Descriptive Psychopathology: The Signs and Symptoms of ...

201 Chapter 8: Disturbances in emotional experiencedisease. 18 Such patients have a paucity of ideas and reduced interests, ignoreonce-cherished hobbies and skills, are indifferent to their situation, and take littleinterest in work, interactions with others, or their medical care. When asked whattheir typical day is like they are at a loss to provide details, their days empty ofactivity unless prodded by others. Prodding may lead to irritability and angryoutbursts.A schizophrenic patient when asked what he did on a typical day said “I go andget the paper every morning and bring it back to the house (a halfway facility).”When asked what he liked in the paper he said “I don’t read it.” “What do you dothen?” “I sit in the day room.” Offering no other details, he said he was not boredand had no desire to do anything else.Such patients offer no plans beyond the next meal or cigarette. They lack longrangegoals, and the plans they mention are unrealistic or never pursued. Oneyoung schizophrenic said his hobby was the guitar. When asked what music heliked to play he responded “Well, I don’t have the guitar yet. I’m thinking ofgetting it.” Another patient with limited education who had been in the hospitalfor several years said he wanted to be a doctor. Another chronically hospitalizedpatient, when asked what his future plans were, said “I’ll get an education.” Hecould not elaborate other than saying “English and things.” Avolitional patientshave a paucity of thoughts and ideas. They cannot elaborate or provide a detailedhistory of their lives or illness.ApathyThe apathetic patient appears listless, does little, makes minimal effort on assignedtasks or needed chores, and is indifferent to his situation. Will and initiative arelost. Abulia is a synonymous term. The minimal expression of emotion maybe distorted. A proposed mechanism is the disruption of emotion-cognitionprocesses so that emotional life no longer drives thinking and the generation ofideas, leading to waning of interests and actions (sometimes referred to as “psychicakinesia”). The inability to generate ideas leads to loss of interest and thushypoactivity. 19Increased emotional expressionSustained and substantially increased intensity in emotional expression is seen inmanic-depressive illness. Brief, but equally intense, emotional expression is seenin panic and phobic disorders, angry outbursts associated with epilepsy, traumaticbrain injury, catastrophic reactions of persons with cognitive disorders,delirium, and in some persons with personality disorder, and in association withpathologic crying and emotional incontinence. Manic-depression and anxietystates are described at the end of the chapter.