Phenomenology

Dr. Mahmoud Bashtawi

Definition
The 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. or what you call it Psychopathology ;the signs and symptoms of psychiatry.

Psychopathology
The study of phenomena of mental illness : abnormal thoughts, feelings, perceptions and cognitions. 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 Psychiatry

Disorders of Perception Disorders of Thinking Disorders of Mood Disorders of Cognition

Perception
the awareness of objects and interpretation of sensory information;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
illusion Hallucination Depersonalization Derealization

Illusions
Illusions
misperceptions of external stimuli conditions 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 ,gustatory and olfactory

Auditory hallucinations
Voices
Single or multiple Male or female Known or unknown person person
1st person: thought echo - hearing own thoughts spoken aloud. 2nd person: calling patient by you 3rd person: calling patient by he or she

Voices
Commanding, running commentary or arguing with each other Timing:
day , night or all the time. continuous or intermittent.

Theme: friendly or derogatory

Hallucinations
Visual Hallucinations: commonly associated with organicity. Olfactory and gustatory hallucinations
often experienced together often unpleasant in nature common in temporal lobe epilepsy

Somatic (tactile and deep)

tactile (haptic): touched, insect crawling under the skin e.g. formication in cocaine abuse deep sensation: e.g. viscera being pulled out, sexual stimulation, electric shock

Hallucinations
Extracampine hallucinations:
perceiving a sensation from beyond the limits of the sense organ e.g. visions from outside visual field, hearing voices from far away

Reflex hallucinations:
stimulus in one sensory modality causing a hallucination in a different sensory modality e.g. music causing visual hallucination (LSD abuse)

Hypnogogic and hypnopompic hallucinations

occurs at the point of falling to or waking from sleep usually brief and elementary

Disorders of Perception
Depersonalization: a feeling that his body parts are abnormal, unreal
e.g. my brain or my head becomes big until it fills the room

Derealization: a feeling that the external environment is abnormal, unreal Patient describe things in his surrounding that are artificial and lifeless both can occur in tiredness, TLE, depression etc.

Thought disorders
Thought disorder (TD) or formal thought disorder (FTD) occurs when an individual has serious problems with thinking, feelings, and behavior.
Thinking : a goal directed flow of ideas initiated by a task leading to a reality orientated conclusion

components of thinking:
Flow or ( stream ) of thought Form of thought content possession

Disorders of flow(stream) of thoughts

1-Preasure of thought: increase amount and speed of speech; we can not interrupt or stop the patient because he has many thoughts in his mind (we see this in mania).

Disorders of flow(stream) of thoughts

2-poverty of thoughts: the has very few thoughts and pass slowly through his mind; (we see this in depression). 3-Thought blocking: Sudden interruption of the flow of thoughts in which the patient experiences as his mind going blank or his mind is 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. - derailment: transition from one topic to another with no logical connection between the two - 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, he never gets from points to desired goals. -Echolalia The patient repeats apart or the whole of what have been said to him -neologism: new words invited by the patient

Disorders of content of thought

Delusion:
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 day to day activities

Classification of delusions
According to special features:
Systematised delusion:
chronic, presence of nucleus, well knitted, inter-connected, layered and well-encapsulated.

Non-systematised delusion Shared 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 him

Delusion of Reference:
idea that objects, events or people have a personal significance for patient e.g. TV programmes, news

Grandiose (expansive):
beliefs of exaggerated self-importance
e.g. wealth, special powers, beauty

Religious:
delusions with religious content
e.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 men delusion of unfaithfulness of spouse (infidelity) spying, checking on spouse, examine for sexual secretions

Themes of delusion
Delusion of Guilt and Worthlessness:
e.g. minor past faults will be exposed, being sinful, deserves to be punished

Nihilistic Delusion
belief about non-existence Cotards Syndrome: failures of bodily functions e.g. bowels are rotting etc.

Hypochondriacal Delusions
belief of ill health despite contrary medical evidence

Other disorders of thought Content

Obsessions:
recurrent persistent thoughts, impulses or images that enter the mind despite efforts to exclude them subjective sense of struggle to resist them recognized as his own regarded as untrue and senseless

Compulsions:
repetitive, purposeful behaviours performed in a stereotyped way, accompanied with subjective sense that it must be carried out and an urge to resist most common: cleaning, counting, dressing

Disorders of thought possession

Thought Insertion:
delusion that some thoughts have been implanted by outside agency

Thought 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 Appropriate affect 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 tone Flat affect: absence or near absence of any signs of affective expression; voice monotonous, face immobile Labile affect: rapid and abrupt changes in emotional feeling tone, unrelated to external stimuli

Emotion
B. Mood: a pervasive and sustained emotion, subjectively experienced and reported by the patient and observed by others; examples 1. elevated mood 2. 3. Euthymic mood: normal range of mood, implying absence of depressed or

Euphoria: intense feeling of well being

Elation: intense feeling of well being with exaggerated motor activity

5. Expansive mood: expression of one's feelings without restraint, frequently with an overestimation of one's significance or importance

Mood
6. Ecstasy: felling of intense rapture 7. Dysphoric mood: an unpleasant mood 8. Anhedonia: loss of interest in and withdrawal from all regular and pleasurable activities, often associated with depression

Other emotions
Anxiety: feeling of apprehension caused by anticipation of danger, which may be internal or external 2 3 4 Fear: anxiety caused by consciously recognized and realistic danger Agitation: severe anxiety associated with motor restlessness

Panic: acute, episodic, intense attack of anxiety associated with overwhelming feelings of dread and autonomic discharge 5 Ambivalence: 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: motor anomalies (stupor or excitement) in some disorders Catalepsy: general term for an immobile position that is constantly maintained Catatonic excitement: agitated, purposeless motor activity, uninfluenced by external stimuli Catatonic stupor: markedly slowed motor activity, often to a point of immobility and seeming unawareness of surroundings

Catatonic symptoms
catatonic stupor = markedly slowed motor activity, often to a point of immobility catatonic excitement = agitated, purposeless motor activity catatonic posturing = voluntary assumption of an inappropriate or bizarre posture echopraxia = pathological imitation of movements stereotypy = repetitive fixed pattern of physical action mannerism = habitual involuntary movement command automatism = automatic following of suggestions