Adobe Systems Psychopathology Seminars on Psychiatry - VLA MUDr. Alena Damborská, Ph.D. Adobe Systems Outline ̶Introduction – why, what, how ̶Domains of psychopathology ̶ MUDr. Alena Damborská, Ph.D. Adobe Systems Aim – learning outcomes ̶ ̶To learn the vocabulary – symptoms of mental illness ̶To learn the concepts of discrete psychological functions ̶To learn the description of major and most frequent symptoms ̶ MUDr. Alena Damborská, Ph.D. Adobe Systems Psychiatry studies mental disorders ̶Description ̶Etiology ̶Prognosis ̶Prevention ̶Treatment ̶ General psychiatry • studies impairment of brain and mind functions Special psychiatry • is devoted to different mental diseases MUDr. Alena Damborská, Ph.D. Adobe Systems Domains of psychopathology ̶Personality ̶Emotions ̶Cognition ̶Behavior MUDr. Alena Damborská, Ph.D. Psychopathology describes symptoms of impaired psychic functions Adobe Systems Psychic functions ̶Personality ̶Emotions •mood •affect ̶ ̶Cognition •consciousness •attention •orientation •perception •memory and learning •thinking and decision making •intellect ̶ ̶Behavior •volition •action Adobe Systems Norm and pathology ̶Personal ̶Subjective ego-dystonic experience ̶Significant change in habitual experience and behaviour •Does not need to be realised – recognized by peers ̶Cultural ̶Conformist and non-conformist behaviour •Usual behaviour and experience corresponding to the culture and individual’s position within it •Non-conformity is not a sign of psychopathology ̶Typical clinical pictures = overt signs of mental illness ̶Hallucinations, catatonia… ̶Always search for the reason of behaviour: “Why”? Adobe Systems Consciousness = awareness of one´s body and environment MUDr. Alena Damborská, Ph.D. Adobe Systems Disorders of Consciousness Quantitative changes - reduced vigility (alertness): ̶Somnolence ̶Sopor ̶Coma MUDr. Alena Damborská, Ph.D. glasgow-coma-scale.jpg Clouding of consciousness = a person is less wakeful or aware than normal, feeling „foggy“, they are not aware of time, their surroundings and find difficult to pay attention Somnolence: •pathologicaly sleepy •delayed reactions to touch, speech •bradypsychism •mild intoxications, mild brain injury, at the beginning and the end of narcosis Sopor •Looks like sleeping •Inapropriate words, incomprehensible sounds •Bradycardia, hypopnoe, hypotensis •intoxications, brain injury, infections Coma •No response to any stimuli Adobe Systems Disorders of Consciousness Qualitative changes – disturbed perception, thinking, affectivity, memory, and behavior: ̶Obnubilation (twilight state) - impaired self-awareness, rapid onset and rapid end, aimless acting, complete amnezia on this state ̶ intoxication, brain tumors, dissociative personality disorder ̶Delirium (confusional state) MUDr. Alena Damborská, Ph.D. Adobe Systems Delirium = transient cognitive disorder ̶core features: impaired consciousness with attention deficit, rapid onset, fluctuating course ̶other features: desorientation, psychomotor changes (agitation), distored perception (illusions, hallucinations), disorganized thought (delusions), sleep disturbances, emotional changes (irritability, flatness of emotions), enhanced suggestibility ̶intoxication, infection, dehydration, abstinence syndrom Adobe Systems Orientation = awarenes of oneself (person) with reference to time, place, and situation MUDr. Alena Damborská, Ph.D. Adobe Systems Disturbances of orientation ̶disorientation in time (major depression) ̶unawareness of onself = disorientation to person (dementia) MUDr. Alena Damborská, Ph.D. Adobe Systems Attention = the act or the power of fixing the mind on something MUDr. Alena Damborská, Ph.D. Adobe Systems Disturbances of attention ̶Hypoprosexia (major depression) ̶Hyperprosexia (neurotic disorders) MUDr. Alena Damborská, Ph.D. Adobe Systems Perception = awareness of what is presented through the sense organs = detection and interpretation of the stimuli MUDr. Alena Damborská, Ph.D. Adobe Systems Disturbances of perception ̶Illusions = distorted perception of present stimuli ̶Hallucinations = perception of absent stimuli ̶Sensory modality Auditory: 3rd person perspective, commenting, imperative, contrary Visual: simple (flashes, geometric patterns), complex scenes, microzoopsia… Tactile, Gustatory, Olfactory, Movements ̶Intrapsychic hallucinations (delusions of control) Thought broadcasting, thought imputation/amputation, thought echo’s ̶Location/source of hallucinations – inadequate (from a teeth, toe…) Adobe Systems Abnormal coordination of sensorimotor cortex ̶Corollary discharge theory: ̶a copy of the motor plan sent from the motor to the sensory cortex (“efference copy”) ̶suppression of awareness of sensation in self-generated actions - expected (efference) and experienced (reafference) sensations match ̶discrimination of origination of actions (self/non-self) …we are not able to tickle ourselves... ̶ ̶absence of the “efference copy” in the sensory cortex = perception of exogenous origin of actions …move the image across your retina by: a) moving an object b) moving your eye c) pressing your eye ̶Schizophrenia: failure of corollary discharge mechanism inner voice = hallucinations Ford et al., 2001; Ford and Mathalon, 2004; 2005 Abbility to distinbuish the sensory consequences of one´s own activity from passive sensory reception from environmental activity Presynaptic and postsynaptic inhibition Expected sensation = „efference copy“ for a particular movement Experienced sensation = „reafference copy“, sensory feedback for the movement – increase in gamma coherence between frontal and temporal lobes during active talking compared to passive listening Parkinson´s disease: misjudgement during limb movement, inapropriate coordination between the proprioceptive sensory feedback and corollary discharge mechanism at higher centres, the patient is unable to predict limb position leading to bradykinesia (slowing of his limb movements) Schizophrenia = inability to distinguish between thoughts and action generated from self and others Adobe Systems Emotions MUDr. Alena Damborská, Ph.D. Adobe Systems Emotions = physiological automatic responses to salient positive/negative stimuli ̶př. potential sexual partner is present/public speaking ̶Brain response – increased arousal, increased attention, increased alertness, increased vigility ̶Body response – endocrine (cortisol), vegetative (flushing, paleness, sweating, tachycardia, mydriasis, increased blood pressure, hyperpnea), behavioral (tremor, face expression, freezing) Feelings = conscious perception of the brain and body changes during emotion - Experiential brain response př. joy, love, anger, fear Adobe Systems Emotions ̶Physiological Mood ̶Long lasting emotional state ̶Strengthens an affect of the same direction, suppresses an affect of the oposite direction ̶Physiological Affect ̶Brief and strong emotional response ̶No changes of consciousness, no amnesia MUDr. Alena Damborská, Ph.D. Adobe Systems Disturbances of emotions MUDr. Alena Damborská, Ph.D. Adobe Systems Disturbances of emotions ̶Pathological mood ̶Manic ̶Depressive ̶Euphoria ̶Expansive ̶Exaltation ̶Explosive ̶Anxious ̶Resonant ̶Apathy ̶ ̶ ̶ MUDr. Alena Damborská, Ph.D. Adobe Systems Disturbances of emotions ̶Pathological affect ̶excessively very strong emotional reaction ̶short change of consciousness (obnubilation) ̶amnesia ̶Phobia = persistent irrational fear and wish to avoid a specific situation, object, activity ̶agoraphobia, claustrophobia ̶ MUDr. Alena Damborská, Ph.D. Adobe Systems Affect ̶Quality (depressed, euthymic, euphoric) ̶Intensity (mild, moderate,severe) ̶Content (perplexity, fatuousity) ̶Dynamics ̶Range = diversity of emotional states (flattening, restricted, expansive) ̶Reactivity = rapidity with which one affect shifts to another (lability, incontinence, irritability) ̶Congruence = Appropriateness (incongruent emotions in schizophrenia) https://www.coursera.org/learn/international-psychiatry/lecture/X6IZW/the-affect-in-the-mental-stat e-examination Flattening of emotions = limitations in capacity to engage in different affects Irritability = escalation into anger Incontinence = easily deflected by suggestive interventions Adobe Systems Depression - syndrom ̶Affective symptoms ̶depressed mood – bad, down, black, oppressive – distinguish from physiological sadness ̶anhedonia ̶(anxiety) ̶Motivation ̶loss of interest in usual activities ̶inability to perform, initiate activity (abulia, hypobulia) ̶Cognitive ̶evaluation, self-esteem ̶attention (hypoprosexia), memory ̶negative cognitive biases ̶Suicidal activity – hoplessness, suicidal thoughts ̶Vegetative, „somatic“ ̶insomnia, constipation, anorexia. decreased libido, loss of energy and fatigue, psychomotor retardation Adobe Systems Mania - syndrom ̶Affective symptoms ̶expansive moods: mania, euforia, iritability, dysforia ̶Cognitive ̶increased speed vs. decreased accuracy: cognition (flight of ideas), memory (hypermnesia), speech (pseudoincoherence), decisions (risky)… ̶distractibility ̶inflated unrealistic self-esteem ̶Behavioral ̶hyperactivity, restlessness ̶overinvolvement – socially, sexually, occupationally… ̶Vegetative, somatic ̶insomnia (decreased need to sleep), anorexia (decreased need to eat), increased energy MUDr. Alena Damborská, Ph.D. Adobe Systems Thinking = goal-directed flow of ideas and associations initiated by a problem and leading toward a reality-oriented conclusion ̶evaluated via speech of the patient Adobe Systems Thought disturbances MUDr. Alena Damborská, Ph.D. Adobe Systems Quantitative disturbances: Speed ̶Decrease ̶bradypsychism (retardation) - slowing of the flow of associations, slowed and diminished verbal production (major depression) ̶thought blocking - cessation of the flow of associations = patient stops the verbal production without any recognisable impulse from surroundings (schizophrenia) ̶Increase ̶flight of ideas: excessive speed of thinking manifested as extreme speed in speech (= logorrhoea) (manic episode of bipolar disorder) MUDr. Alena Damborská, Ph.D. Adobe Systems Quantitative disturbances: Structure ̶circumstantiality ̶indirect speech that is delayed in a reaching the point, characterised by an overinclusion of details (obsessive-compulsive disorder, neurotic disorders) ̶perseverative thinking ̶involuntary persistence of response to some question or topic, verbigeration - a meaningless repetition of specific word or phrase (manic episode of BD) ̶tangentiality ̶patient never gets from desired point to desired goal ̶ MUDr. Alena Damborská, Ph.D. Adobe Systems Quantitative disturbances: Structure ̶illogical (paralogic) thinking, loosening of associations ̶thinking containing erroneous conclusions or internal contradiction ̶neologism ̶new word created by the patient often by combining syllables or other words ̶incoherent thinking ̶thought that is not understandable ̶word salad: incoherent mixture of words and phrases ̶absence of abstraction = hyperconcretism The apple does not fall far from the tree ̶ https://www.coursera.org/learn/international-psychiatry/lecture/BzKL8/the-thought-process-in-the-me ntal-state-examination Idiosyncratic = peculiar to the individual, strange, unusual Magic and symbolic thinking – a type of paralogic thinking: illogical associations (e.g. guessing hockey results by clockwise position) Adobe Systems Semanting priming = automatic (implicit) memory function ̶tunes your associations based on current content of mind ̶network of representations (words, meanings) is activated ̶optimal performance = focused activation around the network node ̶ ̶Lexical decision task: word x nonword (student x stadent) ̶ MUDr. Alena Damborská, Ph.D. Adobe Systems File:This is a picture showing the processes involved in semantic priming experiments.jpg Lexical decision task Pomarol-Clotet et al., 2008 http://upload.wikimedia.org/wikiversity/en/8/81/Spreadingactivation.png Adobe Systems Semantic priming and Formal Thought Disorder (FTD) ̶Meta-analysis of 36 studies (Pomarol-Clotet et al., 2008) ̶SCH vs. HC d = 0,7 (95% CI -0,02 – 0,16) ̶FTD vs. HC d = 0,38 (95% CI 0,21 – 0,55) ̶ Semantic hyperpriming in FTD = pathological hightening of normal associative processes = fast response to distant words - more extensive network activation MUDr. Alena Damborská, Ph.D. Adobe Systems MUDr. Alena Damborská, Ph.D. Qualitative disturbances: Content ̶Delusions ̶Obsessions Adobe Systems Delusions = False beliefs ̶not a conventional belief (not shared) ̶inadequate/bizzare content ̶formed by logical thinking process but based on a patholgical assumption ̶not consistent with patient‘ s intelligence and cultural background ̶cannot be corrected by rational arguments ̶influence on behaviour ̶Formation (development) ̶Delusionoal mood – feeling that something is wrong, different, unreal ̶Delusional perception – things have special meaning, perceived as significant ̶Making sense out of it = ”AHA”, delusion formation MUDr. Alena Damborská, Ph.D. Adobe Systems Melancholic delusions (micromanic, depressive) ̶delusion of self accusation ̶false interpretation of real past event resulting in feeling of guilt ̶hypochondriac delusion ̶false belief of having a fatal physical illness ̶nihilistic delusions ̶false feeling that self, others or the world is non-existent or ending ̶delusions of failure ̶false belief that one is unable to do anything useful, worthlessness ̶delusion of property (ruin) ̶false belief that one lost all property Adobe Systems Delusions of grandeur (megalomanic, expansive) ̶delusion of importance ̶exaggerated conception of one‘s importance ̶delusion of power, extrapotence ̶exaggerated conception of one‘s abilities/possibilities, supernatural skills ̶delusion of identity ̶false belief of being the offspring of member of an important family MUDr. Alena Damborská, Ph.D. Adobe Systems Paranoid Delusions qbased on ideas of reference (false ideas that behaviour of others refers to a patient): ̶delusion of persecution ̶false belief that one is being persecuted ̶delusion of infidelity ̶false belief that one‘s lover is unfaithful ̶erotomanic delusion ̶false belief, that someone (usually famous) is deeply in love with them MUDr. Alena Damborská, Ph.D. Adobe Systems Delusions of thought control = false feeling that one‘s will, thoughts, feelings, or movements are controlled by another agent ̶thought withdrawal ̶false belief that one‘s thought are being removed from one‘s mind by other people or force ̶thought insertion ̶false belief that thought are being implanted in one‘s mind by other people or force ̶thought broadcasting ̶false belief that one‘s thought can be heard by others ̶thought control ̶false belief that one‘s thoughts are being controlled by other people or force ̶ MUDr. Alena Damborská, Ph.D. Adobe Systems Obsessionshttps://www.coursera.org/learn/international-psychiatry/lecture/klFvK/thought-content-and -the-delusion = thoughts, impulses or images entering the mind despite the person´s effort to exclude them ̶persistent, irresistible, repetitive, stereotypical, monotonous ̶interfere with directed behaviour and attention ̶ego-dystonic => associated with anxiety ̶ vs. preoccupation of thought (Over-valued ideas): certain idea is in the centre of thinking, is coming back, usually associated with a strong affective tone (person, money, success…), other things are not considered to be important - schizophrenia, narcissistic personality, BPD, mania, psychosis Obsessions Adobe Systems Memory = function that enables to store and remember information MUDr. Alena Damborská, Ph.D. Adobe Systems „Life cycle“ of a memory trace ̶Immediate memory ̶information stored for 15-20s ̶Short-term memory ̶consolidation of the memory trace – several minutes to 2 days ̶medial temporal structures (hippocampus) ̶Long-term memory ̶formed trace ̶large cortical areas ̶Declarative (explicit) – for events, language, knowledge ̶Procedural – for motor patterns (riding bike, skiing) Adobe Systems Memory disturbances MUDr. Alena Damborská, Ph.D. Adobe Systems Quantitative disturbances ̶Amnesia: short/long-term memory impairment in a state of normal consciousness ̶anterograde: failure to form new information ̶retrograde: failure to recall old information organic (head trauma, tumor, surgery etc.) dissociative amnesia: selective inability to recall previously learned information with normal functioning in the present (normal learning) ̶Hypomnesia ̶Hypermnesia: unusually vivid memory ̶mania, posttraumatic stress disorder (intrusive memories), obsessive or paranoid personality traits Dissociative amnesia – crime victim has no memory of having been robbed but recalls details of the rest of the day -Caused by overwhelming stress during traumatic events Adobe Systems Qualitative disturbances ̶paramnesias – retrospective falsification of memories during its recollection (incaccuracy in time and situation of the recalled event) ̶confabulation – filling memory gaps with inaccurate information MUDr. Alena Damborská, Ph.D. Adobe Systems Amnestic disorders MUDr. Alena Damborská, Ph.D. Adobe Systems Characteristics ̶Definition: acquired impaired ability to learn and recall new information (and past events sometimes) ̶ ̶No attention deficit or clouding of consciousness (delirium), no other cognitive dysfunction (dementia) ̶caused by structural or chemical damage to the brain via systemic disease (metabolic, hypoxia, substance abuse) or primary cerebral disease (brain infections, brain tumors, head trauma) Adobe Systems Clinical notes ̶Transient global amnesia ̶episodes of transitory inability to learn (to form memories) ̶inability to recall memories from the episode ̶restoration to completly intact cognitive state ̶no behavioral changes x may be confusion ̶sudden/gradual onset (head trauma/chronic toxic exposure) ̶disorientation to place and time, spared orientation to person ̶lack of insight ̶confabulations Adobe Systems Intellect = mental ability that includes logical and rational aspects of the mind MUDr. Alena Damborská, Ph.D. Adobe Systems Intellect disturbances ̶Mental retardation (insufficient development) ̶Dementia (decline) ̶ MUDr. Alena Damborská, Ph.D. Adobe Systems Dementia ̶persistent diminution of cognition in the setting of a stable level of consciousness ̶three main symptomatic domains: ̶neuropsychologic: cognitive decline ̶neuropsychiatric: behavioral and psychological symptoms ̶activities of daily living MUDr. Alena Damborská, Ph.D. Adobe Systems Dementia ̶memory: impaired learning, recall, and recognition ̶executive functions: non-realistic planning, decreased flexibility ̶thought and language (disorganized structure, decreased fluency) ̶perseveration (following a topic after its change), echolalia (repetition of other's speech) ̶impaired abstraction (concrete thinking) ̶poor judgment („what to wear in cold weather“), loss of insight (unawareness of symptoms) ̶attention: increased distractibility ̶visuospatial abilities (inability to reproduce a complex drawing) ̶higher cortical functions - gnosis and praxis: apraxia (lack of motion skills), agnosia (inability to recognize objects, sounds..) Distractibility = state of being easily distracted Perseveration = a person who continues talking about a topic even when the conversation has moved on to other things Adobe Systems Volition and Action = voluntary movements MUDr. Alena Damborská, Ph.D. Adobe Systems Volition disturbances ̶Hypobulia (depression, schizophrenia) ̶Abulia ̶Hyperbulia (mania) ̶ Adobe Systems Catatonia = qualitative disturbance of voluntary movements ̶immobility, abnormal behaviors, abnormal movements MUDr. Alena Damborská, Ph.D. Adobe Systems „Positive“ ̶agitation ̶active negativism ̶mannerism (odd caricature of normal movements) ̶stereotypies (repetitive, nonsensical movements) ̶grimacing ̶echolalia, echopraxia Active negativism = doing oposit to the demand Adobe Systems „Negative“ ̶mutism ̶passive negativism ̶catalepsy (passive induction of a posture held against gravity) ̶posturing (spontaneous and active maintenance of posture against gravity) ̶waxy flexibility (slight and even resistance to positioning by examiner) ̶stupor (no psychomotor activity) Passive negativism= refuse to meet demands, obey orders Adobe Systems Presentations ̶Psychosis: https://www.youtube.com/watch?v=ZB28gfSmz1Y&t=35s ̶ ̶Depression: https://www.youtube.com/watch?v=4YhpWZCdiZc ̶ ̶Mania: https://www.youtube.com/watch?v=zA-fqvC02oM&list=PLFZTljPAn-Kx257X3b9ET8qZfVOcC8V5o&index=7&t=0s ̶ Adobe Systems Next steps – clinical vignettes ̶Have a look at videos: ̶Depression: https://www.youtube.com/watch?v=4YhpWZCdiZc ̶Mania: https://www.youtube.com/watch?v=zA-fqvC02oM ̶Hallucinations: https://www.youtube.com/watch?v=0tn8xLQY53U ̶Hallucinations and delusions: https://www.youtube.com/watch?v=ZB28gfSmz1Y ̶Delirium: https://www.youtube.com/watch?v=lJH1AoVuVS0 ̶Delirium: https://www.youtube.com/watch?v=hwz9M2jZi_o ̶Anxiety: https://www.youtube.com/watch?v=Ii2FHbtVJzc ̶Panic attack: https://www.youtube.com/watch?v=9YaS_4tXBNU ̶Catatonia: https://www.youtube.com/watch?v=_s1lzxHRO4U ̶Obsessions, Compulsions: https://www.youtube.com/watch?v=xMwOLoPFKlM ̶Obsessions, Compulsions: https://www.youtube.com/watch?v=syM6XYzht20 ̶Conversion: https://www.youtube.com/watch?v=_jOuqAcgMrA ̶Suicide: https://www.youtube.com/watch?v=A-m_aIQfXZA Děkuji za pozornost