Descriptive Psychopathology: The Signs and Symptoms of ...

148 Section 3: Examination domainsTable 6.1. Minor physical anomaliesHeadAbnormal circumference (norm for adult males 21–23inches; for females 20.5–22.5inches)More than one central hair whorl“Electric” hair (remains erect despite combing)Low-set ears (entirely below the plane of the pupils)Malformed or asymmetrical earsClose-set (hypotelorism) or far-set (hypertelorism) eyesAbnormal epicanthic foldsWide-spaced nares and upper lip furrow hinting of subthreshold cleft lipFurrowed tongueHigh arched palate, bifurcated uvulaHands and feetCurved small finger (clinodactyly)Single palmar creaseWide gap between the first and second toeThird toe larger than second toePartial syndactyly of toesSchizophrenic patients and persons with conduct disorder and violent criminalbehavior are found to have such features. Table 6.1 displays the commonly seenminor physical anomalies. 46MannerManner refers to the general characteristic tenor of the patient’s interactions withthe examiner. The degree of cooperativeness is noted. Suspiciousness and hostilitysuggests delusional thinking or lack of candor. 47 Indifference to the examinationdespite obvious dysfunction suggests apathy or avolition, or denial of illness.Failure to make eye contact is seen in depression, catatonia, and autistic spectrumdisorders. Over-eager persistent questions and demands (importunate behavior)is seen in mania and other frontal lobe disinhibited syndromes. When associatedwith agitation, importunate behavior suggests depressive illness. The process ofpersonality assessment begins by broadly characterizing the patient’s temperament(e.g. mild mannered, shy, outgoing).Gestures, facial expression and body languageAs people converse they also communicate non-verbally. Facial expressionchanges with mood. The norm is modest variability during social interaction.An expressionless face throughout most of an evaluation is abnormal. Reduced