Psychopathology

Dr. Amro Alomari, MD

Psychiatrist
• Psychopathology is the scientific study of mental disorders,
including their causes, symptoms, diagnosis, and treatment.

• It involves understanding mental health conditions that deviate

from the norm and lead to distress or dysfunction.

• Individual symptoms are rarely diagnostic; it is usually the pattern

of symptoms (together with altered behaviour) that provides the
basis for diagnosis.
Mood and Emotions
• Mood refers to a persistent, internal feeling state (Subjective). Think
of it as the underlying emotional climate you experience for a
sustained period.

• Affect, on the other hand, refers to the outward expression of

emotion (Objective). It is the observable weather patterns reflecting
your emotional state, including facial expressions, body language,
tone of voice, and overall behavior. Affect can be fleeting and
changeable compared to mood.
Terms to describe mood
• Euthymic mood: neutral (normal) mood

• Dysphoria: unpleasant mood.

• Elation/euphoria: abnormally high mood.

• Alexithymia: impaired ability to describe one’s emotions

• Anhedonia: impaired ability to enjoy activities that would normally be

pleasurable.
10 Euphoria

Euthymic
5

O
Dysphoria
Terms to describe affect
• Reactive affect: the appropriate and expected emotional response
to a given situation. For example, smiling when happy or frowning
when sad.

• Restricted Affect: reduced range of emotional expression.

• Flat Affect: Flat affect is characterized by a complete lack of

emotional expression. Their facial expressions, tone of voice, and
body language remain neutral and unresponsive.
 Flat affect
Reactive affective
 Congruent mood: appropriate link
between an individual’s mood and their
circumstances or topic of conversation.

Incongruent mood: inappropriate

dissonance between an individual’s
mood and their circumstances or topic
of conversation.
• Lability of mood: mood tends to fluctuate with unusual rapidity.

10

0
Thoughts
 1. Thought Form
• Thought form refers to how thoughts are organized, structured,
and expressed. It’s about the process of thinking.

• It includes:
1. Flow of ideas (Is it logical, coherent, goal-directed?)
2. Association between thoughts (Are they connected or
fragmented?)
 2. Thoughts Content
• Thought content refers to what the person is thinking about.

• It includes the ideas, and beliefs occupying the mind.

 Formal disorders
o Circumstantiality

o Flight of ideas
Thoughts
o Loosening of associations

o Tangentiality

o Thought blocking
Circumstantiality
• Excessive detail and unnecessary information, but eventually
gets to the point.
Flight of ideas
• Rapid shifting of ideas with superficial connections, often seen in
mania.
• Extreme form is called Clang Association were speech is driven
by the sound of words (e.g., rhyming), rather than meaning.
Loosening of associations
• Thoughts jump from one idea to another with little or no logical
connection. Often seen in schizophrenia.
• Extreme form is called Word salad where words has no logical
connection.
Tangentiality
• The person responds to a question with an answer that is
obliquely related or unrelated.
Thought blocking
• Sudden interruption in the train of thought, often followed by
silence.
 Content disorders
o Anxiety

o Phobia
Thoughts
o Obsessions

o Delusions
Anxiety
• Anxiety is a normal emotional response to perceived future
threats or uncertainty.

• However , it becomes a pathology if:

1. Excessive (disproportionate to the situation).
2. Persistent (lasting longer than expected).
3. Distressing.
4. Impairing (interferes with daily functioning).
 Physical and psychological
symptoms

Anxiety

Apprehension Avoidance
Phobia
• a persistent, excessive, and irrational fear of a specific object,
situation, or activity that is out of proportion to the actual threat
posed.

• This fear leads to avoidance behavior or is endured with intense

distress.
Obsessions
• Recurrent, intrusive, unwanted, irrational

1. Thoughts
2. Images
3. Impulses

• that cause marked anxiety or distress. Despite the individual’s

efforts to ignore, suppress, or neutralize them.
Delusions
• Fixed, false beliefs that are firmly held despite clear or obvious
evidence to the contrary, and are not shared by others in the
same cultural or social group.

• These beliefs are not amenable to reason or logic, and the

person holds them with strong conviction.
Types of delusions
• Primary delusions: spontaneously, without any preceding event,
mood, or perceptual abnormality, and cannot be explained by
other psychopathological processes. They are un-
understandable.

• Secondary delusions: arise in response to other

psychopathological experiences, such as mood disorders,
hallucinations, or pre-existing thoughts or feelings. They are often
understandable
Primary delusions
• Sudden delusional ideas: A sudden, out-of-nowhere “revelation” of
a delusional belief, without any logical reasoning or context.
Example: While sitting quietly, a person suddenly “knows” that their
neighbor is an alien.

• Delusional Perception: normal, real perception is given a false,

delusional meaning.
Example: Seeing two people talking in the street and believing this
is a sign that the government has launched a secret mission against
you.
• Delusional Memory: false memory that is entirely fabricated and
invested with delusional meaning.
Example: A person believes they remember being abducted by a
secret organization as a child, despite no such event occurring.

• Delusional Mood: vague, unsettling sense that something is

profoundly wrong or significant, but without clear content. Often
the precursor to a more systematized delusion.
Example: The patient feels that something terrible is about to
happen or that they are at the center of a mysterious change, but
cannot say exactly what or why.
Secondary delusions
• Persecutory Delusion: Belief that one is being harassed, spied
on, conspired against, or targeted for harm.

Example: Believing that the person is being spyed on by cameras

that are planted at his house
Example: Believing that his food is poisoned
Example: Believing that the FBI is following him
Example: Believing that a magical spell is casted on the person
• Delusion of Reference: Belief that ordinary events, objects, or
people have special meaning directed toward the person.

Example: Believing that random people on the street are talking

about the person

Example: Believing that TV or radio or social media posts are

sending him hidden messages
• Grandiose Delusion: Belief that one has exceptional abilities,
wealth, fame, or identity (e.g., divine or political mission).

Example: Believing that one is related to the royal family

Example: Believing that one is sent from god with a special

message

Example: Believing that one has great wealth

• Nihilistic Delusion: Belief that oneself, others, or the world does
not exist or is ending
• Example: My organs have already rotted; I’m just a hollow shell
walking around

• Delusion of Guilt: Belief that one has committed a terrible crime

or sin and deserves punishment
• Example: I caused the COVID outbreak by having impure
thoughts.
• Erotomanic Delusion: Belief that another person (often of higher
status) is in love with them.
• Example: Believing that Tom Cruse loves me because he winked in
his last movie

• Jealous Delusion: Belief that one’s partner is unfaithful despite

lack of evidence
• Example: Believing that his wife is cheating with her boss because
she started watering the flowers everyday
• Passivity Delusions: believing that someone or some agency is
interfering with ones thoughts by:

• Thought insertion: The belief that thoughts are being placed into
one’s mind by an external force.
• Thought withdrawal: The belief that thoughts are being taken out
of one’s mind by someone or something.
• Thought broadcasting: The belief that one’s thoughts are being
transmitted and can be heard by others.
• Thought Control: a believe that a person or an external force is
controlling ones:

• bodily movements: The belief that one’s physical actions are being
controlled by an outside force.
• Made will (volition): The belief that one’s decisions or intentions
are not their own but imposed by an external agent.
• Made affect (emotions): The belief that one’s emotions are being
artificially produced or manipulated by an external power.
Perception
Normal perception
• We perceive the world around us through our senses; sight,
hearing, touch, taste and smell

• Normal perception is the accurate and coherent awareness of

external sensory stimuli, where the brain correctly interprets
signals from the environment through the senses.
 Abnormalities
o Illusions

o Hallucinations
Perception
o Depersonalization

o Derealization
Illusions
• illusions are misinterpretations of real external stimuli. The
sensory information is present, but the brain misinterprets it.

• experiencing illusions is a relatively common and normal

phenomenon, particularly under certain circumstances.
Examples:

• Driving on a dark road, the driver misinterpret the speed sign for a
person who is trying to cross the street

• While gazing into a campfire, you perceive faces or dancing figures

within the flickering flames and smoke.
Hallucinations
• A hallucination is a sensory perception that occurs in the
absence of an external stimulus and has the compelling sense
of reality of a true perception.

• Hallucinations is almost always abnormal and refers to a

pathology (except in few cases)
Auditory Hallucinations
• Perceptions of sounds, most commonly voices, when no external
sound is present.

• Main Causes: Schizophrenia and other psychotic disorders

• Most important in psychiatric settings

 2nd person auditory 3rd person auditory
hallucination hallucination

• voices that speak directly to • Voices that speak about the

the individual. individual.

• using "You" pronoun. • referring to them in the third

person (He, She).
 Commanding auditory Running
hallucination Commentary auditory
hallucination
• Voices that issue direct
orders or instructions to the • Voices that describe the
individual. individual's actions,
thoughts, or appearance as
• Can pose significant risk if they occur, often in a
commands are for self-harm, narrative or descriptive
harm to others, or dangerous manner.
acts.
Visual Hallucinations
• Seeing things that are not actually there.

• Can ranging from simple flashes of light or geometric patterns to

complex scenes or figures.

• Main Causes: substance intoxication/withdrawal, neurological

conditions (e.g., migraine aura)
Tactile Hallucinations
• Perceptions of sensations on or under the skin when nothing is
physically touching it.

• Main Causes: Substance withdrawal (e.g., cocaine)

• Example: A patient experiencing cocaine-induced psychosis

repeatedly scratches their arms, convinced that insects are
crawling under their skin (formication).
Olfactory Hallucinations
• Perceptions of smells that are not present in the environment.

• These are often unpleasant smells (e.g., burning rubber).

• Main Causes: Temporal lobe epilepsy (often as an aura).

Gustatory Hallucinations
• Perceptions of tastes in the absence of food or drink.

• These are often strange or unpleasant.

• Main Causes: Temporal lobe epilepsy (often as an aura)

Depersonalization
• A persistent or recurrent feeling of detachment or estrangement
from one's own mental processes, body, or self.

• Subjective Experience: Individuals feel as if they are an outside

observer of their own thoughts, feelings, sensations, body, or
actions. They may feel unreal, robotic, or like they are living in a
dream.
Derealization
• A persistent or recurrent feeling of detachment or unreality
regarding one's surroundings.

• Subjective Experience: The external world is perceived as unreal,

dreamlike, foggy, lifeless, or visually distorted. Objects may seem
dull, two-dimensional, or distant.
 Depersonalization Derealization

• It's a disturbance of self- • It's a disturbance of the

experience, where perception of external
theindividual feels "not real" reality,where the
or disconnected from world around the individual
themselves. feels "not real."
• A person experiencing severe trauma reports feeling as if their
body is floating above them, watching the event unfold from an
out-of-body perspective.

• A person under extreme stress looks at their familiar living room,

but the furniture and walls appear strangely distorted and
unfamiliar, making them feel like they've stepped into a
new environment.