Descriptive Psychopathology: The Signs and Symptoms of ...

126 Section 2: The neuropsychiatric evaluation“Has anyone in your family suffered from difficulties similar to yours? Do you recall yourmother or anyone else saying that after your birth or during her pregnancy with you that shehad a depression or other difficulties? Did she or anyone else see a psychiatrist, psychologist orsocial worker for emotional problems? Were they ever treated with medication . . . shocktreatment?” (Details about any illness, treatments and outcomes are then obtained.)Childhood health“How was your health as an infant? Do you recall anyone saying that they were worried aboutyour health? Did anyone say that when you were young you had high fevers and that sometimesthese lead to fits or convulsions?”“Do you recall anyone mentioning to you how old you were when you started walking andtalking? Did they say that they were concerned about how you were progressing as a young kid?”“Do you recall being sick a lot as a child? Were you ever in a hospital as a child? Do you recallhaving Strep throats? Did anyone mention if these were more severe than the usual ones? Didyou have any after-effects from them as far as you recall?”Family and abuseAfter determining the members and their ages, and their relationship to thepatient, 11 helpful questions are:“Can you tell me about your family when you were growing up? . . . How did they get along?”“Were you a happy child? Were you hit or hurt in any way?” (Details are then obtained.)“How long did all that go on?”Head injuryMany patients have had a head injury, but only substantial injuries are associatedwith later behavioral difficulties. A period of unconsciousness greater than 20minsand the presence of abnormal neurologic features immediately after the injurypresage future behavioral disturbances, as does the length of the period of amnesiafollowing the head trauma. The longer the period of this anterograde amnesia, themore severe the brain injury, and the more likely later behavioral problems willoccur. The amnesia occurs because the post-injury brain is not adequately processingand storing new information. 12 The image of this period can be elicited by suchquestions as:“After your injury was there a period of time that you don’t remember well . . . that seemedfuzzy? Did it feel like you were half-asleep? Do people tell you that back then you didn’t seem toremember from one event or conversation to the next? How long did this experience last?”“Have you ever had a head injury where you were knocked out? What happened?”A blow to the head that is damaging (e.g. being hit with a blunt object) producestrauma beneath the impact. In head injury where the head is in motion and hits