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Ministry of Health of Ukraine Bukovynian State Medical University




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Ministry of Health of Ukraine

Bukovynian State Medical University


“Approved”

on the methodical meeting

of the Department of neurology, psychiatry

and medical psychology nm. S.M.Savenko

“____” ___________ 2009 (Report № __).

Chief of the Department

_______________________

Professor V.M. Pashkovsky


Methodical INSTRUCTION

for 4-th year students of medical faculty №2

(the speciality “medical affair”)

for independent work during preparing to practical class


Theme 6: Thoughts and intellect disorders


MODULE 1. GENERAL QUESTIONS OF PSYCHIATRY AND NARCOLOGY. GENERAL PSYCHOPATHOLOGY


Topical module 2. General psychopathology


Сhernivtsi, 2009


1. Actuality Aim

The high degree of cognition is thought. Thought is the higher form of reflection of reality. Due to thought the level of judgements is provided about facts, their generalizations, accumulations of knowledges, hypothesizing, theories, tasks which are put by society and personality decide.

^ An intellect is a capacity of man for using the operations of thought: an analysis, synthesis, comparison, abstraction, specification, generalization.

At psychical disorders and somatic illnesses disorders of thought take place. The flow of ideas, their maintenance, changes. It is important for doctors, find out symptoms and syndromes of disorders of thought and intellect which will allow in good time to propose a diagnosis and appoint adequate treatment.


^ 2. EDUCATIONAL PURPOSE

2.1.A student must know:

  1. Determination of thought.

  2. Operations of thought.

  3. Classification of thought disorders

  4. Types of intellect disorders.

  5. Classification and clinical signs of dementia.

  6. Classification and clinical symptoms of mental retardation depending on a degree.

  7. Criteria of diagnostics of mental retardation.

^ 2.2. A student must be able:

  1. To diagnose symptoms of thought disorders.

  2. To diagnose syndromes of thought disorders.

  3. To conduct the differential diagnosis of delusions.

  4. To find out the decline of intellect as a result of psychical disorders.

  5. To differentiate the different types of dementia.

  6. To diagnose a mental retardation.

  7. To conduct the differential diagnosis of easy and moderate mental retardation.

^ 2.3. To seize practical skills.

  1. To ask the data of anamnesis in patients with thought and intellect disorders.

  2. To conduct the clinical examination of patient with thought and intellect disorders.

  3. To define the type of thought disorder.

  4. To define the type of speech disorders.

  5. To diagnose delusions.

  6. To define the level of intellect in mentally patients.

  7. To diagnose the type of dementia.

  8. To diagnose a mental retardation.

  9. Able to direct mentally ill patient to psychiatry clinic.


^ 3. EDUCATE PURPOSE.

On practical employment a teacher notice for students that the thought develops in the conditions of intercourse, studies, labour. It is underlined that thought and intellect disorders are possible as a result of the negative factors carried in childhood, which result to organic changes in a cerebrum, which, in the turn, result in thought and intellect disorders.

Come into special notice for students about development of clinical thought of doctor and his value in a diagnostically-medical process.


^ 4. INTERSUBJECT INTEGRATION (base level of preparation).


Names of previous disciplines

Skills are got

1. Anatomy.


2. Physiology.


3. General psychology.



  1. To know an anatomy and topographical anatomy of cerebrum.

  2. To know the basic cork functions of cerebrum. Able to define the type of higher nervous activity.

  3. To know psychology of thought and intellect.


^ 5. CONTENTS OF THEME.


Disorders of thought

Disturbances in speech.

1. Pressure of speech: rapid speech that is increased in amount and difficult to interrupt.

2. Volubility (logorrhea): copious, coherent, logical speech.

3. Poverty of speech: restriction in the amount of speech used; replies may be monosyllabic.

4. Nonspontaneous speech: verbal responses given only when asked or spoken to directly; no self-initiation of speech.


5. Poverty of content of speech: speech that is adequate in amount but conveys little information because of vagueness, emptiness, or stereotyped phrases.

6. Dysprosody: loss of normal speech melody (called prosody).

7. Dysarthria: difficulty in articulation, not in word finding or in grammar.

8. Excessively loud or soft speech: loss of modulation of normal speech volume; may reflect a variety of pathological conditions ranging from psychosis to depression to deafness.

9. Stuttering: frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency.

10. Cluttering: erratic and dysrhythmic speech, consisting of rapid and jerky spurts.

B. Aphasic disturbances: disturbances in language output.

1. Motor aphasia: disturbance of speech caused by a cognitive disorder in which understanding remains but ability to speak is grossly impaired; halting, laborious, and inaccurate speech (also known as Broca's, nonfluent, and expressive aphasia).

2. Sensory aphasia: organic loss of ability to comprehend the meaning of words; fluid and spontaneous but incoherent and nonsensical speech (also known as Wernicke's, fluent, and receptive aphasia).

3. Nominal aphasia: difficulty in finding correct name for an object (also termed anomia and amnestic aphasia).

4. Syntactical aphasia: inability to arrange words in proper sequence.

5. Jargon aphasia: words produced are totally neologistic; nonsense words repeated with various intonations and inflections.

6. Global aphasia: combination of a grossly non-fluent aphasia and a severe fluent aphasia.

7. Alogia: inability to speak because of a mental deficiency or an episode of dementia.

8. Copropregia: involuntary use of vulgar or obscene language; seen in Tourette's disorder and some cases of schizophrenia.


Disorders of intellect

An intellect is a capacity of man for using the operations of thought, ability to apply the purchased knowledge and experience in practical activity, to get to essence of things and phenomena of environment, select a main link in the difficult chain of connections and accumulate new knowledge and experience.

Violations of intellectual activity at psychical diseases are various enough. The states which insufficiency of intellect is named dementia (if purchased ) and mental retardation (if born).

Dementia is characterized the proof decline of cognitive activity of man.

Partial dementia is characterized the partial defects of intellect as a result of decline of memory. A man have difficulties at the operations of thought. At vascular diseases, cranial-cerebral traumas, syphilitic defeats of cerebrum.

Total dementia appears the decline of all forms of cognitive activity. A patient loses ability to use the operations of thought, critically to estimate the state, acts, and also outward things. There is a global decline of intellection with disintegration of kernel of personality. A patient needs examination and supervision. Total dementia develops at a dotage, progressive paralysis, illnesses of Al'tsgeymera, Lance and other.

Concentric (epileptic) dementia is characterized gradual psychical degradation of personality with the loss of flexibility of thought due to the decline of capacity for using the operations of thought. Thought becomes viscid, gone into detail. Attention of patients is concentrated on own necessities, mainly biological. Observed at epilepsy.

Schizophrenic dementia is characterized the weakness of cognitive processes, by propensity to progress. Patient not able to use the operations of thought not due to violation of memory or loss of knowledges and abilities, but as a result of dissociation of psychical processes. At schizophrenia.

Oligophrenia (born mental retardation)

A general sign there is a presence of born retardation with predominance of intellectual insufficiency.

General signs:

  1. An abnormal psychology structure with totality of psychical retardation and predominance of weakness of abstract thought.

  2. Stable state of intellectual insufficiency.

  3. The rate of psychical development of individual is slow.

After the degree of psychical retardation and clinical picture select such forms:

easy mental backwardness (JQ in a range 50-69);

moderate mental backwardness (JQ – 35-49);

heavy mental backwardness (JQ – 20-34);

deep mental backwardness (JQ below 20).

Students on the basic stage of employment independently under the direction of teacher inspect mentally patients with disorders of thought and intellect. Independently collect information of anamnesises, find out quantitative and high-quality violations of thought. Diagnose disorders of intellect, conduct experimentally-psychological researches.

With the purpose of mastering of new knowledges and abilities on this stage of employment the tasks of situations are used and questions, which are executed in writing, checked up a teacher during employments and results come into question, are standardized.


^ 5.1. QUESTIONS OF CONTROLS:

  1. Describe classification of disorders of thought.

  2. Describe raving ideas on maintenance.

  3. Describe raving ideas after a structure.

  4. Give description of disorders of intellect.

  5. Determination of thought.

  6. Operations of thought.

  7. Classification of thought disorders

  8. Types of intellect disorders.

  9. Classification and clinical signs of dementia.

  10. Classification and clinical symptoms of mental retardation depending on a degree.

  11. Criteria of diagnostics of mental retardation.


^ 6. MATERIALS OF METHODICAL PROVIDING OF EMPLOYMENT (MATERIALS OF CONTROL OF BASE (INITIAL LEVEL) PREPARATION OF STUDENTS):

6.1. Additions. Facilities for control:

Questions of controls:

  1. Determination of concepts of «thought» and «intellect».

  2. Classification of disorders of thought.

  3. Disorders of thought on the type of motion of associations.

  4. Disorders of thought after connection of associations.

  5. Determination of concept and classification of sickly ideas.

  6. Raving ideas on maintenance.

  7. Raving ideas are after a structure.

  8. Description of the fixed ideas.

  9. Types of disorders of intellect.

  10. Dementia, their description and classification.

  11. Mental retardation, their description and classification.

  12. Criteria of diagnostics of Mental retardation.

  13. Prophylaxis of Mental retardation.

The tests:

1. The high level of capabilities is named:

A. temperament.

B. character.

C. capability.

D. creation.

*E. talent.


2. A memory disorder in which someone can recall certain information, but they do not know where or how they obtained the information, named:

*A. Retrograde amnesia

B. Gypomnezia.

C. Anterograde amnesia.

D. Traumatic amnesia

E. Lacunar amnesia.


3. A patient actively casts aside ideas about illness and her consequences are possible, estimates the displays of illness as not "serious feelings", that is why renounces an inspection and treatment or limited to "self-treatment". Which type of reacting on illness?

A. Egocentric.

B. Harmonious.

C. Apathetical.

D. Euphoric.

*E. Anosognosia.


4. Purchased organic and global deterioration of intellectual functioning without clouding of consciousness named:

A. Concrete thinking.

B. Abstract thinking.

C. Mental retardation.

*D. Dementia.

E. Pseudodementia.


5. A patient is sure of presence for him of serious illness, constantly concentrated on the sickly feelings, experiencing and continuous talks about illness result in the exaggerated subjective perception of those, that is present and search of pseudo maladies. Desires to treat oneself are combined with disbelief in success. Which type of reacting on illness?

A. Anxiously-depressed.

*B. Hypochondria.

C. Apathetical.

D. Egocentric.

E. Dysphoric.


6. Ability to appreciate nuances of meaning, multidimensional thinking with ability use metaphors and hypotheses appropriately named:

A. Concrete thinking.

*B. Abstract thinking.

C. Mental retardation.

D. Dementia.

E. Volubility.


7. Ability to understand, recall, mobilize, and constructively integrate previous learning in meeting new situations named:

A. Feeling.

B. Perception.

C. Memory.

*D. Intellect.

E. Thought.


8. False belief, based on incorrect experience about external reality, cannot be corrected named:

*A. Delusion.

B. Neologism.

C. Verbigeration.

D. Derailment.

E. Blocking.


9. Literal thinking, limited use of metaphor without understanding of nuances of meaning named:

*A. Concrete thinking.

B. Abstract thinking.

C. Mental retardation.

D. Dementia.

E. Volubility.


10. The inability to recall some memory or memories of the past, beyond ordinary forgetfulness named:

*A. Retrograde amnesia

B. Gypomnezia.

C. Anterograde amnesia.

D. Traumatic amnesia

E. Lacunar amnesia.


11. A psychical process, higher form of creative activity of man through which the most substantial signs of objects and phenomena of the objective world are represented and their intercommunications open up named:

A. Feeling.

B. Perception.

C. Memory.

D. Attention.

*E. Thought.


12. Inborn lack of intellect to a degree in which there is interference with social and vocational performance named:

A. Concrete thinking.

B. Abstract thinking.

*C. Mental retardation.

D. Dementia.

E. Pseudodementia.

Clinical Tasks.


  1. A patient is long time in psychiatric permanent establishment. During hospitalization a linguistic contact is absent, does not execute instruction, indifferent to surrounding to the fate. After the improvement of mental condition told, that he had been among aliens, built with them new civilization both on Earth and in space. The language of patient is un successive, paralogism. Sliding off, neologisms, symbolizing appear.

1. What symptoms of psychical disorder?

2. What illness are they characteristic for?



  1. A patient feels on a body the unpleasant feelings as a result of action of electromagnetic vibrations. This influencing resulted in the loss of ideas («emptiness is in a head»). On the body of patient leaden plates are fixed («for the removal of these influencing»). For a patient execution of motives, desires, emotions.

1. What symptoms of abnormal psychologies?

2. What illness are they characteristic for?


  1. A patient 38 years is in psychiatric permanent establishment. The conduct of him is scornful, haughty. Declares, that he is a «colonel of troops» of rockets and electromagnetic rays which destroy the mews of cerebrum operate on him. «It enemies influence, so as I stand on verge of great discovery, what will change on better habitants of planet».

1. What pathology of psyche?

2. What disorder it is characterise?


  1. A patient declares, that the special vehicles which are «fastened on his chairman and is invisible operate on him». They «do» voices in my head. By these vehicles «they» take away his ideas, manage his motions, actions. «I am an as though walking robot».

1. What symptoms of abnormal psychologies.

2. What states of abnormal psychologies are they characterise for?


  1. The sick grumbles about insomnia, absence of appetite, reduced mood, general weakness. The flow of ideas is slow. Accuses itself: «I hoodoo all, children suffer from me». Expresses opinions about pointlessness of life. An attempt to convince her appeared vain.

1. What disorders of abnormal psychologies?

2. What diseases are they characterise?


  1. Sick, 21years old, student of university, gradually became apathetical, indifferent, progress went down. Feels the action of some force which «interferes with me to study, in a head inlays extraneous ideas, compels something to do». Explaining the state, reasons of sick are not based on the real facts. It is verbal references, that not досяґгають purpose, sterile reasonings, deprived concrete maintenance.

1. What is the state of abnormal psychology?

2. What illness is it characterise?


  1. Patient of 39 years old, doctor. Constantly something writes and the written hides with application. In a linguistic contact enters reluctantly, suspicious. Told a treating doctor, that opened the method of treatment of AIDS, but «all his developments were stolen by the agents of institute of oncology». Convinces a doctor, that kidnappers «hired three killers, to put to death me».

1. What pathology of thoughtis it?

2. What syndrome?


^ 8. LITERATURE IS RECOMMENDED:

8.1. Basic:

  1. Clinical Psychiatry from Synopsis of Psychiatry by H.I.Kaplan, B.J.Sadock. – New York: Williams @ Wilkins. – 1997.

  2. Psychiatry. Course of lectures. – Odessa: The Odessa State Medical University. – 2005. – 336 p.

  3. Lectures.

  4. Internet resource.

8.2. Additional:

  1. Морозов Т.В., Шумский Н.Г. Введение в клиническую психиатрию. – Н.Новгород: Изд-во НГМА, 1998.

  2. Попов Ю.В., Вид В.Д. Современная клиническая психиатрия. – М., 1997.

  3. Сонник Г.Т. Психіатрія: Підручник / Г.Т.Сонник, О.К.Напрєєнко, А.М.Скрипніков. – К.: Здоров’я, 2006.     



Prepared by assistant S.D.Savka

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