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The neurological examination adapted for neuropsychiatry

Published online by Cambridge University Press:  23 May 2018

Sheldon Benjamin  and
Margo D. Lauterbach
Sheldon Benjamin*
Affiliation:
Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Margo D. Lauterbach*
Affiliation:
Sheppard Pratt Health System, Neuropsychiatry Program, Towson, Maryland, USA
*
*Address for correspondence: Margo D. Lauterbach, MD, Sheppard Pratt Health System, Neuropsychiatry Program, 6501 N. Charles St. PO BOX 6815, Baltimore, MD 21285-6815 Sheldon Benjamin, MD, UMass Medical School, Dept. of Psychiatry, 55 Lake Avenue North, Worcester, MA 01655. (Email: sheldon.benjamin@umassmed.edu)
*Address for correspondence: Margo D. Lauterbach, MD, Sheppard Pratt Health System, Neuropsychiatry Program, 6501 N. Charles St. PO BOX 6815, Baltimore, MD 21285-6815 Sheldon Benjamin, MD, UMass Medical School, Dept. of Psychiatry, 55 Lake Avenue North, Worcester, MA 01655. (Email: sheldon.benjamin@umassmed.edu)
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Abstract

The neuropsychiatric examination includes standard neurological and cognitive examination techniques with several additional observations and tasks designed to capture abnormalities common among patients with neuropsychiatric disorders or neurocognitive complaints. Although useful as a screening tool, a single standardized rating scale such as the Mini Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) is insufficient to establish a neuropsychiatric diagnosis. Extra attention is paid to findings commonly seen in the setting of psychiatric disorders, dementias, movement disorders, or dysfunction of cortical or subcortical structures. Dysmorphic features, dermatologic findings, neurodevelopmental signs, signs of embellishment, and expanded neurocognitive testing are included. The neuropsychiatric clinician utilizes the techniques described in this article to adapt the examination to each patient’s situation, choosing the most appropriate techniques to supplement the basic neurological and psychiatric examinations in support of diagnostic hypotheses being considered. The added examination techniques facilitate diagnosis of neurocognitive disorders and enable neuropsychiatric formulation.

Keywords

Cognitive examinationdiagnosismental status examinationneurological examinationneuropsychiatric educationneuropsychiatry
Type
Review Articles
Information
CNS Spectrums , Volume 23 , Special Issue 3: Theme: Neuropsychiatry , June 2018 , pp. 219 - 227
Copyright
© Cambridge University Press 2018 

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References

1. York, G, Steinberg, D. Hughlings Jackson’s neurological ideas. Brain. 2011; 134: 3106–3113.Google Scholar
2. Jablensky, A. Karl Jaspers: psychiatrist, philosopher, humanist. Schiz Bull. 2013; 39(2): 239–241.Google Scholar
3. Benjamin, S, Lauterbach, M. The Brain Card. 3rd ed. Boston: Brain Educators LLC; 2016.Google Scholar
4. Cummings, J, Trimble, M. Concise Guide to Neuropsychiatry and Behavioral Neurology. 2nd ed. Washington, DC: American Psychiatric Publishing, Inc. 2002.Google Scholar
5. Benjamin, S, Lauterbach, M, Stanislawski, A. Congenital and acquired disorders presenting as psychosis in children and young adults. Child Adolesc Psychiatr Clin N Am. 2013; 22(4): 581–608.Google Scholar
6. Miles, JH, Takahashi, TN, Hong, J, et al. Development and validation of a measure of dysmorphology: useful for autism subgroup classification. Am J Med Genet A. 2008; 146A(9): 1101–1116.Google Scholar
7. Chernoff, KA, Schaffer, JV. Cutaneous and ocular manifestations of neurocutaneous syndromes. Clin Dermatol. 2016; 34(2): 183–204.Google Scholar
8. Doty, R. Olfactory dysfunction and its measurement in the clinic. World Journal of Otorhinolaryngology-Head and Neck Surgery. 2015; 1(1): 28–33.Google Scholar
9. Hopf, H, Müller-Forell, W, Hopf, N. Localization of emotional and volitional facial paresis. Neurology. 1992; 42: 1918–1923.Google Scholar
10. Schott, JM, Rossor, MN. The grasp and other primitive reflexes. J Neurol Neurosurg Psychiatry. 2003; 74(5): 558–560.Google Scholar
11. De Renzi, E, Barbieri, C. The incidence of the grasp reflex following hemispheric lesion and its relation to frontal damage. Brain. 1992; 115(Pt 1): 293–313.Google Scholar
12. Fradis, A, Botez, M. The groping phenomena of the foot. Brain. 1958; 81(2): 218–230.Google Scholar
13. Owen, G, Mulley, GP. The palmomental reflex: a useful clinical sign? J Neurol Neurosurg Psychiatry. 2002; 73(2): 113–115.Google Scholar
14. Bodranghien, F, Bastian, A, Casali, C, et al. Consensus paper: revisiting the symptoms and signs of cerebellar syndrome. Cerebellum. 2016; 15(3): 369–391.Google Scholar
15. Dubois, B, Slachevsky, A, Pillon, B, Beato, R, Villalponda, JM, Litvan, I. “Applause sign” helps to discriminate PSP from FTD and PD. Neurology. 2005; 64(12): 2132–2133.Google Scholar
16. Doody, RS, Jankovic, J. The alien hand and related signs. J Neurol Neurosurg Psychiatry. 1992; 55(9): 806–810.Google Scholar
17. Munetz, MR, Benjamin, S. How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry. 1988; 39(11): 1172–1177.Google Scholar
18. Whitty, PF, Owoeye, O, Waddington, JL. Neurological signs and involuntary movements in schizophrenia: intrinsic to and informative on systems pathobiology. Schizophr Bull. 2009; 35(2): 415–424.Google Scholar
19. Kertesz, A, Hooper, P. Praxis and language: The extent and variety of apraxia in aphasia. Neuropsychologia. 1982; 20(3): 275–286.Google Scholar
20. Mittal, VA, Hasenkamp, W, Sanfilipo, M, et al. Relation of neurological soft signs to psychiatric symptoms in schizophrenia. Schizophr Res. 2007; 94(1–3): 37–44.Google Scholar
21. Sandson, J, Albert, ML. Perseveration in behavioral neurology. Neurology. 1987; 37(11): 1736–1741.Google Scholar
22. Nowrangi, M, Lyketsos, C, Rao, V, Munro, CA. Systematic review of neuroimaging correlates of executive functioning: converging evidence from different clinical populations. J Neuropsychiatry Clin Neurosci. 2014; 26(2): 114–125.Google Scholar
23. Mak, MK, Wong, A, Pang, MY. Impaired executive function can predict recurrent falls in Parkinson’s disease. Arch Phys Med Rehabil. 2014; 95(12): 2390–2395.Google Scholar
24. Velligan, DI, Bow-Thomas, CC, Mahurin, RK, Miller, AL, Halgunseth, LC. Do specific neurocognitive deficits predict specific domains of community function in schizophrenia? J Nerv Ment Dis. 2000; 188(8): 518–524.Google Scholar
25. Luria, A. Higher Cortical Functions in Man. Oxford, England: Basic Books; 1966.Google Scholar
26. Lhermitte, F, Pillon, B, Serdaru, M. Human autonomy and the frontal lobes. Part I: Imitation and utilization behavior: a neuropsychological study of 75 patients. Ann Neurol. 1986; 19(4): 326–334.Google Scholar