Basics Psy Ug Class

8/17/2019 Basics Psy Ug Class

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Dr.G.vaidyanath MBBS MD FIPS ASSISTANT PROFESSOR

SIDDHARTHA MEDICAL COLLEGE

(Ex asst r!"#ss!r PSIMS and G$nt$r %#di&a'&!''##)


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DEFINITION OF A PSYCHIATRIC

DISORDER

• The simplest way to conceptualize apsychiatic !iso!e is a !istu"anceo# Co$nition %i&e& Thou$ht'(

• Conation %i&e& Action'( o

• A)ect %i&e& Feelin$'( o

•

any !ise*uili"ium "etween the thee!omains


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NOR+A, +ENTA, HEA,TH

• Acco!in$ to the -ol! HealthO$anization %-HO'( Health is a stateo# complete physical( mental an!

social well."ein$( an! not meelya"sence o# !isease o in/mity&

• Nomal mental health( much li0e

nomal health( is a athe !i1cultconcept to !e/ne&


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2& Reality oientation&

3& Sel#.awaeness an! sel#.0nowle!$e&

4& Sel#.esteem an! sel#.acceptance&5& A"ility to e6ecise 7oluntay contol

o7e thei "eha7iou&

8& A"ility to #om a)ectionateelationships&

9& Pusuance o# po!ucti7e an! $oal.

!iecti7e acti7ities&


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INTER:IE- TECHNI;


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Psychiatic 7s +e!icalInte7iew

• A psychiatic inte7iew can "e !i)eent #om a me!ical inte7iew inse7eal ways( some o# which can inclu!e=

• 2& Pesence o# !istu"ances in thin0in$( "eha7iou an! emotionscan inte#ee with meanin$#ul communication

• 3& Collateal in#omation #om si$ni/cant othes can "e eally

impotant• 4& Impotant to o"tain !etaile! in#omation o# pesonal histoy an!

pe.mo"i! pesonality

• 5& Nee! #o moe astute o"se7ation o# patient>s "eha7iou

• 8& Di1culty in esta"lishin$ appot may "e encountee! moe o#ten

• 9& Patients may lac0 insi$ht into thei illness an! may ha7e poo ?u!$ement

• @&


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• Duin$ the inte7iew session%s'( thepatient shoul! "e put at ease an! anempathic elationship shoul! "e

esta"lishe!&• It is help#ul to eco! patient>s esponses

7e"atim athe than only namin$ thesi$ns %#o e6ample( athe than ?ust witin$

!elusion o# pesecution( it is "ette toeco! in a!!ition= my nei$h"ou is tyin$to poison meB


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• It is use#ul to as0 open.en!e! an!non.!iecti7e *uestions %#o e6ample(how ae you #eelin$ to!ayB' athe

than as0in$ !iect( lea!in$ *uestions%#o e6ample( ae you #eelin$ sa! atpesentB'&


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• A$ua"ly the most impotantinte7iewin$ s0ills ae listenin$( an!!emonstatin$ that you ae

inteeste! in listenin$ an! atten!in$to the patient&

• It is impotant to emem"e that

listenin$ is an acti7e( an! not apassi7e( pocess


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• Con/ !entiality must always "e o"se7e!&

• Howe7e( in cases o# suici!alhomici!al is0 an! chil!a"use( an e6ception may ha7e to "e ma!e &

• Patients su)ein$ #om psychiatic !iso!es ae

usually no moe 7iolent than the $eneal population&

• Howe7e( it is impotant to ensue sa#ety i# any is0sae appaent&

• A compehensi7e psychiatic inte7iew o#ten e*uies

moe than one session&• The psychiatric assessment can be discussed

under the following headings


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IDENTIFICATION DATA

• Name %inclu!in$ aliases an! pet names'(

• A$e(

• Se6(

• +aital status(

• E!ucation(

• Occupation(

• Income(

• Resi!ential an! O1ce A!!ess%es'(

• Reli$ion( an!

•

Socioeconomic "ac0$oun!( as appopiate acco!in$ to thesettin$&

• It is use#ul to eco! the souce o# e#eal o# the patient&

• In medicolegal cases, in addition, two identi cation marksshould also be recorded.


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INFOR+ANTS

• Since sometimes the histoy po7i!e! "y thepatient may "e incomplete( !ue to #actossuch as a"sent insi$ht o uncoopeati7eness(

it is impotant to ta0e the histoy #ompatient>s elati7es o #ien!s who act asin#omants an! souces o# collateal

in#omation&

•

It is impotant to ta0e the patient>s consent"e#oe ta0in$ this collateal histoy unless thepatient !oes not ha7e capacity to consent&


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• The in#omants> i!enti/cation !ata shoul! "e eco!e! alon$ withthei elationship to the patient( whethe they stay with the patient onot( an! the !uation o# stay to$ethe&

• Finally( a comment shoul! "e ma!e e$a!in$ the elia"ility o# thein#omation po7i!e!&

• The elia"ility o# the in#omation po7i!e! "y the in#omants shoul!"e assesse! on the #ollowin$ paametes=

• 2& Relationship with patient(

• 3& Intellectual an! o"se7ational a"ility(

• 4& Familiaity with the patient an! len$th o# stay with the patient( an!

•

5& De$ee o# concen e$a!in$ the patient&• The souce o# e#eal %such as a lette #om patient>s $eneal

pactitione o a lette o# e#eal #om the e#ein$ physiciansu$eonin case o# a liaison psychiaty e#eal' o#ten po7i!es 7alua"lein#omation e$a!in$ the patient>s con!ition&


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PRESENTIN %CHIEF'CO+P,AINTS

• The pesentin$ complaints an!o easons #oconsultation shoul! "e eco!e!& oth the patient>s an!

the in#omant>s 7esion shoul! "e eco!e!( i# ele7ant&

• I# the patient has no complaints %!ue to a"sent insi$ht'

this #act shoul! also "e note!&• It is impotant to use patient>s own wo!s an! to note

the !uation o# each pesentin$ complaint&

• Some o# the a!!itional points which shoul! "e note!

inclu!e=

• 2& Onset o# pesent illnesssymptom& 3& Duation o#pesent illnesssymptom& 4& Couse o# symptomsillness&5& Pe!isposin$ #actos& 8& Pecipitatin$ #actos %inclu!e

li#e stessos'& 9& Pepetuatin$ an!o elie7in$ #actos


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HISTORY OF PRESENTI,,NESS

• -hen the patient was last well o asymp tomatic shoul! "e clealy note!& This po7i!esuse#ul in#omation a"out the onset as well as!uation o# illness& Esta"lishin$ the time o# onset

is eally impotant as it po7i!es claity a"out the!uation o# illness an! symptoms& The symptomso# the illness( #om the ealiest time at which achan$e was notice! %the onset' until the pesent

time( shoul! "e naate! chonolo$ically( in acoheent manne& The pesentin$ %chie#'complaints shoul! "e e6pan!e!


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• In paticula( any !istu"ances in physiolo$ical #unctionssuch as sleep( appetite an! se6ual #unctionin$ shoul! "e

en*uie!&

• One shoul! always en*uie a"out the pesence o# suici!al

i!eation( i!eas o# sel#.ham an! i!eas o# ham to othes (with !etails a"out any possi"le intent an!o plans&

• It is also essential to consi!e an! eco! any impotant

ne$ati7e histoy %such as histoy o# alcohol !u$ use innew onset psychosis'&

• A li#e chat po7i!es a 7alua"le !isplay o# the couse o#illness( episo!ic se*uence( polaity %i# any'( se7eity(#e*uency( elationship to stessos( an! esponse to

teatment( i# any


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PAST PSYCHIATRIC AND +EDICA, HISTORY

• Any histoy o# any past psychiatic illness shoul! "e o"tai

ne!&• Any past histoy o# ha7in$ ecei7e! any psychotopic

me!ication( alcohol an! !u$ a"use o !epen!ence( an!psychiatic hospitalisation shoul! "e en*uie!&

• A past histoy o# any seious me!ical o neuolo$ical illness(

su$ical poce!ue( acci!ent o hospitalisation shoul! "eo"taine!&

• The natue o# teatment ecei7e!( an! alle$ies( i# any(shoul! "e ascetaine!&

• A past histoy o# ele7ant aetiolo$ical causes such as hea!in?uy( con7ulsions( unconsciousness( !ia"etes mellitus(hypetension( coonay atey !isease( acute intemittentpophyia( syphilis an! HI: positi7ity %o AIDS' shoul! "ee6ploe!&


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TREAT+ENT HISTORY

• Any teatment ecei7e! in pesentan!o pe7ious episo!e%s' shoul! "eas0e! alon$ with histoy o# teatment

a!heence( esponse to teatmentecei7e!( any a!7ese e)ectse6peience! o any !u$ alle$ies

which shoul! "e pominently note! inme!ical eco!s&


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• FA+I,Y HISTORY The #amily histoy usually inclu!es theG#amily o# oi$in> %i&e& the patient>s paents( si"lin$s($an!paents( uncles( etc&'& The G#amily o# poceation> %i&e&the patient>s spouse( chil!en an! $an!chil!en' iscon7entionally eco!e! un!e the hea!in$ o# pesonalhistoy& Family histoy is usually eco!e! un!e the#ollowin$ hea!in$s= 2& Family stuctue= Dawin$ o# a G#amilytee> %pe!i$ee chat' can help in eco!in$ all the ele7antin#omation in 7ey little space which is easily ea!a"le&

• It shoul! "e note! whethe the #amily is a nuclea( e6ten!e!

nuclea o ?oint #amily& Any consan$uineous elationshipsshoul! "e note!& The a$e an! cause o# !eath %i# any' o##amily mem"es shoul! "e as0e!&


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• 3& Family histoy o# simila o othe psychiatic illnesses(ma?o me!ical illnesses( alcohol o !u$ !epen!encean! suici!e %an! suici!al attempts' shoul! "e eco!e!&

• 4& Cuent social situation= Home cicumstan ces( pe

capita income( socioeconomic status( lea!e o# the#amily %nominal as well as #unctional' an! cuentattitu!es o# #amily mem"es towa!s the patient>sillness shoul! "e note!&

• The communication pattens in the #amily( an$e o#

a)ecti7ity( cultual an! eli$ious 7alues( an! socialsuppot system( shoul! "e en*uie! a"out( wheeele7ant


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PERSONA, AND SOCIA,HISTORY

• In a youn$e patient( it is o#ten possi"le to $i7e moeattention to !etails e$a!in$ ealie pesonal histoy&

• In ol!e patients( it is sometimes ha!e to $et a!etaile! account o# the ealy chil!hoo! histoy&

• Paents an! ol!e si"lin$s( i# ali7e( can o#ten po7i!emuch a!!i tional in#omation e$a!in$ the pastpesonal histoy&

• Not all *uestions nee! to "e as0e! #om all patients

an! pesonal histoy %much li0e est o# the histoyta0in$' shoul! "e in!i7i!ualise! #o each patient&Pesonal histoy can "e eco!e! un!e the #ollowin$hea!in$s=


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Peinatal Histoy

• Di1 culties in pe$nancy %paticulaly in the / stthee months o# $estation' such as any #e"ile illness(me!ications( !u$s an!o alcohol use a"!ominaltauma( any physical o psychiatic illness shoul! "e

as0e!&• Othe ele7ant *uestions may inclu!e whethe the

patient was a wante! o unwante! chil!( !ate o# "ith(whethe !eli7ey was nomal( any instumentationnee!e!( whee "on %hospital o home'( any peinatal

complications %cyanosis( con7ulsions( ?aun!ice'(APAR scoe %i# a7aila"le'( "ith cy %imme!iate o!elaye!'( any "ith !e#ects( an! any pematuity&


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Chil!hoo! Histoy

• -hethe the patient was "ou$ht up"y mothe o someone else("east#ee!in$( wean in$ an! any

histoy su$$esti7e o# matenal!epi7ation shoul! "e as0e!&

• The a$e o# passin$ each impotant

!e7elop mental milestone shoul! "enote!&

• The a$e an! ease o# toilet tainin$

shoul! "e as0e!


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• The occuence o# neuotic taitsshoul! "e note!&

• These inclu!e stuttein$(stammein$( tics( enuesis(encopesis( ni$ht teos( thum" suc0in$( nail "itin$( hea! "an$in$( "o!y

oc0 in$( mo"i! #eas o pho"ias(somnam"ulism( tempe tantums(an! #oo! #a!s&


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E!ucational Histoy

• The a$e o# "e$innin$ an! / nishin$#omal e!ucation( aca!emicachie7ements an! elationships with

pees an! teaches( shoul! "e as0e!&

• Any school pho"ia( non.atten!ance(tuancy( any leanin$ !i1culties an!

easons #o temi nation o# stu!ies %i#occus pema tuely' shoul! "e note!


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Play Histoy

• The *uestions to "e as0e! inclu!e(what $ames wee playe! at whatsta$e( with whom an! whee&

Relationships with pees( paticulalythe opposite se6( shoul! "e eco!e!&

The e7aluation o# play histoy is

o"7iously moe impotant in theyoun$e patients&


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Pu"ety

• The a$e at menache( an! eactionto menache %in #emales'( the a$e atappeaance o# secon!ay se6ual

chaacteistics %in "oth #emales an!males'( noctunal emissions %inmales'( mastu"ation an! any

an6iety elate! to chan$es in pu"etyshoul! "e as0e!&


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+enstual an! O"steticHistoy

• The e$ulaity an! !uation o#menses( the len$th o# each cycle(any a"nomalities( the last menstual

peio!( the num"e o# chil!en "on(an! temination o# pe$nancy %i# any'shoul! "e as0e! #o&


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Occupational Histoy

• The a$e at statin$ wo0

• ?o"s hel! in chono lo$ical o!e

• easons #o chan$es

• ?o" satis#actions• am"itions elationships with authoities(

pees an! su"o!inates

• pesent income an!

• whethe the ?o" is appopiate to thee!ucational an! #amily "ac0$oun!( shoul!"e as0e!&


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Se6ual an! +aital Histoy• Se6ual in#omation( how ac*uie! an! o# what 0in! mastu"ation

%#antasy an! acti7ity'• se6 play( i# any

• a!olescent se6ual acti7ity

• pe maital an! e6tamaital se6ual elationships(

• i# any se6ual pactices %nomal an! a"nomal' an! any $en!e

i!entity !iso!e( ae the aeas to "e en*uie! a"out&• The !uation o# maia$e%s' an!o elationship%s'

• time 0nown the patne "e#oe maia$e

• maia$e aan$e! "y paents with o without consent( o "y sel#.choice with o without paental consent

• num"e o# mai a$es(

• !i7oces o sepaations

• ole in maia$e intepesonal an! se6ual elations

• contacepti7e measues use!

• se6ual satis#action mo!e an! #e*uency o# se6ual intecouse an!psychose6ual !ys#unction %i# any' shoul! "e as0e!& Con7entionally(

the !etails o# the G#amily o# poceation> ae eco!e! hee&


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Pemo"i! Pesonality %P+P• It is impotant to elicit !etails e$a!in$ the pesonality

o# the in!i7i!ual %tempeament( i# the a$e is less than29 yeas'&

• Instea! o# usin$ la"els such as schizoi! o histionic( itis moe use#ul to !esci"e the pesonality in some!etail& The #ollowin$ su"hea!in$s ae o#ten use! #o the!esciption o# pemo"i! pesonality&

• 2& Intepesonal elationship= Intepesonalelationships with #amily mem "es( #ien!s( an! wo0collea$ues into7ete!e6to7ete! ease o# ma0in$

an! maintainin$ social elationships&• 3&


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• 5& Attitu!e to sel# an! othes= Sel#.con/ !ence le7el sel#.citicism sel#.consciousness sel#cente!thou$ht#ul o#othes sel#.appaisal o# a"ilities( achie7ements an! #ailues&

• 8& Attitu!e to wo0 an! esponsi"ility= Decision ma0in$acceptance o# esponsi"ility e6i"ility pese7eance#oesi$ht&

• 9& Reli$ious "elie#s an! moal attitu!es= Reli$ious "elie#stoleance o# othes> stan!a!s an! "elie#s consciencealtuism&

•

@& Fantasy li#e= Se6ual an! nonse6ual #antasies!ay!eamin$.#e*uency an! content ecuent o #a7ouite!ay!eams !eams&

• J& Ha"its= Foo! #a!s alcohol to"acco !u$s sleep


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• One o# the most elia"le metho!s o#assessment o# pemo"i! pesonalityis inte7iewin$ an in#o mant #amilia

with the patient pio to the onset o#illness&


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+ental status e6amination

• is a stan!a!ise! #omat in which the clinicianeco!s the psychiatic si$ns an! symptomspesent at the time o# the inte7iew&

•

+SE shoul! !esci"e all aeas o# mental#unctionin$ & Some aeas( howe7e( may!ese7e moe emphasis acco!in$ to theclinical impessions that may aise #om the

histoy #o e6ample( moo! an! a)ect in!epession( an! co$niti7e #unctions in!eliium an! !ementia&


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eneal Appeaance an!eha7iou

• A ich !eal o# in#omation can "eelicite! #om e6amination o# the$eneal appeaance an! "eha7iou&

• -hile e6aminin$( it is impotant toemem"e patient>s sociocultual"ac0$oun! an! pesonality&


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+ental Status E6amination

• 2& eneal Appeaance an! eha7iou

• i& eneal Appeaance

• ii&Attitu!e towa!s E6amine

• iii&Compehension

• i7& ait an! Postue

•

7& +oto Acti7ity• 7i& Social +anne

• 7ii& Rappot


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• 3& Speech i& Rate an! ;uantity ii& :olume an! Toneiii& Flow an! Rhythm

• 4& +oo! an! A)ect

• 5& Thou$ht i& Steam an! Fom ii& Content

• 8& Peception

• 9& Co$nition %Hi$he +ental Functions' i&Consciousness ii& Oientation iii& Attention i7&Concentation 7& +emoy 7i& Intelli$ence 7ii&A"stact thin0in$

• @& Insi$ht

• J& Ku!$ement


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• eneal appeaance The impotant points to "e note! ae=

• Physi*ue an! "o!y ha"itus %"uil!' an! physical appeaance%appo6imate hei$ht(

• wei$ht( an! appeaance'(

•

,oo0s com#ota"leuncom#ota"le(• Physical health(

• oomin$(

• Hy$iene(

• Sel#.cae(

• Dessin$ %a!e*uate( appopiate(• any peculiaities'(

• Facies %non.7e"al e6pession o# moo!'(

• E)eminatemasculin


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Attitu!e towa!s e6amine

• Coopeation

• $ua!e!ness

• e7asi7eness

•

hostility• com"ati7eness

• hau$htiness(

• Attenti7eness(

• Appeas inteeste!!isinteeste!apathetic(• Any in$atiatin$ "eha7iou(

• Peple6ity


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• C!%r#h#nsi!n Intactimpaie! %patially#ully'

• Gait and !st$r# Nomal o a"nomal %way o# sittin$(stan!in$( wal0in$( lyin$'

• M!t!r a&tivity Incease!!ecease!( E6citementstupo(

A"nomal in7oluntay mo7ements %AI+s' such as tics(temos( a0athisia( Restlessnessill at ease( Catatonicsi$ns %manneisms( steeotypies( postuin$( wa6y

e6i"ility( ne$ati7ism( am"i ten !ency( automatico"e!ience( stu po( echo pa6ia( psycholo$ical pillow(

#oce! $aspin$' %see Chapte 8 #o !etails'( Con7esionan! !issociati7e si$ns %pseu!o seizues( possession

states'( Social with!awal( Autism( Compulsi7e acts(ituals o ha"its %#o e6ample( nail "itin$'( Reaction time


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• S!&ia' %ann#r and n!n*v#r+a'+#havi!$r Incease!( !ecease!( oinappopiate "eha7iou Eye contact

%$aze a7esion( stain$ 7acantly(stain$ at the e6amine( hesitant eyecontact( o nomal eye contact'&

• Ra!rt -hethe a wo0in$ an!empathic elationship can "eesta"lishe! with the patient( shoul!

"e mentione!


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• Ha''$&inat!ry B#havi!$r Smilin$o cyin$ without eason( +ut tein$o tal0in$ to sel# %non.social speech'&

O!! $estuin$ in esponse toau!itoy o 7isual hallucinations&


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Speech

• Speech can "e e6amine! un!e the #ollowin$ hea!in$s= Ratean! *uantity o# speech -hethe speech is pesent o a"sent%mutism'( I# pesent( whethe it is spontaneous( whethepo!ucti7ity is incease! o !ecease!(

• Rate is api! o slow %its appopiateness'(

• Pessue o# speech o po7ety o# speech&

• :olume an! tone o# speech Incease!!ecease! %itsappopiateness'(

• ,owhi$hnomal pitch Flow an! hythm o# speechSmoothhesitant(

• loc0in$ %su!!en'( Dysposo!y(Stuttein$Stammein$Cluttein$( Any accent(Cicumstantiality( Tan$entiality( :e"i$eation( Steeotypies%7e"al'( Fli$ht o# i!eas( Clan$ associations&


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+oo! an! A)ect

• +oo! is the pe7asi7e #eelin$ tone which is sustaine! %lasts #osome len$th o# time' an! colous the total e6peience o# thepeson&

• A)ect( on the othe han!( is the outwa! o"?ecti7e e6pes siono# the imme!iate( coss.sectional e6peience o# emotion at a

$i7en time&• The assessment o# moo! inclu!es testin$ the *uality o# moo!(

which is assesse! su" ?ecti7ely %Ghow !o you #eel>' an!o"?ecti7ely %"y e6amination'&

• The othe components ae sta"ility o# moo! %o7e a peio! o#

time'( eacti7ity o# moo! %7aiation in moo! with stimuli'( an!pesistence o# moo! %len$th o# time the moo! lasts'&

• The a)ect is similaly !esci"e! un!e *uality o# a)ect( an$eo# a)ect %o# emotional chan$es !isplaye! o7e time'(


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• !epth o inten sity o# a)ect %nomal( incease! o"lunte!' an! appopiateness o# a)ect %in elation tothou$ht an! suoun!in$ en7ionment'&

• +oo! is !esci"e! as $eneal wamth( euphoia(

elation( e6altation an!o ecstasy %seen in se7eemania' in mania

• an6ious an! estless in an6iety an! !epes sion

• sa!( iita"le( an$y an!o !es paie! in !epessionan! shallow( "lunte!( in!i)eent( esticte!( inappopiate an!o la"ile in schizophenia&

• Anhe!onia may occu in "oth schizophenia an!

!epession


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Thou$ht

• Nomal thin0in$ is a $oal !iecte! ow o# i!eas(sym"ols an! associations initiate! "y a po"lem o atas0( chaacteise! "y ational connections "etweensuccessi7e i!eas o thou$hts( an! lea!in$ towa!s a

eality oien te! conclusion&• Thee#oe( thou$ht pocess that is not $oal.!iecte!(

o not lo$ical( o !oes not lea! to a ealistic solutionto the po"lem at han!( is not consi!ee! nomal&

•

Ta!itionally( in the clinical e6amination( thou$ht isassesse! %"y the content o# speech' un!e the #ouhea!in$s o# steam( #om( content an! possession o#thou$ht&


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• Howe7e( since thee is wi!espea! !isa$eement e$a!in$this su"!i 7ision( Gthou$ht> is !iscusse! hee un!e the#ollowin$ two hea!in$s o# Gsteam an! #om>( an! Gcontent>&

• Steam an! #om o# thou$ht Fo o"7ious easons( the Gsteamo# thou$ht> o7elaps with e6amination o# Gspeech>& Spontaneity(

po!ucti7ity( i$ht o# i!eas( poli6ity( po7ety o# content o#speech( an! thou$ht "loc0 shoul! "e mentione! hee&

• The Gcontinuity> o# thou$ht is assesse! -hethe the thou$htpocesses ae ele7ant to the *ues tions as0e! Any loosenin$o# associa tions( tan$en tiality( cicumstantiality( illo$ical

thin0in$( pese7eation( o 7e"i$eation is note!& Content o#thou$ht Any peoccupations O"sessions %ecuent( iational(intusi7e( e$o!ystonic( e$o.alien i!eas'


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• Contents o# pho"ias %iational #eas' Delusions%#alse( unsha0a"le "elie#s' o O7e.7alue! i!eas

• E6ploe #o !elusionsi!eas o# pesecution(e#eence( $an!eu( lo7e( ?ealousy %in/!elity'( $uilt(

nihilism( po7ety( somatic %hypochon!iacal'symptoms( hopeless ness( helplessness(

wothlessness( an! suici!al i!eation& Delusions o#contol( thou$ht insetion( thou$ht with!awal( an!thou$ht "oa! castin$ ae Schnei!eian / st an0symptoms %SFRS'&

• The pesence o# neolo$isms shoul! "e eco!e!hee&


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Peception

• Peception is the pocess o# "ein$ awae o# asensoy e6peience an! "ein$ a"le to eco$nizeit "y compain$ it with pe7ious e6peiences&

• Peception is assesse! un!e the #ollowin$

hea!in$s=

• Hallucinations

• The pesence o# hallucinations shoul! "e note!&A hallucination is a peception e6peience! in the

a"sence o# an e6tenal stimulus&

• The hallucinations can "e in the au!itoy( 7isual(ol#actoy( $ustatoy o tactile !omains&


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• Au!itoy hallucinations ae commonest types o# hallucinations innon.o$anic psychia tic !iso!es& It is eally impotant to clai#ywhethe they ae elementay %only soun!s ae hea!' o comple6%7oices hea!'&

• The hallucination is e6peience! much li0e a tue peception an!

it seems to come #om an e6tenal o"?ecti7e space %#o e6ample(#om outsi!e the eas in the case o# an au!itoy hallucination'&

• I# the hallucination !oes not eithe appea to "e a tue peceptiono comes #om a su"?ecti7e intenal space %#o e6ample( insi!ethe peson>s own hea! in the case o# au!itoy hallucination'( thenit is calle! as a pseu!ohallucination&

• It shoul! "e #uthe en*uie! what was hea!( how many 7oiceswee hea!( in which pat o# the !ay( male o #emale 7oices( howintepete! an! whethe these ae secon! peson o thi! pesonhallucinations


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• %i&e& whethe the 7oices wee a!!essin$ the patiento wee !iscussin$ him in thi! peson' also en*uiea"out comman! %impeati7e' hallucinations %which$i7e comman!s to the peson'&

•En*uie whethe the hallucinations occue! !uin$wa0e#ulness( o wee they hypna$o$ic %occuin$while $oin$ to sleep' an!o hypno pompic %occuin$while $ettin$ up #om sleep' hallucinations&

• Illusions an! misintepetations -hethe 7isual(au!itoy( o in othe sensoy / el!s whethe occu inclea consciousness o not whethe any steps ta0ento chec0 the eality o# !istote! peceptions&

li i ! li i


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Depesonalisation!eealisation

• Depesonalisation an! !eealisation ae a"nomalitiesin the peception o# a peson>s eality an! ae o#ten!esci"e! as Gas.i#> phenomena&

• S!%ati& assivity h#n!%#n!n

• Somatic passi7ity is the pesence o# stan$esensations !esci"e! "y the patient as "ein$ impose!on the "o!y "y Gsome e6tenal a$ency>( with thepatient "ein$ a passi7e ecipient&

• It is one o# the Schnei!e>s / st an0 symptoms&Othes

• Autoscopy( a"nomal 7esti"ula sensations( sense o#

pesence shoul! "e note! hee


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Documents

Basics Psy Ug Class