Descriptive Psychopathology: The Signs and Symptoms of ...

118 Section 2: The neuropsychiatric evaluationTable 5.7. Big picture illness patternsAge of onset (childhood, adolescence, young adulthood, middle age, >60)Episodic or continuous illnessFrequency of episodes (one, few, intermittent, or many)Changes in course (frequency and length of episodes increasing, form of episodes changing)Inter-episode function (full recoveries, modest decline, substantial decline after early episodes,progressive decline [rapid, slow, step-wise])weaknesses used to shape treatment (e.g. level of education, skill levels, family andfriend supports).Neuropsychiatic illnessLinking questions about past episodes to the patient’s present complaints makesthe effort important for the patient, rather than appearing to be for the examiner’sbenefit. 9 Questioning about personality traits and illness associated withpersonality deviation is detailed in Chapter 14. Questioning about previousepisodes begins with characterizing the big picture:“Have you ever experienced anything like this before? . . . Is this time different in any way? . . . Isthis time the worst? . . . Over the years, have the [characterization of the episode] been gettingmore frequent/longer/more severe? How are things when you are not ill?”Questions determining specific forms of illness are asked next and are presentedin Appendix 5.1. Some lead-in questions are:“I knew a patient who had similar experiences to what you’ve been telling me and at that time[he/she] also experienced . . . ”“When patients have [the patient’s prominent clinical concern], they also experience [theexaminer’s concern]. How about you?”“With all the things that have been happening to you, do they ever affect [the examiner’sconcern]?”Symptom rating scalesSymptom rating scales are used worldwide. Designed primarily to encouragesystematic and thorough collection of clinical information for research, they areused to assess syndrome severity, symptom change over the course of treatment,and as a data source structure to help establish syndrome and subject groupcharacteristics. Their psychometric properties, however, are often more sophisticatedthan their psychopathologic content, and most do not contain most