BasPsychopathology & Classification of Mental Disorders

Classification of Mental Disorders
Wherever we try to mark out the frontier between mental health and disease, we find a neutral territory, in which the imperceptible change from the realm of normal life to that of obvious derangement takes place.’ – Kraepelin (1917)

There is no consensus definition of Abnormal Behaviour. The elements (changes as society changes) of abnormality include:

Distress (suffering)
Dysfunction (maladaptiveness)
Deviancy (statistical deviance)
Deviancy (social deviance – violation of the standards of society)
Discomfort (social)
Dangerousness (irrationality and unpredictability)

Mental disorders are classified so as to provide:

A nomenclature (to structure information helpfully)
An effective ‘language’
Social and political implication (legal etc)
Natural history of disorder defined (prognosis)
Effective specific treatments
Aetiology and pathophysiology
Genetgics (phenotype vs genotype )

Stigmas, Labelling and the Downside to Classfication:

Loss of information
Absence of context
Stereotyping -
Labeling - What happens if fail to label correctly? Diagnoses can be self-fulfilling prophecy for patient. How long does the label apply?
Sigma – Is it ever removed?

DSM classification of mental disorders:

- Patient’s subjective description of a physical or mental disorder
- Objective observation of a patient’s physical or mental disorder by a diagnostician.
Basic Psychopathology - The study of abnormal states of mind

Disorders of Perceptions:

Perception is a process of becoming aware of what is presented to the sensory organs. An illusion is a misinterpretation of a normal perception (normal phenomenon). E.g. saw a shadow and perceived the tenant had come home. Hallucination is a sensory perception without an external stimulus. Hallucinations may occur in any sensory modality—visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, thermoceptive.

Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up. Hallucinations may also be associated with drug use (particularly hallucinogenic drugs), sleep deprivation, psychosis or neurological illness.

Disorders of Thinking:

In psychiatry, thought disorder is a term used to describe a pattern of disordered language use that is presumed to reflect disordered thinking. It describes a persistent underlying disturbance to conscious thought and is classified largely by its effects on speech and writing. Disorders of thinking may affect the stream of thought. Affected persons may show pressure of speech (speaking incessantly and quickly), derailment or flight of ideas (switching topic mid-sentence or inappropriately), thought blocking, rhyming, punning, or 'word salad' when individual words may be intact but speech is incoherent.

Eugen Bleuler, who named schizophrenia, held that its defining characteristic was a disorder of the thinking process. It is important to note however that the delusions and hallucinations of psychosis could also be considered as disorders of thoughts in its content. Delusion is a belief that is unshakeable, untrue and unshared. It can be persecutory (paranoid), grandiose (expansive), jealous, love, hypochondriacal (the belief and fear of serious illness which lasts for six months, beyond and despite medical reassurance), nihilistic (severe depression) and guilt.

Disorders of form of thought is persistent and inappropriate repetition of a response, eg dementia - Perseveration. Rapid shifting on one topic to another, eg mania - Flight of ideas. Clang Association is based on similarity of sound without regard for differences, eg. Schizophrenia.

Disorders of Emotion:

Affect is a subjective feeling at a point in time while mood is a prolonged emotional state. Changes in the nature of emotion come in the form of anxiety, depression, elation, anger, fear and panic. Abnormal fluctuations of affect refer to blunted, flattened, labile and incongruity of affect.
Disorders of Consciousness:

This is a state of drowsiness resulting in incomplete reactivity to external stimuli. Stupor is a state in which patient is mute, immobile and unresponsive yet fully conscious.

Disorders of Memory:

Memory processing involves registration, retention, recognition and recall of datas.
Left brain is for verbal memory. Right brain is for visor-spatial memory. Amnesia is failure of memory.

Disorders of Motor:

There are many types of Motor Disorders. Tics refer to irregular repeated movements of a group of muscles. Echopraxia attempts to imitate movements of others.

Other disorders:

Depersonalization - change of self-awareness, a feeling of unreal, of being detached and unable to feel emotion.

Derealization – objects and environment seem unreal and lifeless.

Déjà vu – recognition of events that are in fact novel/new

Jamais vu – failure to recognize events encountered before

Confabulation – fabrication of stories in response to questions about situations or events that are not recalled