Phenomenology

Dr. Mahmoud Bashtawi ,

M.D.
Psychiatrist: Child &
Adolescent
Division of Psychiatry

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.
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 Psychiatry

Disorders
Disorders
Disorders
Disorders

of
of
of
of

Perception
Thinking
Mood
Cognition

Perception
Perception:the awareness of objects
andinterpretation ofsensory
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
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; 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(her) 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(her)
surrounding that are artificial and
lifeless
both 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 conclusion

components of thinking:

Flow or ( stream ) of thought

Form of thought
content
possession

Disorders 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
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(her) day to
day activities.

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

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.

Hypochondriacally 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(her) 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 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
Mood: 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
importance

Mood
Ecstasy: felling of intense rapture
Dysphoric mood: an unpleasant
mood
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
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
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: abnormal motor (stupor or
excitement) in some disorders
Catalepsy: general term for an immobile
position that is constantly maintained
Catatonic 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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