Many brain functions, thought processes, and mental processes are examined and questioned: to rule out disorders of consciousness, the function of the senses, orientation, memory and recall, attention, concentration and comprehension, and the ability to behave appropriately to the situation are tested. Quantitative disorders of consciousness such as drowsiness, somnolence, sopor, precoma, and coma, in which consciousness is increasingly impaired, are distinguished from qualitative disorders of consciousness such as delirium and twilight state. Here, hallucinations, anxiety, irritability, or a narrowing of consciousness occur.
Contents of a pathologic finding
- One tests orientation with questions about time, situation, place, and oneself. Especially in organic brain diseases such as Alzheimer’s dementia, the orientation increasingly decreases and in the order mentioned above: information about the own person is possible the longest.
- Attention, concentration and comprehension can be tested well with simple tests, for example, with the enumeration of days of the week (forward or backward), spelling longer words or simple arithmetic tasks. A comprehension disorder is when someone has difficulty explaining a familiar saying.
- Memory and recall help us to retain and recall what we have experienced. To test short-term memory, ask the patient to remember several terms (car, house, cake) and ask them a little later. Gaps in long-term memory is discovered when the patient tells his life story chronologically.
- In an amnesia, the memory is missing at a certain time period – paramnesias, on the other hand, are distorted memories (e.g., the well-known déjà vu experience). They can occur in dreams in any person, but also occur in many psychiatric disorders.
- The further psychopathological findings are concerned with thinking and possible thinking disorders, affectivity and drive. Thinking is a process in which a situation or object is grasped and processed. Processing always includes judging, comparing, abstracting, and drawing conclusions. Thinking differs individually in terms of speed, agility and richness of content and is mood-dependent.
- In formal thinking disorders, the process of thinking is disturbed, while in content thinking disorders, the result of thinking is altered. Thinking can be slowed, inhibited, brooding circumstantial or conversely disjointed and too fast – all formal thought disorders – in addition, delusions, compulsions or hallucinations are content thought disorders that massively affect the affected person in his experience and interaction with his environment.
- The delusion is a complex content thought disorder in which persons, memories, ideas, moods and perception are wrongly judged and become life-determining. For the affected person, this reality is uncorrectably correct, he is not able to critically question his ideas. Common themes for delusions are persecutory thoughts, thoughts of guilt and sin, a massive focus on the patient (relationship delusion, “everything happens only because of me”) or love and jealousy.
- Compulsive thoughts or actions are not suppressible impulses, which the affected person very well recognizes as nonsensical or unpleasant, but against which he can not defend himself. Perceptual disorders affect either our sense organs or the interpretation of the sensory impression. The most common perceptual disorder is hallucination, in which a sensory impression occurs without a corresponding stimulus. They can affect any sense, however, for example, visual hallucinations are more common in withdrawal delirium and auditory hallucinations in schizophrenia.
- A disturbance of ego consciousness (“I am myself”) can manifest itself in the fact that the affected person feels that his thoughts and will are influenced from the outside, this severe disturbance is common in schizophrenia. In addition, a feeling of alienation is also possible (“I perceive everything as if in a fog”) – a feeling that can also occur in any healthy person when overtired and under stress.
- Affectivity describes the entire emotional life of a person – both the ability to feel emotions, to adapt them adequately to the situation, and the ability not to change a mood inappropriately can be disturbed. Other disorders of emotional life are anxiety, panic and phobias, which can cause increasing isolation of the affected person and often show vegetative symptoms such as rapid heartbeat, tremors or sweating.
- The drive is the basic activity of each person, individually different and manifests itself in initiative, drive, drive and attention with which one pursues a particular goal. Visible is the drive, among other things, in the motor activity, which, depending on the disorder, can be slowed, inhibited, but also increased and disinhibited. Inhibition of drive is a common symptom in depressive disorders.
Almost all formal and content thought disorders – exceptions are delusions and often hallucinations – are perceived by the affected person. He can compare the course of his thought processes with that of healthy phases of life and name the sometimes very stressful changes.
