Descriptive Psychopathology: The Signs and Symptoms of ...

xiPreface“lumpers” and “splitters” that led to present classifications. We next show that the“mental status examination” is better considered the “behavioral examination ofthe brain”. The limited neuroscience of psychopathology is presented.In Section 2, we describe the principles of diagnosis, and detail the examinationstyle, structure, and techniques.In Section 3, we define and describe psychopathology that goes beyond thatfound in present classification manuals, and show how the identification ofthese phenomena is of diagnostic importance. We present the behavioral domainsof the examination in the order commonly addressed clinically. We start withchapters on general appearance, motor behavior, and emotion, areas of theassessment that rely heavily on inspection rather than extensive conversation.In the chapter on motor disturbances we also delineate catatonia, and distinguishthe motor disturbances of basal ganglia, cerebellar and frontal circuitrydisease. We describe the differences in the speech and language problems encounteredin patients with aphasia, mania, catatonia, and the “formal thought disorder”associated with psychosis. In the discussion of perceptual disturbances we detailthe phenomena associated with temporal–limbic disease. We discuss delusionsand aspects of abnormal thought content. The spectrum of obsessive–compulsivebehaviors is presented as a more coherent picture than the present scatteringof related conditions throughout classification. We detail the behaviors andcognitive impairment patterns of patients with delirium and different forms ofdementia. We describe the dimensional structure of personality and personalitydisorder and how this approach is more productive than the present categoricalsystem in predicting co-morbidities and in shaping behavioral treatments.Lastly, in Section 4, we propose a re-structuring of present-day classificationbased on the psychopathology literature and its validating data. Our goal is tore-establish the best of the past within the framework of modern insights intobrain function and psychopathology.Nevertheless, present-day psychiatry retains much ambiguity. There are nolaboratory tests that define psychiatric illness to the precision achieved in identifyingspecific strains of a virus or the number of trinucleotide repeats in a geneticallybased illness. Sustained pleasure for the psychiatric clinician must come fromexamining and making sense of diverse psychopathological expressions of illnessand the satisfaction from using that understanding to shape treatments andresolve distress. “Figuring it out” and “getting all better” patients with complexpatterns of psychopathology are experiences that sustain clinical practice. Tellingthe distraught mother and sister of an 18-year-old man who had been hospitalizedfor “encephalitis” and was considered “a hopeless case”, but who in fact hada mood disorder and malignant catatonia that “We’re going to get him all better,not just a little better” and then doing it, finally watching the previously mute