Functional psychopathology

Psychopharmacotherapy is the combined use of psychoactive medication and psychotherapy. Brent and Kolko (1998) define the latter as a treatment modality in which therapist and patient collaborate to ease functional psychopathological impairment through attention to (1) the therapeutic relationship, (2) the patient s behavior, thoughts, attitudes and affect (the working diagnosis), and (3) the social context and development (this is especially salient in the work of the child and adolescent psychiatrist). 

This, what 1 have called, functional psychopathological approach has merits over and above the opportunistic ones 1 mentioned. Because many psychological dysfunctions are measurable, in contrast to disorders and syndromes, this approach will provide psychopathology with a scientific foundation. Moreover, this psychological spectral analysis provides a map of functions still operating within normal limits and those that deviate from the norm. 

There is ample support for the hypothesis of noradrenergic system dysfunction in depression however, the inconsistencies in findings rule out any simple model of increased or decreased noradrenergic activity. It is important to determine which noradrenergic system abnormalities relate specifically to the pathogenesis of mood disorders, and which are related to nonspecific effects of stress, homeostatic mechanisms, or comorbid psychopathology. More work is needed on the mood-state-depen-dence of noradrenergic function. 

Table 2 Functional serotonergic gene variations associated with behavioral phenotype, psychopathology, and psychiatric disorders...

Gene Functional variation Behavioral traits Psychopathology/disorders... 

Lesch, K.R (1998) Hallucinations psychopathology meets functional genomics. Mol Psychiatry 3 278-81. 

Younger children with manic symptoms tend to have severe functional impairment and comorbid psychopathology such as anxiety dysregulation, disruptive behaviors, and developmental delays that further complicate their clinical picture. In addition, these children may have mood symptoms that merge with other disorders, making manic episodes difficult to define. Irritability is part of the clinical picture of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). Poor concen-... 

Good intermorbid function Comorbid psychopathology (e.g., anxiety)... 

Schizophrenic adolescents who are characterized by deficits in cognitive functioning, subjective complaints, and psychopathological symptoms do profit from a structured 1-year rehabilitation program. Most of these deficiencies improved considerably. 

It became known in the same year (1954) that the substance reserpine, derived from the Indian plant Rauxcolfia serpentina, had antipsychotic effects similar to those of chlorpromazine This finding was of interest for two reasons the molecular structure of reserpine has some similarity to that of serotonin and LSD and it was found that reserpine liberates serotonin from presynaptic stores in the CNS and thus produces a short-lived excess supply of functionally available serotonin at the synapse. In the context of a serotonin hypothesis of schizophrenia, it could be postulated that the antipsychotic effect of reserpine was due to its ability to liberate serotonin presynaptically and make it functionally available. However, despite its scientific appeal, the serotonin hypothesis of schizophrenia did not last long because it was in conflict with both psychopathological and pharmacological findings ... 

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