Descriptive Psychopathology: The Signs and Symptoms of ...

124 Section 2: The neuropsychiatric evaluation“Are you a restless sleeper? Do you kick off the bed covers?”“Do you ever have sudden sleep-like experiences during the day? Are you fully alert duringthese periods? What have people said that you do during these periods?”The time of night difficulties occur has diagnostic implications. Non-REMdisorders tend to occur in the first third of the night. Patients with non-melancholicdepression often have initial insomnia, but then may sleep through their alarm.Patients with melancholia have delayed sleep onset (>20mins) and reduced REMlatency (their first REM period occurs shortly after sleep onset). They do not haverestorative sleep and wake anxious, sweaty, and with tachycardia. Questioningassesses these details.Migraine and cluster headache 6“Do you have frequent severe headaches? ...Howoften do these occur? ...Howlong do theylast? . . . Do you have any warning that you are going to get a headache (e.g. odd skin sensationof the headache spot, stuffy nose on the side of the headache onset)?”“Where on your head do the headaches begin? . . . Does your vision change with theheadache (e.g. seeing a herringbone pattern, shimmering lights, arcs of light)? Do you experiencethe visual symptoms you’ve told me about at times when you don’t have a headache? . . .Have you ever had sudden, but temporary loss of full vision (tunnel vision, loss of acuity,everything looking grey)?”“Do the headaches come in bunches? . . . Is there anytime of the year when they are morelikely to occur?” (the weeks around the summer solstice is a peak).“Is there anything you’ve noticed that triggers a headache (e.g. late luteal phase of menstrualcycle, long exposure to strong florescent light, frequent or long air flight)?”Seizure disorder 7“Have you ever had ‘blackout spells’, or episodes were you couldn’t account for a short periodof time? ...Haveyouever found yourself someplace where you didn’t remember how you gotthere (in a different room in the house than remembered, in a building, but only recalling beingin the street or parking lot outside the building)?”“Have people told you that you have ‘spells’ you don’t remember where you seem ‘spaced out’or unresponsive or where you do something odd or some repeated action? . . . Have you ever had‘fits’ where you pass out and fall, injuring yourself? . . . Have you ever had ‘fits’ were you were toldyour arms and legs were shaking, or where you lost control or your bladder, or bit your tongue?” 8Cognitive decline 9“Of late have you been worried about your memory? ...Haveyour friends or family expressedconcerns about your memory? ...Howhasyour concentration been? ...Haveyourecentlyhad more trouble than you expected learning something you wanted to know?”