Descriptive Psychopathology: The Signs and Symptoms of ...

211 Chapter 8: Disturbances in emotional experienceTable 8.4. Behaviors defining cyclothymia 57Mood: periods of irritability lasting several days; explosive and aggressive outbursts; grandioseoverconfidence followed by periods of low self-esteem and confidenceCognition: periods of sluggish thinking and poor concentration interspersed with periods ofcreative, focused and rapid thoughtVegetative symptoms: Hypersomnia alternating with periods of decreased need for sleep;periods of increased food, illicit drug, and alcohol consumption interspersed with periods ofabstinence and indifference to such consumption; periods of hypersexuality and promiscuityfollowed by periods of low or no libidoActivity: Buying sprees and financial extravagance, erratic work efforts from great intensity andproductivity to little interest; periods of intense involvement in new often unusual topicsfollowed by periods of profound disillusionmentdepression are commonly experienced. During their brief periods of mania, elation,grandiosity, and racing thoughts are reported. 58 Such persons can be misdiagnosedas having borderline personality disorder. 59MelancholiaMelancholia is a syndrome that has been recognized for millennia, and a recentreview of the mood disorder literature finds it to be the core depression inclassification. 60Pathological emotional state is always present from the onset and is experiencedas unease, inner agitation, irritability, or tearfulness. Some patients initiallyexperience a dulling of emotion. In its severe form, a pervasive and unremittingapprehension and gloom colors all cognitive processes, resulting in a loss ofinterest, decreased concentration, poor memory, slowed thinking, feelings offailure and low self-worth, and thoughts of suicide. The patient may becometerror-stricken and tormented by delusions of guilt or by condemning hallucinatedvoices, or the hallucinated screams of their “victims”. Some cognitivedisturbance is always present. The experience is unremitting, and the patientcannot be consoled.Psychomotor disturbance, either as retardation or agitation, is always present. 61Retardation varies from a reluctance and hesitation to participate in daily activities,to prolonged inactivity and stupor. 62 Agitation is expressed as restlessness, handwringing,and inability to remain still. Patients pace and are in continuousmovement progressing to purposeless activity.Vegetative functions, basic physiologic processes, are severely affected. Sleep isdisrupted, appetite and weight lost, sex no longer arouses interest, and the responseto stress and chronobiologic functioning are disturbed. The signs of illness areobvious in a loss of weight, unkempt appearance, body odor, and haggard look.