Descriptive Psychopathology: The Signs and Symptoms of ...

149 Chapter 6: Psychopathology of everyday behavior and general appearancefacial expression is associated with reduced arousal, catatonia, Parkinsonism,depressive stupor, schizophrenia and frontal lobe apathetic syndromes, andmotor aprosodia. The patient with melancholia may have an unwavering gaze,as if staring into an abyss. Patients who are toxic from antipsychotic medicationwill have a blank, stiffened look, with a greasy skin sheen from sebaceous glandhypersecretion. Manic patients will have increased skin turgor and a wide-eyedanimation. Schizophrenics will offer little facial expression and will indifferentlyshift their attention.Body language is an aspect of interpersonal communication. When personsconverse they assume similar postures as their listeners, and these postural behaviorsare considered to have evolved as enhancers of communication and cooperationamong primates. 48 Body language also conveys the person’s emotional stateand aids in the interpretation of facial expression. It is easier for an observer tocorrectly identify a person’s emotional state when facial expression and bodylanguage are congruent. For example, a person who paces vigorously, shouts in alanguage unknown to the observer, and is wide-eyed with clenched jaw and tightfists, is angry. If the same person is laughing rather than shouting, the valence of theperson’s emotional expression is unclear. Body language can convey happiness,sadness, fear, pain, and anger. 49 The importance of body language as an expressionof a patient’s emotional state is recognized by dentists, nurses managing pain inpatients who are cognitively or verbally impaired, clinicians caring for potentiallyviolent patients, psychotherapists, and assessors of psychopathology. 50Intense mood of any valence is a state of heightened arousal, and thus typicallyassociated with increased activity. Anger is also associated with approach behaviors.The angry person stands and assumes the largest posture possible whilelooking directly at the person who may be the target of aggression. Feet are widespaced,hands may be clenched into fists, the upper body may be thrust forward,as is the head and jaw. Manic patients may stand too close to the examiner orprolong eye contact. The fearful person withdraws and will try to appear small,look down and away, and when terrified, tensely huddle. The sad person willslump and also make little eye contact.Hand gesturing during conversation is linked to speech production as thesemovements have overlapping neurologic underpinnings. Speech-related gesturesvary in intensity across cultures and ethnic groups, but hand gesturing duringspeech production is universal and occurs even when the speaker knows that otherscannot see the gestures (e.g. during a phone call). 51 Congenitally blind personsgesture when speaking with each other. 52 Speech-related hand gestures freeze at thesame time speech is disturbed in persons who stutter while non-speech-relatedhand movements continue normally. 53 Speech gesturing is seen in infants, and ishypothesized as an early step in language development and learning. 54 Adults show