schizo

1. Semeiology of mental disorder

2. Aims and demands
To master the names, the concepts and the meanings of the
symptoms of mental disorder.
To master the distinctions between the confusing symptoms.

3. Common Psychiatric Symptom
 Disorders of sensations and perceptions
 Disorders of thought
 Disorders of mood
 Disorders of consciousness
 Disorders of attention and concentration
 Disorders of memory
 Disorders of intellectual performance
 Insight

4. Sensations, perceptions and imagery
• Sensation: a reflection to individual attributes of things that produced
by a sense organ under objective stimulus.
• Perception: a whole reflection that various attributes are synthesized
in brain.
• Imagery: is an experience within the mind, usually without the feeling
of reality that is part of perception.

5. Disorders of sensation
• Hyperesthesia
• Hypoesthesia and anesthesia
• Senestopathias

6. Disturbance of perception
• Illusion: a distorted perception of the external objective stimuli.
• Hallucination: perception without an object, or as the
appearance of an individual thing in the world without any
corresponding material event .

7. Classification of Hallucination
According to the involved organs
• auditory hallucination
• visual hallucination
• olfactory hallucination
• gustatory hallucination
• bodily, tactile hallucinations
• visceral hallucination
According to the feeling source:
• Genuine hallucinations: Hallucinatory figure
is vividly existing in external space and
experienced by sensory organs.
• Pseudohallucinations: Hallucinatory figure
is not so vivid, come from the subjective
space, not experiencing by sensory organs.

8. Disorders of thought
 Disturbances of the speed and interruptions in the flow of thought
 Disorders of the form of thought
 Disorder of the content of thought
 Overvalued idea

9. Disturbances of the speed and
interruptions in the flow of thought
 Poverty of thought
 Inhibition of thought
 Thought blocking
 Loosening of associations
 Flight of thought
 Splitting of thought
 Circumstantiality

10. Flight of thought
• Known as the fleet of concept. The association speeds up, manifolds,
the content is abundant and vividly.
• The patients speak rapidly, and state that their brain response agility,
topic of speaking is liable to change with the surrounding stimulus;
• Mostly occur in mania.

11. Inhibition of thought
• Inhibition of association, low speed of speaking, the amount of speech
decrease, low voice, slow response.
• People feel themselves difficulty of association, become stupid, and their
brains “dull”.
• Mostly found in depression.

12. Poverty of thought
• The quantity of association decreases, poverty of concept and glossary.
• Experiencing empty of brain, nothing existing.
• Patients are silent, wordless, and void. The severe ones are similar to
idiots.
• It can be found in schizophrenia, organic mental disorders of brain and
mental retardation.

13. Looseness of association
• Disturbance of objective, coherence and logicality of thinking in
consciousness state. looseness of content, lack of topic or main idea.
• Patient’s reply to the question is not to the point, so that the interviewers
find it difficult to talk with the patients.

14. Splitting of thought
• The splitting of associations of concepts, internal connection lack
between associated concepts, or no connection between sentences, or
even words (called word salad).
• Mostly found in schizophrenia.

15. Circumstantiality
• Twist and turns of thinking activities, over abundance of the
meaningless associations, too detailed and unnecessary
describe, yet in the end coming back to the point.
• Found in epilepsy, organic and geriatric mental disorder.

16. Blocking of thought
• The process of thinking intermits suddenly, while the patient has no
consciousness disorder or external disturbance.
• The patient stops talking suddenly, and speak again after a while, but the
content is not the previous topic.
• It can be also called thought deprivation.

17. Disorders of the form of thought
Coherent disorder
 thought insertion
 thought hearing
 diffusion of thought
Logical disorder
 neologism
 Pathological Symbolic thought
 paralogism thinking
 obsessive idea

18. Thought insertion
• Patients believe some of their thought are not their own but have been
implanted compulsively by an outside agency.
• If the pointless thoughts emerged compulsively by large amount style,
then called forced thoughts.
• This symptom usually emerge suddenly and vanish promptly.

19. Thought hearing
• Patients believe that their thought are turning into voice, so others and
themselves can hear it.
• Frequently occur in schizophrenia.

20. Diffusion of thought
• Patients believe that their thoughts are known by all as soon as they think,
and that they share their thought with other people and have no privacy.
• If patients believe that their thought be broadcasted known by others, it is
called thought broadcasting.
• It’s a diagnostic significance for schizophrenia.

21. Neologism
• Mingling, condensing of concept and piecing
together of unrelated concept.
• Patient invents some new symbols, graphs, words
or language and endow them with special concept.
• Mostly found in hebephrenic schizophrenia.

22. Pathological Symbolic thought
• Concept conversion, substituting an abstract concept for
a concrete one.
• e.g. a buddhist consider the sunshine as the light of
Buddha

23. Paralogism Thinking
• Main characteristic is the absence of logicality in reasoning,
neither premise nor basis, or inversion of cause and effect.
• It can be seen in schizophrenia and paranoid psychosis.

24. Obsessive idea
• Repeated emergence of the same concept or thought obsessively.
The patient knows it unnecessary but can’t get rid of.
• Predominated by obsessive thoughts, ideas, recall or image, opposite
thoughts, obsessive rumination, obsessive suspicion, obsessive fear
of loss of self-control, usually combining with behaviors.

25. Disorder of the content of thought
 Delusion concept
 Characteristics
 Main categories of delusion

26. Delusion concept
A firmly held false belief or idea based on a pathological
process, despite the abundant contradictory evidences, or a
morbid reasoning and judgement.

27. Characteristics
• Content doesn’t agree with fact, no objective basis, but firmly held by the
patient.
• Content involves the patient self, and concerns his benefits.
• Delusion is individual-specific or single to patient.
• Contents vary from the cultural background and individual experience,
usually have the characteristics of the times.

28. Main categories of delusions
• It can be classified into primary and secondary delusion by its
originality and relation with other mental activity.
• It can be also categorized into systematic and non-systematic delusion
according to the structure of the delusion.
• It is mostly classified according to the content.

29. Primary delusions
• Appearing suddenly and with full conviction but without any
mental events lead up to it.
• It is the characteristic symptom of schizophrenia, and is very
helpful for the diagnoses.

30. Secondary delusions
• The delusion derives from other morbid mental basis,
or other delusions.
• Found in many mental diseases.

31. Systematic delusions
• Delusional content interrelate with each other, and has a strict structure
and a good logicality.
• or else, it is non-systematic delusions.

32. Delusions according to the content.
 delusion of persecution
 delusion of reference
 delusion of physical influence
 grandiose delusion
 delusion of guilt
 hypochondriacal delusion
 delusion of love
 delusion of jealousy
 experience of being revealed

33. Delusions of persecution
• Believing firmly himself to be tracked, watched, slandered , isolated, etc.
• Under the control of the delusions, the patient may refuse to eat or accuse,
self-defend, escape, suicide, or injure others.
• Mostly found in schizophrenia and paranoid psychosis.

34. Delusions of reference
• The patient concerns with the idea that objects, events, or people have a
personal significance for himself. Commonly accompanying with
persecutory delusions.
• Mostly found in schizophrenia.

35. Delusions of physical influence
• Also called delusions of control . The patients believes that their
thoughts, feelings, and behaviors are under the control of some outside
agency or forces；
• The symptom strongly suggests schizophrenia.

36. Grandiose delusions
• Or expensive delusions, the patient thinks himself having
extraordinarily ability or wisdom, sovereign right or status, wealth or
invention ,or is the descendant of some celebrity.
• Can be seen in mania, schizophrenia, and some organic psychosis.

37. Delusions of guilt
• Patient believes firmly that he commits severe errors or irremissible guilt,
and deserves rigorous punishment without any reason, and just sits still
waiting for death or refuses any food, or may suicide; demands punish for
atonement .
• The symptom strongly suggests depression, also schizophrenia.

38. Hypochondriacal delusions
• Patient believes firmly that he suffers some serious or incurable diseases,
then seek treatment everywhere, even a series of careful examination and
medical test can’t correct it.
• Found in schizophrenia, menopausal or geriatric mental disorders, etc.

39. Delusions of love
• Believes himself to be deeply loved by opposite sex without any
evidence, adopts corresponding behaviors to approach the opposite
side, even received refusal, so, it is not simple one-sided love.

40. Delusions of jealousy
• Believes his spouse not to be loyal to him and have another lover, therefore
tracks and watches his spouse’s daily activity or checks spouse’s
personal matters to seek the evidences of cuckoldry.
• May found in male schizophrenia, or climacteric mental disorder.

41. Experiences of being revealed
• Believes that his unspoken thoughts are known to others, but can’t
confirm how be known by others.
• Strongly suggests schizophrenia.

42. Overvalued idea
• A unilateral and extreme false idea that occupies a leading position
and commonly has some factual basis, and with strong emotional
color, obviously affecting behaviors and other mentality.
• Mostly find in personality disorder and psychological disorder.

43. Disorders of mood
• Mood can be considered as a quality of the state of mind which is more
lasting than affects and feelings
• Mood can be abnormal in several ways:
 sad or anxious in depressive disorders;
 euphoric in mania;
 irritated in mania or agitated depression;
 dysphoric in depression ;
 morose in chronic depressed states.

44.  Disorientation: time, place, or person.
 Twilight state: a well-defined interruption of the continuity of consciousness.
Consciousness is clouded and sometimes narrowed. The patient is able to perform
certain actions, such as dressing, driving, or walking around. Subsequently, there is
amnesia for this state.
 Oneiroid state: the patient experiences narrowing of consciousness together with
multiple scenic hallucinations.
 Narrowing of consciousness: the awareness of a person's environment is restricted,
for example owing to an abnormal affective or delusional state.
Disorders of consciousness

45. Disorders of attention and concentration
 Attention and concentration both mean the directing of mental activities
towards a particular object.
 Little difference: attention is associated with present alertness, and
concentration with longer-lasting achievement and performance.

46. Disorders of memory
 Memory may be differentiated into short-term or recent memory and long-
term or remote memory.
 Short-term memory reflects new learning. Long-term memory is usually
associated with earlier data or other information that has been stored for
months or years.
 recent memory is usually impaired earlier than remote memory.

47.  Amnesia: a period of time which cannot be recalled and it may be
global or partial.
• With regard to time it may be retrograde—an expression derived from
the idea that one is looking backwards from an event (such as brain
trauma or electroconvulsive therapy) to find the period before the event
to be deleted. Correspondingly, anterograde amnesia means a period of
deleted memory after an event.
• focal lesions in the hippocampus seem to affect remote memory less
than recent memory, whereas diffuse brain disease often affects both.

48.  Confabulations: inventions which substitute for missing contents in gaps of
memory; the patient is not aware that they are not true memories.
 False memories: an erroneous feeling of familiarity with, for example, a
person or a room. It may occur in temporal lobe epilepsy, but it is not
specific for that disorder.

49. Disorders of intellectual performance
 Intelligence: the capacity to solve problems, to cope with new situations,
to acquire skills through learning and experiences, to establish logical
deductions, and to form abstract concepts.
 It canbe measured by intelligence quotient (IQ)

50. • If the development of intellectual performance does not reach an IQ
level of 70, the condition is called ‘mental retardation'.
• Four levels are recognized in ICD-10 for mental retardation:
 mild (IQ 50–69)
 moderate (IQ 35–49)
 severe (IQ 20–34)
 profound (IQ below 20).

51. Insight
 The clinical assessment of a patient's capacity to understand the nature,
significance, and severity of his or her own illness.
 It is composed of three overlapping dimensions: the ability to relabel unusual
mental events as pathological, the recognition that one has mental illness, and
compliance with treatment
 In clinical practice, the patient's awareness of the presence of illness (insight) is
related to the compliance with prescribed treatment, so it is considerable
significance.