Descriptive Psychopathology: The Signs and Symptoms of ...

128 Section 2: The neuropsychiatric evaluationbecause they have never thought of stopping. The DSM approach also elicitstoo many false negative conclusions. 18 Alcoholism is defined when the patientcontinues to drink heavily despite health, employment, or interpersonal difficultiesdirectly related to the consumption of alcohol. Assessment is directed to theamount (estimate ounces) consumed daily and the potential consequences.A person who continues to work, has never been arrested for public intoxicationor for driving under the influence of alcohol, and who only drinks at night afterwork, but does so daily to frequent intoxication is an alcoholic, and will ultimatelyhave alcohol-related health and other problems.Illicit drugs: a patient’s use of illicit drugs is a threefold problem. Illicit drug useis a crime that carries heavy legal penalties. Illicit drug use can cause braindamage (e.g. white matter small vascular-related bradyphrenia and executivefunction decline from prolonged cocaine use, recurrent chronic psychotic disorderfrom hallucinogen use, and basal ganglia dysfunction and movement disorder fromecstasy) and other health problems (e.g. fatal arrhythmia, stroke, seizure, andplacenta previa from cocaine use, chronic obstructive pulmonary disease (COPD)from heavy cannabis use). Illicit drug use also interferes with all psychiatrictreatments leading to non-compliance, and has adverse pharmacodynamic effectsfor drug therapies. 19 Questioning focuses on the age of onset of use, approximatefrequency of use, and acute adverse reactions from use. The earlier the onset, theheavier the use, the more severe the adverse reaction, the more likely the patient’spresent illness is related to brain dysfunction from illicit drugs. Substances thatare specifically addressed are: LSD, PCP, cocaine and crack, ecstasy, methamphetamine,volatile solvents, opiates and opioids, hallucinogenic mushrooms,mescaline and other organic hallucinogens, and cannabis.NOTES1 Taylor and Fink ( 2006), chapters 1–4.2 Goodwin and Jamison (1990).3 Taylor (1999), chapter 9.4 Taylor (1999), chapter 16.5 A quick assessment of the quality of a couple’s relationship is the manner used to awaken thesnorer. It ranges from a gentle pat or shake to kicking and punching.6 Taylor (1999), chapter 16.7 Taylor (1999), chapter 10.8 Although tongue biting and urinary incontinence are consistent with a grand mal seizure,they do not always occur with generalized seizures. They almost never occur with ECT,although a generalized brain seizure is induced.9 Taylor (1999), chapter 12.