NEUROSIS
&PSYCHOSIS
Dr. Ayatulla Elsayed
Assistant lecturer at
neuropsychiatry
department at Benha
university hospitals
PSYCHOSIS NEUROSIS
• severe mental illness usually affect thinking , • usually, mild psychiatric disorder with mild
behavior , speech , judgment impairment (except in severe cases)
• The patients came by their family seeking • patients come by themselves seeking
treatment psychiatric advice.
• Social and functional impairment
Loss contact with reality Contact with reality preserved except in severe Reality
cases
Loss of insight usually insightful Insight
Affected Not affected Personality
No hallucination except in severe cases Perception
Hallucination
Delusion No delusion except in severe cases Content of
thinking
harm to self and others : High harm to self or to others : low Harm
Not compliant to treatment Compliant to treatment Compliance
,Schizophrenia, delusional disorder Anxiety disorders, depression ,obsessive Examples
bipolar disorder (mania) compulsive, somatoform, post traumatic stress
,disorder
may be hospitalized Psychotherapy Treatment
Antipsychotics Anxiolytics
Mood stabilizer antidepressant
psychotherapy
DISORDERS OF PERCEPTION
• Hallucination
• illusions
HALLUCINATION
• is a perception in the absence of external stimulus.
• Hallucinations can occur in any sensory modality:
visual , auditory, olfactory, gustatory, tactile.
• Hypnagogic hallucinations and hypnopompic hallucinations are considered
normal phenomena.
• Hypnagogic hallucinations can occur as one is falling asleep and
hypnopompic hallucinations occur when one is waking up.
ILLUSION
• An illusion is a distortion of perception i.e. misinterpretation of a stimuli.
• Illusions in themselves are not indicative of psychopathology since they can
occur in the absence of psychiatric disorder……
• Can be auditory or visual.
ASSESSING THINKING
• Content
• Control
• Stream
• Form
DISORDERS OF CONTENT OF THINKING :
• Delusions
• Obsessions
• Preoccupation
WHAT IS A DELUSION?
• Delusions are defined as fixed, false beliefs that conflict with reality.
• Delusions are characterized by an unshakable belief in things that are not true, and often,
there is a continued belief in the delusion despite contrary evidence.
• Not all delusions are the same. Some might involve non-bizarre beliefs that could
theoretically occur in real life. Others may be bizarre, fantastical, or impossible.
• Types: grandiosity, persecutory, erotomanic (delusion of love ), Hypochondriacal delusions,
reference, nihilism, delusions of guilt, infidelity.
OBSESSIONS
• Pathological persistence of an irresistible thought, feeling, idea, image or
impulse that can not be eliminated from consciousness by logical effort;
associated with anxiety and against one's will.
• Obsession is characterized by all of the following:
1. Recurrent idea
2. Ego dystonic (distressing)
3. Explained by the patient as wrong and senseless
4. Resistance (patient is trying to resist even if he failed)
PREOCCUPATION
It is an idea that is characterized by:
• It is considered quantitative difference from normal idea.
• Persistent most of the time( day and night)
• is not distressing (ego-syntonic ) but it allow him to plan his action
DISORDERS OF CONTROL OF
THINKING
• Thought reading
• Thought insertion
• Thought broadcasting
• Thought withdrawal
• Thought reading:
patients say that their thoughts are being read, what they mean is not that other
people can tell from their expression or from their habits what they are likely to
be thinking ..
Can be associated with delusion of reference or persecution ….
• Thought broadcasting:
patients experience their thought are diffusing out of their mind and can be
experienced by others ( TV, social media)
It is a passive as it is not willed.
• Thought insertion
patient believes that his thoughts are implanted by some outside force , they lack the
normal sense of their ownership of the thoughts .. Sometimes they do not know where
they come from, but they are sure they are not their own …
• Thought withdrawal
patient believes that his own thought are taken out of his mind so that they
have no thought left.
DISORDERS OF STREAM OF THINKING
• Disorders of thought tempo:
1. Flight of ideas : thoughts follow each other rapidly; there is no general
direction of e.g. manic patient.
2. Inhibition or slowing of thinking: Slowing of thinking is seen in both
depression.
• Disorders of the continuity of thinking:
1. Perseveration : say the same thing or behave in the same way repeatedly.
2. Thought blocking: when there is a sudden arrest of the train of thought,
leaving a ‘blank’.
DISORDERS OF THE FORM OF THINKING
• Circumstantiality : Circumstantiality occurs when thinking proceeds slowly
with many unnecessary and trivial details, but finally the point is reached.
• Tangentiality : excessive or irrelevant detail that never reaches the essential
point of a conversation or the desired answer to a question.
• Derailment: talks in chains of only semi-related ideas. Their ideas often fall
further and further from the topic of conversation.
• Loss of association and incoherent speech (word salad) .
• Poverty of the content of thinking.
• Neologism : novel words or bizarre use of existing words
DISTURBANCES OF EMOTIONS:
1. Pleasant emotions
A) Euphoria
It is a subjective feeling of well being and confidence, the patient is rather happy, unconcerned of
his physical or mental illness.
It occurs in:
a. Some physical diseases as syphilis, multiple sclerosis, frontal lobe tumors, etc..
b. Psychiatric disorders as (mania, hypomania and schizophrenia).
B) Elation
It is a sense of enjoyment and self-confidence, which is radiating from the patient and infectious
to other persons who share the patient's happiness. It occurs in mania and hypomania .
C) Exaltation
It is an intensive elation accompanied by grandiosity. It occurs in mania,
hypomania, schizophrenia
D) Ecstasy
It is a sense of tranquility and power with peaceful feeling. It occurs in hysterical
dissociation, epilepsy, schizophrenia, affective disorders and religious settings.
2. Unpleasant emotions:
A) Grief
It is sadness secondary to loss of a beloved person.
B) Depression
It is a feeling of unhappiness, hopelessness, helplessness, guilt feelings, lack of
appetite, lack of concentration and insomnia. It occurs in mood disorders
(depression).
C) Anhedonia
Loss of pleasure in pleasurable activities.
D) Anxiety
It is a feeling of apprehension and fear associated with symptoms of increased
activity of the autonomic nervous system. It occurs in: Anxiety disorders,
thyrotoxicosis, hypoglycemia and other physical illnesses.
E) Others
e.g., panic and phobia
III- Inadequate emotions
A. Apathy:
Emotional expression ( body and fascial expression) and experiences are affected
B. Indifference:
Emotional expression is abolished while emotional experiences are not affected.
