أﻧﺎ ﻣﺗﻔﮭم إﻧﮫ اﻟﻔﺗرة اﻷﺧﯾرة ﻛﻧت ﺑﺗﺳﻣﻊ
ﻓﯾﮭﺎ اﻷﺻوات ﻣن ﻏﯾر اﻟﻠﻲ ﺣواﻟﯾك ﻣﺎ
ﯾﻛوﻧوا ﺳﺎﻣﻌﯾﻧﮭﺎ ...ھل ده ﻣﻣﻛن ﯾﻛون
ﺟزء أو ﻋرض ﻣن ﺗﻌب ﻧﻔﺳﻲ؟
•
إﻧﺗﺎ وﺻﻔﺗﻠﻲ ﻛذا ﺣﺎﺟﺔ ﺑﺗﺷﺗﻛﻲ ﻣﻧﮭﺎ
ﻛﺄﻋراض ...ﺗﻔﺗﻛر اﻷﻋراض دي ﻟﯾﮭﺎ
ﻋﻼﻗﺔ ﺑﺣﺎﻟﺗك اﻟﻧﻔﺳﯾﺔ؟
•
إﻧﺗﺎ ﺣﺎﺳس إﻧﮫ ﻋﻧدك أي ﺗﻌب؟
• ﺗﻔﺗﻛر ده ﺑﯾﺣﺻل ﻣن إﯾﮫ؟ إﯾﮫ ﺗﻔﺳﯾرك؟
•
ﻣﻣﻛن ده ﯾﻛون ﺗﻌب ﻧﻔﺳﻲ؟
• ﺣﺎﺳس إﻧك ﻣﺣﺗﺎج ﻣﺳﺎﻋدة ﻓﻲ اﻟﻣﺷﺎﻛل دي
ﻋﺷﺎن ﺗﺗﻌﺎﻣل ﻣﻌﺎھﺎ؟
•
•
ﻣﺣﺗﺎج ﻋﻼج ﻟﻠﻣﺷﻛﻠﺔ اﻟﻧﻔﺳﯾﺔ دي؟
إﻧﺗﺎ ﺟﯾت اﻟﻣﺳﺗﺷﻔﻰ ﻟﯾﮫ؟
•
اﻟﻌﻼج ﺑﯾﺳﺎﻋدك؟ ﺣﺎﺳس ﺑﺗﺣﺳن؟ إﯾﮫ اﻟﻠﻲ
اﺗﺣﺳن؟ ﻛﻧت ازاي و ﺑﻘﯾت ازاي؟
• إﯾﮫ اﻟﻠﻲ ﻣﺿﺎﯾﻘك ﻓﻲ اﻟﻌﻼج؟ ﻟﯾﮫ ﻣش ﻣﻧﺗظم
ﻓﯾﮫ؟ ﻣﻣﻛن أﺳﺎﻋدك إزاي إﻧﻧﺎ ﻧظﺑطﮫ ﻣﻊ
ﺑﻌض؟
• ھل ﻓﯾﮫ أي أﻧواع ﻋﻼج ﺳﺎﻋدﺗك و اﺳﺗﻔدت
ﻣﻧﮭﺎ ﻗﺑل ﻛدة؟
Cognitive Functions
• Memory:
Immediate, short-term & longterm
• Orientation:
Time, place & person
• Intelligence:
IQ
• Attention:
Ability to direct mental energy.
• Knowledge base:
• Capacity to read & write:
• Abstraction & concrete
thinking.
• Concentration:
Sustained focus of attention
for a period of time.
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Cognitive Functions
•
•
•
•
اﻟﺳﺎﻋﺔ ﯾﺟﯾﻠﮭﺎ ﻛﺎم؟ اﺣﻧﺎ اﻟﺻﺑﺢ و ﻻ
ﺑﺎﻟﻠﯾل؟
اﻟﻧﮭﺎردة إﯾﮫ ف أﯾﺎم اﻷﺳﺑوع؟
ﺗﻌرف ﺗﺎرﯾﺦ اﻟﻧﮭﺎردة ﻛﺎم؟
ﻓﺻل إﯾﮫ ف اﻟﺳﻧﺔ؟ ﯾﻌﻧﻲ اﻟدﻧﯾﺎ ﺣر
و ﻻ ﺑرد؟
• Orientation:
Time, place & person
• اﺳﻣك إﯾﮫ؟ ﺳﺎﻛن ﻓﯾن؟ ﻣﻊ ﻣﯾن؟
ﺑﺗﺷﺗﻐل إﯾﮫ؟
• ﻣﯾن اﻟﻠﻲ ﻣﻌﺎك ﺑرة دول؟
•
•
•
•
•
اﺣﻧﺎ ﻓﯾن؟ )اﻟﻣﻛﺗب – اﻟدور – اﻟﻌﯾﺎدة(
اﻟﻣﻛﺎن اﻟﻠﻲ اﺣﻧﺎ ﻓﯾﮫ ده إﯾﮫ؟
ﻣﺳﺗﺷﻔﻰ ﺑﺗﺎﻋﺔ إﯾﮫ؟
اﻟﻠﻲ ﺑﯾﺟوھﺎ ﺑﯾﺑﻘو ﺑﯾﺷﺗﻛو ﻣن إﯾﮫ؟
ﻣوﺟودة ﻓﻲ ﺑﻠد إﯾﮫ؟ ﻣﺣﺎﻓظﺔ إﯾﮫ؟
Cognitive Functions
Digits – spelling - calculations
)2. Spelling (forward & reverse
• ﻣﻣﻛن ﺗﺳﺗﮭﺟﻰ ﻛﻠﻣﺔ )ﻣدﯾﻧﺔ( )ﻣﺷﻛﻠﺔ(
• ھﺎﻗول ﺟﻣﻠﺔ ﻛﻠﻣﺔ ﻛﻠﻣﺔ و ﻛل ﻣﺎ ﺗﺳﻣﻊ
ﺣرف اﻟﺷﯾن ﺗرﻓﻊ إﯾدك
)ﻛﺎﻧت اﻟﺷﻣس ﻗﺑل اﻟﯾوم ﻣﺷرﻗﺔ ﺣﺗﻰ ﺟﺎء
اﻟﺷﺗﺎء ﻓﺎﺧﺗﻔت(
3ﻣرات
• Attention & concentration
- Ability to direct mental energy.
- Sustained focus of attention for a
period of time.
)1. Digit span (forward & reverse
• ھﺎﻗول ﺑﻌض اﻷرﻗﺎم و ﻋﺎوزك ﺗﻛررھم
وراﯾﺎ و ﺑﻌدﯾن ﺗﻘوﻟﮭم ﺑﺎﻟﻌﻛس
)ﻣﯾﻛوﻧوش أرﻗﺎم ﻣﺗﺗﺎﻟﯾﺔ(
)(9 4 1
)(2 5 8 3
)(5 3 9 0 7
)(8 2 6 1 9 4
)(1 4 9 3 7 2 6
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Cognitive Functions
• رﻛز ﻓﻲ اﻟﺳرﻋﺔ – دﻗﺔ اﻹﺟﺎﺑﺔ – اﻟﻣﺟﮭود
– رد ﻓﻌﻠﮫ ﻋﻠﻰ اﻷﺳﺋﻠﺔ دي
• إﯾﮫ ﺟﻣﻊ 7 + 15 + 12
• إﯾﮫ ﺣﺎﺻل ﺿرب 6 X 25
• ﻟو ﺑﺗﺷﺗري ﺣﺎﺟﺔ ﺣﺳﺎﺑﮭﺎ 78ﺟﻧﯾﮫ و
إدﯾت اﻟﺑﯾﺎع 100ﺟﻧﯾﮫ ...ﯾﺑﻘﻰ اﻟﺑﺎﻗﻲ
ﻛﺎم؟
• Attention & concentration
- Ability to direct mental energy.
- Sustained focus of attention for a
period of time.
3. Calculations
Serial 7’s
ﺑﺗﻌرف ﺗﺣﺳب ؟ ﺷﺎطر ﯾﻌﻧﻲ ﻓﻲ اﻟﺣﺳﺎﺑﺎت ؟
طب ھﺎﺳﺄﻟك ﻛﺎم ﺳؤال ﺻﻐﯾرﯾن ﻛدة؟
) .... 7-7-7- 7-100ﻟﺣد ﻣﺎ ﯾﺟﯾب آﺧره(
Serial 3’s
20-3-3-3-3 …..
Cognitive Functions
• Memory:
• Interrupted counting
Immediate, short-term & long-term
• ﻣﻣﻛن ﺗﻌد ﻣن 1ل 100
Immediate memory:
• ﻋﻧد 27ھﺗوﻗف اﻟﻌﯾﺎن و ﺗﺗﻛﻠﻣوا ﻓﻲ أي
ﻣوﺿوع و ﺑﻌد دﻗﯾﻘﺔ ﺗطﻠب ﻣﻧﮫ ﯾرﺟﻊ
ﯾﻌد ﻣن آﺧر رﻗم ﻣن ﻏﯾر ﻣﺎ ﺗﻘوﻟﮭوﻟﮫ
• ھﺎﻗوﻟك 3ﻛﻠﻣﺎت و ھﺎطﻠب ﻣﻧك ﺗﻛررھم
• ﻋﻧد 43ﺗوﻗﻔﮫ ﺗﺎﻧﻲ و ﺗﺳﺗﻧﻰ وﻗت أﻛﺗر
ﺑﻌد 5دﻗﺎﯾﻖ )ﺣﺻﺎن – أزرق – ﻓراوﻟﺔ(
) 3دﻗﺎﯾﻖ(
• ﻣﺗﺑﻘﺎش ﺣﺎﺟﺎت ﻣوﺟودة ﻓﻲ اﻷوﺿﺔ و
ﻣﯾﻛوﻧش ﺑﯾﻧﮭم رواﺑط
• Digit span test
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Cognitive Functions
•
•
•
•
• Memory:
• Long-term\remote memory
Immediate, short-term & long-term
ﺣﺎﻓظ رﻗم ﺑطﺎﻗﺗك؟
Short-term\recent memory:
إﻧت دﻓﻌﺔ ﻛﺎم؟
أوﻻدك ﻋﻧدھم ﻛﺎم ﺳﻧﺔ؟ ﻓﺎﻛر ﺗوارﯾﺦ
ﻣﯾﻼدھم؟
ﻓﺎﻛر إﺳﻣﻲ؟
ﻣﺗﺟوز ﺑﻘﺎﻟك أد إﯾﮫ؟
آﺧر ﻣرة ﻗﻌدﻧﺎ ﻣﻊ ﺑﻌض إﻣﺗﻰ؟
ﻓﺎﻛر اﺗﻔﻘﻧﺎ ﻋﻠﻰ إﯾﮫ ﻓﻲ اﻟﻣرة دي؟
ﻓطرت إﯾﮫ اﻟﻧﮭﺎردة؟
أﺧدت ﻋﻼج إﯾﮫ اﻟﻧﮭﺎردة؟
Cognitive Functions
• Abstraction & concrete
thinking.
• Proverbs
• ﯾﻌﻧﻲ إﯾﮫ
اﻟﻠﻲ ﺑﯾﺗﮫ ﻣن إزاز ﻣﯾﺣدﻓش اﻟﻧﺎس ﺑﺎﻟطوب
اﻟﻘرش اﻷﺑﯾض ﯾﻧﻔﻊ ف اﻟﯾوم اﻷﺳود
ﻋﻠﻰ ﻗد ﻟﺣﺎﻓك ﻣد رﺟﻠﯾك
ﻣﺗﻌﯾطش ﻋﻠﻰ اﻟﻠﺑن اﻟﻠﻲ ﯾﻘﻊ ع اﻷرض
دﻣﺎﻏﯾن أﺣﺳن ﻣن دﻣﺎغ واﺣدة
• Similarities
• إﯾﮫ اﻟﺷﺑﮫ ﺑﯾن
اﻟﺗﻔﺎﺣﺔ و اﻟﺑرﺗﻘﺎﻟﺔ )ﻣدورﯾن – ﻓﺎﻛﮭﺔ(
ﻛرﺳﻲ و ﺗراﺑﯾزة )ﺧﺷب – أﺛﺎث(
اﻟﺳﺎﻋﺔ و اﻟﻣﺳطرة )أدوات ﻗﯾﺎس(
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Questions and feedback
78
