Descriptive Psychopathology: The Signs and Symptoms of ...

67 Chapter 3: The brain and psychopathologyTable 3.4. Psychopathology and lateralized cerebral hemisphere diseaseLeft (dominant) cerebralhemisphere diseaseAvolition, apathy and depressive-likesyndromes with anterior hemispherediseaseSpeech and language problems; formalthought disorderPathological crying (with ablating lesions)Right-sided catatonic featuresRight (non-dominant) cerebralhemisphere diseaseLoss of emotional expression (motoraprosodia)Denial of illness (anosagnosia); minimizingthe illness (anosodiaphoria); the delusion of adoppelgänger (a double)Experiences of alienation and controlCapgras and Fregoli misidentificationdelusional syndromes (prosopagnosia)Reduplicative delusions (reduplicativeparamnesia)Left-sided catatonic featuresFantastic confabulationsEating disorders 73patient is more likely to have risk factors for depressive illness and co-occurringmood disorder. 72 Table 3.4 displays some of the associations between left andright hemisphere disease and psychopathology.Motor system functioning and psychopathologyThe motor system is a dominant feature of the brain. Composed of several units,it elicits whole-body, limb, and skilled movements, particularly of the hand andfingers. Normal movement also requires adequate sensory input that permits therecognition and localization of one’s body parts. 74The spinal cord and brainstem convey the elements of simple and complexmovements, reflexes, and motor sequences. Although disease in these structures istypically the focus of neurologists and rehabilitation specialists, their assessmentis part of a thorough behavioral examination, and many psychopathological motorfeatures are understood only after determining that the patient has adequatebrainstem–spinal cord–peripheral nerve functioning.Diseases of the brainstem disrupt the essential human behaviors of posture andwalking, feeding and drinking, sleeping and waking, and sexual behaviors. Spinalcord and peripheral nerve dysfunction are features in many nervous system diseasesthat are mistaken for psychiatric disorder (e.g. conversion disorder, chronic pain).Assessing gait, muscle strength, vibratory sense and touch characterizes nervoussystem function to this level.