CHAPTER 3

SIGNS AND SYMPTOMS OF

PSYCHIATRIC ILLNESS
Contents
⚫ Disorders of emotion
⚫ Disorders of perception
⚫ Disorders of thought
⚫ Speech disorders
⚫ Disorders of memory
⚫ Motor disorders
DISORDERS OF EMOTION
⚫ Depression: psychopathological feeling of sadness
⚫ Elation: Mood more cheerful than normal.
⚫ Irritability: Getting easily annoyed and provoked to anger
⚫ Anxiety: Feeling of apprehension due to anticipation of danger
which may be internal or external
⚫ Fear: anxiety due to consciously recognized and realistic danger
DISORDERS OF EMOTION
⚫ Panic: Acute, episodic, and intense attack of anxiety associated
with overwhelming feeling of dread and autonomic discharge.
⚫ Apathy: With out feeling, total loss of emotion
⚫ Blunt or flat affect: Normal variation of emotion is reduced.
⚫ Labile affect: Excessively rapid and abrupt emotional change
⚫ Incongruent affect: Emotion not congruent with ones
thoughts, actions and circumstances
DISORDERS OF PERCEPTION
Illusions
⚫ Misinterpretations of external stimuli
⚫ Can occur in the absence of psychiatric disorder
⚫ Visual are most common
DISORDERS OF PERCEPTION
Hallucination
⚫ A false perception in the absence of
external stimuli
⚫ Hallucination is not a sensory distortion or
a misinterpretation
⚫ Hallucinations differ from Mental Images
(Pseudo-hallucinations) in that
Pseudo-hallucinations are:
◦ Seen in full consciousness
◦ Known to be not real
◦ Located in subjective space
DISORDERS OF PERCEPTION

TYPES OF HALLUCINATIONS:
⚫ Auditory hallucination
⚫ Visual hallucination
⚫ Olfactory hallucination
⚫ Tactile hallucination
⚫ Gustatory (taste) hallucination
Sensory Deceptions
Auditory hallucination:
1. Elementary or unformed – simple noises,
bells, undifferentiated whispers or voices
2. Organized – music or voices
◦ Imperative hallucinations – voices giving
instructions to the patient
◦ Voices speaking about the person in third
person or running commentary on the
person’s actions
Sensory Deceptions
Visual hallucinations:
1. Elementary – flashes of light
2. Completely organized – visions of people, objects or
animals
• Delirium – seeing small animals and insects
Sensory Deceptions
Olfactory hallucinations:
⚫ Differentiate from delusion – belief that one emits smell
◦ Schizophrenia
◦ Temporal lobe epilepsy
◦ Severe depression (uncommon)
Sensory Deceptions
Gustatory hallucinations:
⚫ Difficult to differentiate from delusions
– loss of taste, ‘all food tastes the same.
Tactile hallucinations:
⚫ ‘formication’ – small animals crawling over the body –
plus delusion - ‘cocaine bug’
⚫ Feeling of cold wind blowing on the person, sensations of
heat
DISORDERS OF THOUGHT
⚫ Disorders of thought are usually recognized from speech and writing. The
disorder may involve the stream, form and/ or its content.
Disorders of stream of thought
⚫ Pressure of thought: Is a condition where by ideas arise in a unusual
variety and abundance and pass through the mind rapidly
⚫ Poverty of thought: there are few thoughts in the person’s mind that lack
variety and richness, and they seem to move through the mind very slowly.
⚫ Thought blocking: Abrupt and complete emptying of mind that leads to
abrupt interruption of conversation
DISORDERS OF THOUGHT
Disorders of form of thought
⚫ Flight of ideas: Thoughts and conversation move quickly from one topic
to another, so that one train of thought is not completed before the next
is taken up.
⚫ Perseveration: Persistent and inappropriate repetition of the same
sequence of thoughts, as shown by repetition of speech or action.
⚫ Loosening of association of thought: Is lack of logical connection
between the parts of train of thoughts,
⚫ Incoherence (word salad): Not only connection between sentences
and phrases but also grammatical structure of speech will be disrupted.
⚫ Neologism: Usage of words or phrases invented by the person himself
Obsessions and Compulsions
Obsession (rumination) - A thought that persists &
dominates an individual’s thinking
⚫ The individual is aware that thought is entirely without
purpose
Compulsions: obsessional motor acts
⚫ OCD, Depression, Schizophrenia
Disorders of the Possession of Thought
⚫ Experiencing one’s thoughts are under the
control of an outside agency
◦Thought insertion: others thought
inserted into his/her own mind
◦Thought withdrawal: thoughts has been
withdrawn away from his/her mind by
alien forces
◦Thought broadcasting: his/ her thoughts
has been broadcasted in the air
Disorder of Content of Thinking
⚫ Delusion: Is a belief that is firmly held but on
inadequate grounds, it is not affected by
evidence to the contrary, and is not a
conventional belief that the person might be
expected to hold given his cultural background.
Overvalued idea – false belief
◦ Can occur in normal people
◦ Thought that takes precedence over all other ideas
and persists for a long time.
◦ Less fixed than delusions
◦ Have some basis in reality
Disorder of Content of Thinking
Types of delusions
Delusion of Persecution:
⚫ Belief that one is extremely wicked that he
is about to be put to death.
⚫ Belief that the patient or his loved ones
are about to be killed or are being
tortured.
⚫ Delusions of being poisoned, being
robbed...
Disorder of Content of thinking
Delusion of reference: patient knows that
people are talking about him or spying on him
Delusions of infidelity:
◦ ‘morbid jealousy’
◦ Belief that one’s spouse or sexual partner is
unfaithful
◦ Schizophrenia, delusional disorder, alcohol
dependence, mood disorders
Disorder of Content of thinking
Delusions of love / ‘erotomania’:
⚫ Conviction that some person is in love
with the patient
⚫ The alleged lover my never have spoken to
the patient
◦ Personality disorders, Schizophrenia
Grandiose delusions: A belief that he/she is
special / above others interms of power,
knowledge, money or identity
Disorder of Content of thinking
Delusions of ill health:
⚫ Characteristic feature of depressive
illness
⚫ May be seen in schizophrenia
⚫ Believe that one has a serious disease
such as cancer, AIDS, incurable insanity
Disorder of Content of thinking
Delusions of guilt:
⚫ Patient believes that he is a bad or evil
person and has ruined his family – in
severe Major depressive disorder
⚫ Assert that he is the most terrible sinner
who will be punished for all eternity
⚫ Such delusions may give rise to delusions
of persecution
Disorder of Content of thinking
Nihilistic delusions:
⚫ Patient believes that he is dead, the world
has stopped, or everyone else is dead.
⚫ Severe depression, schizophrenia.
Delusions of poverty:
⚫ Conviction that one is impoverished &
beliefs that destitution is facing one & one’s
family
⚫ Seen in severe depression
Speech disorders
Stammering and stuttering – normal
flow of speech is interrupted by pauses or
by repetition of fragments of the word.
Mutism – is the complete loss of speech
Neologisms – invention of new words
Verbigeration - monotonous repetition of
syllables and words.
Echolalia - repetition of words or parts of
sentences that are spoken by others.
Word Salad- Incomprehensible mixture of
words and phrases.
Disorders of Memory
Amnesia:- partial or total inability to recall past
experiences and events.
◦ Normal memory decay
Dèjà vu – feeling of having seen a current event in the past
Jamais vu – an event that has been seen in the past is not
presently associated with appropriate feelings of familiarity
Hyperamnesia: exaggerated retention & recall
Motor Disorders
Psychomotor retardation – subjective feeling that all
actions have become more difficult to initiate & carry out
Mannerism – unusual repeated performances of goal
directed motor action
Chorea – abrupt jerking movements that resemble
fragments of expressive or reactive movements. E.g.
Huntington’s,
Stereotypy – repetitive, non-goal directed action that is
carried out in a uniform way
◦ Schizophrenia
Motor Disorders
Automatic Obedience – the patient carries out every
instruction regardless of the consequence
Echopraxia – patients imitate simple actions that they
see.
◦ Catatonic schizophrenia, Mental retardation
Motor Disorders
Forced grasping - Despite instructions not to touch the
examiners hand, the patient continues to shake hand when the
examiner offers his hand
Negativism - Apparently motiveless resistance to all
interference
Ambitendency – the patient makes a series of tentative
movements that do not reach the intended goal
Motor Disorders
⚫ Psychological pillow – a stereotyped
posture in which the patient lies with the head a
few inches off the pillow. E.g. catatonia, dementia
⚫ Posturing: Adoption of unusual bodily
posture continuously for a long time E.g.
standing on one leg
⚫ Stupor – a complete loss of activity and
lack of reaction to external stimuli
⚫ Excitement – uncontrolled motor activity
THE END

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