Sims' Symptoms in the Mind - Textbook of Descriptive Psychopathology

19  The Expression of Disordered Personality 291

and may overcompensate for this indecisiveness by by others; hesitancy in new social relationships; restric-
making arbitrary decisions that then become immutable tion of lifestyle because of the need for security; and
on insufficient evidence, or he may compensate for his avoidance of those social situations that might provoke
legalistic rigidity by flaunting the law ostentatiously. disapproval (ICD-10; World Health Organization, 1992).
Even in this, his basic perfectionism is still manifest.
The anankast finds the initiation or completion of any Dependent Personality Disorder
activity difficult, but hard work is highly prized, and
he is therefore prepared to carry on the middle part The dependent personality is characterized by feelings
of the task indefinitely. of inadequacy concerning self and dependence on other
people. There is gross lack of self-confidence, initiative
There is a need for formality, and his feelings of and drive. Such a person is unable to react to the changing
sensitivity about how other people view him, results demands of life and allows other people, sometimes
in restricted ability to express tender emotion. He is one other person, to assume responsibility for major
unduly conventional, serious and formal. Stinginess areas of life. He may function reasonably well and appear
may be shown both with money and with the expression inconspicuous when carried along through life by a
of feelings. Such a person actually experiences strong dominant close relationship. However, when external
affect but is quite unable to express this appropriately stress occurs he lacks confidence, is unable to cope and
towards other people. craves long-term support and encouragement from
relatives, a close friend, his family doctor, his social
The different facets of the anankastic personality worker, his minister, his employer or his surrounding
disorder are, of course, interlocked. As traits of per- social organizations. He may, for example, flourish in
sonality, they are seen frequently, not least among the armed forces but be unable to adjust to civilian life.
members of the medical profession. However, developed
as a personality disorder, this way of life may be Such people tend to go through life with one
incapacitating, especially the indecisiveness and inability dominant dependent relationship; for a man, this may
to express strong emotion. Depression, obsessive- be initially his mother and subsequently his wife, who
compulsive disorder, eating disorder and hypochon- takes over his mother’s role. Crises resulting in psychi-
driasis are not uncommonly associated with this atric referral may occur when a parent dies or becomes
abnormality of personality (Samuels and Costa, 2012). incapable, his marriage breaks down, he loses his job,
after detection in crime or after physical illness. It is
Anxious (Avoidant) Personality Disorder usually only after such situations that a person with
this type of personality disorder comes to the attention
This is a disorder of trait, whereas anxiety disorder is of the caring professions. Dependence amounts to
a disorder of state (see Chapter 17). There is often passive compliance with the aims and demands of the
free-floating anxiety that is exacerbated by any overt more dominant partner. There is a lack of vigour in
predisposing cause. Such people often find the public maintaining aims and goals and in attempting to achieve
side of life, for example at work, very much more these. They may describe themselves as depressed, but
stressful than the private side, within the family. Trait it is more a feeling of inertia and an inability to cope
anxiety is present when the development of the indi- with their problems than the symptoms of affective
vidual’s personality results in some level of abnormal disorder. Originally, this personality disorder was con­
anxiety being a persistent background part of their ceptualized as arising out of problematic early parent–
constitution (Sims and Snaith, 1988); this could alte­ child relationships but pathologic dependency is now
rnatively be described as anxious temperament or seen as stemming from a perception of the ‘self’ as
anxiety-prone personality. Such people describe them- weak accompanied by the belief that other people are
selves as ‘born worriers’. comparatively competent and confident. As a result of
this the individual becomes preoccupied with obtaining
This personality disorder is characterized by per- and maintaining relationships with potential caregivers
sistent and pervasive feelings of terror and apprehension; (Bornstein, 2012).
a belief that one is socially inept, unattractive or inferior;
excessive preoccupation with criticism and rejection

292 SECTION VI  Variations of Human Nature

Persistent Mood Disorders Other Personality Disorders

In the ICD-9 (World Health Organization, 1977), these DSM-5 (APA, 2013) includes two other personality
conditions were classified as disorder of personality. disorders. They are briefly described here for complete-
However, in the ICD-10, they have been listed as a ness.
subcategory of affective disorders because they are
genetically related to mood disorders and sometimes NARCISSISTIC PERSONALITY DISORDER
respond to the same methods of treatment. They are
retained in this chapter because they conform with the This is categorized by a grandiose sense of self-
psychopathology of personality disorders. Akiskal (1993) importance or uniqueness; preoccupation with fantasies
has made a convincing case for depressive personality of unlimited success, power, brilliance, beauty or ideal
to be returned to the generic category of personality love; an exhibitionistic need for constant attention
disorders rather than being classified with axis 1 mood and admiration; indifference, anger or humiliation in
(affective) disorders. There is a persistent lifelong abnor- response to criticism or indifference from others; and
mality of mood, not amounting to illness, as opposed characteristic disturbances in interpersonal relationships,
to those reactive or endogenous disturbances of affect such as feelings of entitlement to special favours, taking
that are of shorter duration and are regarded as illness. advantage of other people, relationships with others
The most frequent types of affective personality disorder that alternate between the extremes of over-idealization
show excessive lability of mood or persistent depressive and devaluation and lack of empathy.
stance towards life. Other abnormalities of personality
may occur, such as persistent hypomania, but these AVOIDANT PERSONALITY DISORDER
rarely present to the psychiatrist.
This personality disorder is, in fact, close to the anxious
Those with cyclothymia show marked fluctuations personality disorder of ICD-10; it is characterized by
of mood, for instance, for a day or a week they may excessive sensitivity to rejection, humiliation or shame.
be optimistic, energetic, creative and garrulous, then There is unwillingness to enter into a relationship unless
for a period they may become gloomy, morose, taciturn the person receives strong guarantees of uncritical
and unable to turn themselves to any useful activity. acceptance. There is social withdrawal, despite a need
These cycles may be linked to other biological rhythms for affection and acceptance, and the person has very
such as the menstrual cycle; they may, however, appear low self-esteem, devaluing his own achievements and
out of the blue, apparently unprovoked. A premorbid is very aware of his personal shortcomings. Such people
cyclothymic personality is thought to predispose to are exquisitely sensitive to the way they believe others
manic-depressive psychosis. Certainly, Goodwin and will react to them.
Jamison (1990), in a study of manic-depressive illness
and creativity, found that among poets especially there In DSM-5, the helpful notion of three clusters of
was an excess of cyclothymic personality, depressive personality types is based on descriptive similarities.
illness and suicide. Cluster A includes paranoid, schizoid and schizotypal
personality disorders. In cluster B are antisocial, borderline,
Dysthymia is manifested by all-pervasive and per- histrionic and narcissistic personality disorders. Cluster C
manent gloom and apprehension. It leads to the contains avoidant, dependent and obsessive-compulsive
diagnostic quandary: ‘is this depressive state or depres- personality disorders. In practice, of course, patients may
sive trait?’ Such people are usually gentle and sensitive; show features from different clusters, and the validity
they take themselves and their activities seriously; they of this subclassification is still being questioned.
are often safety-conscious and hypochondriacal in
disposition. An acquaintance with this personality Why is a text on psychopathology concerned with
structure coined aphorisms that revealed his mental personality classification and disorder? The accurate
state, such as ‘there is no situation in life so bad as to observation and delineation of personality characteristics
be incapable of further deterioration’ or ‘every silver is valuable in clinical practice for diagnosis, prognosis
lining has its cloud’. and the rational planning of treatment. The skills of a
trained psychopathologist are ideally suited to the
observation of consistent personality traits and forming

19  The Expression of Disordered Personality 293

an opinion unprejudiced by preconceived theoretical Mullen, P.E., 1999. Dangerous people with severe personality disorder.
Br. Med. J. 319, 1146–1147.
considerations.
Paris, J., 2013. The Intelligent Clinician’s Guide to the DSM-5. Oxford
REFERENCES University Press, Oxford.

Anonymous, 1986. Management of borderline personality disorders Prichard, J.C., 1835. A Treatise on Insanity and Other Disorders
[leading article]. Lancet 2, 846–847. Affecting the Mind. Sherwood, Gilbert and Piper, London.

Akiskal, H.S., 1993. Proposal for a depressive personality (tempera- Rush, B., 1812. Medical Inquiries and Observations Upon the Diseases
ment). In: Tyrer, P., Stein, G. (Eds.), Personality Disorder Reviewed. of the Mind. Kimber and Richardson, Philadelphia.
Gaskell, London.
Samuels, J., Costa, P.T., 2012. Obsessive-compulsive personality
American Psychiatric Association, 1994. Diagnostic and Statistical disorder. In: Widiger, T.A. (Ed.), The Oxford Handbook of Per-
Manual of Mental Disorders, fourth ed. American Psychiatric sonality Disorders. Oxford University Press, Oxford.
Association, Washington, DC.
Schneider, K., 1923 and 1958. Psychopathic Personalities. Cassell,
American Psychiatric Association, 2013. Diagnostic and Statistical London.
Manual of Mental Disorders, fifth ed. American Psychiatric Associa-
tion, Washington, DC. Schneider, K., 1958. Clinical Psychopathology, fifth ed. Grune and
Stratton, New York, p. 1959.
Bluglass, R.S., 1983. A Guide to the Mental Health Act, 1983.
Churchill Livingstone, Edinburgh. Skodol, A.E., 2012. Diagnosis and DSM-5: work in progress. In:
Widiger, T.A. (Ed.), The Oxford Handbook of Personality Disorders.
Bornstein, R.F., 2012. Dependent personality disorder. In: Widiger, Oxford University Press, Oxford.
T.A. (Ed.), The Oxford Handbook of Personality Disorders. Oxford
University Press, Oxford. Sims, A.C.P., 1983. Neurosis in Society. Macmillan, Basingstoke.
Sims, A., Snaith, R., 1988. Anxiety in Clinical Practice. John Wiley,
Carrasco, J.L., Lecic-Tosevski, D., 2000. Specific types of personality
disorder. In: Gelder, M., López-Ibor, J.J., Andreasen, N.C. (Eds.), Chichester.
New Oxford Textbook of Psychiatry. Oxford University Press, Snaith, R.P., Taylor, C.M., 1985. Irritability: definition, assessment
Oxford.
and associated factors. Br. J. Psychiatry 147, 127–136.
Chick, J., Waterhouse, L., Wolff, S., 1979. Psychological construing Tantam, D., 1988. Personality disorders. In: Granville-Grossman, K.
in schizoid children grown up. Br. J. Psychiatry 135, 425–430.
(Ed.), Recent Advances in Clinical Psychiatry, vol. 6. Churchill
Cleckley, H.M., 1941. The Mask of Sanity. Kingston, London. Livingstone, Edinburgh.
Craft, M., 1966. Psychopathic Disorders. Pergamon Press, Oxford. Thomas, D., 1954. Under Milk Wood. Dent, London.
Crawford, M.J., Koldobsky, N., Mulder, R., Tyrer, P., 2011. Classifying Thompson, D.J., 1980. A comprehensive study of hysterical personality
disorder. MSc thesis, University of Manchester.
personality disorder according to severity. J. Personal. Disord. 25, Tyrer, P., Alexander, J., 1979. Classification of personality disorder.
321–330. Br. J. Psychiatry 135, 163–167.
De Alarcon, R.D., 1973. Hysteria and hysterical personality disorder. Tyrer, P., Crawford, M., Mulder, R., et al., 2011. The rationale for
Psychiatric Quarterly 47, 258–275. the reclassification of personality disorder in the 11th revision of
Dolan, B., Coid, J., 1993. Psychopathic and Antisocial Personality the International Classification of Diseases. Personal. Ment. Health
Disorders: Treatment and Research Issues. Gaskell, London. 5, 246–259.
Goodwin, F.K., Jamison, K.R., 1990. Manic-Depressive Illness. Oxford Tyrer, P., Evans, K., 2000. Personality disorders. Principles of Medical
University Press, New York. Biology 14, 451–461.
Haddock, A., Snowden, P., Dolan, M., Parker, J., Rees, H., 2001. Tyrer, P., Reed, G.M., Crawford, M.J., 2015. Classification, assessment,
Managing dangerous people with severe personality disorder: a prevalence, and effect of personality disorder. Lancet 385, 717–726.
survey of forensic psychiatrists’ opinions. BJPsych Bull. 25, Tyrer, P., Stein, G., 1993. Personality Disorder Reviewed. Gaskell,
293–296. London.
Henderson, D.K., 1939. Psychopathic States. Norton, New York. Whiteley, J.S., 1975. The psychopath and his treatment. In: Silverstone,
Hinshaw, S.P., 1994. Attention Deficits and Hyperactivity in Children. T., Barraclough, B. (Eds.), Contemporary Psychiatry. Headley
Sage, Thousand Oaks, CA. Brothers, Ashford.
Hooley, J.M., Cole, S.H., Gironde, S., 2012. Borderline personality Widiger, T.A., Samuel, D.B., Mullins-Sweatt, S., Gore, W.L., Crego,
disorder. In: Widiger, T.A. (Ed.), The Oxford Handbook of Per- C., 2012. An integration of normal and abnormal personality
sonality Disorders. Oxford University Press, Oxford. structure: the five-factor model. In: Widiger, T.A. (Ed.), The Oxford
Jaspers, K., 1997. General Psychopathology (J. Hoenig, M.W. Handbook of Personality Disorders. Oxford University Press,
Hamilton, Trans). The Johns Hopkins University Press, Baltimore. Oxford.
Malmberg, A., Lewis, G., David, A., Allebeck, P., 1998. Premorbid Wooton, B.F., 1959. Social Science and Social Pathology. Allen and
adjustment and personality in people with schizophrenia. Br. J. Unwin, London.
Psychiatry 172, 308–313. World Health Organization, 1977. International Statistical Classifica-
Mill, J.S., 1811. A System of Logic, vol. II, third ed. John W. Parker, tion of Diseases, Injuries and Causes of Death, ninth revision.
London. World Health Organization, Geneva.
Mulder, R.T., 2012. Cultural aspects of personality disorder. In: World Health Organization, 1992. The ICD-10 Classification of
Widiger, T.A. (Ed.), The Oxford Handbook of Personality Disorders. Mental and Behavioural Disorders: Clinical Description and
Oxford University Press, Oxford. Diagnostic Guidelines. World Health Organization, Geneva.

This page intentionally left blank

SECTION 7

DIAGNOSIS

295

This page intentionally left blank

CHAPTER 20 

Psychopathology and Diagnosis

KEYWORDS diagnostic categories are actually greater, as mental
disorders include situational, social, emotional and
Diagnosis psychological disturbance as well as physical illness.
Health Understandably, most of the medical illnesses that have
been described are based on signs or symptoms; this
Summary is true also for psychiatry. There is, therefore, a very
close association between the observation and classifica-
Diagnosis allows the naming, defining and identification tion of ‘symptoms in the mind’ (Burton, 1621) and
of a singular malady so that it can become an object psychiatric diagnosis.
for consideration, comparison, explanation and control.
It is therefore self-evident that the diagnostic process The importance with which diagnosis is regarded
is fundamental to the practice of psychiatry. The in psychiatry has developed alongside the introduction
importance and relevance of psychopathology is that of effective remedies for many conditions. There has
it is the constellation of abnormal phenomena that are been a substantial change in the attitude of psychiatrists
elicited by the clinical interview, reinforced by the since Stengel wrote in 1959 that there was ‘almost general
phenomenological approach, that constitute psychiatric dissatisfaction with the state of psychiatric classification,
syndromes. In other words, psychopathology is the national and international’. Much of the progress made
foundation upon which clinical psychiatry is built. has arisen directly from the more careful application
of descriptive psychopathology, for instance, Kendell
‘There’s glory for you!’ ‘I don’t know what you mean by (1975). Schwartz and Wiggins (1987) have shown that
“glory”,’ Alice said. ‘I meant, there’s a nice knock-down to make a diagnosis an experienced clinician uses a
argument for you!’ ‘But “glory” doesn’t mean “a nice mechanism of typification: ‘This more fundamental
knock-down argument”,’ Alice objected. ‘When I use a capacity to recognize various mental disorders arises,
word,’ Humpty Dumpty said in a rather scornful tone, not through mastering conceptual definitions, but rather
‘it means just what I choose it to mean, – neither more through directly encountering individual patients who
nor less.’ manifest these disorders. Through such direct encounters
we learn the typical forms of the various mental disorders.
Lewis Carroll (1872), Through the Looking Glass We learn what is distinctive to each condition and
how to distinguish these conditions from one another’.
Diagnosis is much more than a word plucked out This process of ‘typification’ seeks to recognize what is
of the air and pinned on to a hapless ‘patient’. It conveys emblematic of different conditions, what is unusual but
meaning about the antecedents of the present state, yet representative, and what is untypical and so highly
about other conditions that are similar and, most unusual as to be uncharacteristic. Thus the detailed
important of all, about what is likely to happen in the examination of psychopathologic functions that forms
future and, therefore, what should be done about it. the substance of this text is a prerequisite to this, the
Diagnosis is a means of communication between doctors; first step for clinical diagnosis in psychiatry.
it should encompass a full formulation (see Chapter
2) rather than just a single word used in an idiosyncratic Abnormal phenomena, then, are the foundation of
manner. the diagnostic process. Diagnosis allows the naming,
defining and identification of a singular malady so that
The importance of making a diagnosis, and the range it can become an object for consideration, comparison,
of diagnoses, is as great in psychiatry as in the rest of explanation and control (Sadler, 2004).
medicine; the conceptual differences between different
297

298 SECTION VII  Diagnosis

In general medicine, diagnosis is based on the Whatever the underlying causes of conditions, the role
complete clinical process: detailed history taking, that the subject himself, the patient, chooses to play
examination of the patient and carrying out appropriate and the role that is forced on him by those around
special investigations. This is true also for psychiatry. him because of his illness are highly significant in the
However, because of the limitations of its subject, this way his symptoms manifest. Parsons (1951b) argued
book does not deal with physical examination nor that health is included in the functional needs of the
with physical (radiologic, laboratory) or psychological individual member of society, so that from the point
(psychometric) investigations. of view of the functioning of the social system, too low
a general level of health, or too high an incidence of
Concepts of Health and Psychopathology illness, is dysfunctional. Disease in this formulation
incapacitates the effective performance of social roles
The late Peter Sedgwick (1981) made the important and there is therefore social interest in the alleviation
point that ‘disease is a human invention … there are of disease. To put this in another way, disease is not
no illnesses or diseases in nature’, hence the quotation purely or merely a natural phenomenon but a state of
at the beginning of this chapter. He rightly pointed out disturbance of the total human being, including the
that human beings describe potato blight as a disease state of the organism as a biological system and of his
solely because they want to grow potatoes: ‘if man personal and social adjustments, including his ability
wished to cultivate parasites (rather than potatoes) there to fulfil social roles.
would be no “blight” but simply the necessary foddering
of the parasite crop’. Sedgwick claimed that it was the This approach introduces the notion that behavioural
human social meaning attached to the fracture of a deviance itself can be the source of disease. Yet how
septuagenarian femur that constituted illness or disease. is such deviance to be recognized and defined? Social
deviance can be recognized by self-definition. The
Out of his anthropocentric self-interest, man has individual may come to hold the belief that he has a
chosen to consider as ‘illness’ or ‘diseases’ those natural problem or there may be a societal reaction that indicates
circumstances which precipitate the death (or the failure that an individual’s behaviour constitutes a problem.
to function according to certain rules) of a limited Societal reaction of this type might occur when a
number of biological species; man himself, his pets community comes to recognize a person’s inability or
and other cherished livestock, and the plant varieties reluctance to respond in a particular expected way.
he cultivates for gain or pleasure. According to David Mechanic (1968), ‘the view taken
of the deviant depends in large part on the frame of
Such arguments point us to the fact that medicine is reference of the observer and the extent to which the
not ‘objective, scientific’ applied biology but is neces- deviant appears to be able or willing to control his
sarily value-laden. This is true of the disruption of the responses. The evaluator views the act within the
internal state that ‘patients’ bring as ‘complaints’ to context of what he believes the actor’s motivation to
the doctor, and true also of those complaints that the be. If the action appears reasonable in terms of the
doctor regards as ‘symptoms’. For Sedgwick (1982), assumed motivation of the actor, there is a very good
all diseases start as illness states recognized as such chance that deviant behaviour will be defined in terms
because of the negative value attached to the symptoms of the goodness–badness dimension. If the behaviour
or complaints. appears to be peculiar and at odds with expectations
of how a reasonable person might be motivated, such
All illness, whether conceived in localized bodily behaviour is more likely to be characterized in terms
terms or within a larger view of human functioning, of the sickness dimension’. The problem with this is
expresses both a social value judgement (contrasting self-evident. Disease definition in this formulation seems
a person’s condition with certain understood and significantly prone to error and subjective judgement
accepted norms) and an attempt at explanation (with and is liable to be used as a tool of social control.
a view to controlling the disvalued condition).
With regard to self-definition of illness, people differ
Another view of the effect of social values on the in the way they perceive, evaluate and act on, or fail
presentation of illness is the notion of the sick role as
developed by Talcott Parsons (1902–1979) (1951a).

20  Psychopathology and Diagnosis 299

to act on, the symptoms they experience. Mechanic conditions. A disease is an illness only if it is serious
(1986) has called this illness behaviour. This is influenced enough to be incapacitating and therefore is regarded
by the salience of the complaint, the degree to which as undesirable, a title for special treatment and a valid
it disturbs social roles, the folk understanding of the excuse for normally criticizable behaviour. For Boorse,
seriousness and consequences of the complaint or mental functions such as perceptual processing, intel-
implied disease, and the competing claims on the ligence and memory clearly serve to provide information
person’s time and resources. about the world that can guide effective action. Drives
serve to motivate it. Anxiety and pain function as signals
Somatic or psychological symptoms do, of course, of danger, language as a device for cultural co-operation
frequently occur without any evidence of organic and cognitive enrichment, and so on. He concludes:
disease. When attempting to describe and classify such ‘it seems certain that a few of the recognized mental
symptoms, it is helpful to establish a phenomenological disorders are genuine diseases, whether mental or
basis; conditions are recognized because of the particular physical. Even without any knowledge of the relevant
characteristics of the patient’s complaints, not because functional systems, one can sometimes infer internal
of some presumed theoretical notion of cause. The malfunction immediately from biologically incompetent
bizarre lengths that result from the application of a behaviour’. Finally, Boorse thought that diseases are
preformed theory of disease aetiology to symptoms, what doctors treat and illnesses are what people suffer
rather than developing from symptoms to theory, is from (Boorse, 1976).
admirably illustrated in Engelhardt’s (1981) essay ‘The
disease of masturbation’. In the nineteenth century, Use of Symptoms to Form
masturbation was widely believed to produce many Diagnostic Categories
signs and symptoms including dyspepsia, constriction
of the urethra, epilepsy, blindness, vertigo, loss of The relationship between signs and symptoms in
hearing, headache, impotence, loss of memory, insanity, psychiatry was discussed in Chapter 1. Traditionally,
cardiac arrhythmia, rickets, leucorrhoea in women, symptoms have been divided into those causing suf-
conjunctivitis and generalized weakness, and it was fering and pain (distress) and those causing loss of
held to be a dangerous disease entity. function (disability). When the only disharmony is
between the individual and his society, the disturbance
Lewis (1953) pointed out that mental illness could is not regarded as mental illness. For the great majority
be characterized in terms of psychopathology: ‘distur- of mental disorders, diagnostic classification is made
bance of part functions as well as general efficiency’. according to the profile of symptoms presented. Excep-
Part functions refer to the different aspects of psychologi- tions to this are as follows:
cal experience and behaviour described in previous
chapters: memory, perception, forming beliefs and so 1. when the aetiology is known, for example,
on. Thus Lewis saw a disturbance in perception, for dementia in human immunodeficiency virus
example hallucination, as a reason for establishing a disease;
case of mental illness – on psychopathologic grounds.
This approach antedated Christopher Boorse’s contribu- 2. when the genetic basis and structural pathology
tion to our understanding of the nature of mental are known, for example, Huntington disease; and
disorders. His distinction between disease and illness
is deservedly influential. He argued that an organism 3. when cause is hypothesized to result from a
is healthy to the degree that it is not diseased. And, he process without conclusive evidence, for example,
defined a disease as a type of internal state of an organism dissociative fugue.
that interferes with some function that contributes to
survival and reproduction. In addition, that the disease Descriptive psychopathology is almost atheoretical
state is not simply in the nature of the species; that is, in nature and thus allows the development of a generally
it is either atypical of the species or, if typical, mainly descriptive diagnostic terminology.
due to environmental causes. Diseases become illnesses
only when they satisfy certain further, and normative, Symptoms are collected into constellations that
commonly occur together to form the syndromes of
mental illness. It is usual to make a distinction between
illness, with a definite onset after normal health, and

300 SECTION VII  Diagnosis

the lifelong characteristics of learning disability or BOX 20.1  CLASSIFICATION OF MENTAL
personality disorder. DISORDERS

Another fundamental distinction often made by PSYCHOSES
psychiatrists and based ultimately on psychopathology • Organic disorders:
is that between psychoses and neuroses. Psychoses ‘are • acute organic syndrome
major mental illness. They are exceedingly hard to define • chronic organic syndrome (dementia)
although they are usually said to be characterized by • dysamnestic syndrome
severe symptoms, such as delusions and hallucinations, • Schizophrenia:
and by lack of insight’ (Gelder et al., 1983); there is • schizoaffective disorders
loss of contact with reality. It is probable that the everyday • paranoid states
use of the concept of psychosis by clinicians is based • Affective disorders:
on the notion of ‘unitary psychosis’; the development • mania
of this concept has been discussed by Berrios and Beer • depressive disorder
(1994). Neurosis ‘is a psychological reaction to acute
or continuous perceived stress, expressed in emotion NEUROSES AND RELATED DISORDERS
or behaviour ultimately inappropriate in dealing with • Neuroses:
that stress’ (Sims, 1983: 3); phenomenological charac- • depressive neurosis
teristics held in common by neurotic patients include • anxiety neurosis
disturbances of self-image, of the experience of relation- • phobic neurosis
ships and, often, bodily symptoms without organic cause • obsessional neurosis
(Sims, 1983). Although the term neurosis has fallen • hysteria
out of favour, the concepts that the term refers to are • depersonalization syndrome
still important as organizing principles: an understandable • nonspecific and mixed
reaction to stress; the emotional disturbance is a variant • Personality disorders
of normal response, possibly only exaggerated in degree • Adjustment disorder
and intensity; a condition in which insight is retained; • Other disorders:
and, finally the extent of disruption to personality and • sexual dysfunction and sexual deviations
self-identity is minimal. • alcohol and drug dependence
• miscellaneous syndromes
Psychiatric diagnosis is often hierarchical, organic • psychological factors associated with medical
syndromes taking precedence over functional psychoses, conditions
these over neuroses and neuroses over situational or • Mental retardation
adjustment reactions. A patient with schizophrenia and • Disorders specific to childhood
super-added anxiety will usually receive only the
diagnosis of schizophrenia. This can be a considerable (After Gelder et al., 1983, with permission of Oxford University Press.)
disadvantage in practice for planning treatment pro-
grammes as, for instance, the prognosis of chronic as advocated by Eysenck (1970), the variations of
schizophrenia may be determined more by the presence presentation of mental illness are accounted for on
of neurotic symptoms than by the response of schizo- just three dimensions: psychoticism, neuroticism and
phrenic symptoms to treatment (Cheadle et al., 1978). extroversion/introversion. Multiaxial classification codes
Foulds (1976) used this hierarchical approach to different sets of information separately.
establish a system of classification of personal illness,
with delusions of disintegration at the apex, taking priority THE PRESENT STATE EXAMINATION
over intervening levels down to dysthymic states as the An example of psychiatric phenomenology applied in
lowest level. nosologic research is the development of the Present
State Examination (PSE; Wing et al., 1974): ‘The Present
An example of categorical classification is shown in State Examination (PSE) schedule is a guide to structur-
Box 20.1. Various noncategorical methods of classifica- ing a clinical interview, with the object of assessing the
tion have also been used. In the dimensional approach present mental state of adult patients suffering from
one of the neuroses or functional psychoses.’ It aims to
enquire about the patient’s condition and subjective state

20  Psychopathology and Diagnosis 301

and to record this information as symptoms. When there syndromes and symptoms in the PSE is shown in
is conflict between clinical and statistical judgements, Fig. 20.1.
clinical judgement is allowed to prevail. Symptoms are
aggregated into a list of syndromes. The classification This example of an excerpt from the PSE involves
of symptoms is carried out on a programme known the terms used for the symptoms of schizophrenia.
as ‘Catego’, which reduces the 500 PSE items to a The nuclear syndrome of Wing et al. (1974) is composed
maximum of six descriptive categories and thence into of Schneider’s (1958) first-rank symptoms. The symp-
one descriptive group for the individual patient. toms they listed as comprising this syndrome in the
ninth edition of the PSE are thought intrusion, thought
An aim of the PSE has been to determine whether insertion, thought broadcast, thought commentary, thought
there are clinically recognizable symptoms on which withdrawal, voices about the patient, delusions of control,
all psychiatrists can agree and label in the same way. delusions of alien penetration and primary delusions. They
Wing et al. (1974) pose two questions: make the useful point that thought insertion is likely to
be rated with a false positive if the examiner does not
First, whether certain psychological and behavioural have the symptom in mind but some general approxima-
phenomena which have generally been thought by tion to it. Voices about the patient implies nonaffective
psychiatrists to be symptoms of mental illnesses can be verbal hallucinations heard by the subject talking about
reliably recognized and described, irrespective of the him in the third person. Delusions of control refers, of
language and culture of the doctor or patient; secondly, course, to passivity experiences. Delusions of alien forces
whether rules of classification can be specified with penetrating or controlling the mind or body is a special
such precision that an individual with a given pattern form of symptom already listed as belonging to the
of symptoms will also be allocated to the same clinical nuclear syndrome. By primary delusions, Wing et al.
grouping. imply delusional perception and give the example of a
patient undergoing liver biopsy who came to believe,
Thus the PSE starts from a psychopathologic stand- as the needle was inserted, that he had been chosen
point. The interviewer is trained to note the presence by God.
or absence of listed symptoms in the glossary. Groups
of symptoms are collected together into syndromes by The tenth edition of the PSE was further developed
use of computerized Catego class. The end product of into the Schedules for Clinical Assessment in Neu-
the PSE is diagnosis as a research tool based on phe- ropsychiatry (SCAN; Wing et al., 1990), which then
nomenology and available for study by other workers in mapped into the diagnostic categories in International
other cultures. An example of the relationship between Classification of Diseases (World Health Organization,
1992) and Diagnostic and Statistical Manual of Mental

Syndrome no. Syndrome name Symptoms (list II)

(a) (b) (c)

1 (NS) Nuclear syndrome 55 Thought intrusion 62 Voices about patient

56 Thought broadcast 71 Delusions of control

57 Thought commentary 81 Delusions of alien penetration

58 Thought withdrawal 82 Primary delusions

0 No symptoms

1 NS? = partial delusions only

2 NS+ = 1 symptom

3 NS+ = 2+ symptoms
FIG. 20.1  Excerpt from the Present State Examination. (From Wing et al., 1974, with permission.)

302 SECTION VII  Diagnosis

TABLE 20.1  First-Rank Symptoms of need for expert phenomenological skills more, rather
Schizophreniaa and Symptoms From than less, important, as it is likely to remain, from the
the Present State Examinationb patient’s point of view, more comfortable to have his
thoughts than his molecules explored. At the oppo-
First-Rank Symptom Equivalent Symptom From site pole of psychiatry, psychodynamics, there is also
Present State Examination great value in descriptive psychopathology, unembel-
lished by interpretation, as a starting point for further
Delusional understanding.

Delusional percept Primary delusion USES OF PSYCHOPATHOLOGY

Auditory Hallucinations It has been said of William of Ockham, who so cou-
rageously navigated the murky and dangerous waters
Audible thoughts Thought echo or of medieval philosophy and science, that he was ‘an
commentary empiricist refusing to stretch knowledge beyond the
Voices arguing or bounds of ascertainable experience’ (Leff, 1958). This
discussing Voices about the patient is the position of descriptive psychopathology: aiming
not to draw conclusions beyond the subjective experi-
Voices commenting on the Voices about the patient ence of the patient and its judicious exploration by the
patient’s action interviewer. Every psychiatrist uses phenomenology to
some extent, but it is a much more valuable tool if
Thought Disorder: Passivity of Thought used rigorously.

Thought withdrawal Thought block or The four practical applications of descriptive psy-
withdrawal chopathology, then, are as follows.
Thought insertion
Thought broadcasting Thought insertion • Communication. It enables clinicians to speak and
Thought broadcast or write to each other about the problems of their
(diffusion of thought) patients in a mutually comprehensible way. This
thought sharing is clearly of value both in clinical practice and
for research.
Passivity Experiences: Delusion of Control
• Diagnosis. Psychiatric diagnosis is based to a
Passivity of affect (‘made’ Delusions of control considerable extent on psychopathology, and this
feelings) is wholly appropriate, especially until there is
Delusions of control more evidence for aetiology and underlying
Passivity of impulse pathology for the different conditions.
(‘made’ drives) Delusions of control
• Therapy. The method of empathy, that is using
Passivity of volition Delusions of alien phenomenology to explore the patient’s subjective
(‘made’ volitional acts) penetration experience, is a rational way of establishing a
therapeutic relationship. It enables the therapist to
Somatic passivity understand the subjective experience of his patient
(influence playing on the and will give the patient confidence in further
body) entrusting the secrets of his internal environment
to the therapist.
aSchneider (1958).
bWing et al. (1974). • The law. Descriptive psychopathology is the only
reasonable way of determining what is mental
Disorders (3rd revised edition; American Psychiatric illness and what are the differences between mental
Association, 1987). The emphasis placed here on the illnesses, from a forensic point of view. Mutual
PSE is intended because it is such a direct application enlightenment in the area between the law and
of descriptive psychopathology to psychiatric diagnosis psychiatry, where there is at present so much
(Table 20.1).

Postscript

Fundamental to psychiatry is the need to understand
what the patient is experiencing. Eisenberg (1986)
has succinctly summarized the aspirations of the
biological school of psychiatry: ‘For every twisted
thought there is a twisted molecule.’ Ironically, if this
association were to be achieved it would make the

20  Psychopathology and Diagnosis 303

misunderstanding, will result from a clearer and the increasing knowledge of disordered neuro-
acknowledgement of the value of psychopathology anatomy – physiology and chemistry – that is resulting
by lawyers and doctors. from more sophisticated methods of neuroimaging and
The patient’s symptoms, his sufferings, are a logical assay. This is the direction that research in descriptive
starting point for the doctor’s sympathy, curiosity and psychopathology should go.
therapeutic endeavour. To start elsewhere turns medicine
on its head and, ultimately, one arrives in a topsy-turvy Investigation of the experience of the individual has
world like Samuel Butler’s Erewhon (1872), where ‘illness to be linked to an understanding of his biology, and
of any sort is considered … to be highly criminal and it is also important to assess how normal phenomena
immoral; and that I was liable, for catching cold, to are distributed within the population. The scientific
be had up before the Magistrates and imprisoned for bases of psychiatry include, as well as biological and
a considerable period’ and ‘if a man forges a cheque, behavioural sciences, epidemiology and phenomenology.
or sets his home on fire or robs with violence from a Recognition of homogeneity includes both the symp-
person, or does any such things that are criminal in toms within an individual patient and the features of
our own country, he is either taken to a hospital and an affected population. The PSE has been discussed
is carefully tended at the public expense, or if he was earlier as a method of quantifying psychopathologic
in good circumstances, he lets it be known to all his information.
friends that he is suffering from a severe fit of immorality
… and they come and visit him with great solicitude’. To introduce experimental methods into research
You may think this is too far-fetched; however, the less in descriptive psychopathology will sometimes involve
pleasant aspects of this certainly appear to have been single case studies in which variables that have been
the situation for some of the dissidents in psychiatric evaluated phenomenologically are altered. For example,
custody in the previous USSR (Bloch and Reddaway, Green and Preston (1981) amplified the quiet whis-
1977). pering of a chronic schizophrenic patient during the
The ultimate aim of psychiatry is not, of course, time he was auditorily hallucinated. He whispered at
knowledge, but to help people to function and feel the same time as he heard voices, and the content
better; phenomenology is a valuable therapeutic tool. of his vocalization corresponded to what the voices
Ideally, it gives the patient, in his doctor, a person who were reported to have said, thus demonstrating the
understands what he is feeling but does not try to disturbance of boundaries of self found in schizophrenia.
explain causes in terms of theory, which the patient This type of investigation has been extended further, and
may find unconvincing. The patient often has a great there are several examples in this book, for example,
sense of relief when the doctor, however falteringly, in Chapters 7 and 11. There has been a danger in that
describes back to him the symptoms, or the internal some other psychological studies, not quoted here, have
experience, that he, the patient, has found so difficult used phenomenology imprecisely and hence vitiated
to describe. the significance of their findings.

NEED FOR RESEARCH An interesting development in research based on
descriptive psychopathology is the application of par­
Psychopathology was introduced into psychiatry before ticular psychological techniques to specific phenomeno-
the current emphasis on quantification, population logical entities. Examples of this are the use of cognitive
surveys and experimental method. It is now imperative behaviour therapy in the treatment of persistent auditory
both for the further development of descriptive psy- hallucinations (Bentall et al., 1994) and more general
chopathology and, more importantly, for continued application of psychological interventions in schizo-
progress in psychiatric research that more rigorous phrenia (Haddock and Lewis, 1996).
research methods be applied. Phenomenology has a
place in psychiatric research that has not yet been fully It is important that progress in the treatment of
exploited. It forms a logical bridge between research patients and in research that advances in biological
findings emanating from clinical and applied psychology aspects of psychiatry are assisted by accurate psychiatric
diagnosis based on phenomenology that is both reliable
(that is, capable of reproduction by the same interviewer
at a different time, or by different interviewers) and

304 SECTION VII  Diagnosis

quantifiable. Never were the skills of the clinical Butler, S., 1872. Erewhon. Cape, London.
phenomenologist more necessary or more likely to yield Carroll, L., 1872. Through the Looking Glass, and What Alice Found
beneficial results both in understanding and in therapy.
The introduction of improved neuropsychiatric methods There. Macmillan, London.
of investigation increases the need for reliable findings Cheadle, A.J., Freeman, H.L., Korer, J., 1978. Chronic schizophrenic
from descriptive psychopathology rather than rendering
it obsolete. Jaspers (1997) commented, ‘phenomenology, patients in the community. Br. J. Psychiatry 132, 221–227.
though one of the foundation stones of psychopathology, Eisenberg, L., 1986. Mindlessness and brainlessness in psychiatry.
is still very crude’. This is still true, but it is now high
time that descriptive psychopathology became more Br. J. Psychiatry 148, 497–508.
sophisticated. Engelhardt, H.T., 1981. The disease of masturbation: values and the

Phenomenology takes the doctor’s art and discipline concept of disease. In: Caplan, A.L., Engelhardt, D.T.McCartney,
of observation inside his patient’s mind. David Hume J.J. (Eds.), Concepts of Health and Disease. Addison-Wesley,
(1804) described the absence of physical examination Reading.
in medicine in his essay ‘Of Polygamy and Divorces’. Eysenck, H.J., 1970. A dimensional system of psychodiagnosis. In:
He tells of the physician brought into the Grand Signior’s Mahrer, A.R. (Ed.), New Approaches to Personality Classification.
seraglio in Constantinople. Columbia University Press, New York, pp. 169–207.
Foulds, G.A., 1976. The Hierarchical Nature of Personal Illness.
He was not a little surprised, in looking along a Academic Press, London.
gallery, to see a great number of naked arms standing Gelder, M., Gath, D., Mayou, R., 1983. Oxford Textbook of Psychiatry.
out from the sides of the room. He could not imagine Oxford University Press, Oxford.
what this could mean; until he was told that those Green, P., Preston, M., 1981. Reinforcement of vocal correlates of
arms belonged to bodies, which he must cure, without auditory hallucinations using auditory feedback: a case study. Br.
knowing any more about them than what he could J. Psychiatry 139, 204–208.
learn from the arms. He was not allowed to ask a Haddock, G., Lewis, S.W., 1996. New psychological treatments in
question of the patient, or even of her attendants, lest schizophrenia. Adv. Psychiatr. Treat. 2, 110–116.
he might find it necessary to enquire concerning cir- Hume, D., 1804. Essays and Treaties on Several Subjects, vol. 1.
cumstances which the delicacy of the seraglio allows Bell and Bradfute, Edinburgh.
not to be revealed. Hence physicians in the east pretend Jaspers, K., 1997. General Psychopathology (J. Hoenig, M.W.
to know all diseases from the pulse, as our quacks in Hamilton, Trans). The Johns Hopkins University Press, Baltimore.
Europe undertake to cure a person merely from seeing Kendell, R.E., 1975. The Role of Diagnosis in Psychiatry. Blackwell,
his water. Oxford.
Leff, G., 1958. Medieval Thoughts. Penguin, Harmondsworth.
Psychiatry must now come out of the seraglio and Lewis, A.J., 1953. Health as a social concept. Br. J. Sociol. 4, 109–124.
use all available information in the service of its patients, Mechanic, D., 1968. Medical Sociology. The Free Press, New York.
including phenomenology, for diagnosis, for understand- Mechanic, D., 1986. The concept of illness behaviour: culture, situ-
ing and for treatment. ation and personal predisposition. Psychol. Med. 16, 1–7.
Parsons, T., 1951a. Illness and the role of the physician: a sociological
REFERENCES perspective. Am. J. Orthopsychiatry 21, 452–460.
Parsons, T., 1951b. The Social System. The Free Press, New York.
Bentall, R.P., Haddock, G., Slade, P.D., 1994. Cognitive behaviour Sadler, J.Z., 2004. Values and Psychiatric Diagnosis. Oxford University
therapy for persistent auditory hallucinations: from theory to Press, Oxford.
therapy. Behav. Psychother. 25, 51–56. Schneider, K., 1958. Clinical Psychopathology, fifth ed. (M.W.
Hamilton, Trans, 1959). Grune and Stratton, New York.
Berrios, G.E., Beer, D., 1994. The notion of unitary psychosis: a Schwartz, M.A., Wiggins, O.P., 1987. Typifications: the first step for
conceptual history. Hist. Psychiat. V, 13–36. clinical diagnosis in psychiatry. J. Nerv. Ment. Dis. 175, 65–77.
Sedgwick, P., 1981. Illness – mental and otherwise. In: Caplan, A.L.,
Bloch, S., Reddaway, P., 1977. Russia’s Political Hospital. Gollancz, Engelhardt, H.T., McCartney, J.J. (Eds.), Concepts of Health and
London. Disease: Interdisciplinary Perspectives. Addison-Wesley, Reading,
pp. 119–130.
Boorse, C., 1976. What a theory of mental health should be. J. Sedgwick, P., 1982. Psycho politics. Harper and Row, New York.
Theory Soc. Behav. 6, 61–84. Sims, A.C.P., 1983. Neurosis in Society. Macmillan, London.
Stengel, E., 1959. Classification of mental disorders. Bull. World
Burton, R., 1621. The Anatomy of Melancholy, What It Is. With All Health Organ. 21, 601–603.
the Kinds, Causes, Symptoms, Prognostickes, and Severall Cures Wing, J.K., Babor, T., Brugha, T., et al., 1990. SCAN: Schedules for
of It by Democritus Junior. Cripps, Oxford. Clinical Assessment in Neuropsychiatry. Arch. Gen. Psychiatry
47, 589–593.
Wing, J.K., Cooper, J.E., Sartorius, N., 1974. The Measurement and
Classification of Psychiatric Symptoms: an Instruction Manual for
the PSE and Category Program. Cambridge University Press,
Cambridge.
World Health Organization, 1992. The ICD-10 Classification of
Mental and Behavioural Disorders: Clinical Description and
Diagnostic Guidelines. World Health Organization, Geneva.

Self-Assessment 1

Instructions Chapter 2

Each set of numbered items is followed by five lettered Specific communication skill techniques include the
options. Select the ONE lettered option that is BEST following EXCEPT:
in each case. a) Summary statements
b) Attentive listening
Chapter 1 c) Normalizing statements
d) Looped questions
Descriptive psychopathology is: e) Open questions
a) The study of ego defence mechanisms that
underlie behaviour change Aspects of observation of appearance and behaviour
b) Concerned with the selection, delimitation, include the following EXCEPT:
differentiation and description of abnormal a) Posture
psychological phenomena b) Gesture
c) Directly the outcome of analyzing the content c) Talk
of dreams d) Facial expression
d) A method of describing the interaction between e) Self-hygiene
doctors and patients
e) An introspective system of understanding and Assessment of insight involves the following domains
describing abnormal cognitions EXCEPT:
a) Fluency of talk
Empathy in descriptive psychopathology is: b) Recognition of subjective psychological change
a) Achieved by precise, insightful, persistent and c) Attribution of the change to pathology
knowledgeable exploration of the patient’s ex- d) Recognition of need for treatment
perience e) Compliance with treatment
b) A communication technique aimed at putting
the patient at ease Chapter 3
c) Meta-communication
d) The basis of sympathy for the patient’s situ- Automatism is characterized by the following EXCEPT:
ation a) Involuntary behaviour
e) An aspect of transference b) Behaviour that is inappropriate to the circum-
stances
The term understanding in psychopathology: c) Complex and coordinated behaviour
a) Derives from Freud’s structural theory of the d) Unimpaired judgement
psyche e) Apparently purposeful and directed behav-
b) Describes the causal mechanisms underlying iour
abnormal experiences
c) Has no limit in the capacity to describe and Mania à potu is a syndrome characterized by the
comprehend experience following EXCEPT:
d) Derives from Dilthey’s conception of the dis- a) Insomnia
tinction between the sciences and humani- b) Total or partial amnesia for the aberrant behav-
ties iour
e) Has no place in contemporary psychiatry c) Alcohol consumption
d) Senseless violence
e) Prolonged sleep

305

306 Self-Assessment 1

Delirium is a condition characterized by the following Long-term memory functions include the following
EXCEPT: EXCEPT:
a) Insidious onset a) Registration
b) Global impairment of cognitive functions b) Retention
c) Reduced level of consciousness c) Repression
d) Impaired attention d) Retrieval
e) Disordered sleep–wake cycle e) Recall

Chapter 4 Chapter 6

Dreams: Formal characteristics of time include:
a) Occur in non-REM sleep a) Duration
b) Are associated with paralysis b) Sequence
c) Involve an accentuation of self-awareness c) Synchrony
d) Involve consolidation of spatial and temporal d) Rhythm
connections e) Bi-directionality
e) Are synonymous with night terror
Déjà vu experience is an example of abnormality of:
Kleine-Levin syndrome is characterized by: a) Rhythm
a) Severe hypersomnia b) Sense of uniqueness of time
b) Sleep paralysis c) Time duration
c) Short REM latency d) Temporal order
d) Hypnogogic hallucinations e) Direction of time
e) Cataplexy
Features of seasonal affective disorder include the
Attention: following EXCEPT:
a) Is the focusing of consciousness on any aspect a) Hypersomnia
of experience b) Insomnia
b) Is synonymous with concentration c) Craving for carbohydrates
c) Involves disinhibition of memory d) Overeating
d) Is distinct from vigilance e) Lethargy
e) Relies solely on active processes
Chapter 7
Chapter 5
Abnormalities of the elementary aspects of visual
The following are TRUE of confabulation EXCEPT: perception include the following EXCEPT:
a) It is a false memory a) Palinopsia
b) It is associated with organic amnesia b) Macropsia
c) It can involve embellishment of actual memo- c) Hemacropsia
ries d) Palinacousis
d) It is typically ‘fantastic’ in nature e) Achromatopsia
e) Suggestibility is a prominent feature
In synaesthesia:
Short-term memory: a) The perception of a sensory object is presented
a) Is an unlimited capacity system in another sensory modality
b) Comprises a central action system b) The perception occurs in peripersonal space
c) Involves a ‘phonological loop’ that holds c) Music to colour transformations occur
memory traces for up to 5 minutes d) Elaboration of form constants is a feature
d) Involves a visuospatial scratch pad that allows e) Emotional distress is a common accompani-
for manipulation of visual information ment
e) Cannot be distinguished from attention

Self-Assessment 1 307

Formal characteristics of images include the following a) Flight of ideas
EXCEPT: b) Loosening of association
a) Images are not clearly delineated c) Concrete thinking
b) Images have a character of objectivity d) Overinclusive thinking
c) Images appear in inner subjective space e) Impedance of flow of thinking by unnecessary
d) Images are actively created
e) Images dissipate rapidly and have to be recre- detail
ated
Chapter 10
Chapter 8
Recognized abnormalities of language in schizophre-
The following are examples of primary delusions: nia include the following EXCEPT:
a) Autochthonous delusions a) Lack of use of cohesive ties
b) Delusional percept b) Alogia
c) Persecutory delusions c) Neologism
d) Delusional atmosphere d) Clang associations
e) Delusional memory e) Telegony

Secondary delusions are: The Cloze technique is a measure of:
a) Secondary to other abnormal experiences a) Predictability of speech
b) Understandable in the light of the patient’s b) The proportion of the number of different
social context words to the total number of words
c) Not held with conviction c) Cohesive ties
d) Amenable to counterargument d) Rules of proposition
e) Transient e) Fluency of language

Delusions are examples of: Primary sensory dysphasia is:
a) Perseveration a) The inability to produce names or sounds at
b) Impairment of consciousness will
c) False perception b) A gross disturbance of words and syntax
d) False beliefs resulting in unintelligible speech
e) Autoscopy c) A disorder of indistinct speech
d) The loss of comprehension of the meaning of
Chapter 9 words
e) The inability to read with understanding
Schneider’s first-rank symptoms include the following
EXCEPT: Chapter 11
a) Somatic hallucinations
b) Audible thoughts Insight in schizophrenia has been shown to be
c) Passivity experiences positively correlated with the following EXCEPT:
d) Thought withdrawal a) The likelihood of developing depression
e) Thought insertion b) The likelihood of hospitalizations
c) Compliance with treatment
Delusions of control of thought include: d) Long-term outcome
a) Thought broadcasting e) Working memory
b) Thought echo
c) Thought insertion Valid measures of insight must take into consideration
d) Thought withdrawal the following EXCEPT:
e) Thought blocking a) The multidimensional aspect of insight
b) The relationship of insight to affect
The term circumstantiality refers to: c) The influence of cultural factors

308 Self-Assessment 1

d) The variation of insight across different symp­ c) Temporal integration
tom domains d) Unreality of self
e) Emotional numbing
e) The added value of behavioural observations Depersonalization is known to be associated with
Insight involves all of the following EXCEPT: the following EXCEPT:
a) Lysergic acid diethylamide (LSD)
a) Awareness of change b) Cannabis
b) Recognition of illness in others c) Mescaline
c) Attribution of change to illness d) Sensory deprivation
d) Recognition of the need for treatment e) Narcolepsy
e) Cooperation with treatment
Chapter 14
Chapter 12
Individual determinants of hypochondriasis include
Autoscopy can involve all of the following EXCEPT: the following EXCEPT:
a) Feeling of presence a) Feelings of disgust
b) Failure to perceive self in a mirror b) Preoccupation with bodily function
c) Visual hallucination of internal organs within c) Serious illness or injury in childhood
bodily space d) Fear of infection
d) Visual hallucination of exact copy of the self e) Fascination with the Internet
in mirror image
e) Projection of the observing self in extra-personal Mass psychogenic illness:
space a) Occurs most commonly in young males
b) Often starts in a child of low status in the
Ego vitality is: peer group
a) Awareness of being an agent c) Affects most severely the most adjusted people
b) Awareness of unity and coherence of self d) Symptoms spread by line-of-sight transmis-
c) Awareness of being sion
d) Awareness of continuity of self over time e) Is unaffected by media response
e) Awareness of boundaries to the self
The concepts of conversion and dissociation suggest:
Nihilistic delusion is an example of: a) That physical symptoms can only have an
a) Disorder of ego boundary organic basis
b) Disorder of continuity of self over time b) That causation is unconscious
c) Disorder of activity c) That symptoms carry no obvious advantage
d) Disorder of vitality for the patient
e) Disorder of unity of self d) That symptoms are unlikely to be psycholo-
gically meaningful
Chapter 13 e) That the patient is acting a part

Definitive features of depersonalization include the Chapter 15
following EXCEPT:
a) The experience is pleasant Pain asymbolia:
b) There is a feeling of strangeness a) Presents with absent pain response
c) It is a subjective experience b) Is associated with increased thermal sensi-
d) Insight is preserved tivity
e) It can affect bodily sensation c) Is associated with hyperhidrosis
d) Presents with self-stimulation
Depersonalization has shown to consist of a number e) Is usually an acquired disorder that occurs
of components including the following EXCEPT: after vascular lesions
a) Perceptual alteration
b) Unreality of surroundings

Self-Assessment 1 309

Pain associated with psychopathology is: c) Shortness of breath
a) Better localized d) Provocation by inhalation of 35% carbon
b) Clearly delineated along recognized neuro-
anatomic distribution dioxide
c) Easy for the patient to describe e) Induced by specific situations
d) Constant and unremitting Selye’s general adaptation syndrome includes one
e) Tends to be provoked by definite agents of the following stages:
a) Shock and numbness
Central pain (thalamic syndrome): b) Sadness
a) Presents with a cutting sensation c) Guilt and hostility
b) Is activated by cutaneous stimulation d) Flight-or-fight response
c) Presents as hypoalgesia e) Resolution
d) Is unaffected by temperature change The constituent elements of obsessive compulsive
e) Does not present with allodynia phenomenon include all the following EXCEPT:
a) Inflated sense of responsibility even for events
Chapter 16
over which the patient has no control
Alexithymia refers to: b) Avoidance of cues likely to trigger obsession
a) Inability to experience pleasure c) Fear of disaster that the patient believes will
b) Reacting to sad news with laughter
c) Absence of unity between different modes of come to pass
experience of emotions d) Resistance
d) Inability to verbalize affect and elaborate fan­ e) Increased discomfort following compulsive
tasy
e) Selective deficiency in correctly appraising act
vocal expression of emotion
Chapter 18
Ekman’s basic emotions include all the following
EXCEPT: Abnormal movement in catatonia include all the
a) Anger following EXCEPT:
b) Disgust a) Waxy flexibility
c) Fear b) Psychological pillow
d) Jealousy c) Stereotypy
e) Sadness d) Cataplexy
e) Mitgehen
Mood is defined as:
a) A positive or negative reaction to an experience Motivation can be defined as:
b) A prolonged prevailing inner state or predis- a) Innate disposition that determines what objects
position to attend to in the world
c) A spontaneous and transitory experience in b) A state that initiates directed action
response to an experience c) A striving towards an object that is experienced
d) The external behavioural manifestation of inner as a desire
state d) A reward system that governs and regulates
e) An evaluative attitude towards an object behaviour
e) The power to put into effect voluntary action
Chapter 17
Impulsivity involves all the following EXCEPT:
The respiratory subtype of panic disorder is char- a) Predisposition towards rapid, unplanned action
acterized by all the following EXCEPT: b) Lack of regard for consequences
a) Fear of dying c) Preference for delayed larger reward over small
b) Chest pain and discomfort but immediate reward
d) Perseverance of behaviour despite punish-
ment

310 Self-Assessment 1

e) Inability to prevent response in response Chapter 20
disinhibition attentional paradigm
Illness behaviour is influenced by all the following
Chapter 19 EXCEPT:
a) Salience of the complaint
Paranoid personality disorder can be defined as a b) Extent of disturbance of social roles
disorder in which: c) Cultural understanding of the seriousness of
a) An individual mistrusts others and is unduly the complaint
suspicious d) Competing claims on the sufferer’s resources
b) There is a lack of need for and defect in e) The underlying biology of the condition
capacity to form relationships
c) A defect in empathy is evident All the following individuals have made contributions
d) Uncontrollable outbursts of intemperate and to our understanding of health and disease
uncontrolled mood occurs EXCEPT:
e) Theatrical behaviour and craving for attention a) Christopher Boorse
occurs b) Aaron Beck
c) Peter Sedgwick
In dependent personality disorder the following d) Talcott Parsons
features all occur EXCEPT: e) David Mechanic
a) Lack of self-confidence
b) Perfectionistic disposition Practical applications of psychopathology include
c) Craving for support and encouragement of all the following EXCEPT:
others a) Communication between clinicians
d) Difficulty in coping with changing demands b) Cognitive neuroscience research
of life c) Diagnosis
e) Presence of a dominant close relationship d) Nosology
e) Therapy
The following conditions have been shown to be
frequently associated with anankastic personality
disorder EXCEPT:
a) Eating disorder
b) Hypochondriasis
c) Alcohol dependence syndrome
d) Obsessive-compulsive disorder
e) Recurrent depressive disorder

Self-Assessment 2

INSTRUCTIONS E. False memory
F. Ganser state
Each set of matching questions consists of a list of 10 G. Perseveration
lettered options (A–J) followed by four numbered items. H. Pseudologia fantastica
For each numbered item, select the appropriate lettered I. Recovered memory
option. Each lettered option may be selected only once. J. Retrograde amnesia
1. A 20-year-old male patient was involved in
CHAPTERS 3 AND 4
a road traffic accident. He sustained a head
A. Confusion injury. He was only able to recall events that
B. Coma happened approximately 5 minutes before the
C. Delirium collision.
D. Disorientation 2. A 20-year-old male patient presented in prison
E. Hypersomnia whilst on remand. When examined, he responded
F. Insomnia to questions about the date and the capital of
G. Oneiroid state France with approximate answers and disorienta-
H. Parasomnia tion for time and place.
I. Stupor 3. A 45-year-old male patient was involved in an
J. Twilight state accident at work where he sustained a serious
1. A 75-year-old female patient is found wandering head injury and lost consciousness. On regaining
his consciousness, he could only recall events
the streets. On examination, she does not know that happened approximately 36 hours after the
the date, day, time, season, where she is or her incident.
own address. 4. A 57-year-old male patient with an established
2. An 18-year-old male patient presents with a history of impairment of short-term memory in
history of several irresistible periods of drowsiness the context of alcohol abuse responded to ques-
during the day. At night he reports periods when tions about how he had spent the previous day
he is fully awake but unable to move his limbs. with objectively false accounts that included
3. The partner of a 25-year-old male patient accom- embellishments and intrusions from previous
panies him to the outpatient appointment. She occasions.
reports that he talks in his sleep, wanders aim-
lessly in the bedroom for a few minutes at night CHAPTER 7
and has no recollection of these incidents.
4. A 47-year-old female patient with a history of A. Imagery
recurrent depression is admitted in a mute B. Palinopsia
state. She is immobile but fully conscious and C. Macropsia
alert. She is able to make eye contact but does D. Micropsia
not respond to any attempt at verbal communi- E. Paraprosopia
cation. F. Alloaesthesia
G. Pelopsia
CHAPTER 5 H. Dyschromatopsia
I. Teleopsia
A. Anterograde amnesia J. Metamorphopsia
B. Confabulation
C. Cryptoamnesia
D. Dissociative fugue

311

312 Self-Assessment 2

1. A 45-year-old man presents with a complaint belief, she said that she had suddenly come to
that he first saw a black cat at the corner where this realization. She denied any other unusual
his drive joined the main street. After this, for experience.
the next 72 hours or so, he kept seeing the same 4. A 54-year-old male patient with a long-standing
cat at various times and situations. What is the history of schizophrenia reported persistent and
term for this experience? stressful auditory verbal hallucinations of deroga-
tory and threatening content. The voices would
2. A 19-year-old man with a recent diagnosis of often tell him that he deserved to be killed and
schizophrenia complained that the faces of people that new immigrants into his local area from
looking at him would suddenly look different, Romania were going to murder him. He then
as if they were pulling faces at him. Sometimes, held a firm belief that he was at risk from
the faces would appear sinister, lopsided and immigrants, particularly Romanians. This belief
strange. What is the term for this experience? was held with conviction and was impervious
to counterargument.
3. A 25-year-old female patient with a history of
complex focal seizures complained of scenes and CHAPTER 9
objects becoming smaller before a seizure. What
is this experience termed? A. Fantasy thinking
B. Imaginative thinking
4. A 25-year-old male patient complained that C. Conceptual thinking
objects look far away. He found this surprising D. Circumstantial thinking
and distressing. What is this experience termed? E. Thought block
F. Concrete thinking
CHAPTER 8 G. Overinclusive thinking
H. Thought insertion
A. Delusional percept I. Thought withdrawal
B. Delusional intuition J. Audible thought
C. Delusional memory 1. A 21-year-old male university student described
D. Delusional atmosphere
E. Secondary delusion spending a lot of time thinking about the future,
F. Overvalued idea about the possibility of becoming a famous
G. Delusion of love musician, becoming rich and being able to live
H. Delusional misidentification in a mansion in Florida.
I. Delusion of persecution 2. A 25-year-old female patient, newly admitted
J. Delusional jealousy into hospital, complained that her thoughts were
1. A 20-year-old male patient was admitted into being interfered with. She was particularly dis-
tressed by the experience of having thoughts
hospital after an attack on his father. He reported manipulated and taken from her.
that his father had been replaced by a robot who 3. In a test, a 19-year-old patient with a diagnosis
looked almost exactly like him but was definitely of schizophrenia responded to a question as
not him. He feared that this ‘robot’ had malignant follows: ‘Which of the following are essential parts
intentions and that his life was in danger. What of a room: walls, chairs, floor, window?’ ‘Chairs’.
is this belief called? 4. A 57-year-old female patient said: ‘I was starting
2. A 40-year-old female patient complained that to feel high, so I tied dumb-bell weights round
her local priest was sending her secret messages, my ankle’.
declaring his feelings for her. She complained
that although he was the father of her child, he CHAPTER 10
was yet to visit them.
3. A 21-year-old female patient suddenly became A. Aphonia
convinced that she was the rightful heir to the B. Logoclonia
throne of Norway. She was not Norwegian by
birth or ancestry. When asked the reason for this

Self-Assessment 2 313

C. Echolalia too large and crooked. Objectively, his nose was
D. Paragrammatism not excessively large or crooked.
E. Nominal dysphasia 4. A 40-year-old female patient presented with the
F. Asyndesis complaint that she could continue to feel her
G. Metonym toothbrush in her hands for up to 15 minutes
H. Jargon aphasia after she used it.
I. Receptive dysphasia
J. Neologism CHAPTER 16
1. A 65-year-old, right-handed male patient, who
A. Anhedonia
was recovering from a left-sided stroke, was B. Echolalia
unable to follow the verbal command: ‘Take the C. Hyperekplexia
paper with your left hand, fold it in two and put D. Coenaesthesia
it on the floor’. E. Prosopoaffective agnosia
2. A 25-year-old patient said, ‘Phlogons have in­ F. Receptive emotional dysprosody
vaded my lungs turning first sideways and now G. Cyclothymia
medways’. H. Ecstasy
3. A 64-year-old male patient with a long-standing I. Echomimia
history of schizophrenia replied to the question, J. Alexithymia
‘What have you got in your cup?’ ‘A fluid that 1. An 8-year-old male patient presented with a
whilst being colourless turns dark on brewing’.
4. A 72-year-old male patient with a diagnosis of history of heightened startle reflex characterized
Parkinson disease said, ‘I’m star …, star …, by eye blinking, head flexion, abduction of the
starting to think of mo …, mo …, mo …, moving upper arms, movement of the trunk and bending
house’. of the knees in response to a loud noise.
2. A 40-year-old female patient with a history of
CHAPTER 14 recurrent depression and current depression gave
a history of inability to experience pleasure in
A. Misoplegia her usual hobbies and interests, as well as a
B. Dysmorphophobia general inability to experience any feeling.
C. Palinaptia 3. A 36-year-old male patient presented to the local
D. Alloaesthesia dental hospital with an aching pain in both sides
E. Exosomesthesia of the lower jaw radiating to the temporo-
F. Microsomatognosia mandibular joints and to the neck. In response
G. Macrosomatognosia to the question, ‘How are you feeling in your
H. Muscle dysmorphia spirits?’, he seemed puzzled and asked for the
I. Paraschemazia question to be repeated. He then said, ‘My body
J. Aschemazia is heavy and I am aching all over’.
1. A 23-year-old male patient presented with the 4. A 75-year-old male patient with a diagnosis of
Parkinson’s disease spoke in a monotonous voice.
belief that his muscles were too small, a preoc- In addition he seemed not to recognize the emo­
cupation with physical build, excessive exercising tional meaning of variations in tone of voice.
and disturbed eating.
2. A 56-year-old female patient complained of hating CHAPTER 17
her left hand. Although it looked normal, she
said that she hated it and had always wished A. Anxiety
that it were different in size, shape and feel. B. Anankastic personality
3. A 27-year-old male patient presented with a C. Compulsion
long-standing belief that his face was ugly, in D. Disgust
particular, his nose, which he thought was far E. Irritability

314 Self-Assessment 2 D. Drive
E. Impulsivity
F. Panic F. Instinct
G. Phobia G. Kleine-Levin syndrome
H. Obsession H. Motivation
I. Rumination I. Urge
J. Social phobia J. Will
1. A 32-year-old female patient presented with 1. A 21-year-old male recently diagnosed with

discrete episodes of intense and extreme fear. schizophrenia and treated with risperidone com­
2. A 23-year-old female patient presented with plains of motor restlessness, inner agitation and
an inability to sit still.
excessive fear, self-consciousness and avoidance 2. A 17-year-old male patient is brought to the atten-
of social situations due to the possibility of tion of his general practitioner because he newly
embarrassment or humiliation. recognized a problem with gambling, drinking
3. A 27-year-old male accountancy trainee presented excessively and misusing cannabis. In addition,
with a history of repetitive and intrusive thoughts he is reported as prone to losing his temper and
about cleanliness and hygiene, which were liable to say things he later regrets.
associated with increasing tension and worry, 3. A 21-year-old male patient presented with a
and which he recognized as his own thoughts. history of episodes of excessive sleeping (up 15
He tried to resist these thoughts but found that hours a day), excessive eating, increased sexual
they became even more urgent and intrusive. libido, low mood and transient persecutory
4. A 32-year-old female patient, who had recently beliefs.
given birth, presented with a 6-week history of 4. A 28-year female patient presented for the first
temper outbursts, feelings of hostility towards time with markedly slowed movements, some-
her husband, an unpleasant feeling of distress times resulting in immobility, strange postures
and impatience with her children. and muteness. On examination, she allows her
upper limbs to be put in uncomfortable postures
CHAPTER 18 that she holds for long periods of time.

A. Akathisia
B. Anhedonia
C. Catatonia

Self-Assessment 1: Answers

Chapter 1 Attention:
a) Is the focusing of consciousness on any aspect
Descriptive psychopathology is: of experience
b) Concerned with the selection, delimitation,
differentiation and description of abnormal Chapter 5
psychological phenomena
The following are TRUE for confabulation EXCEPT:
Empathy in descriptive psychopathology is: d) It is typically ‘fantastic’ in nature
a) Achieved by precise, insightful, persistent and
knowledgeable exploration of the patient’s Short-term memory:
experience d) Involves a visuospatial scratch pad that allows
for manipulation of visual information
The term understanding in psychopathology:
d) Derives from Dilthey’s conception of the dis- Long-term memory functions include the following
tinction between the sciences and humanities EXCEPT:
c) Repression
Chapter 2
Chapter 6
Specific communication skill techniques include the
following EXCEPT: Formal characteristics of time include the following
d) Looped questions EXCEPT:
e) Bidirectionality
Aspects of observation of appearance and behaviour
include the following EXCEPT: Déjà vu experience is an example of abnormality of:
c) Talk b) Sense of uniqueness of time

Assessment of insight involves the following domains Features of seasonal affective disorder include the
EXCEPT: following EXCEPT:
a) Fluency of talk b) Insomnia

Chapter 3 Chapter 7

Automatism is characterized by the following Abnormalities of the elementary aspects of visual
EXCEPT: perception include the following EXCEPT:
d) Unimpaired judgement d) Palinacousis

Mania à potu is a syndrome characterized by the The following are true of synaesthesia EXCEPT:
following EXCEPT: e) Emotional distress is a common accompaniment
a) Insomnia
Formal characteristics of images include the following
Delirium is a condition characterized by the following EXCEPT:
EXCEPT: b) Images have a character of objectivity
a) Insidious onset
Chapter 8
Chapter 4
The following are examples of primary delusions
Dreams: EXCEPT:
b) Are associated with paralysis c) Persecutory delusions

Kleine-Levin syndrome is characterized by: 315
a) Severe hypersomnia

316 Self-Assessment 1: Answers

Secondary delusions are: Chapter 13
a) Secondary to other abnormal experiences
Definitive features of depersonalization include the
Delusions are examples of: following EXCEPT:
d) False beliefs a) The experience is pleasant

Chapter 9 Depersonalization has shown to consist of a number
of components including the following EXCEPT:
Schneider’s first-rank symptoms include the following c) Temporal integration
EXCEPT:
a) Somatic hallucinations Depersonalization is known to be associated with
the following EXCEPT:
Delusions of control of thought include: e) Narcolepsy
b) Thought echo
Chapter 14
The term circumstantiality refers to:
e) Impedance of flow of thinking by unnecessary Individual determinants of hypochondriasis include
detail the following EXCEPT:
e) Fascination with the Internet
Chapter 10
Mass psychogenic illness:
Recognized abnormalities of language in schizophre- d) Symptoms spread by line-of-sight transmission
nia include the following EXCEPT:
e) Telegony The concepts of conversion and dissociation suggest:
b) That causation is unconscious
The Cloze technique is a measure of:
a) Predictability of speech Chapter 15

Primary sensory dysphasia is: Pain asymbolia:
d) The loss of comprehension of the meaning of a) Presents with absent pain response
words
Pain associated with psychopathology is:
Chapter 11 d) Constant and unremitting

Insight in schizophrenia has been shown to be Central pain (thalamic syndrome):
positively correlated with the following EXCEPT: b) Is activated by cutaneous stimulation
b) The likelihood of hospitalizations
Chapter 16
Valid measures of insight must take into consideration
the following EXCEPT: Alexithymia refers to:
b) The relationship of insight to affect d) Inability to verbalize affect and elaborate
fantasy
Insight involves all of the following EXCEPT:
b) Recognition of illness in others Ekman’s basic emotions include all the following
EXCEPT:
Chapter 12 d) Jealousy

Autoscopy can involve all of the following EXCEPT: Mood is defined as:
c) Visual hallucination of internal organs within b) A prolonged prevailing inner state or
bodily space predisposition

Ego vitality is: Chapter 17
c) Awareness of being
The respiratory subtype of panic disorder is char-
Nihilistic delusion is an example of: acterized by all the following EXCEPT:
d) Disorder of vitality e) Induced by specific situations

Self-Assessment 1: Answers 317

Selye’s general adaptation syndrome includes one In dependent personality disorder the following
of the following stages: features all occur EXCEPT:
d) Flight-or-fight response b) Perfectionistic disposition

The constituent elements of obsessive compulsive The following conditions have been shown to be
phenomenon include all the following EXCEPT: frequently associated with anankastic personality
e) Increased discomfort following compulsive disorder EXCEPT:
act c) Alcohol dependence syndrome

Chapter 18 Chapter 20

Abnormal movement in catatonia include all the Illness behaviour is influenced by all the following
following EXCEPT: EXCEPT:
d) Cataplexy e) The underlying biology of the condition

Motivation can be defined as: All the following individuals have made contribu-
d) A reward system that governs and regulates tions to our understanding of health and disease
behaviour EXCEPT:
b) Aaron Beck (well known to psychiatrists as
Impulsivity involves all the following EXCEPT: creator of cognitive behavioural therapy and
c) Preference for delayed larger reward over small not an authority on concept of illness and
but immediate reward disease)

Chapter 19 Practical applications of psychopathology include
all the following EXCEPT:
Paranoid personality disorder can be defined as a d) Nosology
disorder in which:
a) An individual mistrusts others and is unduly
suspicious

This page intentionally left blank

Self-Assessment 2: Answers

Chapters 3 and 4 that happened approximately 36 hours after the
incident.
1. A 75-year-old female patient is found wandering A. Anterograde amnesia
the streets. On examination she does not know 4. A 57-year-old male patient with an established
the date, day, time, season, where she is or her history of impairment of short-term memory in
own address. the context of alcohol abuse responded to ques-
D. Disorientation tions about how he had spent the previous day
with objectively false accounts that included
2. An 18-year-old male patient presents with a embellishments and intrusions from previous
history of several irresistible periods of drowsiness occasions.
during the day. At night he reports periods when B. Confabulation
he is fully awake but unable to move his limbs.
E. Hypersomnia Chapter 7

3. The partner of a 25-year-old male patient accom- 1. A 45-year-old man presents with a complaint
panies him to the outpatient appointment. She that he first saw a black cat at the corner where
reports that he talks in his sleep, wanders aim- his drive joined the main street. After this, for
lessly in the bedroom for a few minutes at night the next 72 hours or so, he kept seeing the same
and has no recollection of these incidents. cat at various times and situations. What is the
H. Parasomnia term for this experience?
B. Palinopsia
4. A 47-year-old female patient with a history of
recurrent depression is admitted in a mute state. 2. A 19-year-old man with a recent diagnosis of
She is immobile but fully conscious and alert. She schizophrenia complained that the faces of people
is able to make eye contact but does not respond looking at him would suddenly look different,
to any attempt at verbal communication. as if they were pulling faces at him. Sometimes,
I. Stupor the faces would appear sinister, lopsided and
strange. What is the term for this experience?
Chapter 5 E. Paraprosopia

1. A 20-year-old male patient was involved in a 3. A 25-year-old female patient with a history of
road traffic accident. He sustained head injury. complex focal seizures complained of scenes and
He was only able to recall events that happened objects becoming smaller before a seizure. What
approximately 5 minutes before the collision. is this experience termed?
J. Retrograde amnesia D. Micropsia

2. A 20-year-old male patient presented in prison 4. A 25-year-old male patient complained that
whilst on remand. When examined, he responded objects looked far away. He found this surprising
to questions about the date and the capital of and distressing. What is this experience termed?
France with approximate answers and disorienta- G. Pelopsia
tion for time and place.
F. Ganser state Chapter 8

3. A 45-year-old male patient was involved in an 1. A 20-year-old male patient was admitted into
accident at work where he sustained a serious hospital after an attack on his father. He reported
head injury and lost consciousness. On regaining
his consciousness, he could only recall events 319

320 Self-Assessment 2: Answers

that his father had been replaced by a robot who 3. In a test, a 19-year-old patient with a diagnosis
looked almost exactly like him but was definitely of schizophrenia responded to a question as
not him. He feared that this ‘robot’ had malignant follows: ‘Which of the following are essential parts
intentions and that his life was in danger. What of a room: walls, chairs, floor, window?’ ‘Chairs’.
is this belief called? G. Overinclusive thinking
H. Delusional misidentification
2. A 40-year-old female patient complained that 4. A 57-year-old female patient said: ‘I was starting
her local priest was sending her secret messages, to feel high, so I tied dumb-bell weights round
declaring his feelings for her. She complained my ankle’.
that although he was the father of her child, he F. Concrete thinking
was yet to visit them.
G. Delusion of love Chapter 10
3. A 21-year-old female patient suddenly became
convinced that she was the rightful heir to the 1. A 65-year-old, right-handed male patient, who
throne of Norway. She was not Norwegian by was recovering from a left-sided stroke, was
birth or ancestry. When asked the reason for this unable to follow the verbal command: ‘Take the
belief, she said that she had suddenly come to paper with your left hand, fold it in two and put
this realization. She denied any other unusual it on the floor’.
experience. I. Receptive dysphasia
B. Delusional intuition
4. A 54-year-old male patient with a long-standing 2. A 25-year-old patient said, ‘Phlogons have invaded
history of schizophrenia reported persistent and my lungs turning first sideways and now
stressful auditory verbal hallucinations of deroga- medways’.
tory and threatening content. The voices would J. Neologism
often tell him that he deserved to be killed and
that new immigrants into his local area from 3. A 64-year-old male patient with a long-standing
Romania were going to murder him. He then history of schizophrenia replied to the question,
held a firm belief that he was at risk from ‘What have you got in your cup?’ ‘A fluid that
immigrants, particularly Romanians. This belief whilst being colourless turns dark on brewing’.
was held with conviction and was impervious G. Metonym
to counterargument.
E. Secondary delusion 4. A 72-year-old male patient with a diagnosis of
Parkinson disease said, ‘I’m star …, star …,
starting to think of mo …, mo …, mo …, moving
house’.
B. Logoclonia

Chapter 9 Chapter 14

1. A 21-year-old male university student described 1. A 23-year-old male patient presented with the
spending a lot of time thinking about the future, belief that his muscles were too small, a preoc-
about the possibility of becoming a famous cupation with physical build, excessive exercising
musician, becoming rich and able to live in a and disturbed eating.
mansion in Florida. H. Muscle dysmorphia
A. Fantasy thinking
2. A 56-year-old female patient complained of hating
2. A 25-year-old female patient, newly admitted her left hand. Although it looked normal, she
into hospital, complained that her thoughts were said that she hated it and had always wished
being interfered with. She was particularly dis- that it were different in size, shape and feel.
tressed by the experience of having thoughts A. Misoplegia
manipulated and taken from her.
I. Thought withdrawal 3. A 27-year-old male patient presented with a
long-standing belief that his face was ugly, in

Self-Assessment 2: Answers 321

particular his nose that he thought was far too of social situations due to the possibility of
large and crooked. Objectively, his nose was not embarrassment or humiliation.
excessively large or crooked. J. Social phobia
B. Dysmorphophobia 3. A 27-year-old male accountancy trainee presented
4. A 40-year-old female patient presented with the with a history of repetitive and intrusive thoughts
complaint that she could continue to feel her about cleanliness and hygiene, which were
toothbrush in her hands for up to 15 minutes associated with increasing tension and worry,
after she used it. and which he recognized as his own thoughts.
C. Palinaptia He tried to resist these thoughts but found that
they became even more urgent and intrusive.
Chapter 16 H. Obsession
4. A 32-year-old female patient, who had recently
1. An 8-year-old male patient presented with a given, birth presented with a 6-week history of
history of heightened startle reflex characterized temper outbursts, feelings of hostility towards
by eye blinking, head flexion, abduction of the her husband, an unpleasant feeling of distress
upper arms, movement of the trunk and bending and impatience with her children.
of the knees in response to a loud noise. E. Irritability
C. Hyperekplexia
Chapter 18
2. A 40-year-old female patient with a history of
recurrent depression and current depression gave 1. A 21-year-old male recently diagnosed with
a history of inability to experience pleasure in schizophrenia and treated with risperidone
her usual hobbies and interests, as well as a complains of motor restlessness, inner agitation
general inability to experience any feeling. and an inability to sit still.
A. Anhedonia A. Akathisia

3. A 36-year-old male patient presented to the local 2. A 17-year-old male patient is brought to the
dental hospital with an aching pain in both sides attention of his general practitioner because he
of the lower jaw radiating to the temporo- newly recognized a problem with gambling,
mandibular joints and to the neck. In response drinking excessively and misusing cannabis.
to the question, ‘How are you feeling in your In addition, he is reported as prone to losing
spirits?’, he seemed puzzled and asked for the his temper and liable to say things he later regrets.
question to be repeated. He then said, ‘My body E. Impulsivity
is heavy and I am aching all over’.
J. Alexithymia 3. A 21-year-old male patient presented with a
history of episodes of excessive sleeping (up 15
4. A 75-year-old male patient with a diagnosis of hours a day), excessive eating, increased sexual
Parkinson’s disease spoke with a monotonous libido, low mood and transient persecutory
voice. In addition he seemed not to recognize the beliefs.
emotional meaning of variations in tone of voice. G. Kleine-Levin syndrome
F. Receptive emotional dysprosody
4. A 28-year-old female patient presented for the
Chapter 17 first time with markedly slowed movements,
sometimes resulting in immobility, strange
1. A 32-year-old female patient presented with postures and muteness. On examination, she
discrete episodes of intense and extreme fear. allows her upper limbs to be put in uncomfortable
F. Panic postures that she holds for long periods of time.
C. Catatonia
2. A 23-year-old female patient presented with
excessive fear, self-consciousness and avoidance

This page intentionally left blank

Index

Page numbers followed by ‘f ’ indicate figures, ‘t’ indicate tables, and ‘b’ indicate boxes.

A Aggressive behaviour dissociative (hysterical) fugue, 62
psychopathology of, 270–271 one-way, 179
Abnormal personality, 23, 284 in schizophrenia, 271 organic (true), 58
Abnormality, 9 psychogenic, 61
Aggressiveness, 269–270, 288 retrograde, 58–59
typological, 9 decreased, 271 Amnesic syndrome, 162
Abstractions, 131 emotionally unstable personality Amok, 214t
Achromatopsia, 87 disorder and, 289 Amputation (Amputee)
Acquired brain injury, of delusional body image and, 210–211
Agitation, 134, 271 grief and, 247
misidentification, 118 in depression, 242–243, 271 phantom limb, 213
Activity in physical illness, 271
pain in, 223
disorder of, 176 Agnosia, 150 Analgesia, psychological, 220
in personality assessment, 23 prosopoaffective, 241 Analogic reasoning, 131
physiologic, abnormality of, 240–241 visual object, 83 Analytical psychopathology, 4
Actual:ideal self-discrepancy, 208–209 Anankastic personality, 156
Actual:ought discrepancy, 208–209 Agnosic alexia without dysgraphia, 150
Adjustment heuristic, 131–132 Agoraphobia, 191, 255 traits, 290
Adolescents Agrammatism, 155 Anankastic personality disorder, 290–291,
dissocial personality disorders in, 288 Agraphia
obesity in, 207 310, 317
obsessive-compulsive disorder in, 260 alexia with, 151 Anastrophy, 113
Adrenaline (epinephrine), 232 pure, 151 Anchoring heuristic, 131–132
Advertence, 273–274 Akataphasia, 152–153 Anger, intensification of, 237–238
Affect Akathisia, 275–276, 314, 321 Angst, 252
alteration in, delusions, 113 dyskinesia and, 276 Anhedonia, 235, 242, 266–267, 313,
blunting, 238 subjective components of, 276b
definition of, 231 Akinesia, 275 321
of depression, 243 Akinesis, 272 Animal phobias, 255
of hopelessness, 61 Akinetic mutism, 40 Anorexia, 267
perception associated, 88 Akinetopsia, 87–88 Anorexia nervosa, 207–210
Affect illusion, 90 Alcohol Anosognosia, 162, 211–212
Affective disorders, 231–250 craving, 258–259 Anosognosic overestimation, 197t,
abnormalities of volition in, 267 diminished pain sensation and,
circadian rhythms associated with, 77 212–213
exacerbation of, 236–237 221–222 Anterograde amnesia, 311, 319
falsification of memory, 60–61 mania and, 268 Antipsychotic drugs, extrapyramidal side
Affective psychoses, auditory withdrawal states, exaggerated startle
effects of, 275–276, 275b
hallucinations in, 93 reflex, 237–238 Antisocial behaviour, 288
Affective response, to delusions, 107 Alcohol abuse, delusions of jealousy and,
Affect-laden complexes, 113 depersonalization after, 189
Age 116 Anxiety, 252–257
Alcoholic hallucinosis, chronic, 93
disorientation in, 73 Alcoholism, pathological intoxication and, characteristics of, 252
severity of irritability in, 257 depersonalization and, 189, 191
Aggernaes, A. 39 in depression, 243
consciousness, disturbed state of, 33 Alertness, 43 free-floating, 252
defect in reality testing in general, 254
increased, depersonalization and, 190 in hypochondriasis, 201
schizophrenia, 139 Alexia, 95–96, 150 in other disorders, 256–257
hallucination from abnormalities of pathological, 252
agnosic, without dysgraphia, 150 self-description of, 254
perception, 92 with agraphia, 151 situational, 254
subjectivity and objectivity, 15 Alexithymia, 240, 309, 313, 316–317, 321 states, 252
Aggression, 269–270 Alloaesthesia, 87, 197t stress and, 252
diminished, 271 Alogia, 155 symptoms of, 252, 253b
excessive, 270–271 Alzheimer’s disease, visual hallucination
innate drive and an acquired response, three-dimensional model of, 253f
in, 95–96 Anxiety disorders, 256–257
270 Ambiguity, tolerance of, 94 Anxious feeling, 254
Aggressive acts, 269–271 Ambitendency, 273 Anxious personality disorder, 291
Amnesia
323
anterograde, 58
dissociative focal retrograde, 61–62

324 Index

Anxious searching, 246 Aura, epileptic, 39 Bipolar affective disorder,
Aphasia, 149 Autochthonous delusions, 109 depersonalization and, 191
Autochthonous idea, 107–108
motor, 151–152 Autogynephilia, 206–207 Bipolar disorders
subcortical visual, 150 Autohypnosis, 54 insight and, 165
Aphonia, 148 Automatic cognitive processes, 44 mood in, abnormality of, 242
dissociative, 148 Automatic obedience, 273
Apophany, 112 Automatism, 39–40, 305–306, 315 ‘Black bile’, 238–239
Appearance of patient, observation of, 25, Blindness
epileptic, 39, 52
305, 315 sane, 52 in body image, 210–211
Appetite speech, 40 cortical, 162
Autoscopy (heautoscopy), 99–100, pure word, 150
abnormalities of, 266b Blocking, 153
excessive, 267 176–178, 308, 316 Blunting, of feeling, 238
loss of, 267 Availability heuristic, 131–132 Bodily feelings, associated with emotion,
‘Appetite centre’, 266 Aversion, 274
Apprehension (loss of intellectual grasp), Avoidant personality disorders, 292–293 238–240
Awareness, 43–48 Bodily function, disorders of,
49
Appropriateness to situation, changes in, of body, disorders of, 195–217 201–203
delusional, 112 Bodily sensation, hallucination of,
of emotions, 238 inner, 175
Approximate answers, 66, 156 of personality, lability in, 179–180 97–98
Argyle, M., nonverbal communication, variations in level of, 45f Body

174 B disorders of the physical characteristics
As if feeling, 185 Basic emotion, 233 and emotional value of, 203–210
Aschemazia, 211–212 Bay, 154
Associations Behaviours dissatisfaction, 197t
in muscle dysmorphia, 210
clang, 154 aggressive. see Aggressive behaviour
constellation of, 154 antisocial, 288 experience, 211
loss of continuity of, 152–153 during automatism, 39 physicality of, 195–196
models based on Jaspers, 132, 133f characteristic, personality revealed by, in psychopathology, 196–197
psychosis of, 122 size, disturbance of, 207–210
Astasia-abasia, 202, 203f 22–23 Body awareness, 173
Asthenopia, 201 in descriptive psychopathology, 4, 4f disorder of, 195–217
Asyndesis, 138, 153 deviant, due to delusions, 107
Atmosphere disturbance of, 277–279 classification of, 197, 197t
delusional, 111 sensory, 210–214
ideas arising from, 108 schizophrenia, 277–278 Body cathexis, 173
Atrabilious, 199 exploratory, abnormalities in, 265, 266b Body checking, 210
Attention, 43–48, 306, 315 maladaptive, 269 Body clock, primary internal, 76–77
alteration of degree of, 44–45 observation of, 5, 25, 305, 315 Body concept, 173
alternating, 44, 44t relationship between instinct, need and, Body dysmorphic disorder, 204–206. see
capacity, 44, 44t
deficits of, 47 264f also Dysmorphophobia
divided, 44, 44t violent. see Violent behaviours Body image, 172–174
focused/selective, 44, 44t
narrowing of, 44 (violence) culture-bound disorders of, 214–215,
in pain perception, 222 Being, disorder of, 175–176 214t
in psychosis, 45–47 Beliefs, 105–107
sustained (vigilance), 44, 44t definition of, 211
Attention-deficit/hyperactivity disorder about the body, disorders of, 197–201, development of, 173–174
198f diminished or absent, 211–212
(ADHD), 272 distortion, 207–210, 212–214
Attitudinal body dissatisfaction, 208 assessment of, 26–27 disturbance, 214
Attribution, in hypochondriasis, 199 false, 105 organic changes in, 210–214
Atypical depression, 223–224 pathologic accentuation of, 211
Atypical facial pain, 223–224 delusions as, 123 sensorium of, 221
Auditory hallucinations, 14, 93–95 folk, 121 social aspects of, 173
symbolic, 113 Body integrity identity disorder, 206
conditions with, 93 Belle indifference, 203 Body schema, 173, 211
delusional atmosphere manifesting as, Berner, P., delusional atmosphere, 111 Borderline type emotionally unstable
Berrios, G.E.
111 delusions, 106 personality disorders, 289
elementary aspects of, 88 pseudohallucinations, 98–99 Bottom-up processing, in visual
in mental state examination, 25 Bias, informant and, 21–22
persecutory, 94 Bigorexia, 210 recognition, 84
in schizophrenia, 93–94 Biological disadvantage, 8 Brain trauma, 38
Auditory perception, 13 Biological rhythms, 76–79 Brainstem, lesions of, dysarthria and,
time and, 72
149
Broca’s areas, 151
Bulimia, 267
Bulimia nervosa, 210
Burning mouth syndrome, 224

Index 325

C Coma, 35 Conversion, 62, 201–203
Communicated hysteria, 202–203 concept of, 308, 316
Cannabis, depersonalization and, 186 Communicated insanity, 122
Capacity, for insight, 160 Communication Conversion hysteria, 197–198
Capgras’ syndrome, 117 Coping behaviour, and life epoch, 79f
Cartesian dualism, 16 descriptive psychopathology, 302 Coprolalia, 276–277
Case vignette method, 165 of mood, 233 Cortical blindness, 95–96
Cataplexy, 51 phenomenology involving, 10 Cortisol, level of, changes in depression,
Catatonia, 273, 277, 309–310, 314, 317, skills and techniques in, 305, 315
77
321 mental state examination, 24b Cotard’s syndrome, 119–120
lethal (pernicious), 273 for understanding of patient’s Counterfactual thinking, 130–131
Catatonic schizophrenia, 273, 277 Creative, inadequate and aggressive
‘Catego,’ classification of symptoms, symptoms, 10
Compliance with treatment, insight and, psychopathy, 288
300–301 Criminal psychopathy, 285
Category-based induction, 131 164 Crowding of thought, 136
Category boundary, broadening of, Comprehension, in impairment of Cryptographia, 149
Cryptolalia, 149
139 language function, 150t Cues, for memory retrieval, 59
Central executive, short-term memory, Compulsions, 257–260 Cultural factors

57–58 assessment of, 27 in hallucination, 92
Central nervous system, pain and, 220 no lack of insight, 258 insight and, 165
Central pain, 221 Compulsive image, 259 Culture-bound disorders, of body image,
Cerebrovascular accidents Concentration, 43–48
in depression, 243 214–215, 214t
of delusional misidentification, 118 Conceptual thinking, 131 Cutting, J.
in time-lapse phenomenon, 75 Concrete thinking, 138, 153, 312, 320
Charles Bonnet’s syndrome, 96 Conduction dysphasia, 150–151 hallucination, 90
Cheek, stroking, 279 Confabulation, 59, 63–64, 306, 311, 315, pathology of emotion, 234
Children Cyberchondriasis, 200
attention-deficit/hyperactivity disorder 319 Cycloid psychosis, 133–134
characteristics of, 63b Cyclothymia, 292
(ADHD), 272 of embarrassment, 63 Cyclothymic personality, 232, 292
dissocial personality disorders, 288 fantastic, 63
nonaccidental injury of, 288 D
Chomsky’s theory of language, 148 with persecutory content, 64 Daydreams, 64
Chronology, disorder of, 73 momentary, 63
Circadian rhythms, 77–78 social, 64 pareidolic illusion and, 90
Circumstantial thinking, 134–135, 135f Configural model, 84 personality assessment and, 23
Circumstantiality, 307, 316 Conflict of interest, 19–20 Deaffectualization, 188, 234–235
Clang associations, 154 Confusion, 38 Deafness, pure word, 150
Cleanliness, obsessive, 260 Confusion psychosis, 133–134 Decision-making, in depression, 243
Closure, principle, completion illusion Conjunction, 155 Deductive reasoning, 153
Consciousness, 32 Defence mechanisms, ego, 4
and, 89 changes of, qualitative, 36–38 Déjà vu, 59–60, 75–76, 188–189, 306,
Clothing clouding of, 35–36
definition of, 31 315
body image and, 173 dimensions of, 35 brain stimulation and, 76
mania and, 279 diminished, levels (stages) of, 33f temporal lobe epilepsy and, 59–60, 76
Cloze procedure, 156 disturbed, 31–41 Delirium, 36–38, 306, 315
modified, 156 fluctuation of, 38 definition of, 36
Cloze technique, 307, 316 intentional, 32 occupational, 40
Cocaine addiction, 121 limit to number of items in, 34 Delirium tremens, visual hallucination in,
Coenaesthesia, 239 of self, 36
Coenestopathic states, 239 Consolidation, in delusion origin, 113 95–96, 97f
Cognition Constellation Delusions, 105–127, 307, 316
in delusions, 114–115 of associations, 132
language and, 147–148 of symptoms, 299–300 acting on, 123
Cognitive impairment, insight and, Constriction, in anxiety, 252 affective response to, 107
Consulting behaviour, in hypochondriasis, of alien penetration, 301
163–165 assessment of, 26–27
Cognitive processing, impairment, in 199 attribution in, 114–115
Content autochthonous, 109
auditory hallucinations, 94 characteristics of, 106
Cognitive state, assessment of, 27 of delusions, 123 cognition and reasoning in, 114–115
Cohesive links, 155 disorder, in morbid jealousy, 116 communicated insanity and, 122
Cohesive ties, 155 of experience, 13–14 content of, 115–123
Coid, J., mania à potu, components of, 39 hypochondriacal, 14 of control, 27, 97–98, 123, 139–140,
Colostomy, body image and, 213 Continuity, feeling of, 180
Colour perception, 87 Continuity view, 5 143, 301
Colour vision, loss of, 95–96 of thought, 140–145, 307, 316

326 Index

Delusions (Continued) Delusional perception, 113, 142 suicidal thoughts in, 245–246
defect, theme, 114 Delusional percepts, 13–14, 109–112 symptoms of, frequency of, 244t
definition of, 106–107 Delusional retrospective falsification, 65 vital feelings of, 221
delusion-like ideas vs., 109 Delusional significance, 112 Depressive facies, 278–279
deviant behaviour due to, 107 Dementia, of delusional misidentification, Depressive illness, in hypochondriasis,
of disintegration, 300
disturbance of, 137–138 118 201
dysmorphic, 120 Dependent personality disorder, 291, 310, Derailment, 153
factors involved in, 113b
as false beliefs, 123 317 in thinking, 135, 135f
as false judgements, 105 Depersonalization, 176, 185–193, Derangement, moral, 288
grandiose, 118–119 Derealization
of guilt, 119 234–235, 308, 316
in hypochondriasis, 201 alteration of consciousness, 190 depersonalization with, 186
of infestation, 121–122 anxiety and, 189, 191 time experience loss of, 76
of infidelity, 116–117 aspects of self-perception in, 186 Descriptive psychopathology, 302, 305,
initiated, 108 assessment of, 27
of love, 117, 312, 320 components of, 186b, 308, 316 315
meaning in life and, 115 definitions and descriptions of, applications of, 302–303
meaning of, 105 behaviour description in, 4, 4f
mimicking disorientation, 49 185–190 continuity and discontinuity views in, 5
of misorientation, 49 definitive features of, 308, 316 definition of, 3
motivational theme, 114 depression and, 191 ego disorders or disorders of self, 175
nihilistic, 119–120, 308, 316 derealization with, 186 empathy in, 3, 5, 305, 315
origins of, 112–115 dissociation associated with, 189–190 fundamental concepts of, 3–17
factors involved in, 112 distortion of time sense in, 188 mind-brain duality and, 16
Garety’s model in, 114 dizziness and, 191 organic and neural substrates and,
German theories of, 112–113 drugs causing, 190
overvalued idea vs., 123–124 fatigue in, 187 15–16
paranoid idea vs., 125 further considerations for, 191–192 phenomenology and, 6–8
patient’s view of, 26–27 onset of, 189 psychoanalytic vs., 5t
of persecution, 115–116 organic and psychological theories of, research, 303–304
persecutory, 125 unconscious experience and, 15
of poverty, 119–120 190–191 understanding in, 305, 315
primary, 107–109, 137–138, 141, 301, personality in, 188 Desomatization, 188
307, 316 as preformed functional response, 190 Determining tendency, 45, 132
types of, 109–112 psychoanalytic theory, 191 Diabetes insipidus, nephrogenic, 267
in psychotic depression, 243 self-induced episodes of, 190 Diagnosis, 297
reality of, 123 social and situational aspects of, 189 descriptive psychopathology, 302
of reference, 125 as symptom, 187 hierarchical, 300
religious, 119 Depersonalization syndrome, 191 importance of, 297
retrospective, 111–112 culture-bound, koro, 188 postscript, 302–304
secondary. see Delusion-like ideas symptoms of, 187 psychiatric, 21
sexual content of, 116–117 Depiction theory, of mental imagery, 85 psychopathology and, 297–304
of unworthiness, 119 Depressio sine depressione, 242 Diencephalic lesions, in chronology
violent behaviour in response to, 123 Depression, 134, 231, 236, 242
agitated, 271 disorders, 73
Delusion-like ideas (secondary delusions), anhedonia and, 267 Digit span, 163–164
107–109, 130, 137–138, 307, atypical, 223–224 Disaster image, 259
312, 316, 320 circadian rhythm changes, 77 Discontinuity view, 5
clinical assessment for, 12 Disease, 8
in hypochondriasis, 200–201 core experience (psychological and Disgust, 200, 260
of reference, 125 Disinhibition, 269
Delusional atmosphere, 111 physical), 242–243 Disintegration, delusions of, 300
Delusional awareness, 112 delusions in Disorientation, 49, 311, 319
Delusional disorder, 120
Delusional evidence, 120 hypochondriacal, 120–122 in age, 73
Delusional idea, 109 of persecution, 116 delusions mimicking, 49
Delusional intuition, 312, 320 of poverty, 119–120 dissociation and, 49
Delusional jealousy, 116 loss and, 246–247 hysterical, 49
Delusional memory, 111–112 of mood, 242–247 of identity, 49
Delusional misidentification, 117–118, mood chart, 234f for person, 49
motivation impairment, 267 situational, 49
312, 320 passage of time disorders, 73 in time, 49, 73
Delusional mood, 111 posture, 278–279 Disruptive image, 259
preoccupation with gloomy thoughts, Dissocial personality disorder, 287–289
Dissociation, 62, 130, 201–203
46 in anxiety, 252–253
retardation, 267, 272 concept of, 308, 316
smiling, 242–243

Index 327

depersonalization associated with, subcortical auditory, 150 borderline type, 289
189–190 syntactical, 150–151 impulsive type, 289
types of, 150t Empathy, 11–13
disorientation and, 49 Dysphonia, 148 assessment of subjective experience,
Dissociative aphonia, 148 Dysprosody
Dissociative disorders, 202 expressive emotional, 241–242 5
receptive emotional, 241–242, 313, 321 in descriptive psychopathology, 3, 5,
depersonalization and, 189–190 Dysthymia, 292
Dissociative (hysterical) fugue, 62 Dystonia, 276 305, 315
Distractibility, 45 Dystonic reactions, acute, 276 genetic, 108
Distraction, auditory hallucination lack of, schizoid personality disorder,
E
reduction, 94 Eating, disturbance of, 207–210 287
Dizziness, depersonalization and, 191 Echolalia, 149 meaningful understanding, 10
Doppelgänger, 177 Echopraxia, 273–274 method of, 12, 25
Dosulepin (dothiepin), 223–224 Ecstasy, 183, 236–237 as therapeutic tool, 13
Double book-keeping, 161 Endorphins, 220
Dream-like (oneiroid) state, 40 in mania, 191 Epidemic hysteria, 202–203
Dreams, 23, 52–53, 176, 306, 315 Ego Epilepsy
of delusional misidentification, 118
unpleasant, 53 disturbances in, schizophrenia, 191 fluctuation of consciousness and,
Drive Freud’s concept on, 172
plurality of conceptions, 171 38
abnormality of, 265–266, 266b self and, 171–172 Epileptic aura, 39
organic causes, 266–267 Ego activity, 175
Ego boundaries, loss of, 182 body image distortion and, 213
biological, 266 Ego consistency, 176–180, 177b Epiphenomena, 4–5
definition of, 264 Ego defence mechanisms, 4, 130 Erotomania, 117
diminution, 265–266 Ego demarcation, 182–183 Erroneous ideas, delusions and, 105–127
exacerbation, 265–266 Ego vitality, 175, 308, 316 Euphoria, 236
innate, aggression, 270 Ekbom’s syndrome, 121 Evaluation, abnormalities of, 241–242
Drivelling, 136 Ekman’s basic emotions, 309, 317 Evil eye, 214t
Drowsiness, 35 Ellipsis, 155 Excitement, in schizophrenia, 277
in clouding of consciousness, 36 Embodiment, self and, 172 Exosomesthesia, 88, 197t
Drugs Emotion Expansive or grandiose delusional beliefs,
antipsychotic, extrapyramidal side abnormalities of appropriateness to
118–119
effects of, 275–276, 275b object, 238–240 Experience
depersonalization due to, 190 abnormalities of evaluation, 241–242
visual hallucination due to, 96 abnormalities of expression, 238–240 abnormality of, 240–241
DSM-IV (Diagnostic and Statistical Manual basic, 233 form and content in, 13–14
bodily feelings associated with, subjectivity and objectivity in, 14–15
of Mental Disorders, fourth edition), Explanation, 10
personality disorders, 286t 238–240 static and genetic, 11b
DSM-5 (Diagnostic and Statistical Manual of changes in intensity, 234–238, 234f understanding and, 10t
Mental Disorders, 5th edition) changes in timing, duration, and Explanatory psychopathologies, 4
delirium, 36 Exploratory behaviours, abnormalities in,
personality disorders, 292 appropriateness to situation, 238
Duality, mind-brain, 16 definition of, 231 265, 266b
Dumbness, pure word, 151 disorders of, 231–250 Expressive emotional dysprosody,
Duration, changes in, of emotions, 238 exacerbation of, 236–237
Dynamic psychopathology, 4 expression of, shallowness, 238 241–242
Dysarthria, 149 free-floating, 240 Expressive emotional prosody, 241–242
Dyschromatopsia, 87 lability, histrionic personality disorder, Extension, 85–86
Dyskinesia, tardive, akathisia and, 276 External loss, subjective experience, 247
Dyslexia, 95–96 289–290
Dysmorphic delusions, 120 pathology of F
Dysmorphophobia, 124, 197–198, 197t, Face processing, impairments of, 205–206
198f, 204–206, 313, 321 changes in, 234–240 Facial expression, unchanging (blunting
abnormalities in, 205–206 classification of, 234, 234b
complaint of, 205 in psychiatry, 231–232 of feeling), 238
Dysphasia, 149 theories of, 232–233 Facial pain, atypical, 223–224
conduction, 150–151 Emotional detachment, 287 Faciobuccolinguomasticatory dyskinesia,
jargon, 151 Emotional distress, symptoms and signs
motor, 149 276
transcortical, 151 of, eliciting, 19 Factual history, 22
nominal, 151 Emotional disturbance, behavioural signs False identity, 62
receptive, 150–151 False memory syndrome, 62–63
sensory, 149–151 of, 278–279 Falsification
transcortical, 151 Emotionally unstable personality
delusional retrospective, 65
disorders, 289 of memory, 60–61
Familiarity, knowing based on, 58
Family history, 21–22

328 Index

Fantastic interpretations, pareidolic G Handwashing, 256
illusion and, 90 Ganser state, 38–39, 66, 311, 319 Hangover, 88
Gate control theory, 219–220 Head injury
Fantasy, 105 General anxiety, 254
capacity for, 54 General paresis, 38 hyperactivity after, 272
Generalized anxiety disorder, panic obsession and, 259–260
Fantasy life, study of, personality Health
assessment and, 23 disorder and, 255 beliefs, 164
Genuineness, lacking in, histrionic concepts of, 298–299
Fantasy thinking, 130, 312, 320 Heautoscopy proper, 176–177
sexual assault and, 130 personality disorder, 289–290 Hebephrenic patients, schizophrenia, 139
Gerstmann’s syndrome, 211–212 Heightened sensation, pain and, 221
Fatigue, depersonalization associated, 187 Gestalt psychology, 161 Hemianopia, homonymous, 150
Fears Gesticulation, reduced, in retardation, Hemidepersonalization, 211–212
Hemi-inattention, 47–48
of death, 200 272 Hemimicropsia, 87
intensification of, 237–238 Gesture, 151 Hemiplegia, left-sided, 162
obsessional, 256 Hemisomatognosia, 211–212
performance, 256 as non-verbal communication, 174 Hemispatial neglect, 211–212
Feature-matching model, 84 Gilles de la Tourette’s syndrome, 276–277 Heterophenomenology, method of, 32
Feelings, 231 Global Insight Scale, 163 Heuristics, 131–132
anxious, 254 Goal, loss of, 153 History, taking of, 21
attached to perception of objects, 240 Grammar, 148 family, 21–22
blunting of, 238 personal, 22
directed towards people, 240 destruction of, 155 Histrionic personality disorder, 99,
flattening of, 238 mental, 148
loss of, 234–235 Grammatical construction, disorder of, 289–290
Fenwick, P., automatism definition, 39 Hoarding, schizophrenia, 278
Five-Factor model, of personality, 284 149 Homicide, in delusions of guilt, 119
Fixed idea, 287 Grandiose delusions, 118–119 Homonymous hemianopia, 95–96, 150
Flattening, of feeling, 238 Grief, 246–247 Hospital Anxiety and Depression Scale,
Flight of ideas, 132, 133f, 155 Grimacing, 273
in mania, 268, 268f Guilt, 243–245 254, 254f
Flow of thought, interruption to, Hunger, 265
delusions of, 119 Hunt test, 157
135–136 feelings of, in eating disorder, 210 Huntington’s chorea, 276
Fluency of association, 138–139 Gustatory hallucination, 98 Hyperacousia, 221
Folie à deux, 122 Hyperactivity, 272
Folie communiquée, 122 H
Folie imposée, 122 Hallucination, 90–98 restless, 272
Folie induite, 122 Hyperacusis, 88
Folie simultanée, 122 auditory, 93–95, 182–183 Hyperekplexia, 237–238, 313, 321
Forced grasping, 273–274 autoscopic, 176–177 Hyperkinesis, 272
Forced or guided mourning, 247 of bodily sensation, 97–98 Hyperkinetic disorders in childhood, 44
Forgetting, 58 cognitive approach to, 91 Hyperschemazia, 211
concepts of Rasmussen in, 92 Hypersomnia, 51, 265, 311, 319
of disagreeable, 61 cultural factors in, 92 Hypnosis, 53–55
influence of affect, 65–66 differentiation of, 98
selective, 60 elementary, 93 fantasy in, 54
Form, 13–14 extracampine, 100 induction of, 54
definition of, 13 functional, 100 Hypochondriacal delusion, 120–122
Form constants, 85–86 Hypochondriacal psychosis,
Formal thought disorder, 129 pareidolic illusion and, 90
Formication, 97–98 gustatory, 98 monosymptomatic, 120
Free-floating emotion, 240 haptic, 97–98 Hypochondriasis, 120, 197–201, 198f
Frégoli’s syndrome, 117 hygric, 97
Freud, S. hypnagogic, 51, 100 content of, 200–201
dreams, 53 hypnopompic, 51, 100 definition of, 199–200
insight, 161–162 kinaesthetic, 97 determinants of, 308, 316
instinct, 264 Lilliputian, 92–93 psychopathology of, 200–201
Frigophobia, 214t musical, 93 Hypochondrium, 199, 199f
Frontal lobe lesions, chronology (temporal normal percept and, 90–91 Hypomania, 247
as normal sensory experience, 90–91 Hyposchemazia, 211–212
order), disorder of, 73 olfactory, 98 Hysteria, 201–202, 223
Full body techniques, 208 reflex, 100–101 communicated, 202–203
Functional hallucination, 13 thermic, 97 conversion, 197–198
Functional imaging, in visual imagery, 84 visceral, 97 epidemic, 202–203
Functional neurologic symptom disorder, visual. see Visual hallucinations mass, 202–203
Hallucinatory voice, in hypochondriasis, visual fields in, 203, 204f
202
Fusion, of thoughts, 136, 136f 200
Handshake, 278

Index 329

Hysterical conversion, 130 Inattention, in children, 44 Irritability, 257, 314, 321
Hysterical mutism, 155–156 Incoherence of syntax, 149 and anxiety, 257
Infestations, delusions of, 121–122 outwardly expressed, 257
I Infidelity, delusion of, 116–117 severity of, age and, 257
I-ness, 175 Information processing, abnormality, in
ICD-9, persistent mood disorders and, Itch
delusions, 114 pruritogenic, 225
292 Inner heautoscopy, 176–177 psychogenic, 225
ICD-10 Insanity
J
dissociative (conversion) disorders, 62 communicated, 122 Jamais vu, 59, 75–76, 188–189
persistent mood disorders, 292 moral, 288
personality disorders, 286, 286t Insight, 159–167, 308, 316 temporal lobe epilepsy, 59–60
‘Ideal,’ normal as, 23 assessment of, 27, 160, 305, 315 James-Lange theory of emotion, 232
Ideas, 105–107 bipolar disorders and, 165 Jargon dysphasia, 151
assessment of, 26–27 capacity for, 160 Jaspers, K.
delusion-like, 109 in clinical practice, 160–161
fixed, 287 cognitive impairment and, 163–165 delusions, 124
initiated, 108 compliance with treatment, 164 disorder of identity, 180
overvalued, 109–110, 287 concept of hallucination, 90
of persecution, 286 imagery, 84
self-reference, 286 criticisms of, 165 insight, 160
Ideation, 15 development, 161–162 phenomenology, 7
erroneous, 123–125 Gestalt psychology and, 161 pseudohallucination, 99
Idée fixe, 287 lack of, 162 self-awareness, 175
Identity social and cultural factors, 165 time disorders, 71
disorder of, 180–182 impaired, aetiology of, 165 unconsciousness, 32–33
temporary loss of, 181 intellectual performance, 163–164 understanding vs. explaining, 10
Illness, 8 measurement of, 162–163 urge, drive and will, 263–264
behaviour, 200, 298–299, 310, 317 neurologic basis, 163–164 Jealousy, morbid, 116–117, 286–287
personal, 300 in schizophrenia, 163 Jet lag, 77
phobia, 256 as sudden, unexpected solution to a Judgement, 137
Illogicality, 153 disturbance of, 137–138
Illusion, 89–90, 89f problem, 161 false, delusions as, 105
affect, 90 valid measures of, 307–308, 316
completion, 89 Insight and Treatment Attitudes K
pareidolic, 90 Key experience, in delusions origin, 113
Imagery, 84–85 Questionnaire (ITAQ), 162–163 Kleine-Levin syndrome, 51, 265–266,
abnormal, 101 Insight Scale for Psychosis, 163
characteristics of, 84, 85t Insomnia, 50–51 306, 314–315, 321
visual, 85 Knowing, remembering vs., 58
vivid, 87 early, 50 Koro, 121, 188, 214t
Images late, 50 Körper, 196
formal characteristics of, 307, 315 Instinct Korsakov’s syndrome, 58
vivid internal, in pseudohallucination, abnormalities of, 265–269
definition of, 264 in age disorientation, 73
99 need and behaviour, relationship with, confabulation, 63
Imagination, 130–131 Kraepelin, Emil
Imaginative thinking, 130–131 264f religious delusions, 119
Impulse Instinctual drive, 263–264 sexual jealousy, 116
Insulin, 266
disorders of, 269 Intellectual function, and life epoch, 79f L
insane, 270 Intellectual grasp, loss (apprehension), Labelling, of disorders, 21
Impulse control, disorders of, 269 Lamentations, of syntax, 155
excessive control of, 269 49 Language
Impulsive acts, 263–264, 269–271 Intellectual performance, insight and,
examples of, 270 Chomsky’s theory of, 148
voluntary inhibitions of, 269 163–164 disorder of, 147–158
Impulsive behaviour, 277–278 Intentional stance, 32
emotionally unstable personality Interests organic, 149–152
schizophrenic, 152–157
disorders, 289 loss of, in depression, 267 impairment of, 150t
psychopathology of, 270–271 in personality assessment, 23 pragmatics of, 148
in schizophrenia, 277–278 Intermetamorphosis, syndrome of, 117 statistical model of, 156
Impulsive insanity, 270 Internal change, 247 Latah, 214t, 237–238
Impulsivity, 270, 309–310, 314, 317, 321 Intervention, response to, in Law, descriptive psychopathology,
venturesomeness vs., 269
hypochondriasis, 199 302–303
Interviews Learning disability, anxiety and, 259–260
Learning theory, 270
short, 20
speech and thought assessment in, 26
Intonation, of speech, 149
Intrusion, 154

330 Index

Leib, 196 Melancholia, 199, 236–239, 242, 271 Mental retardation, 272
Lexical cohesion, 155 delusions of persecution vs., 115–116 in pain perception, 222
Life epochs, 79
Memory Mental state, 21
psychiatric disturbance and, 79f acoustic, errors, 61 examination, 24–25
Listening, for understanding of patient’s bias, in affective disorder, 65–66
cue for retrieval, 58 Mescaline
symptoms, 12 declarative (explicit), 58 depersonalization and, 190
Literal paraphasia, 155 delusional, 111–112 visual hallucination due to, 96
Locked-in syndrome, 40 disturbance of, 59–65
Logoclonia, 149, 313, 320 meaningful, 61–63 Metamorphopsia, 87
Loners, 287 psychogenic, 61 Metonyms, 153, 313, 320
Long-term memory, 306, 315 echoic, 57 Micropsia, 87, 312, 319
Loss episodic (autobiographical incidents), 58 Microsomatognosia, 211
false, delusional memory as, 112 Mind, philosophy of, 16
depression and, 246–247 falsification of, 60–61 Mini-Mental State Examination, 27
external, subjective experience, 247 see also Confabulation Mirror neurons, 233
Love iconic, 57 Misidentification, delusional, 117–118
being in, 173 impairment/disorder Misnaming objects, 61
delusions of, 117 affective, 65–66 Misoplegia, 197t, 212–213, 313, 320
Lucidity, 35 organic, 58–59 Mitgehen, 273–274
heightened, 36 in schizophrenia, 65 Mixed affective states, 134, 271
Lycanthropy, 181–182 see also Amnesia Mixed personality types, 286
Lying, fluent plausible (pseudologia implanted, false memory syndrome, 62 Mixing, 136
long-term, 58, 306, 315 Monthly cycles, 78
fantastica), 60–61 functions, 58 Mood, 309, 317
Lysergic acid diethylamide loss for words, 61
mechanisms of, 57–58 in bipolar disorder, abnormality of, 242
depersonalization, 190 mood-congruent, 65–66 communication of, 233
intense pain in, 221 recall, 58 definition of, 231
visual hallucination due to, 96 impairment of, 59 delusional, 111
inaccuracy, 61 depression of, 242–247
M recognition, 58 diurnality of, 77
Macropsia, 87 impairment of, 59 histrionic personality disorder and, 290
Macrosomatognosia, 211 recovered, 62–63 and life epoch, 79f
Made experiences, 143 registration/encoding, 58 normal, 232
Mania, 236–237, 247–248 impairment of, 58 persistent disorders, 292
retention, 58 in personality assessment, 23
abnormality of exploratory behaviour impairment of, 58–59 subjective and objective descriptions of,
and, 265 retrieval, 58
direct, 59 26
alcohol and, 268 impairment of, 59 swings
clothing in, 279 indirect (strategic), 59
decisions and, 268 semantic (fact memory), 58 extreme, in depression, 245
flight of ideas in, 268 errors, 61 in premenstrual syndrome, 78
in grandiose delusion-like ideas sensory, 57 Mood disorders
short-term, 57–58, 306, 315 circadian rhythms in, 78
(secondary delusions), 118–119 state-dependent, 65–66 in flow of time disorders, 74
insight, 165 storage, 57 Moral derangement, 288
passage of time disorders, 74–75 working, 57–58 Moral insanity, 288
speech in, 149 Morbid grief, 246–247
Mania à potu (pathological intoxication), Menstrual cycle, 78 Morbid surprise, 237–238
Mental arousal, excessive, in insomnia, 50 Morphemes, 148
39, 305–306, 315 Mental disorders, classification of, 300b Motivation, 264, 309, 317
Manic-depressive psychosis, 133f abnormalities of, 265–269, 266b
Manipulativeness, histrionic personality categorical, 300 in schizophrenia, 267
dimensional, 300 definition of, 264
disorder and, 290 multiaxial, 300 intrinsic and extrinsic factors, 264
Mannerisms, 273, 278 Mental illness, 8 Motor aphasia, 151–152
Mass hypnosis, 181 eliciting symptoms of, 19–27 Motor disorders, 274–275. see also
Mass hysteria, 202–203 onset after normal health, 299–300
Mass psychogenic illness, 202–203, 308, syndromes, 299–300 Movement, disturbance of
Mental imagery, 85, 130–131 in brain disease, 275–276
316 in auditory hallucinations, 94 categories of, 274–275, 274t
Mass sociogenic illness, 202–203 Mental images, hallucination as, 91 in Parkinson’s disease. see Parkinson’s
Mastectomy, in phantom limb, 213
Masturbation, 299 disease
Maternal reverie, 131 Motor dysphasia
Meaning, alternative tests, 94
Meaningful connections, 14 primary, 151
transcortical, 151
delusions and, 108
Medial thalamus, sleep stages and, 49–50
Megaphagia, 51

Index 331

Motor retardation, 272 Normal, definition of, 9, 23 Overactivity, in mania, 267
Movement, disturbance of, 271–277. see Normal personality, 23 Overvalued ideas, 123–125, 287
Normalizing statements, 24
also Motor disorders Nuclear syndrome, 301 in bulimia nervosa, 210
agitation. see Agitation Nymphomania, 117 disorders with, 124t
in catatonia, 273 in dysmorphophobia, 205
in execution of movement, 273 O in hypochondriasis, 201
hyperactivity, 272 Obesity, 207, 267 morbid jealousy as, 124
isolated disorders of movement, in paranoid personality disorder, 124
schizophrenia and, 267
273–274 Objective assessments, 15 P
in schizophrenia, 272–274 Objective (clock) time, 72 Pain

see also Motor disorders disorder of, 72–73, 72b attention and, 219–220
Muddling, 136 Objectivity, 14–15 central nervous system and, 220
Multiple personality (dissociative identity central (thalamic syndrome), 221, 309,
definition of, 15
disorder), 178–179 of normal sensation, 92 316
Muscle dysmorphia, 210, 313, 320 Object(s), in delusional misidentification, craving, 221–222
Mutism, 152 definition of, 219
118 depression and, 223
akinetic, 40 Observant, 25 diminished sensation, 221–222
hysterical, 155–156 Observation gate control theory in, 219–220
in stupor, 40 heightened sensation and, 221
My-ness, 175 of appearance and behaviour, 25 loss and, 223
for understanding of patient’s nonorganic, classification of, 223
N organic or psychogenic, 219–221
Nail biting, 149 symptoms, 12 perception and, 219
Naming, in impairment of language Observer, 6 phantom limb, 213, 223
Obsession, 314, 321 phenomenological aspects of, 219
function, 150t Obsessional (anankastic) personality, with psychiatric illness, 220
Narcissism, 100 psychopathology and, 219–227, 309,
Narcissistic personality disorder, 292 259–260
Narcolepsy, 51 Obsessional ideas, 259 316
Need Obsessional image, 259 recalcitrant in, 222
Obsessional rumination, in subjective experience, 219
abnormalities of, 265–269, 266b suffering and, 225
definition of, 264 hypochondriasis, 201 threshold for, 219–220
primary, 264 Obsessions, 257–260 transmission of, 219–220
relationship between instinct and without organic cause, 222–225
assessment of, 27 Pain asymbolia, 221–222, 308–309,
behaviour, 264f religious beliefs and, 258
secondary, 264 Obsessive-compulsive disorder, 257 316
Negative heautoscopy, 176–177 Obsessive compulsive phenomenon, Palinacousis, 88
Negative traits, of schizophrenia, 267 Palinaptia, 88, 197t, 313, 321
Negativism, 274 elements of, 309, 317 Palinopsia, 87, 312, 319
in schizophrenia, 273 Obstruction, of flow of action, 273 Panic, 251–261, 314, 321
Neologisms, 149, 153–154, 313, 320 Obstructive sleep apnoea, 51 Panic attacks and disorder, 254–255
Neuroanatomy, 303 Occipital lobe tumours, visual
Neuroleptic malignant syndrome, generalized anxiety disorder and, 255
hallucinations with, 95–96 respiratory subtype of, 309, 317
272–273 ‘Old maids’ insanity, 117 Paradoxical sleep (REM sleep), 53
Neuromas, stump, 223 Olfactory paranoid syndromes, 121 Paraesthesiae, 97
Neurosis Olfactory reference syndrome, 121 Paragrammatism, 149, 155
Oneiroid states, visual hallucination in, 96 Paralogia, 155
psychoses and, 300 Opposition, to movement, 274 Paramimia, 238
stress and, 300 ‘Organic amnesic syndrome’, 63 Paramnesia, 59–61
Night terrors, 52 Organic brain disease, acute, in time-lapse Paranoia, 120
Nightmares, 53 Paranoid, 125, 286
Nihilistic delusions, 119–120, 176, 308, phenomenon, 75 Paranoid ideas, 125
Organic pain, 219–221 Paranoid personality disorder, 286–287,
316 Organic psychiatry, symptomatic
Nominal dysphasia, 151 310, 317
Nonaccidental injury, of children, 288 psychiatry vs., 15 active, 286–287
Nonorganic pain, classification of, 223 Organic psychosyndromes, anxiety in, passive, 287
Nonverbal communication Paraphasia, 155
256 Paraprosopia, 87, 312, 319
assessment of, 25–26 Orientation, 48–49 Paraschemazia, 212–214
self-image and, 174 Parasomnias, 52, 311, 319
Norms, 9 definition of, 43
individual, 9 in space, 48
social, 9 in time, 48
statistical, 9 Orthodox sleep, 53
value, 9 Out of body experience, 176–177
‘Out of the blue,’ delusions, 109
Over-inclusive thinking, 138–139, 153,

312, 320

332 Index Personality Pictorial theory, of mental imagery, 85
abnormal, 23 Pinta, 9
Parathymia, 238 assessment of, 22 Polydipsia, 267
Pareidolia, 90 definition of, 22–23 Positive and Negative Syndrome Scale
Parietal lobes, 211 depersonalization and, 188
Parkinsonian syndromes, 273 lability in awareness of, 179–180 (PANSS), 163
Parkinson’s disease, 275 multiple, 178–179 Possession state, 181–182
normal vs. abnormal, 23
exacerbation of drive and, 265–266 premorbid, previous or usual, 22–23 and trance, 181
Part functions, 299 sensitive premorbid, 113 Post-traumatic stress disorder
Part of body methods, 208
Passion, disorders of, 116 Personality disorders exaggerated startle reflex, 237–238
Passive dependence, 290 anankastic, 290–291 irritability in, 257
Passivity, 27 anxious, 291 unpleasant dreams, 53
avoidant, 292–293 Posture, 25–26
disorders of, 143 classifications of, 284–285 in catatonia, 273
of emotions, 143–144 dependent, 291 in catatonic schizophrenia, 273
of experience, 180, 266 differentiation of, 23–25 isolated disorders of, 273–274
of impulse, 144 dissocial, 287–289 as non-verbal communication, 174
somatic, 144 emotionally unstable, 289 pharaonic, 25–26
of thought, in delusional atmosphere, expression of, 283–293 Poverty, delusions of, 119–120
histrionic, 289–290 Pragmatics, 148
111 mixed, 286 Preconscious processes, 34
of volition, 144 paranoid, 286–287 Predictability, 156
Pathologic lying, 130 schizoid, 287 Premenstrual syndrome, 78
Pelopsia, 87, 312, 319 sociopathic, 289 Presence, feeling of, 176–177
Penile change, in hypochondriacal theory of, 283 Present State Examination (PSE), 144,

delusions, 121 Personality type, 23 254, 300–302
Penoscrotodynia, 224 Phantom head, 178 first-rank symptoms of, 301f, 302t
Perceived body, 173 Phantom limb, 213–214 ‘total insight score’ and, 163
Percept, idea occurring on, 108 Pressure of talk, 155
Perception, 13 body image, 210–211 Primary delusions, 107–109, 137–138,
pain, 213, 223
abnormal, 87–90 Phenomena, primary and secondary, 14 141, 301, 307, 316
abnormal imagery, 101 Phenomenological selves, 173–174 types of, 109–112
assessment of, 26–27 Phenomenology, 303 Primary motor dysphasia, 151
autoscopy, 99–100 definition of, 6 Primary sensory dysphasia, 150–151,
false perception, 89–90, 89f
sensory deprivation, 101–102 confusion over, 7 307, 316
sensory distortions, 87–89 method of, 7 Private meaning, 149
Problem solving, 131
auditory, 13 communication facilitation, 10 Prognosis, insight and, 164
elementary aspects of, 88 psychopathology and, 6–8 Propositional analysis, 157
purpose of, 13 Prosody, 148, 241–242
characteristics of, 85t Phobia, 204, 251–261 Prosopoaffective agnosia, 241
delusional, 110–111 animal, 255 Provoked vestibulodynia, 224
of objects, attached to, 240 in depression, 256 Pruritogenic itch, 225
pathology of, 83–103 illness, 256 Pseudohallucinations, 50–51, 87, 89,
perception, 89–90, 89f simple, 255
pseudohallucinations, 98–99 social, 256 98–99
quality of, 88 species of, 255b Pseudologia fantastica, 60–61, 130
sensation and, 83–86 Phobic anxiety depersonalization Psychiatric disorder, memory disturbances

form constants, extension and syndrome, 191 secondary to, 63–65
synaesthesia, 85–86 Phobic neurosis, subdivisions of, 256b Psychiatric examination, outline for, 20b
Phobic states, 255–256 Psychiatric history, 21–22
imagery, 84–85 Phonemes, 93, 148 Psychiatric illness, in hypochondriasis,
private speech and inner speech, Phonological loop, short-term memory,
199
86 57–58 Psychiatry
splitting of, 89 Photophobia, 201
tactile, elementary aspects of, 88–89 Phrases, 149 biological school of, 302
visual, elementary aspects of, 87–88 definition of, 3
Perceptual delusional bicephaly, 178 misuse of, 153–155 scope of, 3
Perfectionism, 290 stock, 153–154 Psychoanalysis, insight, 161–162
Periodic catatonia, 273 Physiologic activity, abnormality of, Psychoanalytic psychopathology,
Persecution
delusions of, 115–116 240–241 descriptive vs., 5t
ideas of, 286 Physiologic itch, 225 Psychoanalytic theory, depersonalization
Perseveration, 25, 65, 137 Pickwickian syndrome, 51
Persistent mood disorders, 292 and, 191
Personal activity, disorders of, 143 Psychodynamics, 302
Personal history, 22 Psychogenic abnormalities, 155–156

Index 333

Psychogenic facial pain, 223–224 Rational thinking, 131 Schachter and Singer’s two-factor theory
Psychogenic itch, 225 Reading, in impairment of language of emotion, 232–233
Psychogenic pain, 219–221
Psychogenic symptom, hypersomnia, 51 function, 150t Schedule for Assessment of Insight in
Psychological pillow, 273 Reality Psychosis, 163
Psychomimetic drugs, visual hallucination
of delusions, 123 Schizoid personality disorder, 287
due to, 96 sense of, hallucinations and, 92 Schizophrenia, 256
Psychopathic personality disorder, Reality testing, poor, in auditory
abnormalities of language in, 307,
287–288 hallucinations, 94 316
Psychopathology, 4–6, 4f Reasoning, 131
anhedonia in, 235
body in, 196–197 deductive, 131, 153 auditory hallucinations in, 93–94
concepts of health and, 298–299 in delusions, 114–115 behavioural disorders of, 277–278
definition of, 4 inductive, 131 Bleulerian, 111
descriptive. see Descriptive Receptive dysphasia, 150–151, 313, boundaries of self in, 182–183, 182f
chronic, in age disorientation, 73
psychopathology 320 clouding of consciousness in, 36
and diagnosis, 297–304 Receptive emotional dysprosody, concrete thinking in, 153
explanatory, 4 deductive reasoning in, 153
increased, in premenstrual period, 241–242, 313, 321 delusional percept in, 109–110
Receptive emotional prosody, 241–242 delusions and
78 Recognition-by-components model, 84
mind-brain duality and, 16 References, 155 hypochondriacal, 120
objectivity in, 16 of infestation, 121
organic and neural substrates and, delusion-like ideas of, 125 of love, 117
delusions of, 113 diminished pain sensation and,
15–16 sensitive ideas of, 113
phenomenology and, 6–8 Referral, psychiatric 221–222
practical applications of, 310, 317 impulsive and aggressive behaviour, ego disturbances in, 191
subjectivity in, 16 examples of, 142–145
unconscious experience and, 15 270 first-rank symptoms of, 109, 140–142,
uses of, 302–303 nature and type of, 21
Psychopathy Regression, thought disorder as, 153 140t, 182, 301f, 302t
creative, inadequate and aggressive, Religious delusions, 119 insight and, 163, 307–308, 316
Remember-know paradigm, 59 language disorder in, 152–157
288 Remembering, 59
definition of, 288 Repetition, in impairment of language models for investigating, 152t
Psychosis linguistic approaches to, 156–157
of association, 122 function, 150t
attention disorder in, 45–47 Representativeness heuristic, 131–132 propositional analysis, 157
feigned, 111 Research, 303–304 syntactical analysis, 157
patient with, insight of, 162 Residuum, 113 loss of unity in, 179–180
Psychosocial rehabilitation, 164 Response to intervention, 199 memory impairment, 65
Psychotic phenomena, and life epoch, Retardation, 134, 134f, 138–139, 155, motor disorders in, 274–275
categories of, 274–275, 274t
79f 242 movement disorder in, 272–273
Publicness, in normal object perception, degree of, 246 obsessional symptoms in, 259–260
in depression, 267, 272 paranoid, 125
92 mental. see Mental retardation prodromal phases of, 111
Pure agraphia, 151 motor, 272 psychogenic abnormalities in, 155–156
Pure word blindness, 150 Retrograde amnesia, 311, 319 psychological theories of thinking in,
Pure word deafness, 150 Retrospective delusions, 111–112
Pure word dumbness, 151 Reverse anorexia, 210 138–140
Purposeless restlessness, in depression, Reverse Cloze procedure, 156 quality of time disorder in, 76
Rewards, motivation and, 264 risk for, schizoid personality disorder
242–243 Right homonymous hemianopia, 150
Rituals, compulsive, 258–259 and, 287
Q Ruminations, 259 seasonal variation and, 78
Questions obsessional, 201 speech, 156
symptoms of, 7
empathic, 12 S thought disorder in
leading, 12 Sachs, Oliver, in visual perception,
in mental state examination clinical description and, 152–155
83–84 destruction of words and grammar,
closed, 24 Sapir-Whorf hypothesis, in language,
open, 24 155
147–148 misuse of words and phrases,
R Satyriasis, 117
Rapid eye movement (REM) sleep, 49–50 Scale for the Assessment of Negative 153–155
Rapport, 15, 26 in speech, 153t
Systems, 267 volition disturbance in, 267
evaluation of, 26 Scale to Assess Unawareness of Mental Schizophrenic inattention, 139–140
Rasmussen, concepts of, 92 Schizotypal personality disorders, 292
Disorder, 163 Schnauzkrampf, 273

334 Index

Schneider, Kurt Sexsomnia, 52 Spinothalamic pathways, disruption of,
delusional idea, 109 Sexual abuse, childhood, recovered 221
first-rank symptoms, 107–108, 307,
316 memories, 62 Spitzer, M., delusions vs. beliefs, 106
Sexual need, exacerbation, 265–266 Spontaneous involuntary movements, in
Searching, stage, after bereavement, 90 Shame, 243–245
Seasonal affective disorder, 78–79, 306, Shame culture, 244–245 schizophrenia, 273
Shift work type, 77 Spontaneous speech-fluent, in impairment
315 Short-term memory, 306, 315
Seasonal Pattern Assessment Sick role, 298 of language function, 150t
Simulated psychosis, 141–142 Stammering, 149
Questionnaire, 78–79 Singleness, disorder of, 176–180, 177b State, 252, 284
Seasonal variation, 78–79 Situational anxiety, 254
Secondary delusions. see Delusion-like Situational aspects, of depersonalization, trait vs., 252, 291
Stereotypy, 273
ideas 189 Stock words/phrases, 149, 153–155
Self, 171 Sleep Stress

boundaries for abnormalities of, 265, 266b and anxiety, 252
disorder of, 182–183 deprivation, 77 hysterical mutism and, 155–156
in schizophrenia, 182–183, 182f drunkenness, 50–51 Structural imaging, 206–207
objective assessment of, 49–50 Stump neuromas, 223
consciousness of, 36 paralysis, 51 Stupor, 40, 152, 311, 319
continuity of, loss of, 180 REM, 49–50 psychogenic vs. neurological causes, 40
disordered, 171–184 requirement, 50–51 Stuttering, 149
embodiment and, 172 stages of, 49–50 Subcortical auditory dysphasia, 150
and ‘other self’, 267–268, 268f Sleep disorders, 49–52 Subcortical visual aphasia, 150
Self-awareness, 159 hypersomnia, 51 Subjective analysis, 15
Self-concept, 172–174 insomnia, 50–51 Subjective doubles, syndrome of, 117
Self-deception, 130 parasomnias, 52 Subjective experience
Self-esteem, feeling of loss of, 187 Sleep-wake cycle, phase advance of, 77 heightened lucidity and, 36
Self-image Sleepwalking, 52 study of, 7
central core of, 174 Snapping off, 136 Subjective Experience of Negative
developmental phases of, 173f Social aspects, of depersonalization, 189
nonverbal communication and, 174 Social censorship, 174 Symptom, 267
Self-induced vomiting, 210 Social deprivation, 288 Subjective (personal) time, 72
Self-inflicted harm, 222 Social factors, insight and, 165
Self-injurious behaviour, 222, 222b Social phobia, 256, 314, 321 disorder of, 72b, 73–76
Self-monitoring, 159 Sociopathic personality disorder, 289 Subjectivity, 14–15
failure of, 139–140 Somatic passivity, 144
Self-outside world relationships, 191 Somatic style, 199 definition of, 15
Self-perception, aspects of, in Somatization, 241 Suffering, pain and, 225
criteria for, 199 Suggestibility, 64
depersonalization relationship, 186 Space, sense of, 71 Suicidal thoughts, in depression, 245–246
Self-reference, ideas of, 286 Speech Suicide
‘Self-referent’, 125 assessment of, 26
Selye’s general adaptation syndrome, 309, automatism, 40 in delusions of guilt and unworthiness,
definition of, 147 119
317 disorder of, 147–158
Semantic halo, 154 rate of, seasonal variation and, 78
Semantics, 148 thought, categorization of, 153t Summary statements, in mental state
Sensation disturbances of, 148–149
hemisphere, 149 examination, 24
experiencing, body schema and, hesitant, 151 Suprachiasmatic nuclei, biological rhythm
174–175 indistinct, 151
inner, 86 control in, 76–77
perception and, 83–86 intonation of, 149 Surprise
form constants, extension and isolated speech area, 151–152
synaesthesia, 85–86 in mania, 149 intensification of, 237–238
imagery, 84–85, 85t manic, 155 morbid, 237–238
private speech and inner speech, poverty of content of, 153 Symbolic representation, 130–131
86 private, 86 Sympathy, 5
schizophrenic, 156 Symptomatic psychiatry, organic
Sensorium, 35 spontaneous speech-fluent, 150t
of body image, 221 unintelligible, 149 psychiatry vs., 15
volume of, changes in, 149 Symptoms
Sensory deficits, 197t
Sensory deprivation, 101–102 classification of, 300–301
Sensory distortions, 87–89 constellation of, 299–300
Sensory dysphasia, 149–151 eliciting, 19–27
present, 21
primary, 150–151, 307, 316 primary vs. secondary, 14
transcortical, 151 understanding, 9–10
Sensory experience, normal, 90–91 use of, to form diagnostic categories,
“Serial sevens”, 44
299–302
Synaesthesia, 85–86, 306, 315
Syndromes, 299–300

Index 335

Syntactical analysis, 157 Time Understandable experience, primary
Syntactical dysphasia, 150–151 biological rhythms and, 72, 76–79 delusions, 108
Syntax, 148 chronology, disorders of, 73
direction of, disorder of, 75 Understanding
incoherence of, 149 disorder of, 71–81 in descriptive psychopathology, 9–11,
lamentations of, 155 classification of, 72b 305, 315
Systematic enquiry, 25–27 disorientation in, 48 explanation and, 10t
duration of, disorder of, 73 of individual’s health and disease, 310,
T flow of, disorder of, 74–75 317
Tactile hallucinations, 97 formal characteristics of, 306, 315 of patient’s symptoms, 9–10
Tangentiality, 153 objective (clock) time, 72 static and genetic, 11b
Technical term, diagnostic implications of, disorder of, 72–73, 72b
quality of, disorder of, 76 Unintelligible speech, 149
25 reduplication of, 76 Unity
Telegony, 154 subjective (personal) time, 72
Telegramese, 155 disorder of, 72b, 73–76 awareness of, 175
Teleopsia, 87 uniqueness of, disorder of, 75–76 loss of, in schizophrenia, 179–180
Telescoping phenomenon, 213 Un-understandable experience, 5–6
Temperature, body, changes in depression, Time-lapse phenomenon, 75 Unworthiness
Time sense, 71 delusions of, 119
77 in depression, 243
Template-matching model, 84 alteration, depersonalization and Urge, non-directional, 263–264
Temporal lobe epilepsy derealization, 76
V
déjà vu, 59–60, 76 distortion of, in depersonalization, Venturesomeness, 269
jamais vu, 59–60 188 Verbal coding, 174
twilight state and, 38–39 Verbal messages, 174
visual hallucination in, 96 loss, in dreams, 53 Verbal paraphasia, 155
Temporal order, disorder of, 73 ‘Time stands still,’ observation of, 73 Verbigeration, 151–152
‘Tension insanity’, 273 Timing, changes in, of emotions, 238 Vertigo, hyposchemazia with, 211
Thalamic syndrome, 221 Top-down process, in visual recognition, Vestibulodynia, provoked, 224
Theories of emotion, 232–233 Vigilance, 35
Theory of mind, 159 84 Vigilance-drowsiness axis, 35
Therapy, descriptive psychopathology, 302 Toronto Alexithymia Scale, 240–241 Vignettes, psychopathology, 163
Thinking Torpor, 190 Violent behaviours (violence)
acceleration of, 132–134 Traits, 284
autistic, 129 during automatism, 40
changes in the flow of, 136–137 anxiety, 252 delusions and, 123
circumstantial, 134–135, 135f negative, of schizophrenia, 267 emotionally unstable personality
concrete, 153 personality, 290
confusion of, 38 state vs., 252, 291 disorder and, 289
disorder of control of, 140–145 Trance, self-induced, 176 irritability and, 257
functions of, 130 Transcendental meditation, 176, 190 morbid jealousy, 116–117
imaginative, 130–131 Transcortical motor dysphasia, 151 twilight state and, 38
over-inclusive, 138–139, 153, 312, Transcortical sensory dysphasia, 151 Violent impulse, 269
Transference, 4 Visual hallucinations, 13–14, 95–97, 97f
320 Transsexualism, 206–207 auditory hallucinations and, 96
performance of, 130 body image and, 174–175 elementary aspects of, 87–88
process, disorder of, 129–145 Transvestism, 206 organic states associated, 95
speech and, 147 Travel, purposeful, dissociative (hysterical) Visual hyperaesthesia, 87
types of, 129–132 Visual object agnosia, 83
Thirst, abnormality of, 265, 266b fugue, 62 Visual perception
Thoughts Trema, 112 colour, 87
alienation of, 144–145 Tricyclic antidepressants, elementary aspects of, 87–88
assessment of, 26
audible, 141–142 depersonalization due to, 190 abnormalities of, 306–307, 315
blocking, 136, 137f, 140–141 Twilight state, 38–39 of motion, 87–88
broadcasting, 140–141, 143 Type:token ratio, 156 size, 87
coherent, 38 Typification, 297 spatial location, 87
disorder, 26 Tyrer and Alexander’s personality Visual pseudohallucinations, 96
Visual system
in speech, 153t disorders, 285–286 recognition in, 84
influence of, 144–145 in sensation and perception, 83
insertion, 140–141, 143, 145, 301 U Visuospatial scratch pad, short-term
loss of goal, 153 Ultimately ununderstandable, 108
withdrawal, 136, 140–141, 143, 312, Unconscious experience, phenomenology memory, 57–58
Vital anxiety states, 239
320 and, 15 Vital feelings, 239
Tics, 276–277 Unconscious state, 31
Unconsciousness, 33–35 of depression, 221

definition of, 33
three dimensions of, 34f

336 Index Vorbeigehen, 66 choice, in mental state examination, 25
Vulvodynia, 224 deafness, pure, 150
Vital self, 239 destruction of, 155
Vocational rehabilitation, 164 W dumbness, pure, 151
Voices, 301 Wahneinfall (delusional intuition), 109 intrusion of, 154
Water intoxication, schizophrenia, 278 loss of memory for, 61
hearing Waxy flexibility, 273 misuse of, 153–155
arguing, 142 Wechsler Adult Intelligence Scale, 66 semantic halo to, 154
giving a running commentary, Weight phobia, 207–208 stock. see Stock words/phrases
142–143 Wernicke’s area, 150 Word salad, 149
in schizophrenia, 93 Will, 263–265 Working memory, abnormality of,

Volition, 263–280 abnormalities of, 265–269, 266b 139–140
affective illnesses of, 267 in schizophrenia, 267 Writing, in impairment of language
disturbance of
in mood disorders, 267–269 concept, 265 function, 150t
in schizophrenia, 267 definition of, 264
loss of, 266 Windigo, 214t Y
Wisconsin Card Sorting Test (WCST),
Volitional act, 263–264 Yoga, 190
Volume, changes in, 149 163–164
Voluntary movements, idiosyncratic, in Words Z
Zeitraffer phenomenon, 75
schizophrenia, 273 blindness, pure, 150
Vomiting, self-induced, 210
Voodoo, 214t

Fast answers and trusted evidence

Drive better outcomes with a clinical search engine
that makes it easier to find and apply relevant knowledge.

Fast Convenient

Anticipates your query, recognizing Accessible at the patient’s bedside or
concepts and offering shortcuts on the go, making it easy to discover,
share, and apply content anywhere
Complete
Trusted
Draws relevant answers from a wide
range of current, comprehensive Content from Elsevier, the
content across 30+ medical and name healthcare professionals
surgical specialties worldwide rely on

ckey.co/books