Descriptive Psychopathology: The Signs and Symptoms of ...

314 Section 3: Examination domainsTable 13.1. Behaviors suggesting cognitive problems 13BehaviorAvolition and apathyLoss of social graces and coarseningof personalityLoss of motor skills (e.g. typing,playing a musical instrument)Forgetting to remember (e.g. failingto turn off the oven or to deliver amessage)“Poor historian”Getting lost in familiar placesHaving several “fender benders”Not recognizing familiar peopleEpisode of melancholia or maniaObsessive–compulsive disorderSchizophreniaChronic mood disorderLikely associated cognitive problem(s)Poor executive functioning; poor abstractthinking and verbal reasoningPoor executive functioning and self-monitoringPoor working memory, recall, and visual–spatialmemoryPoor working memoryPoor recall and poor executive function,or loss of long-term memory storagePoor visual–spatial perception; poor visualmemoryPoor visual–spatial perceptionPoor facial recognition and visual–spatialmemoryPoor working memory; recall distorted by qualityof moodPoor working memory and visual–spatial memoryPoor executive functioning, abstract thinking,verbal and visual reasoningPoor working memory and new learning, andability to organize and relate a sequential historyTable 13.2. Reasons for bedside cognitive assessmentTo confirm or reject differential diagnostic possibilitiesTo obtain specific assessment of the patient’s cognitive strengths and weaknesses to shapetreatment and disposition plansTo obtain a baseline and then re-examinations to follow the illness progression or to monitortreatmentsbecause such instruments are designed for a general purpose rather than to definespecific dysfunction. Knowing a number of bedside tasks that can be appliedas needed for one or more of the purposes shown in Table 13.2 permits thegathering of more specific information, helps resolve differential diagnosticquestions, and shapes treatment plans. Patient 13.3 illustrates the value of assessingthe patient’s cognitive strengths and weaknesses.