Descriptive Psychopathology: The Signs and Symptoms of ...

111 Chapter 5: Examination style, structure, and techniqueTable 5.1. Behavioral domains in the neuropsychiatric examinationDomainGeneral appearance andsocialization behaviorMotor behaviorEmotional expression andvolitionSpeech and languagePerceptual disturbancesDelusional phenomena andthought contentCognitive functioningPersonalityConsiderationsGender, age, ethnicity, body habitus, level of arousal,manner, hygiene, grooming and dress; species-specific,gender-specific, culture-specific, and contextually specificsocial behaviorsActivity, gait, motor regulation and catatonia, dystonia,dyskinesia, dyspraxia, compulsions and other perseverativeactions and movements, basal ganglia and cerebellarsymptomsVolition, emotional expression, prosody, mood lability,intensity and appropriatenessConversational speech, articulation, speech production andorganization, cortical and subcortical aphasia, reading andwriting, speech organization, formal thought disorderDistortions and psychosensory features, illusions,hallucinationsSuicidal and violent thoughts, culturally deviant ideas,over-valued ideas, obsessions, delusional mood, primaryand secondary delusional ideas, delusional perceptions,delusional memories, confabulation and fantasticconfabulationLevel of arousal, concentration, executive functions, cognitiveflexibility, ideational fluency, thinking and problemsolving, visual–spatial function, verbal and visual memory,procedural memoryDimensional trait behaviors (e.g. persistence,reward dependence, harm avoidance, novelty seeking)15 follow the sequence of the examination from behavioral domains that focuson observation and inspection through those that require more intrusiveinteractions (Table 5.1).Although each domain of the examination is systematically covered, the examinationbegins with what is most appropriate under the clinical setting and the acuity ofthe situation. A calm, alert, and cooperative patient will respond to a matter-of-factintroduction followed by “What’s been happening that has brought you here today?”A modestly anxious patient can feel some relief from the recognition of that anxietyfrom an opening comment such as “I know this is an upsetting situation and thatyou’re nervous, but tell me what has been going on that has led to . . . ”. Specifictechniques are needed for the severely anxious, agitated, or psychotic patient.