phenomenology yr4

8/8/2019 Phenomenology Yr4

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PHENOMENOLOGYPHENOMENOLOGY(MED 4048)(MED 4048)

Assoc Prof DrAssoc Prof Dr MuhdMuhd. Najib Mohd.. Najib Mohd.AlwiAlwi


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PHENOMENOLOGYPHENOMENOLOGY

Definition:Definition:

-- The study of events, either psychological or physical,The study of events, either psychological or physical,

without embellishing those events with explanation ofwithout embellishing those events with explanation of

cause or functioncause or function-- In psychiatry, it involves theIn psychiatry, it involves the observationobservation andand categorizationcategorization

ofofabnormal psychic eventsabnormal psychic events, the internal experiences of the, the internal experiences of the

patient and his consequent behaviourpatient and his consequent behaviour

-- NB: It is sometimes called Descriptive Psychopathology:NB: It is sometimes called Descriptive Psychopathology:

-- Empathic evaluation of patients subjective experienceEmpathic evaluation of patients subjective experience

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General objectives

To know the main headings under which the

mental state is described.

To know the main phenomenology conceptsand their descriptions.

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Specific ObjectivesSpecific Objectives

To understand the definition of phenomenology and itsTo understand the definition of phenomenology and itsimportance in psychiatry.importance in psychiatry.

To comprehend how to elicit and describe common signs andTo comprehend how to elicit and describe common signs andsymptoms in psychiatry.symptoms in psychiatry.

To understand the basic classification of signs and symptomsTo understand the basic classification of signs and symptomsin psychiatry.in psychiatry.

To be aware of common perceptual disturbances.To be aware of common perceptual disturbances.

To distinguish the differences between true andTo distinguish the differences between true andpseudohallucinations.pseudohallucinations.

To define thinking and understand the basic components ofTo define thinking and understand the basic components ofthought and the disturbances associated with each one ofthought and the disturbances associated with each one ofthem.them.

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SOME DEFINITIONS..SOME DEFINITIONS..

Symptoms:Symptoms:

-- subjective experiences described by the patientsubjective experiences described by the patient

-- e.g. Depressed mood, poor concentratione.g. Depressed mood, poor concentration

Signs:Signs:

-- objective findings observed by the clinicianobjective findings observed by the clinician

-- e.g. Psychomotor retardation, restricted affecte.g. Psychomotor retardation, restricted affect

Syndrome:Syndrome:-- a group of signs and symptoms that occur together as aa group of signs and symptoms that occur together as a

recognizable condition that may be less than specific thanrecognizable condition that may be less than specific than

a cleara clear--cut disorder or diseasecut disorder or disease

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Becoming an expert in recognizing specific

signs and symptoms allows the clinician to:

Becoming an expert in recognizing specific

signs and symptoms allows the clinician to:understandably communicate with otherclinicians,

understandably communicate with otherclinicians,

accurately make a diagnosis,

accurately make a diagnosis,

effectively manage treatment,

effectively manage treatment,

reliably predict prognosis, and

reliably predict prognosis, and

thoroughly explore pathophysiology and causesof a patients condition.

thoroughly explore pathophysiology and causesof a patients condition.

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observation and categorizationof abnormal psychic

events

Phenomenology:


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DESCRIPTION OF SYMPTOMSDESCRIPTION OF SYMPTOMS

Significance:Significance:

symptoms are more likely to indicate mental disorder ifsymptoms are more likely to indicate mental disorder if

theythey areare intenseintense andand persistentpersistent..

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Primary and Secondary:Primary and Secondary:

Temporal:Temporal:

PrimaryPrimary antecedentantecedent

SecondarySecondary subsequentsubsequent

Causal:Causal:

PrimaryPrimary direct expression of the pathological processdirect expression of the pathological process SecondarySecondary a reaction to the primary symptomsa reaction to the primary symptoms

primary secondary


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Normally is what the doctor is interested in

e.g. Voices - internal/external,second/third person, true

voices/implanted thoughts etc.

Form

What the patient is pre-occupied with e.g. Voices - what the voices says, his

feelings towards them etc.Content

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Asking the patient:

imagine someoneasking you:

Do you hav anyfix d,fals eliefs

that are outof

keeping with yourculture or

educationalackground?

thus, it is veryimportant to start off

ith open-ended

uestion (screening)an then procee to

close-ended uestion(specific symptoms)

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Asking the patient:Asking the patient:now imagine you asking the patient:now imagine you asking the patient:

Do you have any odd experiences lately?Do you have any odd experiences lately?

Well, like strange sensasations, feelings or thoughts?Well, like strange sensasations, feelings or thoughts?

If so, is it in the form of voices that other people cannot hear?If so, is it in the form of voices that other people cannot hear?

..... And so on......... And so on....

Sometimespeople earthings henthereisnothingSometimespeoplehearthings henthereisnothing

actually theretoexplainit, likeavoicecalling theiractually theretoexplainit, likeavoicecalling their

name. Do youhavesuchanexperience?name. Do youhavesuchanexperience?

can youtell memoreaboutit?can youtell memoreaboutit?

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Quiz

Please indicate TRUE or FALSE:

A. Doctors are more interested in the CONTENT of

a symptom

B. Psychopathology is determined by the

INTENSITY of a symptom

C. Closed ended questions should never be used in

patient interviewD. Secondary psychiatric symptoms do develop

from physical causes

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Classification of signs and symptomsClassification of signs and symptomsin Psychiatryin Psychiatry

Disorders of PerceptionDisorders of Perception

Disorders of ThinkingDisorders of Thinking

Disorders of MoodDisorders of Mood

Disorders ofCognitionDisorders ofCognition

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Perception:Perception:

the process of becoming aware of what is presentedthe process of becoming aware of what is presentedthrough the sense organs i.e. the understanding of athrough the sense organs i.e. the understanding of a

sensory stimulussensory stimulus

c/fc/fimagery (fantasy): an experience within the mind,(fantasy): an experience within the mind,

usually without the sense of reality, can be called outusually without the sense of reality, can be called out

and terminated by voluntary effort.and terminated by voluntary effort.

e.g.e.g.

Eidetic imagery: a visual image which is so intense andEidetic imagery: a visual image which is so intense and

detailed that it has a photographic qualitydetailed that it has a photographic quality

Pareidolia: images created out of admixture of sensoryPareidolia: images created out of admixture of sensory

percepts and imagination; maybe provoked by psychomimeticpercepts and imagination; maybe provoked by psychomimetic

drugsdrugs

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Alterations in Perception:Alterations in Perception:

intensityintensity

E.g.E.g.

Hyperacusis (a/w hangover, depression, migraine)Hyperacusis (a/w hangover, depression, migraine)

Visual hyperaesthesia (colours more vivid/intense): LSD,Visual hyperaesthesia (colours more vivid/intense): LSD,mania, epileptic auramania, epileptic aura

qualityquality

shapeshape -- e.g. macropsia, micropsia, dysmegalopsia (larger one.g. macropsia, micropsia, dysmegalopsia (larger on

one side), distortedone side), distorted foodfood bitterbitter

Changes occur in epilepsy, acute schizophrenia, mescalinChanges occur in epilepsy, acute schizophrenia, mescalin

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IllusionsIllusions

misperceptions of external (objective) stimulimisperceptions of external (objective) stimuli

conditions more likely to occur:conditions more likely to occur:

reduced level of sensory stimulation (e.g. at dusk)reduced level of sensory stimulation (e.g. at dusk)

reduced level of consciousness (e.g. delirious pts.)reduced level of consciousness (e.g. delirious pts.)

when attention is not focussed on the sensory modality (e.g. inwhen attention is not focussed on the sensory modality (e.g. in

darkness)darkness)

when there is a strong affective state (e.g. stressed up / angry)when there is a strong affective state (e.g. stressed up / angry)

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HallucinationsHallucinations

sensory perception without an objectivesensory perception without an objectivestimulus but with a similar quality to a truestimulus but with a similar quality to a true

perceptpercept experienced as originating in the outside worldexperienced as originating in the outside world

and not in the mind (like imagery)and not in the mind (like imagery)

can be of all sensory modalities:can be of all sensory modalities:

visual / auditory / tactilevisual / auditory / tactile

gustatory / vestibular / olfactorygustatory / vestibular / olfactory

presencepresence

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HallucinationsHallucinations

objective spaceobjective space

perceived via a sensoryperceived via a sensory

modalitymodalityclear, distinct, vividclear, distinct, vivid

beyond voluntarybeyond voluntary

controlcontrol

no *insight (towards theno *insight (towards thesymptom)symptom)

PseudohallucinationsPseudohallucinations

subjective spacesubjective space

may not be perceived bymay not be perceived by

a sensory modalitya sensory modalityunclear, foggyunclear, foggy

within voluntary controlwithin voluntary control

of a personof a person

there is insightthere is insight

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*about the absurdity of the perception

True differentiating factors are only: voluntary control and insight.Other criteria can overlap.


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Description of hallucinationsDescription of hallucinations

According to complexityAccording to complexity

elementaryelementarycomplexcomplex

According to sensory modalityAccording to sensory modality

According to special featuresAccording to special featuresauditory: 2nd or 3rd personauditory: 2nd or 3rd person

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Auditory hallucinationsAuditory hallucinations

Elementary / complexElementary / complex

VoicesVoices

single/multiplesingle/multiple male/femalemale/female

known/unknown personknown/unknown person

personperson

1st person: thought echo1st person: thought echo -- hearing own thoughtshearing own thoughtsspoken aloud (spoken aloud (GedankenlautwerdenGedankenlautwerden,, echo de la penseeecho de la pensee))

2nd person: calling patient by you2nd person: calling patient by you

3rd person:calling patient by he or she3rd person:calling patient by he or she

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Auditory hallucinationsAuditory hallucinations

VoicesVoices

commanding / running commentary / arguing withcommanding / running commentary / arguing with

each othereach other

timing:timing:

day / night / all the timeday / night / all the time

circumstances when it occurscircumstances when it occurs

continuous / intermittent / frequencycontinuous / intermittent / frequency

theme:theme:

friendly, derogatoryfriendly, derogatory

patients response to the voicespatients response to the voices

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Visual HallucinationsVisual Hallucinations

elementary (e.g. flashes of light)elementary (e.g. flashes of light)

complexcomplex

semisemi--formed: with some structureformed: with some structurefullyfully--formed: e.g. human figures, treesformed: e.g. human figures, trees

black and white / colouredblack and white / coloured

static / mobilestatic / mobile

stable form / changing designstable form / changing designsize (e.g.size (e.g. lilliputianlilliputian))

commonly associated with organicitycommonly associated with organicity

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Olfactory an gustatory hallucinationsOlfactory an gustatory hallucinations

often experienced togetheroften experienced togetheroften unpleasant in nature (e.g. rotten fish, bitter)often unpleasant in nature (e.g. rotten fish, bitter)

common in temporal lobe epilepsycommon in temporal lobe epilepsy

Somatic (tactilean deep)Somatic (tactileand deep)

tactile (haptic): touched, pricked e.g. insecttactile (haptic): touched, pricked e.g. insect

crawling under the skin (e.g. formication in coccainecrawling under the skin (e.g. formication in coccaine

abuse)abuse)

deep sensation: e.g. viscera being pulled out,deep sensation: e.g. viscera being pulled out,

sexual stimulation, electric shocksexual stimulation, electric shock

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AutoscopichallucinationAutoscopichallucination

seeing own body projected into objective space (can happen inseeing own body projected into objective space (can happen indepression)depression)

negative autoscopy also can occur!negative autoscopy also can occur!

ExtracampinehallucinationsExtracampinehallucinations

perceiving a sensation from beyond the limits of the senseperceiving a sensation from beyond the limits of the sense

organorgan

e.g. visions from outside visual field, hearing voices from far fare.g. visions from outside visual field, hearing voices from far far

awayaway

Functional hallucinationFunctional hallucination

Normal perception of a stimulus and a hallucination in theNormal perception of a stimulus and a hallucination in the

same modality are experienced simultaneouslysame modality are experienced simultaneously

E.g. hearing hallucinatory voices only when water was runningE.g. hearing hallucinatory voices only when water was running

through the pipes.through the pipes.28


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ReflexhallucinationsReflexhallucinations

stimulus in one sensory modality causing astimulus in one sensory modality causing a

hallucination in a different sensory modalityhallucination in a different sensory modality

e.g. music causing visual hallucination (LSDe.g. music causing visual hallucination (LSD

abuse)abuse)

Hypnogogicand hypnopompicHypnogogicand hypnopompichallucinationshallucinations

occurs at the point of falling to or waking fromoccurs at the point of falling to or waking from

sleepsleep

usually brief and elementaryusually brief and elementary

Feeling ofPresenceFeeling ofPresence

feeling the presence of somebody near butfeeling the presence of somebody near but

realises that he is nonrealises that he is non--existent!existent!29


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Other Perceptual Disturbances

Depersonalization:Depersonalization: a feeling that his bodya feeling that his bodyparts are abnormal, unrealparts are abnormal, unreal

e.g. my brain becomes big until it fills the roome.g. my brain becomes big until it fills the room Derealization:Derealization: a feeling that the externala feeling that the external

environment is abnormal, unrealenvironment is abnormal, unreal

e.g. people are 2 dimensional card board figurese.g. people are 2 dimensional card board figures

BOTHBOTH can occur in tiredness, TLE, depressioncan occur in tiredness, TLE, depressionetc.etc.

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ThinkingThinking

Definition:Definition:

a goal directed flow of ideas, symbols ora goal directed flow of ideas, symbols or

associations, initiated by a problem/task, leading toassociations, initiated by a problem/task, leading to

a reality orientated conclusiona reality orientated conclusion disorders of thinking are usually recognized fromdisorders of thinking are usually recognized from

speech and writingspeech and writing

4 components of thinking:4 components of thinking:

form of thoughtform of thought

flow (stream) of thoughtflow (stream) of thought

contentcontent

possessionpossession32


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Formal Thought DisorderFormal Thought Disorder

Disorder in the form (structure) of thoughtsDisorder in the form (structure) of thoughts

3 main subgroups:3 main subgroups:

loosening of associationloosening of associationflights of ideasflights of ideas

perseverationperseveration

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Loosening of AssociationLoosening of AssociationLoss of the normal structure of thinkingLoss of the normal structure of thinking

muddled and illogical conversation that cannot be clarified bymuddled and illogical conversation that cannot be clarified by

further enquiry.further enquiry.

Several forms:Several forms:

Knights move / derailment:Knights move / derailment:transition from one topic to another with no logical connectiontransition from one topic to another with no logical connection

between the twobetween the two

Word salad:Word salad:

severe form of derailment affecting the grammatical structure ofsevere form of derailment affecting the grammatical structure of

speechspeech

Talking past the point (Talking past the point (vorbeiredenvorbeireden) / tangentiality:) / tangentiality:

touching the point just a little bit before going offtouching the point just a little bit before going off

Circumstantiality:Circumstantiality:

going round and round before finally reaching the pointgoing round and round before finally reaching the point

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Flights of IdeasFlights of Ideas

Patients thoughts and conversation move quickly fromPatients thoughts and conversation move quickly from

one topic to another so that one train of thought is notone topic to another so that one train of thought is not

completed before the another appears but there is ancompleted before the another appears but there is an

apparent association between them (clang (similarapparent association between them (clang (similar

sound) or chance associations)sound) or chance associations)

3 components have to be there:3 components have to be there:

pressure of speechpressure of speech

shifting topicsshifting topics

apparent association (can be followed)apparent association (can be followed)NB: if without pressure of speech =NB: if without pressure of speech = PROLIXITYPROLIXITY

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Other Formal Thought DisordersOther Formal Thought Disorders

Perseveration:Perseveration:

Giving a response beyond the point of relevance i.e. sameGiving a response beyond the point of relevance i.e. same

answer to each question (stimulus)answer to each question (stimulus)

c/f verbal stereotypy (verbigeration): words, sounds or phrasec/f verbal stereotypy (verbigeration): words, sounds or phrase

repeated in a senseless way (no stimulus)repeated in a senseless way (no stimulus)

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Perseveration

Verbal Stereotypy


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Disorder of flow (stream)Disorder of flow (stream)

Both the amount and the speed of thoughts areBoth the amount and the speed of thoughts are

changedchanged

Different levels:Different levels:

mutenessmuteness

poverty of thoughtpoverty of thought

thought blockthought block

volubility:volubility: amount & speed, still can interruptamount & speed, still can interrupt

pressure of speech:pressure of speech: amount & speed, cannotamount & speed, cannot

interrupt speechinterrupt speech

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Disorders ofContent of ThoughtDisorders ofContent of ThoughtDelusion:Delusion:

false belief, unshakeable, inappropriate to a personsfalse belief, unshakeable, inappropriate to a persons

educational and social backgroundeducational and social background

double orientation: wholly convinced about the truth of thedouble orientation: wholly convinced about the truth of the

delusional belief but the conviction may not influence hisdelusional belief but the conviction may not influence his

feelings and emotionsfeelings and emotions

OverOver--valued ideas:valued ideas:

ideas held with a lot of emotion (highly charged) but withideas held with a lot of emotion (highly charged) but with

some degree of ambivalence and doubts about the belief.some degree of ambivalence and doubts about the belief.

(Emotions are expressed to compensate for the ambivalence)(Emotions are expressed to compensate for the ambivalence)

PrePre--occupation:occupation:

ideas which comes to mind, again and again and may preventideas which comes to mind, again and again and may prevent

the patient from performing his day to day activitiesthe patient from performing his day to day activities

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Classification of DelusionsClassification of Delusions

According to fixity:According to fixity: complete / partial / overcomplete / partial / over--valued ideas / ideasvalued ideas / ideas

According to onset:According to onset:

Primary: autochthonous delusionsPrimary: autochthonous delusions

sudden onset (out of the blue) of delusionsudden onset (out of the blue) of delusion other forms:other forms:

delusional mood: anxiety, foreboding something to happendelusional mood: anxiety, foreboding something to happen((WahnstimmungWahnstimmung))

delusional perception:delusional perception: false meaning to a normal perceptfalse meaning to a normal percept

memory: attribute new meaning to old experiencememory: attribute new meaning to old experience

Secondary: derived from preceding morbidSecondary: derived from preceding morbidexperience e.g. hallucinations, depressive moodexperience e.g. hallucinations, depressive moodetc.etc.

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Classification of DelusionsClassification of Delusions

According to special features:According to special features:

Systematised delusion:Systematised delusion:

chronic, presence of nucleus, well knitted, interchronic, presence of nucleus, well knitted, inter--

connected, layered and wellconnected, layered and well--encapsulated.encapsulated.NonNon--systematised delusionsystematised delusion

Shared delusion:Shared delusion:

folie a deuxfolie a deux(two person, including patient)(two person, including patient)

folie a massfolie a mass (> than two person)(> than two person)

According to themeAccording to theme

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Themes of DelusionThemes of Delusion

Persecutory (paranoid):Persecutory (paranoid):

others/organizations trying to inflict harm on himothers/organizations trying to inflict harm on him

Delusion ofReference:Delusion ofReference:

idea that objects/events/people have a personalidea that objects/events/people have a personalsignificance for patient e.g. TV programmes, newssignificance for patient e.g. TV programmes, news

Grandiose (expansive):Grandiose (expansive):

beliefs of exaggerated selfbeliefs of exaggerated self--importanceimportance

e.g. wealth, special powers, beautye.g. wealth, special powers, beauty

Religious:Religious:

delusions with religious contentdelusions with religious content

e.g. chosen to be prophet, communicating directly to Gode.g. chosen to be prophet, communicating directly to God

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Amorous DelusionAmorous Delusion

more common in womenmore common in women

(? stalking in men)(? stalking in men)

De Clerambaults SyndromeDe Clerambaults Syndromebeing lovedbeing loved by a man who is inaccessible, high status, neverby a man who is inaccessible, high status, never

spoken before, unable to reveal his love for herspoken before, unable to reveal his love for her

Delusion of Jealousy:Delusion of Jealousy:

common in mencommon in mendelusion of unfaithfulness of spouse (infidelity)delusion of unfaithfulness of spouse (infidelity)

spying, checking on spouse, examine for sexualspying, checking on spouse, examine for sexual

secretionssecretions

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Delusion of Guilt and Worthlessness:Delusion of Guilt and Worthlessness:e.g. minor past faults will be exposed, being sinful,e.g. minor past faults will be exposed, being sinful,

deserves to be punisheddeserves to be punished

Nihilistic DelusionNihilistic Delusion

belief about nonbelief about non--existence of some person / thing +existence of some person / thing +pessimistic ideas e.g. career is gonepessimistic ideas e.g. career is gone

CotardsSyndromeCotardsSyndrome: failures of bodily functions e.g.: failures of bodily functions e.g.

bowels are rotting etc.bowels are rotting etc.

Hypochondriacal DelusionsHypochondriacal Delusionsbelief of ill health despite contrary medicalbelief of ill health despite contrary medical

evidenceevidence

usually of a particular theme & may haveusually of a particular theme & may have

relative/friend suffering the supposed illnessrelative/friend suffering the supposed illness 44


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OTHER DISORDERS OF THOUGHTOTHER DISORDERS OF THOUGHT

CONTENTCONTENT

Obsessions:Obsessions:recurrent persistent thoughts, impulses or images thatrecurrent persistent thoughts, impulses or images thatenter the mind despite efforts to exclude thementer the mind despite efforts to exclude them

subjective sense of struggle to resist themsubjective sense of struggle to resist them

recognized as his own (not implanted)recognized as his own (not implanted)

regarded as untrue and senselessregarded as untrue and senseless

Compulsions:Compulsions:repetitive, purposeful behaviours performed in arepetitive, purposeful behaviours performed in a

stereotyped way, accompanied with subjective sensestereotyped way, accompanied with subjective sense

that it must be carried out and an urge to resistthat it must be carried out and an urge to resistmost common: cleaning, counting, dressingmost common: cleaning, counting, dressing

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DESCRIPTION OF OBSESSIONSDESCRIPTION OF OBSESSIONS

FiveFive forms:forms: thoughtsthoughts: intrusive words: intrusive words

or phrases, upsetting e.g.or phrases, upsetting e.g.

blasphemous phrasesblasphemous phrases

ruminationrumination: worrying: worrying

themes e.g. ending of thethemes e.g. ending of the

worldworld

doubtsdoubts: uncertainty about: uncertainty about

previous action (realizesprevious action (realizes

done)done)

impulsesimpulses: urges to carry: urges to carryout actions: dangerous orout actions: dangerous or

embarrassingembarrassing

obsessional phobiaobsessional phobia

SixSix common themes:common themes: dirt & contaminationdirt & contamination

aggressivethoughtsaggressivethoughts: e.g.: e.g.striking othersstriking others

orderlinessorderliness: how things / work: how things / workneed to be arranged / doneneed to be arranged / done

illnessillness: e.g. dread about: e.g. dread aboutcancercancer

sex:sex: e.g. perverse sexual actse.g. perverse sexual acts

religionreligion: doubts about: doubts aboutfundamental beliefs e.g. Doesfundamental beliefs e.g. DoesGod exist?God exist?

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Disorders of Thought PossessionDisorders of Thought Possession

Thought Insertion:Thought Insertion:

delusion that some thoughts have beendelusion that some thoughts have been

implanted by outside agencyimplanted by outside agency

Thought Withdrawal:Thought Withdrawal:

delusion that thoughts have taken out of hisdelusion that thoughts have taken out of his

mind (may accompany/explain thought block)mind (may accompany/explain thought block)

Thought Broadcasting:Thought Broadcasting:delusion that his unspoken thoughts are knowndelusion that his unspoken thoughts are known

to other peopleto other people

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SCHNEIDERIAN FIRSTSCHNEIDERIAN FIRST--RANK SYMPTOMSRANK SYMPTOMS

(FRS)(FRS)

arespecifictypesofarespecifictypesofdelusions andand hallucinations thatthatinvolvethemesofpassivity.involvethemesofpassivity. FRSarehighly suggestiveofFRSarehighly suggestiveofschizophrenia,ratherthan being suresignsofthat disorder.,ratherthan being suresignsofthat disorder.

Patients ithPatients ithneurological impairment thatproducethatproducepathological impulsesor behaviors ill commonly saypathological impulsesor behaviors ill commonly say "Thisbehaviorisnotme," yet ill readily acceptresponsibility foryet ill readily acceptresponsibility forthe behavior.the behavior.

Incontrast,patients ithIncontrast,patients ithFirstRank Symptoms denydenyresponsibility forthestrange behavior,claiming thatresponsibility forthestrange behavior,claiming that"othersmademe doit."

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Auditory Hallucinations

Audiblethoughts

auditory hallucinations in which the patient hears his ownthoughts being spoken aloud by others

Voicesarguing

are auditory hallucinations in which the patient hears two ormore people arguing, typically about the patient, whom theyrefer to as a third party

Voicescommenting

are auditory hallucinations in which the patient hears peoplecommenting on his actions while they are occurring

Made Phenomenon

Beingcontrolled(delusions of)

reflect the patient's experience of his actions beingcompletely under the control of external influences. He feelslike an automaton, a totally passive observer of his ownactions. These are also called "made acts."

"Made"feelings

are delusions in which the patient experiences emotionswhich she insists are not her own, but have been imposed onher by others

Somaticpassivity

are somatic hallucinations in which the patient is convincedthat an external agent has caused him to be a passiverecipient of unwanted bodily sensations made sensations


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Thought Alienation

Thoughtbroadcasting

are beliefs that one's inner thoughts are no longer private,have escaped from one's mind, and have become knownto everyone

Thoughtinsertions

are ego-alien convictions that thoughts have been placedinto one's mind, with the person believing his thoughts arenot his own

Thoughtwithdrawal

is a patient's ego-dystonic belief that thoughts are taken,or stolen, from her mind or brain, and that she has fewerthoughts than before. "I was discussing Rome, when mybrain was sucked empty by the Pope's vacuum cleaner

Primary Delusion

DelusionalPerception

A normal perception which has become highly investedwith significance and which has become incorporated intoa delusional system, e.g. 'when I saw the traffic lights turnred I knew that the calculator that I brought has changedinto a KGB detector'.


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SCHNEIDERS FIRST RANK SYMPTOMSSCHNEIDERS FIRST RANK SYMPTOMS

Remembering SchneiderianFirstRank symptomsisasRemembering SchneiderianFirstRank symptomsisaseasy asABCD:easy asABCD:

A=A=AuditoryAuditory hallucinationshallucinations -- 3rd person (arguing &3rd person (arguing &

commenting)/thoughtechocommenting)/thoughtecho

B=B=BroadcastingBroadcasting ofthoughts/ insertion/ ithdrawalofthoughts/ insertion/withdrawal

C=C=ControlControl experiences/ passivity phenomenaexperiences/ passivity phenomena

(madeact,feeling,sensation)(madeact,feeling,sensation) D=D= DelusionalDelusional perceptionperception

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3A, 3B, 3C, 1D3A, 3B, 3C, 1D


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ReferencesReferences

Oxford Textbook ofPsychiatry (Third

Edition) Gelderetal

Symptomsinthe Mind:An Introductionto

Descriptive Psychopathology (Second

Edition) AndrewSims

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phenomenology yr4

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