Phenomenology

PhenomenologyDr. Mahmoud Bashtawi , M.D. Psychiatrist: Child & AdolescentDivision of Psychiatry -JUSTDefinitionThe study of events, either psychological or physical.In psychiatry, it involves the observation and categorization of abnormal psychic events, the internal experiences of the patient and his consequent behavior. Psychopathology ;the abnormal psychiatric signs and symptoms.

Psychopathology Descriptive psychopathology aims to describe such phenomena. Psychodynamic psychopathology aims to describe and explain causes of abnormal mental phenomena using psychoanalytic theories.Classification of signs and symptoms in PsychiatryDisorders of PerceptionDisorders of ThinkingDisorders of MoodDisorders of Cognition

Perception Perception:the awareness of objects andinterpretation ofsensoryinformation;i.e. awareness of what is presented through the sense organs. Imagery: A sensory experience over which the subject has voluntary control and experiences as taking place within the mind.Disorders of Perception

illusionHallucinationDepersonalizationDerealizationIllusions

Illusionsmisperceptions of external stimuliconditions more likely to occur:reduced level of sensory stimulation (e.g. at dusk)reduced level of consciousness (e.g. delirious pts.)when attention is not focussed on the sensory modality (e.g. in darkness)when there is a strong affective state (e.g. stressed and anxiety)

Hallucinations

sensory perception without an objective stimulus but with a similar quality to a true percept.can be of all sensory modalities:visual auditory somatic Gustatoryolfactory

Auditory hallucinationsVoicesSingle or multipleMale or femaleKnown or unknown personperson1st person: thought echo - hearing own thoughts spoken aloud.2nd person: calling patient by you3rd person: calling patient by he or sheVoicesCommanding, running commentary or arguing with each otherTiming:day , night or all the time.continuous or intermittent. Theme: friendly or derogatory

HallucinationsVisual Hallucinations: commonly associated with organicity.Olfactory and gustatory hallucinationsoften experienced togetheroften unpleasant in naturecommon in temporal lobe epilepsySomatic (tactile and deep)tactile (haptic): touched; insect crawling under the skin e.g. formication in cocaine abusedeep sensation; viscera being pulled out, sexual stimulation, electric shock

Hallucinations

Extracampine hallucinations:perceiving a sensation from beyond the limits of the sense organe.g. visions from outside visual field, hearing voices from far awayReflex hallucinations:stimulus in one sensory modality causing a hallucination in a different sensory modalitye.g. music causing visual hallucination (LSD abuse)Hypnogogic and hypnopompic hallucinationsoccurs at the point of falling to or waking from sleepusually brief and elementaryDisorders of PerceptionDepersonalization: a feeling that his(her) body parts are abnormal, unreale.g. my brain or my head becomes big until it fills the roomDerealization: a feeling that the external environment is abnormal, unrealPatient describe things in his(her) surrounding that are artificial and lifelessboth can occur in tiredness, TLE, depression etc.

Thought disorders

Thought disorder: occurs when an individual has serious problems with thinking.Thinking : a goal directed flow of ideas initiated by a task leading to a reality orientated conclusioncomponents of thinking:Flow or ( stream ) of thoughtForm of thoughtcontentpossessionDisorders of flow(stream) of thoughts -Preasure of thought increase amount and speed of speech; we can not interrupt or stop the patient because he(she) has many thoughts in his(her) mind. we see this in mania.

Disorders of flow(stream) of thoughts -poverty of thoughts very few thoughts and pass slowly through the mind. we see this in depression. -Thought blocking: sudden interruption of the flow of thoughts in which the patient experiences as his(her) mind going blank or empty. we see this in schizophrenia.Formal thought disorders-Loosening of association:there is a breakdown in the normal structure of thinking in which ideas shift from one subject to another in completely unrelated way.- Flights of ideas: the patients thoughts move rapidly from one idea to another, each idea being more or less meaningfully related to the preceding idea. characteristic of mania .- Perseveration: giving a response beyond the point of relevance i.e. same answer to each question (stimulus)

Formal thought disorders-Word salad: severe form of derailment affecting the grammatical structure of speech.-Circumstantialities: going round and round before finally reaching the point.- Tangentiality: inability to have goal directed association of thoughts, the patient never gets from points to desired goals.-Echolalia: the patient repeats apart or the whole of what have been said to him(her).-Neologism: new words invited by the patient.

Disorders of content of thoughtDelusion:False fixed unshakeable belief, inappropriate to a persons educational and social background.

Over-valued ideas:Ideas held with a lot of emotion (highly charged) but with some degree of ambivalence and doubts about the belief.

Pre-occupation:Ideas which comes to mind, again and again and may prevent the patient from performing his(her) day to day activities.

Classification of delusionsAccording to special features:Systematised delusion:chronic, presence of nucleus, well knitted, inter-connected, layered and well-encapsulated.Non-systematised delusionShared delusion:folie a deux (two person, including patient) folie a mass (> than two person)Themes of delusion (According to theme)Persecutory (paranoid):others trying to inflict harm on himDelusion of Reference:idea that objects, events or people have a personal significance for patient e.g. TV programmes, newsGrandiose (expansive):beliefs of exaggerated self-importancee.g. wealth, special powers, beautyReligious:delusions with religious contente.g. chosen to be prophet, communicating directly to God

Themes of delusion-De Clerambaults Syndrome being loved by a man who is inaccessible, high status, never spoken before, unable to reveal his love for her -Delusion of Jealousy:common in mendelusion of unfaithfulness of spouse (infidelity)spying, checking on spouse, examine for sexual secretions

Themes of delusionDelusion of Guilt and Worthlessness:e.g. minor past faults will be exposed, being sinful, deserves to be punishedNihilistic Delusionbelief about non-existence Cotards Syndrome: failures of bodily functions e.g. bowels are rotting etc.Hypochondriacally Delusionsbelief of ill health despite contrary medical evidenceOther disorders of thought ContentObsessions:recurrent persistent thoughts, impulses or images that enter the mind despite efforts to exclude themsubjective sense of struggle to resist themrecognized as his(her) own regarded as untrue and senselessCompulsions:repetitive, purposeful behaviours performed in a stereotyped way, accompanied with subjective sense that it must be carried out and an urge to resistmost common: cleaning, counting, dressing

Disorders of thought possessionThought Insertion:delusion that some thoughts have been implanted by outside agencyThought Withdrawal:delusion that thoughts have taken out of his mind Thought Broadcasting:delusion that his unspoken thoughts are known to other people

Emotion Affect: a feeling-tone that accompanies an idea; observed. expression of emotion; may be inconsistent with patient's description of emotion inappropriate affect Restricted or constricted affect: reduction in intensity of feeling tone less severe than blunted affect but clearly reduced Blunted affect: a disturbance in affect manifested by a severe reduction in the intensity of externalized feeling toneFlat affect: absence or near absence of any signs of affective expression; voice monotonous, face immobileLabile affect: rapid and abrupt changes in emotional feeling tone, unrelated to external stimuli

EmotionMood: a pervasive and sustained emotion, subjectively experienced and reported by the patient .Euthymic mood: normal range of mood, implying absence of depressed or elevated mood.Euphoria: intense feeling of well being.Elation: intense feeling of well being with exaggerated motor activity.Expansive mood: expression of one's feelings without restraint, frequently with an overestimation of one's significance or importanceMoodEcstasy: felling of intense rapture Dysphoric mood: an unpleasant moodAnhedonia: loss of interest in and withdrawal from all regular and pleasurable activities, often associated with depression

Other emotionsAnxiety: feeling of apprehension caused by anticipation of danger, which may be internal or externalFear: anxiety caused by consciously recognized and realistic dangerAgitation: severe anxiety associated with motor restlessnessPanic: acute, episodic, intense attack of anxiety associated with overwhelming feelings of dread and autonomic dischargeAmbivalence: coexistence of two opposing impulses toward the same thing in the same person at the same time.

Motor behavior Echopraxia: pathological imitation of movements of one person by another Catatonia: abnormal motor (stupor or excitement) in some disorders Catalepsy: general term for an immobile position that is constantly maintainedCatatonic excitement: agitated, purposeless motor activity Catatonic stupor: markedly slowed motor activity, often to a point of immobility and seeming unawareness of surroundings

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