By the end of the session the student should be able to describe

psychopathology and general symptomatology of mental

disorders
1. Define the term psychopathology
2. Describe the theoretical approaches to the study of
psychopathology
3. Explain the classification of psychiatric symptomatology
4. Explain assessment of psychiatric symptoms
5. Explain general management of psychopathology
Definition:
Psychopathology describes an approach to the study of mental
disorders.
The term descriptive psychopathology is used to describe
symptoms of mental disorders

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There are various approaches /schools of thought to
psychopathology
◦ Biological
◦ Psychological
◦ Cultural, Social and Developmental Factors
1. Biological approach 1. Psychological
◦ Genetics ◦ Behavioral and
◦ Brain and neural cognitive factors
systems ◦ Psychodynamic-
◦ Neurotransmitters unconscious processes

◦ structural abnormalities ◦ Learned helplessness

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3. Social
◦ Friends and family
◦ Social learning

4. Developmental-Reactivity, critical period

Genetic contributions to psychopathology
◦ Most of our behavior and personality is probably
polygenic (influenced by many genes)
◦ In general – our psychological make-up is heritable up to
50%
◦ Some mental disorders are attributed to chromosomal
disorders

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The Interaction of Genetics and Environmental Effects
◦ The Diathesis-Stress Model: The diathesis (inherited
tendency) interacts with stress we encounter to initiate the
illness
◦ The Reciprocal Gene-Environment Model: Genetic
endowment may increase the probability that an individual
will experience stressful life events

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Neurotransmitters
 Drugs can influence
neurotransmitters as agonists
(increase the activity of a
neurotransmitter), antagonists
(decrease or block) or inverse
agonists (effects opposite to
effects of a neurotransmitter)

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Neurotransmitters
 Serotonin
◦ regulates moods, thought processes, regulation of eating,
sexual and aggressive behavior
◦ Redux (antiobezity)and Prozac (antidepressant)
 Gamma Aminobutyric Acid (GABA)
◦ Reduces anxiety, overall arousal and emotional responses
(aggressive behavior, hostility)

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 Norepinephrine: Controls heart rate, blood pressure, and
respiration; contributes to panic attacks, anxiety and mood
disorders (beta-blockers)
 Dopamine:
◦ Activates other neurotransmitters and aids in exploratory and
pleasure-seeking behaviors
◦ Excess is implicated in schizophrenia and deficit in
Parkinson’s disease

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 Genetic contributions may lead to patterns of neurotransmitter
activity that influence personality
 Psychological treatment can influence neural circuits directly
 Extreme abuse severely impedes intellectual, emotional, and
social growth
 Psychosocial factors changes activity levels of neurotransmitters
(e.g. Sense of control and reaction to GABA antagonist)

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 Learned helplessness
◦ If people believe that they have no control over the stress in their
lives, they give up attempting to cope and develop depression
 Social learning
◦ people can learn a lot by observing what happens to someone else
in a given situation (modeling or observational learning)

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 Cognitive science and the unconscious
◦ we are not aware of much of what goes on inside our heads
◦ dissociation between consciousness and behavior (blind
sight and implicit memory)
 Psychodynamic causes of mental disorders
 Cognitive misinterpretation of experiences and mental
disorders

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 Emotions
◦ Components of emotions (physiological reactions, motor
expression, action tendency, appraisal , subjective feeling)
◦ Emotions (last from several minutes to several hours), mood (more
persistent ), affect (momentary emotional tone)
◦ Influence of anger and hostility on heart is much stronger than stress
alone
◦ Suppressing emotional reactions has significant physiological
consequences

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 Gender differences
◦ Women – an insect or small animal phobia
◦ Men – alcoholism
 Social effects
◦ Social relationships seem to protect individuals against
many physical and psychological disorders
 The principle of equifinality
◦ Developmental psychopathology says that a behavior or
disorder may have several different causes
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18
Definition:
 Systematic evaluation and measurement of psychological, biological, and
social factors, their contribution to mental disorders,their role in
management and symptoms.
 Collecting objective and subjective data of the patient’s condition

Diagnosis-The process of determining whether the particular problem

afflicting the individual meets all the criteria for a psychological disorder
according to the DSM-5
Key assessment procedures and methods must meet the following criteria;
 Reliability-The degree to which a measurement is consistent across people
(inter-rater reliability) or across time (test-retest reliability)
 Validity-Whether something measures what it is designed to measure (e.g.
concurrent validity of IQ tests)
 Standardization-Process of establishing specific norms and requirements
for a measurement technique

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Psychiatric assessment are ;
 Techniques employed to:
Describe client’s problem
Determine causes of problem
Arrive at a diagnosis
Develop a treatment strategy
Monitor treatment progress

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 Ideal assessment methods involve multiple measures and methods
including;
 Interviews, personality inventories
 Mental state assessments-discussed as a separate lecture
 Physical examination
 Laboratory investigations,
 Radiological tests,etc

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The Clinical Interview
 Unstructured / Semi-structured interviews used to obtain history and

perform mental status examination

 The Mental Status Examination

Appearance and behavior (overt behavior, posture, expressions)

Thought processes (rate, continuity and content of speech)
Mood and affect (emotional state-current and predominant feeling of
the individual)
Intellectual functioning (type of vocabulary, use of metaphors and
abstractions)
Sensorium (orientation in time, place and person)

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 Physical examination
◦ Psychological disorders associated with medical conditions
(e.g. thyroid gland – overactive results in anxiety, underactive
results in depression)
◦ Structural abnormalities
◦ Co morbidity-medical conditions, physical injuries
 Behavioral assessment
◦ To assess formally an individual’s thoughts, feelings, and
behavior in specific situations or contexts

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 Radiological examination-Neuroimaging
◦ Structural (computerized axial tomography (CT or CAT) &
Magnetic resonance imaging (MRI)) reveal structural
abnormalities by detecting differences in tissue density.e.g.
enlarged ventricles
◦ Functional (measuring metabolic changes- Positron Emission
Tomography (PET scan),fMRI)
 Images reveal function as well as structure
 Measures blood flow in the brain-(BOLD- blood
oxygenation level dependent)

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 Psychophysiological assessment
◦ Electroencephalogram (EEG)
◦ ERP (event-related potentials)
 Skin conductance response-Electrodermal responding-
Sweat-gland activity measured by electrodes placed on
hand.
 Heart rate
 Respiration

◦ Electromygraphy (EMG)

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Neurotransmitter Assessment
 Metabolite assays
◦ Metabolite levels: By-products of neurotransmitter breakdown found in
urine, blood serum or cerebral spinal fluid
◦ May not reflect actual level of neurotransmitter
 Blood studies e.g. full haemogram & U/E may identify some medical
conditions in co morbidity or causing psychiatric symptoms.

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Neuropsychological Tests-Reveal performance deficits that can
indicate areas of brain malfunction
 Halstead-Reitan battery:A combination of neuropsychological
tests used to assess the possible physical aspects and localization
of neurological damage.
 It includes:
Trails A and B (which see how quickly a patient can connect a
sequence of numbers (trail A) or numbers and letters (trail B).
Controlled Oral Word Association Test (COWAT, or Verbal
Fluency) - a measure of a person's ability to make verbal
associations to specified letters.

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 Halstead Category Test (including seven subtests which form three
factors: a Counting factor ,a Spatial Positional Reasoning factor
and a Proportional Reasoning factor
Tactile Performance Test - Time
Tactile Performance Test - Memory
Speech Sounds Perception Test

Luria-Nebraska battery-is a standardized test based on the theories of

Alexander Luria regarding neuropsychological functioning
Assesses motor skills, tactile & kinesthetic skills, verbal & spatial
skills, expressive & receptive speech, etc.

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 Measures developed for one culture or ethnic group may not be
valid or reliable for another.
Not simply a matter of language translation
Meaning may be lost
 Cultural bias can lead to minimizing or exaggerating
psychological problems

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Psychological testing
 Projective testing
◦ Ambiguous stimuli are presented to a person who is asked to
describe what he/she sees
◦ Rorschach inkblot test
◦ Thematic Apperception Test (TAT)

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 Psychological tests that use ambiguous or
unstructured stimuli; person needs to describe the
ambiguous stimuli or make up stories about them
◦ Rorschach Technique: Developed by Swiss
psychologist Hermann Rorschach; contains 10
standardized inkblots (the “inkblot” test)
◦ Thematic Apperception Test (TAT): Developed by
Henry Murray, personality theorist; projective
device consisting of 20 drawings (black and
white) of various situations; people must make up
stories about the people in it
 Personality inventories
◦ Minnesota Multiphasic Personality Inventory (MMPI) (scales like
anxiety, depression etc.)

 Intelligence testing
◦ Stanford-Binet test
◦ Wechsler test (verbal scales, performance scales)

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 Neuropsychological testing
◦ Measuring language abilities, attention, memory, perception,
motor skills, learning and abstraction to detect possible brain
dysfunction
◦ Luria-Nebraska Neuropsychological Battery
◦ Halstead-Reitan Neuropsychological Battery

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 Diagnosis :The classification of disorders by symptoms and signs.
 Advantages of diagnosis:
◦ Facilitates communication among professionals
◦ Advances the search for causes and treatments
◦ Cornerstone of clinical care

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 Some concepts
◦ classification (assignment into categories)
◦ taxonomy (system of classification in science)
◦ nosology (naming system for medical and psychological
phenomena)
 Approaches to classification
◦ classical categorical approach (clear-cut differences, different
cause)
◦ dimensional approach (continuum)
◦ prototypical approach (defining, essential characteristics)

36
 American Psychiatric Association
◦ System for categorizing disorders using both essential, defining
characteristics and a range of variation on other characteristics Diagnosis
◦ Criteria for different disorders as specified in DSM-5

 International classification of diseases(ICD)-WHO

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 Distress - experiencing personal distress or extreme anxiety 
 Maladaptiveness - acting in ways that do not contribute to     personal

well-being 
 Irrationality - acting or talking in ways that are irrational or

incomprehensible 
 Unpredictability - behaving erratically from situation to situation 

 Unconventionality & Statistical Rarity - behaving in ways that are

rare and violate social standards 

 Observer discomfort - creating discomfort in others by making them

feel threatened
International classifications of mental disorders-DSM & ICD

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Psychiatric symptomatology
 Psychiatric symptomatology can be under the following
abnormal phenomena;
1. Consciousness 5. Mood
(emotions)
2. Perception 6. Intelligence
3. Thinking 7. Motor
4. Memory 8. Personality

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 Consciousness is awareness of the self and the
environment
Disorders of consciousness:
qualitative
quantitative
short-term
long-term

◦ Hypnosis – artificially incited change of consciousness

◦ Syncope – short-term unconsciousness

41
 Quantitative changes of consciousness mean reduced vigility
(alertness):
◦ somnolence
◦ Sopor (stupor)
◦ coma

42
 Qualitative changes of consciousness mean disturbed perception,
thinking, affectivity, memory and consequent motor disorders:
◦ delirium (confusional state) – characterized by disorientation,
distorted perception, enhanced suggestibility, misinterpretations
and mood disorders
◦ obnubilation (twilight state) – starts and ends abruptly, amnesia is
complete; the patient is disordered, his acting is aimless,
sometimes aggressive, hard to understood
 Perception is a process of becoming aware of what is presented through the
sense organs
 Imagery means an experience within the mind, usually without the sense of
reality that is part of reality
 Pseudoillusions – distorted perception of objects which may occur when
the general level of sensory stimulation is reduced
 Illusions are psychopathological phenomena; they appear mainly in
conditions of qualitative disturbances of consciousness (missing insight)
 Hallucination are perceptions without any obvious stimulus to the sense
organs; the patient is unable to distinguish it from reality

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Hallucinations:
 auditory (acousma)
 visual
 olfactory
 gustatory
 tactile (or deep somatic)
 hypnagogic and hypnopompic (hypnexagogic)
Pseudohallucinations - patient can distinguish them from reality

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Disorders of thinking are usually inferred from speech or behaviour
 Thinking
 Cognitive functions
 Disorders of thinking:
◦ quantitative
◦ qualitative

46
 Disorder Of Thought

stream
formal 1-tangentiality content
2-circumstantially
3-loseness of association
1-Concrete
4-flight of idea 1-delusion.
thinking
5-clang association
6-incoherence or word salad
2-autistic 2-obsession
7-pressur of speck
thinking
8-poverty of speech
9-Retardation
3-peroccuption.
10-Blocking
11-preservation
12-pallilalia
4-suicidal ideation.
13-Echolalia
14-Irrelevant answer
15-Neologisms
Quantitative (formal) disorders of thinking:
 pressure of thought

 poverty of thought

 thought blocking

 flight of ideas

 perseveration

 loosening of associations

 word salad

 neologisms

 verbigeration

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Content thought disorders:
 Delusions: belief that is firmly held on inadequate grounds, not affected by
rational arguments, not a conventional belief and not keeping with the
individual’s background.
 Overvalued idea: Differs from delusion in that it is in keeping with the
individual’s background

 Obsessions (obsessive thought) are recurrent persistent thoughts, impulses

or images entering the mind despite the person's effort to exclude them.
Obsessive phenomena in acting (usual as senseless rituals – cleaning,
counting, dressing) are called compulsions .

49
Categorization/classification of delusions:
 According to onset
a)Primary (delusion mood, perception)
b)Secondary (systematized)
c)Shared (folie a deux)

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 According to theme
a) Paranoid (persecutory) delusion of reference, jealousy, control,
concerning possession of thought
b)Megalomanic (grandiose, expansive) delusion of power, worth, noble
origin, supernatural skills and strength, amorous
c) Obsession
d)Preoccupation
e) Depressive (micromanic, melancholic) delusion of guilt and
worthlessness, nihilistic ,hypochondriacal
f) Concerning the possession of thoughts (usually identified in thought
processes)-Thought insertion, Thought withdrawal, Thought broadcasting
 Sensory stores - retains sensory information for 0.5 sec.
 Short - term memory (working memory) - for verbal and visual
information, retained for 15-20 sec., low capacity
 Long-term memory – wide capacity and more permanent storage
◦ Declarative (explicit) memory – episodic (for events) or semantic
(for language and knowledge)
◦ Procedural memory – for motor arts
◦ Priming – unconscious memory
◦ Conditioning – classic or emotional

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Disorders of memory:
 Amnesia – inability to recall past events
 Jamais vu, déja vu
 Confabulation, amnesic disorientation, Korsakov’s
syndrome
 Pseudologia phantastica
 Hypomnesia
 Hypermnesia

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 Concentration  Vigility
 Capacity  Hypoprosexia (global,
 Tenacity selective)

 Irritability
 Hyperprosexia
 Paraprosexia

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Normal affect – brief and strong emotional response
Normal mood – subjective and for a longer time lasting disposition to
appear affects adequate to a surrounding situation and matters
discussed
Higher emotions:
◦ intellectual
◦ aesthetic
◦ ethic
◦ social

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 Pathological mood:
 lability,helpless
◦ Origin – based on pathological
 Pathological features of mood:
grounds, no psychological cause
◦ Euphoria,expansive,exaltation
◦ Duration – unusually long-lasting
◦ Explosive,mania,hypomania
◦ Intensity – unusually strong, large
◦ Depression,apathy (anhedonia)
changes in intensity
◦ Blunted, flattened affect
◦ Impossibility to be changed by
◦ Emotional
psychological means

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 Intelligence:
◦ Abstract
◦ Practical
◦ Social
 Intelligence quotient (IQ):
IQ = (mental age/chronological age) x 100
 Disorders of intellect:
◦ Mental retardation
◦ Dementia

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Disorders of volition:
◦ Hypobulia
◦ Abulia
◦ Hyperbulia

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 Personality means a complex of persistent mental and physical traits of
a person that serve to identify them from others
 Disturbances of personality:
◦ Transformation of personality
◦ Appersonalization
◦ Multiple personality (alteration of personality)
◦ Specific personality disorder
◦ Deprived personality

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Integrative approach: Applying contributions from all the
factors to explain causes of a mental disorder in a specific
individual

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 Biological
◦ Pharmacotherapy
◦ ECT
 Psychological
 Psychodynamic
 Behavioural
 Cognitive behavioural therapy
 Social, cultural

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