Psychology
Dr. Mushtaq Talib
Lec 21 Abnormal PsychologyAbnormal Psychology
Four basic mental functionsConsciousness
Cognitive function
Affect
Conation
consciousness:
Consciousness
Unconsciousness :
Drowsy (Sleepy)
Semi-comatosed (responds only to very painful stimuli)
Comatose
Cognitive function includes:
Attention
Orientation
Concentration
Memory
Perception
Thinking
Judgement
Insight, ...etc
Attention:
Ability to focus on material by hand
Types of attention:
External, if disturbed then called distractability
Internal, if disturbed called flight of idea
Active
Passive
Distractability: attention directed to every external passing stimuli
Flight of idea: attention is directed to every internal passing stimuli.
Orientation:
include time, place, person
Disorders of orientation starts with :
Time: ask the patient about (year, season, day, daytime(day or night), hours) to exclude correct answers by coincidence.
In elderly, not all answers will be correct.
Place: ask the patient the same way for time but about orientation to places ( country, governorate, city, quarter, specific places).
Person: ask about persons around the patient.
Concentration:
Ability to sustain focusing on the material by the hand
Concentration is tested by :
Subtract 7 series from 100, for well educated person
Ask the patient to enumerate the days of the week backwards for illiterate person.
Cognitive assessment does not need advanced investigation (like MRI or brain CT scan), just the above test is enough for diagnosis.
Memory: discussed in previous lectures
Perception:
How we perceive the environment through sense organs.
Abnormalities of perception:
Distortion: disorder in the sense organ itself.
Sensory distortion: abnormality of the sensory organs leads to distortion in perception, e.g. macropsia, dysmegalopsia.
Deception: normal sensory organs yet abnormality in perceiving stimuli.
Deception is of 2 types:
Hallucination: perceiving without any external stimuli.
Types of hallucination:
Tactile
Auditory
Visual
Olfactory
Gustatory
Illusion: Mis-interpretation of external stimuli, positive stimuli but wrong perception. E.g. seeing the pen as a snake.
Imagination differs from hallucination in that:
In imagination, the patient realizes that it is not realNo real stimuli in hallucination, while imagination the stimuli is effected by set and will.
In hallucination the patient sees them as real, clear images and background. While they’re hazy in imagination.
Pseudo hallucination: involuntary sensory experience vivid enough to be regarded as hallucination, but recognized by the patient not to be the result of an external stimuli. i.e. it is a hallucination that is recognized as a hallucination as opposed to a “normal typical” hallucination which would be perceived as real. E.g. an old woman seeing her dead son in front of her despite knowing that he is dead.
Visual hallucinations and illusions: mainly organic lesions (e.g. epilepsy)
Content of hallucination stimuli:
Auditory: commanding = schizophrenia. Talking in bad way (worthlessness) = depressed.
2nd person = directly hearing a person talking about him.
3rd person = hearing 2 persons talking about him.
Type and content are very important in diagnosis.
Thinking:
The ability to learn new information and to acquire knowledge and resolve a problem.
Compare obstract with concert
Best examined by speech, notice the flow, form and content.
Flow: (stream), fluency is either normal or abnormal:
Rapid speech (pressure of speech) expansion of speech, can occur in schizophrenia, mania and other pathologies.
Slow, few or no speech: could be normal or in depressed people; sometimes monotonous which is lack of emotions in speech.
Blocking of the stream which may occur normally or in schizophrenia.
Form :
Form abnormality: formal thought disorder, e.g. schizophrenia, which is lack of grammar and syntax leading to incoherent speech.
Types if incoherence: neologism; flight of idea; dereailment; words salad; loosing of association.
Content:
detecting abnormalities can show : delusion, guilt, suicidal thoughts. But keep in mind the educational background of the patient.
Delusion: false unshakable belief that can’t be changed by any reason and it’s inappropriate or incongrrant with patient cultural and education backgrounds.
Mood:
Mood is subjectively experienced by the patient
Affect is objectively seeing by the examiner, physician through:
Facial expression
Gesture
Setting and dressing
Movement
Speech
