Verbigeration is a type of abnormality where there is a loosening of association, which can occur in severe expressive aphasia of schizophrenia. Knight’s move thinking is another example of loosening of associations, where there is a transition from one topic to another with no logical relationship between them. Neologisms are words of phrases invented by the patient to describe a morbid experience. Overinclusion is when the boundaries of concepts are widened, grouping things together that are not normally connected. Vorbeireden, of talking past the point, is when the patient seems to be about to reach the end point of a topic but never actually does. For more information, the Shorter Oxford Textbook of Psychiatry is a recommended resource.

Dhat syndrome is a condition commonly observed in the Indian subcontinent, characterized by fatigue and weakness, and the belief that one is expelling semen in their urine. The condition has no identifiable physical cause.

Hyperschemazia is a condition where individuals perceive certain body parts as being larger than they actually are.

Koro is a belief, typically found in Southeast Asia, that the penis is shrinking and will eventually retract into the abdomen, leading to death. This belief is thought to stem from a misunderstanding of anatomy.

Latah is a condition similar to Tourette’s syndrome, where individuals exhibit abnormal behavior in response to exaggerated startle responses. This may include screaming, cursing, dancing movements, uncontrollable laughter, and obeying commands they would not normally follow.

Nihilistic delusion is characterized by a strong sense of self-negation, where individuals may believe that they are dead of that their internal organs are decaying.

Delusional perception is a symptom of schizophrenia where a person interprets normal sensory experiences with a delusional meaning. Other first rank symptoms of schizophrenia include delusions, auditory hallucinations, thought disorders, and passivity experiences. Delusional awareness is when ideas seem more real, while delusional intuition is a sudden onset of delusional beliefs. Delusional mood is a feeling of unease and confusion where the environment seems threatening but the reason is unclear to the person experiencing it.

There are several types of perceptual experiences that fall under the category of hallucinations of synaesthesia. Functional hallucinations occur when a normal perception leads to a hallucinatory perception of the same modality, such as hearing music when a tap is running. Delusional perception, on the other hand, is a primary delusional experience that starts with a normal perception and is not an hallucination. Gedankenlautwerden is the experience of hearing one’s thoughts spoken aloud as they are thought, while reflex hallucination occurs when a stimulus in one sensory modality leads to an hallucination in another modality. Finally, synaesthesia is the automatic and involuntary experience of a stimulus in one sensory of cognitive pathway in a second pathway, such as experiencing letters of numbers as inherently coloured.

Blocq’s disease, also known as astasia-abasia, is a conversion symptom characterized by an abnormal gait that is not indicative of any organic lesion. Hypochondriasis is excessive worry about having a serious illness despite the absence of a medical condition. Malingering involves fabricating symptoms for secondary gain, while somatization is a chronic condition with multiple physical complaints for which no physical cause can be found and is associated with frequent medical contact.

Types of Hallucinations

Reflex hallucinations occur when a stimulus in one sensory modality leads to hallucinations in another sensory modality. Autoscopy is the experience of seeing one’s own body projected into external space, typically in front of oneself. Extracampine hallucinations are those that occur outside of an individual’s sensory fields. Écho de la pensée refers to the experience of hearing voices that repeat one’s thoughts immediately after thinking them. Functional hallucinations occur when an external stimulus triggers hallucinations that are experienced simultaneously and in the same modality as the initial stimulus.

Speech disturbances can be caused by organic of psychogenic disorders. In this case, the patient is experiencing dissociative aphonia, which is a conversion disorder where psychological stress is converted into physical symptoms. Aphonia is the loss of ability to vocalize, resulting in whispered speech, and can also occur in organic disorders. Dysphonia is a speech impairment characterized by hoarseness but without complete loss of function. Echolalia is the automatic repetition of words of parts of sentences spoken in the presence of the person. Logoclonia is a condition where the patient may get stuck on a particular word, resulting in spasmodic repetition of syllables of words. Stuttering is a speech disorder characterized by involuntary repetitions, prolongations, of blocks in speech flow, resulting in silent pauses of difficulty producing sounds.

The term Fregoli syndrome refers to a delusion where the patient mistakenly identifies an unfamiliar person as someone they know. This condition is named after Leopoldo Fregoli, an Italian actor who was known for his ability to quickly change his appearance during performances. Cotard syndrome is a type of delusion that occurs in cases of psychotic depression, where the patient believes that they are already dead. Capgras syndrome is another type of misidentification delusion, but in this case, the patient believes that someone they know has been replaced by an identical imposter. Charles Bonnet Syndrome is a condition that causes complex visual hallucinations. Finally, Couvade syndrome, also known as sympathetic pregnancy, is a phenomenon where men experience symptoms similar to their pregnant partners. These conditions are all well-documented in the field of psychiatry.

Karl Jaspers, a German psychiatrist and philosopher, first described tangentiality as a formal thought disorder where the patient deviates from the topic at hand and introduces new but related words. Although the examiner can usually follow the patient’s train of thought, the patient often loses track of the interviewer’s question. While tangentiality is not specific to any particular mental disorder, it can be present in conditions such as mania, hypomania, and schizophrenia. Other examples of formal thought disorder include loosening of associations, circumstantiality, thought block, perseveration, and flight of ideas.

Typically, when a delusion arises, the patient feels a sense of relief from the preceding anxiety and tension. The delusional atmosphere is the perception that something is amiss, while the delusional mood refers to the accompanying feelings of anxiety and tension.

– Pseudohallucinations are figurative and not real
– They are located in the inner subjective space
– Auditory hallucinations are concrete, tangible, and real
– They are located in the outside objective space
– Autoscopy is the experience of seeing oneself
– Reflex hallucination is where a stimulus in one modality produces hallucination in another modality
– Hypnopompic hallucinations occur when waking up from sleep.

Long term memory can be categorized into five functions: Registration, Retention, Retrieval, Recall, and Recognition. Memory issues can arise in any of these areas. Retrieval refers to the ability to retrieve stored information from memory, and its loss indicates an organic cause. Registration involves the ability to add new information to the memory store, which can occur through repeated exposure of a single presentation. Retention refers to the ability to store information that can be retrieved later. Recall is the act of bringing stored information back into consciousness at a specific time. Recognition is the feeling of familiarity that accompanies the retrieval of stored information, and while it is related to memory, it is not strictly a part of the memory process.

Common Behavioral Symptoms in Dementia

Perseveration is a behavior where a person repeatedly carries out an action beyond its normal usefulness. This behavior is often observed in individuals with dementia. Another behavior seen in dementia is Ambitendency, where a person alternates between two different actions. Echopraxia is an automatic imitation of the interviewer’s movement, even when asked not to. Mannerism is a repetitive action that appears to have some functional significance, such as saluting. Lastly, stereotypy is a repeated, regular movement that appears to have no significance. These behaviors can be challenging for caregivers to manage and may require specialized interventions.

– Functional hallucination requires an external stimulus to provoke the hallucination
– The normal perception and hallucination are in the same modality
– Example: sound of the boiler triggers auditory hallucinations
– Extracampine hallucinations occur outside of one’s sensory field
– Reflex hallucination is when a stimulus in one modality produces hallucination in another
– Reflex hallucination is a form of synaesthesia
– Third person auditory hallucination is when a person hears voices talking about them as a third person.

Culture-bound disorders are mental health conditions that are specific to certain cultural settings and may be related to other diagnostic categories such as anxiety disorders of psychosis. Examples of these disorders include windigo and brain fag, which are depressive states, latah and piblokto, which are hysterical states, and amok, which is a dissociative state.

Brain fag is commonly observed in West African students and is a reaction to extreme stress, often related to school work. Symptoms include difficulty concentrating, memory problems, low mood, and sometimes pain around the head and neck, and blurred vision.

Amok is a dissociative state that is more prevalent in Malaysia. It is characterized by symptoms such as neurasthenia, depersonalization, rage, automatism, and violent acts.

Latah is a condition similar to Tourette’s syndrome, where an exaggerated startle response leads to abnormal behavior such as screaming, cursing, dancing movements, and uncontrollable laughter. Upon provocation, affected individuals may also shout obscene utterances, imitate a word, gesture, of action, of automatically obey commands that they would not normally follow.

Piblokto, traditionally found among Eskimo women, presents with attacks of screaming, crying, and running naked through the snow.

Wendigo is a depressive condition characterized by the delusion that one has become cannibalistic. It is mostly observed in Native Americans.

Delusional perceptions involve attaching a delusional meaning to an accurate perception, which can feel like a significant realization. This differs from interpreting accurate perceptions in a way that aligns with pre-existing delusions. These perceptions are considered a primary symptom.

When a patient exhibits verbigeration, it can be a sign of loosening of association, which can also be seen in severe expressive aphasia and sometimes in schizophrenia. Knight’s move thinking is another example of loosening of associations, where the patient transitions from one topic to another without any logical connection. Neologisms are words of phrases created by the patient to describe their experiences, often related to their illness. Overinclusion is when the patient expands the boundaries of concepts, grouping things together that are not normally associated. Talking past the point, of vorbeireden, is when the patient seems to be approaching the end of a topic but never actually reaches it.

Mitgehen, also known as the ‘anglepoise sign’, refers to a phenomenon where a patient moves in response to very slight pressure, indicating a lack of resistance of rigidity in their muscles. This can be observed in various conditions, including Parkinson’s disease and catatonia.

Psychiatric Syndromes

Couvade syndrome, also known as sympathetic pregnancy, is a conversion disorder that affects expectant fathers. It is characterized by the experience of physical symptoms of pregnancy. This is not a delusion, as the individual does not believe they are pregnant. Epidemiology, such as prevalence rates, may be useful in understanding this syndrome.

Capgras syndrome is a delusional misidentification syndrome in which an individual believes that a familiar person has been replaced by an imposter.

Cotard’s syndrome is a condition characterized by nihilistic delusions, such as the belief that one is dead.

Frégoli syndrome is a delusional misidentification syndrome in which the patient falsely identifies familiar people in strangers.

Koro is a culture-specific syndrome in which the patient believes that their penis is retracting into their abdomen and that they will die as a result.

Affect illusions occur when a person’s mood affects their perception of everyday objects, leading to misinterpretation. These illusions are temporary and can be dispelled with increased attention. Completion illusions occur when the brain fills in incomplete perceptions with extrapolation from previous experiences to create meaning. An example is reading misprints in newspapers as if they were written correctly. Reflex hallucinations occur when a stimulus in one modality produces a hallucination in another modality. Pareidolic illusions involve a mixture of sensory perceptions and imagination, such as seeing faces in clouds.

Types of Shared Psychotic Disorders

There are different types of shared psychotic disorders, also known as folie à deux. Folie induite occurs when one person with psychosis adopts the delusions of another person with psychosis. On the other hand, folie imposée happens when a healthy individual takes on the delusions of a psychotic person. Folie simultanée is when two people with psychotic illnesses develop identical delusions at the same time. Meanwhile, folie communiqué is when a healthy individual eventually adopts the delusions of a person with psychosis after initially resisting them. It is important to note that a healthy individual who mimics the delusions of a psychotic person for attention is not considered to have a delusional disorder.

Auditory Hallucinations: Running Commentary, Audible Thoughts, Thought Broadcast, and Thought Withdrawal

Running commentary is a type of auditory hallucination that is classified as a first rank symptom. Patients who experience running commentary hear voices that comment on their activities. The commentary may occur before, during, of after the patient’s actions.

Audible thoughts are another type of auditory hallucination where patients hear their own thoughts spoken aloud. They may hear people repeating their thoughts out loud just after they have thought them, answering their thoughts, of saying aloud what they are about to think. This can cause their thoughts to repeat the voices they hear.

Thought broadcast is a passivity experience where patients believe that their thoughts are being taken away from their heads and widely broadcast. This is also classified as a first rank symptom.

Thought withdrawal is another type of passivity experience where patients believe that their thoughts are being taken away from their heads against their will.

It is important to note that these symptoms are often associated with schizophrenia and other psychotic disorders. Proper diagnosis and treatment are crucial for managing these symptoms and improving the patient’s quality of life.

A delusion is a false and unwavering belief that is not in line with the individual’s education, cultural of social background. It is held with strong conviction. Erotomania is a type of delusional disorder where the affected person believes that someone, usually of higher status and often a stranger, is in love with them. This disorder is more common in women and can cause them to believe that someone who has no knowledge of their existence is in love with them. Nymphomania is a condition where a woman experiences uncontrollable and excessive sexual desire, while satyriasis is the male equivalent. Morbid jealousy is a disorder that can manifest in various forms, including delusions, overvalued ideas, depressive affect, of anxiety state. With this disorder, a person may believe that their partner is being unfaithful without any of little evidence to support their belief. Grandiose delusion is where a person believes they have supernatural powers of are a famous celebrity, and may think they are involved in secret missions of have connections with wealthy and famous people.

Pareidolic illusions are vivid illusions that can occur from indistinct stimuli, such as seeing a face in the clouds. These illusions are a result of fantasy and vivid visual imagery and can intensify with concentration. Affect illusions arise from a particular mood state and disappear with concentration. Autoscopic hallucinations involve seeing oneself, such as in an out-of-body experience. Charles Bonnet syndrome is a type of hallucination that occurs in elderly people with reduced visual acuity. Complete illusions occur in the context of inattention, where an incomplete stimulus is perceived as complete. For more information, refer to Casey PR and Kelly B’s book, Fish’s Clinical Psychopathology: Signs and Symptoms in Psychiatry.

Formication refers to the sensation of movement under the skin, which can be associated with cocaine abuse and is commonly referred to as the cocaine bug. Autoscopic hallucinations occur when an individual perceives their own body as being projected into external space. Delirium tremens, a symptom of alcohol withdrawal, can cause visual hallucinations such as dark shadows of rats, often appearing as Lilliputian figures.

Hallucinations that occur when falling asleep are called hypnagogic and are typically short and basic, such as simple sounds of flashes of light. Non-complex hallucinations, like sudden noises of brief flashes, are referred to as elementary hallucinations and can happen at any time. Tactile hallucinations are also known as haptic hallucinations. On the other hand, hypnopompic hallucinations are experienced upon waking up. It’s important to note that pseudohallucinations are not related to sleep and do not have the same quality as real perceptions.

Diogenes syndrome is a condition where elderly reclusive individuals, often wealthy and intelligent, exhibit gross self-neglect without necessarily having a psychiatric illness. It is named after an ancient Greek philosopher known for his simple lifestyle. Briquet’s syndrome, now called somatisation syndrome, is a chronic condition where individuals have multiple physical complaints across various systems without any physical cause found. Cotard’s syndrome is a type of psychotic depression in the elderly, characterized by nihilistic and hypochondriacal delusions, along with a depressed mood and either retardation of agitation. Munchausen’s syndrome is a factitious disorder where individuals repeatedly seek medical treatment for false symptoms and history, seemingly motivated by assuming the role of a patient and receiving care.

The German psychiatrist August Cramer coined the term ‘gedankenlautwerden’ to describe the experience of hearing one’s thoughts spoken out loud just before of at the same time as they occur, which is a first rank symptom of schizophrenia. ‘Thought echo’ is another term used to describe the phenomenon of hearing one’s thoughts spoken after they have occurred. ‘Running commentaries’ and ‘thought withdrawal’ are also first rank symptoms of schizophrenia, with the former referring to auditory hallucinations commenting on the patient’s actions and the latter being a delusional belief that thoughts are being taken away from the patient’s mind.

A woman is experiencing an obsessive thought that manifests as persistent imagery, which she cannot control. She tries to suppress the thought, indicating the development of compulsive behavior. She may also experience autoscopic hallucinations, where she sees a hallucinatory double of herself. Compulsions are repetitive behaviors that she uses to alleviate anxiety caused by obsessive experiences, which can be either motor of cognitive. Additionally, she may experience ruminative cognitions, which are repetitive thoughts that do not lead to any conclusion. In some cases, she may also experience thought insertion, where she attributes the source of the image to an external force.

All of the options describe passivity phenomena, which are first rank symptoms. Passivity of volition involves feeling like one’s actions are controlled by someone else. Passivity of impulse is experiencing an urge that originates outside oneself. Thought insertion is the awareness of an alien presence inserting thoughts into one’s mind, which may be accompanied by visceral hallucinations. Somatic passivity is the feeling that someone is controlling things inside one’s body. Passivity of affect involves feeling emotions that originate outside oneself, which is different from incongruity of blunting of affect.