Descriptive Psychopathology: The Signs and Symptoms of ...

58 Section 1: Present, past, and futureTable 3.1. Brain functional systems and their signature psychopathologyFunctional brain systemSignature featuresFrontal lobe circuitsCerebellar-ponsDominant cerebral cortexFrontalTemporalCatatonia, perseverative and stereotypic behaviors;avolitional and disinhibition “frontal lobe” syndromes;basal ganglia signs, obsessive–compulsive behaviors;personality change“Frontal lobe” syndromes; cerebellar motor signsBroca’s and transcortical motor aphasia; frontal lobesyndromesWernicke’s aphasia; psychosensory features; verbal memoryproblemsParietal Transcortical receptive aphasia; Gerstmann’s syndrome; 26astereognosia and graphesthesiaNon-dominant cerebral cortexFrontalLoss of emotional expression (motor aprosodia)Temporal–parietalCapgras and Fregoli syndromes; reduplicative delusionsReceptive aprosodiaVisual–spatial and visual memory problemsPsychosensory features and passivity delusionsStress–response system 27 Melancholia; anxiety disorders; circadian and ultradianrhythm perturbationsHedonistic reward system 28 Alcoholism and substance abuseArousal systemStupor; delirium; sleep disordershave signature signs and symptoms (e.g. localization of stroke by languageimpairment) eliciting different diagnostic considerations (e.g. partial complexseizure foci are more common in the temporal than parietal lobe).Table 3.1 displays functional brain systems associated with psychopathologyand their signature features. The neuroanatomy of the systems overlaps, facilitatingdisease localization. For example, severe psychomotor slowing is seen in bothdepressive illness and basal ganglia disease; the depressed patient, however, willnot have a fine resting tremor, and unless also catatonic, muscle rigidity will notbe present.The recognition of the brain system involved in a patient’s behavioral syndromealters differential diagnosis and thus treatment options. Recognizing the frontallobe avolitional syndrome encourages the prescription of stimulants while avoidingantidepressant agents. 29 Recognizing disturbance in the stress–response system in adepressed patient indicates melancholia and its treatment requirements. Identifying