Descriptive Psychopathology: The Signs and Symptoms of ...

13Cognitive testing and the psychopathologyof cognitive dysfunctionThe mistake of deriving all phenomena from one principle may occur in somatic andphysiological (materialistic) as well as in philosophical and psychological concepts; for instance,when all psychic phenomena are reduced to the single scheme of the reflex process, it is no morea lasting contribution to science than when the philosophical schools deduce this from theprinciple of identity or that of polarity, etc. The psychic phenomena have first to be viewed andcompiled quite without prejudice, like individual phenomena in other sciences, and only whensubstantial material comes to be available in at least a somewhat different form and in greaterabundance than hitherto will it be possible to attempt causal or physiological and anatomicalsubstantiation. 1Patients with behavior-altering brain disease often experience cognitive difficulties,and the assessment of their cognitive functioning is essential in their diagnosisand management. Patients with melancholic depression, for example, haveprofound cognitive difficulties which resolve with successful treatment. Ifimproperly treated, however, their cognitive deficits persist and result in chronicpoor functioning. Moderate cognitive difficulty in a patient with melancholia isalso an independent risk factor for suicide. 2 Patients with schizophrenia havepersistent cognitive problems in working memory, fluency of ideas, and executivefunction that influence long-term decisions on placement and socializationrehabilitation. 3 Patients with anxiety disorders and obsessive–compulsive syndromeshave cognitive difficulties in working memory and visual–spatial functionundermining treatment compliance. 4Different patterns of cognitive decline are recognized and point to specific diseaseprocesses. In the early phases of Alzheimer’s disease, visual and episodic memory areaffected. In Pick’s disease and primary frontal lobe degeneration, problems withexecutive functioning are early features. 5 Persons with basal ganglia disease havedeficits in working and procedural memory and visual–spatial functions. 6Several classic psychopathologic phenomena are also associated with specificcognitive deficits. Capgras syndrome, the delusion of familiar persons being impostors,is associated with poor facial recognition (prosopagnosia) and non-dominant310