Lecture no.

3
1 Semiology
1.1 Motivational-affective
1.2 Volition and activity
1.3 Relational behavior
2 Paraclinic explorations in
psychiatry
 Content
1 Semiology:
1.1 Motivational-affective functions:
– Motivation
– Instincts
– Emotions
– Mood
– Feelings
– Passions
1.2 Effective functions:
– Volition and activity
1.3 Synthetic group
– Temperament
– Character
– Personality
2 Paraclinic explorations in psychiatry
– Ophthalmologic examination
– Electroencephalography
– Neuroradiology
– Biochemistry
– Genetics
– Psychology
– Other procedures used to investigate the neurologic system
 1.1 Motivational-affective functions
• Motivation = internal factor guiding behavior
using:
– Impulses
– Needs
– Tendencies
– Goal-achieving
• Pathologic motivation (as a consequence of
hallucinations): “I locked all the doors and I hided
myself under the table. I knew they were coming
for me because I was hearing them.”
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 1.1 Motivational-affective functions
• Instincts = psychological functions related to the
unconscious, unconditioned mind, necessary for
survival
– Alimentary
• Quantitative – ↓anorexia, ↑ bulimia
• Qualitative – pica, opsomania (sugar), dipsomania (alcohol),
potomania (liquids)
– Sexual
• Quantitative – ↑nymphomania, ↑ satyriasis, ↓ impotence,
↓ frigidity
• Qualitative – paraphilias, geronto/pedophilia,
exhibitionism/voyeurism, sadomasochism, zoophilia,
necrophilia
• Can be related to the object/person giving pleasure
(pedophilia) or the manner in which pleasure is achieved
(exhibitionism)
1.1 Motivational-affective functions
Instincts
– Defense
• ↑Aggression (verbal/physical), hypochondria
• ↓ Self-mutilation, suicide attempts/ realized suicide/
parasuicidal attempts (cries for attention)
– Social
• ↑ Extroverted
• ↓ Introverted, antisocial behavior
– Maternal
• ↑ Overprotectiveness (child may develop schizoid
symptoms)
• ↓ Neglect (may even lead to violence against the
child/abandon)
 1.1 Motivational-affective functions
• Emotions = reactions to specific stimuli causing spikes in
mood; they are transient.
– E.g. sadness, euphoria
• Sentiments (feelings) = attitudes related to social situation
– affective stimulus associated with neurovegetative
stimuli; more complex than emotions, last longer than the
action of the stimuli.
• Passion = long-term motivation with a goal to be reached
– Static – no adjustment according to the situation (e.g.
alcoholics)
– Dynamic – goals are flexible and can be adjusted according to
the situation
• Qualitative alteration of affect:
– Affective ambivalence – coexistence of two opposite feelings
manifested toward the same person (e.g. hate an love)
– Affective inversion – reaction of hostility manifested by the
patient toward a person who he used to love
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 1.1 Motivational-affective functions
• Mood = state of mind – a diffuse projection (over the
grey matter) of the total number of specific and non-
specific stimuli; it is affected by external/internal
stimuli, e.g. sunlight/seasons, hormones, glycemia, life
events.
– Disthymia – “dis” = nonspecific alteration of mood
– Cyclothymia = alternation of hypo/hyperthymia (aprox. 3
weeks each of them), with no connection to the life events
– Intensity: euthymia, ↑Hyperthymia/ ↓hypothymia,
blunted affect
– Polarity: positive/negative
• depressive episode, major depressive disorder – negative
hyperthymia;
• manic episode, bipolar disorder – positive hyperthymia;
• schizoaffective manic episode – positive hypothimia;
• schizoaffective depressive episode – negative hypothymia.
1.1 Motivational-affective functions
 1.2 Effective functions
• Volition (will) = psychological process that
transforms ideas into behavior (action or non-
action); requires energy – activatory (for
movements, thinking) or inhibitory (to restrain
from moving)
– Quantitative:
• Avolitia/abulia (no will - dementia)
• Hypovolition/hypobulia (depression)
• Hypervolition/hypobulia (paranoia, OCD – obsessive
compulsive disorder)
– Qualitative:
• Parabulia (cannot finalize an action but starts many - mania)
• Dysabulia (wants to do many actions but can’t decide which
one to follow – neurosis, anxiety)
• Impulsivity (psychopathy)
 1.2 Effective functions
• Activity = psychological process related to
biological, psychological and social aspects
• Motor behavior – self care, autonomy (↓ in dementia,
oligophrenia);
• Sleep = activity of recovering
– 90% of the psychiatric diseases include sleep
disturbances;
– Quantitative:
• Insomnia: difficulty falling asleep (anxiety), middle insomnia
(not specific), terminal (depression, alcohol abuse);
• Hypersomnia (depression).
– Qualitative: parasomnias – pavor, somnambulism,
nightmares (see Lecture no. 10)
1.2 Effective functions
 1.3 Synthetic group
• Temperament = totality of attributes that
express the ability of a system to rebalance;
innate and unchangeable.
– Phenotypes (Kretschmer – each of these body
types was associated with certain personality
traits):
• Pyknic
• Athletic
• Asthenic
• Dysmorphic
1.3 Synthetic group - temperament
1.3 Synthetic group - temperament
 1.3 Synthetic group
• Character – part of the personality which is
changeable, depending on education, social
values, principles and morals – family,
legislation, religion, school;
– Can be affected by trauma and life events –
psychotherapy;
– Habit-related.
• Personality – the “mask” – filters what is showed
to others – flexibility, dynamic
– Desanimation (one can’t recognize his own
psychological attributes no more – personality
disorder);
– Desomatization (one can’t recognize his own physical
attributes any more - hallucinations ).
 1.3 Synthetic group
• Intellect – academic and emotional
– IQ measures the ability to process thoughts
– EQ has 4 components:
• to recognize one’s own feelings;
• to cope with one’s own feelings;
• to recognize other’s feelings;
• to cope with other’s feelings.
– Recommended book: Daniel Goleman – “Emotional
Intelligence”
• Consciousness – establishment of an identity and the
limits between self and non-self;
– Orientation = spatial and temporal awareness
(autoorientation and alloorientation)
– Quantitative: dullness (obnubilation - drunkenness),
dizziness (disorientation), stupor, torpor (reaction
unconnected to stimulus), coma.
– Qualitative: habitude, onerate state, twilight, delirium,
amantive
2 Paraclinic explorations in psychiatry
• Ophthalmologic examination – if signs/symptoms
are present:
• Frequent symptoms: scotoma, hemianopia, diplopia,
photopsia, metamorphopsia
• Visual acuity: the eye's ability to detect fine details; the
quantitative measure of the eye's ability to see an in-focus
image at a certain distance.
• Visual field: confrontation field testing in which each eye
is tested separately to assess the extent of the peripheral
field.
• Ophthalmoscopy:
– In arterial hypertension, hypertensive changes of the retina
closely mimic those in the brain, and may predict cerebrovascular
accidents;
– It is used to detect and evaluate symptoms of various retinal
vascular diseases or eye diseases such as glaucoma.
2 Paraclinic explorations in psychiatry
• Electroencephalography – EEG measures voltage
fluctuations resulting from ionic current within the
neurons of the brain.
• Differential diagnosis between psychiatric disorders
and neurologic diseases :
• Epilepsy
• Brain tumors;
• Cerebrovascular accidents;
• Degenerative neurological diseses.
2 Paraclinic explorations in psychiatry
• Neuroradiology
• Computer Tomography (CT):
– used to detect brain tumors, cerebrovascular
accidents that can determine a psychiatric
disorder;
– E.g.: first psychotic episode, first affective
episode (>50 years old), personality alterations
(>50 years old), focal neurological signs,
abnormal EEG, alcohol abuse;
• Magnetic Resonance Imaging (MRI):
– The same indications as CT;
2 Paraclinic explorations in psychiatry
• Biochemistry and Hematology:
• Anorexia and bulimia can lead to modified ion levels;
• Hypocalcaemia can lead to depression, irritability;
• Hypomagnesemia can lead to agitation, convulsions.
• ↑creatine phosphokinase (CPK) can be found in:
– Neuroleptic malignant syndrome;
– Drugs abuse;
– Dystonia (determed by neuroleptics);
• ↑ Urine urea: patients treated with Litium, dehidrated
patients;
2 Paraclinic explorations in psychiatry
• Genetics: Data about a patient’s genetic profile can increase
the ability to select a medication that is more likely to be
effective and less likely to cause side effects.
• E.g.:
– CYP2D6, CYP1A2, CYP2C9, CYP2C19, CYP3A4 and others -
Metabolism of medications (elimination or in some cases
activation) – Blood levels that may be significantly higher or
lower than predicted based on dose
– SLC6A4 - Serotonin Transporter Gene (target for serotonin
reuptake inhibitors) - Short form of the allele produces fewer
receptors and is associated with lower remission rates
– HTR2A - Serotonin 2A receptor - Variant can increase risk of
drug reaction with serotonin reuptake inhibitors
– COMT - Enzyme involved in metabolism of dopamine -
Differing response rates to some stimulant medications
2 Paraclinic explorations in psychiatry
• Psychological and psychiatrical tests:
• IQ – Wechsler, Stanford-Binet;
• Personality – Eysenk, MMPI (Minnessota Multiphasic
Personality Inventory);
• Impulsivity – BDHI (Buss-Durkee Hostility Inventory);
• Life-quality – QOLI (Lehman Quality of Life Interview);
• Suicidal risk – BSS (Beck Scale for Suicide Ideation);
• Substance abuse – ASI (Addiction Severity Index);
• Functional level – GAF (Global Assesment of Functioning
Scale);
• Mania – YMRS (Young Mania Rating Scale);
• Depression – HAM-D (Hamilton Rating Scale for
Depression);
2 Paraclinic explorations in psychiatry
• Other procedures used to investigate the
neurologic system
• Endocrine tests: prolactine, thyroid
function, grouth hormone, sexual
hormones;
• Noradrenaline and serotonin plasmatic
levels;
• Toxicology: medication, drugs;
• Immunology: infectious diseases,
autoimmune diseases;
• Nutritional tests: vitamins, minerals.
The most important lesson from 83,000
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