1. Signs And Symptoms of
Mental Disorders
Fareed Minhas
Professor of Psychiatry
Head, Institute of Psychiatry
Rawalpindi Medical College
Rawalpindi

2. General Issues…
 Psychopathology-study
of abnormal states of mind
Three approaches
Phenomenological- objective descriptions of
abnormal states entirely of conscious experiences
and observable behavior
Psychodynamic- explains causation of the
abnormal events by postulating unconscious mental
processes in addition to description
Experimental- relationships between abnormal
phenomena examined by inducing change in one
and observing impact on others

3. General Issues…(contd.)

Significance of individual symptomscharacteristic grouping of symptoms is
important.

Primary and Secondary Symptoms-
establishing a temporal relationship between
symptoms if possible.

Form and Content of Symptoms- eg. “form” of
a chair contains a seat, back and four legs whilst
“content” is wood and straw

4. Categorizing Disorders…










Disorders of perception
Disorders of thinking
Disorders of mood
Disorders of general behavior
Motor Signs and Symptoms
Disorders of Body Image
Disorders of Memory
Disorders of Consciousness
Disorders of Attention/Concentration
Disorders of Insight

5. Disorders of Perception

Perception is the process of becoming aware of what
is presented through the sense organs

Imagery is the experience within the mind (without
sense of reality ) which is a part of perception eg.
Eidetic imagery, pareidolia etc

Alterations in perception of intensity eg. mania or
depression and quality eg. Schizophrenia

Illusions are misperceptions of external stimuli eg.
Delirium, normal situations

6. Disorders of Perception (contd.)

Hallucination is a percept experienced in absence of
external stimulus to sense organ and with a similar
quality to a true percept
Auditory
Visual
Olfactory or gustatory
Somatic (tactile or deep)
Delusional Perception
Normal situations(hypnagogic/hypnopompic)

Pseudohallucinations are of a less intensity and the
person recognizes the absence of external correlates

7. [Description of Hallucinations]




According to complexity
 Elementary
 Complex
According to sensory modality
 Auditory
 Visual
 Olfactory and gustatory
 Somatic (tactile or deep)
According to special features
 Auditory : second-person or third-person
Gedankenlautwerden
echo de la pensee
 Visual : extracampine
Autoscopic hallucinations

8. Disorders of Thinking
TH O U GH T D ISO RD ERS
STREAM O F TH O U G H T
-Pressu re
- T h o u g h t b lo c k
FO R M O F TH O U G H T
- F lig h t o f id e a s
- P e r s e v e r a t io n
- L o o s e n in g o f a s s o c ia t io n
PARTICU LAR KIN D S
- D e lu s io n s
- O b s e s s io n s

9. Disorders of Thinking(contd.)

Pressure of thought- when ideas arise in unusual
variety and pass through the mind rapidly

Thought Block- sudden, striking and repeated
interruptions in speech when the patient describes an
abrupt emptying of the mind

Flight of ideas- thoughts/conversations move quickly
from one topic to another with understandable links eg.
Clang associations, punning, rhyming

Persevaration- persistent inappropriate repetition of
same thoughts

10. Disorders of Thinking(contd.)

Loosening of association- loss of normal structural
links such as:
 Knight’s move or derailment
 Word salad
 Verbigeration
 Talking past the point

Neologisms- use of self-invented words and phrases
to describe morbid experiences

Delusions – false, firm belief impervious to reasoning
and against the social and cultural norms

11. Disorders of Thinking(contd.)

According to theme :
 Persecutory(paranoid) delusions
 Delusions of reference
 Grandiose(expansive) delusions
 Delusions of guilt and worthlessness
 Nihilistic
 Hypochondriacal
 Delusions of control
 Sexual
 Delusions concerning possession of thought:
thought insertion, thought withdrawal, thought
broadcast

12. Disorders of Thinking(contd.)

Other delusional experiences:
 Delusional mood
 Delusional perception
 Delusional memory

Obsessions- recurrent persistent thoughts, impulses
or images that enter the mind despite the person’s
efforts to exclude them. Types maybe:
 Thoughts
 Ruminations
 Doubts
 Impulses
 Phobias

13. Disorders of Thinking(contd.)

Compulsions- repetitive and seemingly purposeful
behaviors performed in a stereotyped way (compulsive
rituals) eg. Cleaning, counting, dressing and these may
lead to obsessional slowness

Obsessions are not always followed by
compulsions but compulsions always have
preceding obsessions associated with them

14. Disorders of Mood

Change in nature of mood- which can be towards
anxiety, depression, elation or anger

Abnormal fluctuations of mood- such as:





Apathy
Blunting or flattening of affect
Labile
Emotional incontinence
Incongruity of mood- for eg. A patient may laugh
when describing the death of his mother

15. Disorders of general behavior

Phobias- A phobia is a persistent irrational fear of a
specific object/activity/situation which the person
recognizes as his own and tries to avoid it at all
possible costs eg. Claustrophobia

Depersonalization- change of self-awareness such
that the person feels unreal

Derealization- objects around the person appear
unreal and people as seen as two-dimensional
cardboard figures

16. Motor Symptoms and Signs

Tics- irregular repeated movements involving a group
of muscles, eg. Raising of shoulders

Mannerisms- repeated movements seeming to have a
functional significance eg. Saluting

Stereotypies- repetitive regular movements having no
obvious functional significance eg. Rocking to and fro

Posturing- adoption of unusual body postures for long
periods of time

17. Motor Symptoms and Signs

Negativism- Patients doing completely opposite of
what is being asked and resisting persuasion

Echopraxia- immitation of interviewer’s movement
automatically even when asked not to do so

Ambitendence- Patients alternate between opposite
movements eg. Putting out an arm to shake hands then
withdrawing

Waxy flexibility- when patient’s limbs can be placed
in any position for long periods while muscle tone is
uniformly increased

18. Disorders of Body Image

Phantom Limb- continuing awareness of a part of body
that has been lost

Unilateral awareness and neglect- resulting from
parietal lobe lesions and in extreme forms patient may
neglect washing that particular side, puts on one shoe
etc

Hemisomatognosis- or hemidepersonalization

Anosognosia- lack of awareness of disease

Pain asymbolia- recognising a painful stimulus as
painless

19. Disorders of Body Image(contd.)

Autotopagnosia- inability to recognize, name or point
on command to parts of the body

Distorted awareness of size and shape- feelings
that a limb is becoming smaller, larger etc

Reduplication phenomenon- experience that part or
all of the body has doubled

Coenesthopatic states- localized distortions of body
awareness eg. Nose feels as if made of cotton wool

20. Disorders of Memory

Normal process:
Sensory stores  Short-term Memory  Long-term
Memory

Amnesia- Failure of memory



Anterograde
Retrograde
Confabulation- Patients have so much difficulty
remembering that they recall even those events that
never happened

21. Disorders of Consciousness

Consciousness- awareness of the self in relation to
environment. Level may vary from extreme alertness to
coma

Coma- Extreme of impaired consciousness
unresponsive to the strongest stimulus. 4 grades

Clouding of consciousness- All cognitive functions
are impaired

Stupor- Immobile, mute, unresponsive patient
appearing to be fully conscious

22. Disorders of
Consciousness(cont)

Confusion- inability to think clearly, usually a
feature of organic states. Three variations exists:
 Oneiroid State (dream-like)
 Twilight State
 Torpor

23. Disorders of
Attention/Concentration

Attention – is the ability to focus on the matter in
hand

Concentration – ability to maintain that focus

Latent Inhibition – the ability of a person to
recognize a previously irrelevant stimulus when it
becomes relevant. In disorders this process is slowed
down

24. Insight
TO CH ECK FO R
IN SIGHT
I s t h e p a t ie n t
aw a re o f th e p h e n om en a
o t h e r p e o p le h a v e
o b se rve d ?
D o e s h e r e c o g n is e
th at th e se p h en o m en a
are
a b n o r m a l?
I f a b n o r m a l, d o e s h e
c o n s id e r t h e m t o b e
r e s u lt in g f r o m a
m e n t a l illn e s s ?
I f h e is m e n t a lly
ill, d o e s h e t h in k h e
needs
tre atm en t?

25. Thankyou
Reference: Oxford Textbook of Psychiatry
(Third Edition)