Descriptive Psychopathology: The Signs and Symptoms of ...

190 Section 3: Examination domainsabnormalities and encephalitis were the most likely defined etiologies. 167 Manysuch patients, however, have non-specific EEG abnormalities, and a seizure spectrumdisorder has been suggested as an underlying factor in these patients. 168ConclusionAlmost all psychiatric disease is associated with disturbances in motor functioning.Almost all patients with movement disorder also experience behavioraldisturbances. Because the brain’s motor system is extensive, many brain diseasesimpinge on that system, eliciting abnormal motor signs and symptoms. All themotor signs and symptoms detailed above are seen in psychiatric and in neurologicpatients, and this common experience illustrates the artificial nature ofseparating these patient groups as either “neurologic” or “psychiatric”. Thepresence of cerebellar or basal ganglia signs, for example, does not exclude thelikelihood that the patient has other features that warrant a psychiatric diagnosis.The presence of the movement disorder increases that likelihood. The presence ofdepressive illness or psychosis also increases the likelihood that the patient mayalso have a recognized neurologic disorder. Evaluating the motor functioning ofa patient with disturbed behavior thoroughly is essential to diagnosis and treatment.The evaluation of a patient with a movement disorder for the presence ofa behavioral disturbance is also necessary for proper diagnosis and treatment.The identification of co-occurring movement and behavior disorder has diagnosticand treatment implications. The presence of motor features consistent withepilepsy, for example, suggests that if such a patient has a depressive illness orpsychotic disorder, that anticonvulsants might be the best treatment options. Thepresence of catatonic features warns against the rash use of antipsychotic agents.Examining the patient from the three-way view perspective of the motor system(see Chapter 3) may reveal circumscribed disease that radically alters the differentialdiagnosis (e.g. identifying a right-sided subcortical stroke as the etiology ofthe psychotic disorder). The presence of motor signs in a person who chronicallyabuses illicit drugs suggests brain damage that involves higher cognitive functioningand the limits of disposition and behavioral intervention. The emergence ofnew motor features may reflect an adverse medication effect or the harbinger of aprogressive pathophysiology.NOTES1 Alexander Pope: An Essay on Man, cited in Sims (1995, p. 22).2 Taylor (1991).3 Rogers (1985).