Psikopatologi Fenomenologik

Pengantar &
Ggn Pembicaraan Ggn Proses
Pikir
dr. Adhitya S Ramadianto
Narasumber: Dr. dr. Nurmiati Amir, SpKJ(K)

Psychiatry & Mental Disorder

Branch of medicine that deals with morbid psychological
experiences
Psychological phenomena are important as causes, symptoms and
observable clinical signs and also as therapeutic agents.

Minor emotional disturbances that are meaningful reactions to environmental or

psychosocial stress

Profound psychological change that is unheralded by significant or meaningful

stress

Disturbances of personality that have a pervasive influence on behaviour

Psychological changes that are directly the consequences of organic brain

change

Psychological and behavioural consequences of the use of substances

Psychiatry & Mental Disorder

A mental disorder is a syndrome characterized by clinically
significant disturbance in an individuals cognition, emotion
regulation, or behavior that reflects a dysfunction in the
psychological, biological, or developmental processes underlying
mental functioning. Mental disorders are usually associated with
significant distress or disability in social, occupational, or other
important activities.
An expectable or culturally approved response to a common stressor or loss, such as
the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g.,
political, religious, or sexual) and conflicts that are primarily between the individual
and society are not mental disorders unless the deviance or conflict results from a
dysfunction in the individual, as described above.

Psychopathology
Systematic study of abnormal experience, cognition
and behaviour the study of the products of a
disordered mind
EXPLANATORY
Explanations according to theoretical constructs
DESCRIPTIVE
Selection, delimitation, differentiation and description of particular
phenomena
Through terminology become both defined and capable of
repeated identificationNormal vs Abnormal

Psychopathology

Descriptive Psychopathology
Two important components
EMPATHIC ASSESSMENT of subjective experience
Feeling oneself into
Imaginative experiencing of another persons world doctors
capacity
OBSERVATION of behavior
Gesture, body stance, behavior, action
Doctors attention & sensitivity

Phenomenology: study of subjective experience

Normal Thinking
Mental activity and processes used to imagine, appraise,
evaluate, forecast, plan, create, and will
Derives

thought

Can

from the study of language as the product (and reflection) of

take place nonverbally or preverbally music, arts

thought is far from logical competing thoughts and

associations; recurring asides, interruptions, delays, and the loss of
ideas; jumping to conclusions, stereotyping

Ordinary

Cognitive

style

Obsessional
Histerical

Types of Thinking - Freud

PRIMARY PROCESS
Dreams,

young children, and psychotic states.

Disregards

logic, permits contradictions, disregards the linear

notion of time

Dominated

by wish and fantasy

Uses

symbol, metaphor, imagery, condensation, displacement, and

concretism in its organization, creating the jumbled and incoherent
style of thinking characteristic of dreams

Right

brain thinking, associated with visual images and creative

thought

Types of Thinking - Freud

SECONDARY PROCESS
Characterized
Uses

by logic deductive

linear notions of time, ideas follow understandable sequence

Clearly
Think

delineated abstract categories

abstractly and in detail about future plans

Predictability,
Words,

coherence, and redundancy

vocal inflections, and gestures provide important contextual

cues and coherence

Types of Thinking Non-Freudian

FANTASY
Allows

escape from, or deny, reality

Can

be seen in normal and pathological thinking,

daydreaming

IMAGINATIVE
Merge

fantasy and memory future plans

RATIONAL or CONCEPTUAL
Uses

logic to solve problems

Disturbances of Flow and Form

Descriptive

underlying processes not understood

Many

types of abnormal thinking include both form and

content abnormalities

Aspects

to evaluate

Rate
Continuity
Control
Complexity

Rate of Thinking
SLOW

Goal directed but characterized by little initiative or planning

Slow decision making, long latency of response, increased pause in speech

THOUGHT BLOCKING

Sudden break in a train of thought

Interrupting thinking (and speaking) in midsentence

ACCELERATED

May be normal variant cultural, situational enjoyable(?)

Pressured speech: rapid, excessive, and typically loud

Flight of idea: switches direction frequently and rapidly, assoc

comprehensible

Thought Continuity
CIRCUMSTANTIALITY: many digressive turns and associations, often
including a great deal of unnecessary detail, returns to goal without
prompt
TANGENTIALITY: wanders from intended point without ever returning,
may not even remember original point
LOOSE ASSOCIATION: flow no longer comprehensible because thoughts
seem to have no logical relation hallmark of schizophrenia
WORD SALAD: stringing together of words that seem to have no logical
association

Thought Continuity

Thought Continuity
VERBIGERATION: disappearance of understandable speech, replaced by strings
of incoherent utterances
CLANG ASSOCIATION: sequence stimulated by sound of preceding word
rhyming sounds
ECHOLALIA: repeats sentence from examiner
PALILALIA: repeats last word or phrase
PERSEVERATION: repeated, sometimes several times over, after it is no longer
relevant
STEREOTYPY: constant repetition of phrae/behavior in different settings

Control of Thought
DELUSIONAL THOUGHT PASSIVITY

Thought insertion

Thought withdrawal

Thought broadcasting

OBSESSIONAL THINKING

Stereotyped, repetitive, persistent thinking that is recognized as one's own

thoughts.

Only partial control over the obsessional thoughts may stop, but recurs

May dominate consciousness

Classic: insight is retained

Simple (sequence of words) & Elaborate (possible consequences of event)

Thought Complexity
ABSTRACT THINKING

Attending to all aspects of complex situation, switch focus, abstract

common properties

Appreciate differing/contradictory POV

Integrate to form nuanced opinions

CONCRETE THINKING

Literal-mindedness

Inability to abstract commonality

Prone to prejudice and stereotypical thinking unidimensional or all-ornone reactions to complex situations

Speech Disturbance
Pressured speech: speed of the word stream is accelerated. If severe,
then the speech may be garbled, imprecise, and difficult to understand
Patients with psychomotor retardation: speak slowly and monotonously
and have a long speech latency in response to questions
Poverty of speech
Poverty of content of speech
Allusory speech: vague, imprecise, and hard to comprehend because too
few cues and details are provided for the listener
Stuttering/stammering: blocking, convulsive repetition, or prolongation of
sounds

Dysarthria: impairment in the motor aspects of speech

Mutism: loss of propositional speech (but with the retained ability to
grunt, cough, sing, etc.) and the complete obliteration of all soundproducing abilities in patients who are alert

Speech Disturbance - Aphasia

Impairments of language produced by brain
dysfunction
FLUENT APHASIA
Dysfunction in the left temporal and parietal area
Normal or elevated output, logorrhea, BUT ignore the social
conventions
Well-articulated & normal prosody, but little informational
content
NONFLUENT APHASIA
Dysfunction in anterior left hemisphere
Slow and poor verbal output, difficulty with spontaneous

Speech Disturbance - Aphasia

Speech Disturbance - Aprosodia

Nonverbal aspects of speech, the melody, pauses,
timing, stress, accent, and intonation are impaired
Expressive aprosodia: damage to the right prefrontal region
Receptive aprosodia: damage to the right temporal region
and insula

References
1. Matorin AA, Ruiz P. Clinical manifestations of psychiatric disorders. In:
Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadocks Comprehensive
Textbook of Psychiatry. 9th ed. Lippincott Williams & Wilkins; 2009.
2. Cummings JL, Mega MS. Neuropsychiatry and Behavioral Neuroscience.
1st ed. Oxford University Press; 2003.
3. Oyebode F. Sims Symptoms in the Mind. 5th ed. Elsevier; 2015.
4. American Psychiatric Association. Diagnostic and statistical manual of
mental disorders. 5th ed. American Psychiatric Publishing; 2013.