6 PSYCHOPATHOLOGY I 1

More documents

Recommendations

Info

DISORDERS OF CONSCIOUSNESSConsciousness is the awareness of self and the environment. When theawareness is focused it is attention and when the attention is sustained it isconcentration. Normally, when an individual is in control of his mind, he is able to shifthis attention at will to concentrate on any immediate task at hand. Other objects orintrusions are kept out. In other words, at any point of time there would be a dominantconsciousness and possibly an hierarchy of subsidiary consciousness in the background.It is like multi-tasking on the computer with windows being opened or minimizedaccording to applications. However, when the mind is disturbed it loses control over whatthe dominant consciousness should be. Other covert mental processes become overtand manifest independently as various forms of psychopathology. Again it is like thecomputer with too many windows opened and fouls up. These “independent” mentalprocesses may dominate, interfere or co-exist with the “normal” mind. Some patients areable to recognize these abnormal mental processes in their mind and learn to suppressor overcome them.Under physiological condition, lowering of consciousness leads to sleep.Pathological clouding of consciousness would result in a comatose state. Confusion isclouding of consciousness with disorientation. It is obvious that other mental functionsi.e. perception, thinking and feeling are also affected. Hallucinations are present,thinking is disordered, the patient exhibits fear and restlessness as in delirium.Consciousness may also be restricted as in a dissociative or fugue state. Thiscondition has a sudden onset usually in response to acute overbearing stress. It isassociated with confusion about personal identity, inability to recall the past anddisorientation. This could result in a person wandering away and sometimes evenassuming a new identity.OTHER DISTURBANCES OF SELF-AWARENESSDepersonalizationThis is a feeling or sense of change in oneself whether emotionally orphysically with an unpleasant quality. It also includes derealization which refers to thesame phenomenon but of the environment. This sense of dissonant change in oneselfor the environment may be due to the dissociation between cognition and affect. Forinstance one patient says, "I know it is raining outside but I am unable to feel that it isso." Yet another who is panting away after exercise says "I am not able to feelbreathless."On the other hand, although the patient is unable to subjectively feel emotionsand yet his external emotional expressions or responses are observed to be quitenormal. Thus he may laugh heartily at a joke but states that he could not feel thehumour. In normal functioning we think, feel and behave in consonance.Identity and BoundaryThese are more psychotic phenomena in which the patient thinks he is nothimself but somebody else; his body is not his own; that he has no control over histhinking and feeling or there is mutual influence between himself and the environment.4
Passivity ExperienceIn schizophrenia there is complaint of being made to think, feel and act in certainmanner by some external force outside voluntary control. For example, a schizophrenicpatient may feel his thoughts are not his own but imposed on him by a computer.MOTOR DISORDERSGenerally, one's posture, movement, action or behaviour is intentional,purposeful and adaptive. But some postures, mannerisms and stereotyped movementsare symptomatic of mental disorders and non-adaptive. In catatonia there may be stiffor frozen posture or restless over-activity.Motor Disorders have been classified according to adaptive and non-adaptivemovements, motor speech, posture and abnormal patterns of behaviour.Thus there may be manneristic or stereotyped (rigid) speech and movements;echoing or repetitive imitating of what others say (echolalia) or do (echopraxia);perseveration of a response or activity and of posture (catalepsy).Catatonia may be exhibited at one extreme as excitement with marked agitation,impulsivity and aggressive behaviour and, at the other extreme, as rigidity with posturingand stereotyped behaviour or a stuporous state.References1. Fish F. Clinical Psychopathology. Bristol: Wright, 1974.2. Sims A. Symptoms of the mind. London: Bailliere Tindall, 1988.5
Page 1 and 2: 6 PSYCHOPATHOLOGY IChee Kuan TseeIn
Page 3: 2. Possession/Ownership - involunta

6 PSYCHOPATHOLOGY I 1

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?