The direct physical examination of psychiatric patients is underutilized by clinicians and underinvestigated by researchers. Both clinicians and researchers thus bypass important information. The authors review the literature on physical and neurologic examinations, with attention to aspects of these examinations that might specifically enhance the understanding of the psychiatric patient. Coverage includes the "minor" physical anomalies and "soft" neurologic signs. Findings related to the psychiatric conditions themselves are given precedence over findings of general medical importance. Some of the available physical and neurologic examination schedules are reviewed. A unified examination protocol is presented, incorporating physical and neurologic examinations pertinent to both general medical and specifically psychiatric assessment.
{"title":"Physical and neurologic examinations in neuropsychiatry.","authors":"R. Sanders, M. Keshavan","doi":"10.1053/SCNP.2002.28986","DOIUrl":"https://doi.org/10.1053/SCNP.2002.28986","url":null,"abstract":"The direct physical examination of psychiatric patients is underutilized by clinicians and underinvestigated by researchers. Both clinicians and researchers thus bypass important information. The authors review the literature on physical and neurologic examinations, with attention to aspects of these examinations that might specifically enhance the understanding of the psychiatric patient. Coverage includes the \"minor\" physical anomalies and \"soft\" neurologic signs. Findings related to the psychiatric conditions themselves are given precedence over findings of general medical importance. Some of the available physical and neurologic examination schedules are reviewed. A unified examination protocol is presented, incorporating physical and neurologic examinations pertinent to both general medical and specifically psychiatric assessment.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 1 1","pages":"18-29"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this report, the special clinical presentations found in neuropsychiatry are discussed. The point is made that conventional diagnostic schedules such as DSM-IV do not serve neuropsychiatry well, and have contributed to a failure to view neuropsychiatry as an independent specialist discipline. In this review some of the characteristic neuropsychiatric syndromes seen in epilepsy, movement disorders, demyelinating, and cerebrovascular diseases are described, followed by a brief discussion of conversion disorder. A plea is made that any future diagnostic schedules contain references to neuropsychiatric disorders and presentations.
{"title":"Clinical presentations in neuropsychiatry.","authors":"M. Trimble","doi":"10.1053/SCNP.2002.28984","DOIUrl":"https://doi.org/10.1053/SCNP.2002.28984","url":null,"abstract":"In this report, the special clinical presentations found in neuropsychiatry are discussed. The point is made that conventional diagnostic schedules such as DSM-IV do not serve neuropsychiatry well, and have contributed to a failure to view neuropsychiatry as an independent specialist discipline. In this review some of the characteristic neuropsychiatric syndromes seen in epilepsy, movement disorders, demyelinating, and cerebrovascular diseases are described, followed by a brief discussion of conversion disorder. A plea is made that any future diagnostic schedules contain references to neuropsychiatric disorders and presentations.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 1 1","pages":"11-7"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since the time the parent discipline of psychiatry became organized as a profession, one of its ludi saeculares (neuropsychiatry) has enjoyed at least 4 vogues. On each, neuropsychiatry has been known to ally itself to a cause: currently it is the big business of neurobiology. This move can be seen as scientific progress or as a side-effect of the (professional rather than scientific) infighting that affected neuromedicine during the late 19(th) century and which led to the construction of the notion of "neurological disease." Alienists responded to this variously: some, like Kahlbaum and Kraepelin accepted the split and returned to the more botanico approach; others, like Ziehen chose psychology; yet others, like Freud, delved in hermeneutics; lastly, there were those, like Meynert, Wernicke, Von Monakow, and Liepmann who sought an accommodation with neurology. Born out of this compromise, neuropsychiatry has remained a blurred activity (whose definitions range from "psychiatry of neurology" to a crusade for the "naturalization of the mind"). Neuropsychiatric assessment is a methodology designed to collect information about patients whose mental symptoms are thought to be caused by brain disease. When it first appeared, it was torn by the debate between "nomothetic versus idiographic" science. For a time, the neuropsychiatry assessment techniques stuck to the old personalized narratives characteristic of 19(th) century "casenotes" (trying to meet its descriptive, explanatory, therapeutic, legal, and ethical obligations). But during the late 19(th) century, measurement and quantification became part of the new rhetoric of science. Soon enough this affected psychology in general and neuropsychology in particular and neuropsychiatric assessment followed suit. It has changed little since except that now and again old tests and markers are replaced by more "reliable" ones and phenomenological data are squeezed out further. Its laudable enthusiasm for objectivity and truth was ab initio justified by 19(th) century Positivism; currently, it seems to be supported by a naïve version of Popperian falsificationism. In the meantime, the scientific worth of the neuropsychiatric assessment remains unclear; indeed, in an age of evidence-based medicine, it is surprising that both its informational and communicational value and its efficiency as a general epistemic tool have not been subjected to any serious empirical testing.
{"title":"Assessment and measurement in neuropsychiatry: a conceptual history.","authors":"G. Berríos, I. Marková","doi":"10.1053/SCNP.2002.30375","DOIUrl":"https://doi.org/10.1053/SCNP.2002.30375","url":null,"abstract":"Since the time the parent discipline of psychiatry became organized as a profession, one of its ludi saeculares (neuropsychiatry) has enjoyed at least 4 vogues. On each, neuropsychiatry has been known to ally itself to a cause: currently it is the big business of neurobiology. This move can be seen as scientific progress or as a side-effect of the (professional rather than scientific) infighting that affected neuromedicine during the late 19(th) century and which led to the construction of the notion of \"neurological disease.\" Alienists responded to this variously: some, like Kahlbaum and Kraepelin accepted the split and returned to the more botanico approach; others, like Ziehen chose psychology; yet others, like Freud, delved in hermeneutics; lastly, there were those, like Meynert, Wernicke, Von Monakow, and Liepmann who sought an accommodation with neurology. Born out of this compromise, neuropsychiatry has remained a blurred activity (whose definitions range from \"psychiatry of neurology\" to a crusade for the \"naturalization of the mind\"). Neuropsychiatric assessment is a methodology designed to collect information about patients whose mental symptoms are thought to be caused by brain disease. When it first appeared, it was torn by the debate between \"nomothetic versus idiographic\" science. For a time, the neuropsychiatry assessment techniques stuck to the old personalized narratives characteristic of 19(th) century \"casenotes\" (trying to meet its descriptive, explanatory, therapeutic, legal, and ethical obligations). But during the late 19(th) century, measurement and quantification became part of the new rhetoric of science. Soon enough this affected psychology in general and neuropsychology in particular and neuropsychiatric assessment followed suit. It has changed little since except that now and again old tests and markers are replaced by more \"reliable\" ones and phenomenological data are squeezed out further. Its laudable enthusiasm for objectivity and truth was ab initio justified by 19(th) century Positivism; currently, it seems to be supported by a naïve version of Popperian falsificationism. In the meantime, the scientific worth of the neuropsychiatric assessment remains unclear; indeed, in an age of evidence-based medicine, it is surprising that both its informational and communicational value and its efficiency as a general epistemic tool have not been subjected to any serious empirical testing.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 1 1","pages":"3-10"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this article the clinical usefulness and limitations of the routine electroencephalogram (EEG) are discussed. Emphasis is placed on 3 specific clinical situations where EEG can be most useful: the differential diagnosis of dementia versus pseudodementia, the evaluation of episodic behavior disorders including aggressive episodes, and acute confusional states. An atypical clinical presentation is emphasized as the most important indiction for obtaining an EEG evaluation. The issue of controversial EEG waveforms is discussed in some detail. The need for well-designed, controlled studies to further examine these EEG patterns is emphasized. Finally, the limitations of the routine EEG are discussed. The article concludes with a brief mention of the future promise of other electrophysiological testing modalities such as quantified EEG, evoked potentials, and sleep studies.
{"title":"Electrophysiological assessment of neuropsychiatric disorders.","authors":"N. Boutros, F. Struve","doi":"10.1053/SCNP.2002.28283","DOIUrl":"https://doi.org/10.1053/SCNP.2002.28283","url":null,"abstract":"In this article the clinical usefulness and limitations of the routine electroencephalogram (EEG) are discussed. Emphasis is placed on 3 specific clinical situations where EEG can be most useful: the differential diagnosis of dementia versus pseudodementia, the evaluation of episodic behavior disorders including aggressive episodes, and acute confusional states. An atypical clinical presentation is emphasized as the most important indiction for obtaining an EEG evaluation. The issue of controversial EEG waveforms is discussed in some detail. The need for well-designed, controlled studies to further examine these EEG patterns is emphasized. Finally, the limitations of the routine EEG are discussed. The article concludes with a brief mention of the future promise of other electrophysiological testing modalities such as quantified EEG, evoked potentials, and sleep studies.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"38 1","pages":"30-41"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Advances in physics, computing, and signal processing have provided a range of computerized brain imaging technologies that facilitate examination of the brain as a dynamical system. This article provides a review of brain imaging advances and their application in neuropsychiatry. The review encompasses (1) a description of the imaging technologies used in neuropsychiatry; (2) an outline of their temporospatial complementarity; (3) application to clinical applications; and (4) suggested future directions including an "integrative neuroscience" approach to neuropsychiatry (in which theoretical models, data and information concerning mechanisms are integrated). In the absence of a unified theory of the brain, an integrated approach is presented as one means of exploring converging brain-imaging evidence in relation to neuropsychiatric disorders.
{"title":"Neuroimaging in neuropsychiatry.","authors":"E. Gordon","doi":"10.1053/SCNP.2002.28982","DOIUrl":"https://doi.org/10.1053/SCNP.2002.28982","url":null,"abstract":"Advances in physics, computing, and signal processing have provided a range of computerized brain imaging technologies that facilitate examination of the brain as a dynamical system. This article provides a review of brain imaging advances and their application in neuropsychiatry. The review encompasses (1) a description of the imaging technologies used in neuropsychiatry; (2) an outline of their temporospatial complementarity; (3) application to clinical applications; and (4) suggested future directions including an \"integrative neuroscience\" approach to neuropsychiatry (in which theoretical models, data and information concerning mechanisms are integrated). In the absence of a unified theory of the brain, an integrated approach is presented as one means of exploring converging brain-imaging evidence in relation to neuropsychiatric disorders.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 1 1","pages":"42-53"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cognitive dysfunction is a core feature of neuropsychiatric illness. We offer a framework or conceptualizing cognitive function and discuss bedside examination and neuropsychological assessment, as well as the limitations of these tools. We stress the clinical importance of executive cognitive dysfunction, and we provide guidance or its assessment.
{"title":"The three cognitive examinations.","authors":"F. Ovsiew, F. Bylsma","doi":"10.1053/SCNP.2002.30373","DOIUrl":"https://doi.org/10.1053/SCNP.2002.30373","url":null,"abstract":"Cognitive dysfunction is a core feature of neuropsychiatric illness. We offer a framework or conceptualizing cognitive function and discuss bedside examination and neuropsychological assessment, as well as the limitations of these tools. We stress the clinical importance of executive cognitive dysfunction, and we provide guidance or its assessment.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"7 1 1","pages":"54-64"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58317783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
During the last few years, an increased interest in the possibility of immune mediated pathophysiology of obsessive compulsive disorder (OCD) and related disorders has been seen. In the late 1980s, the National Institute of Mental Health reported an increase of obsessive compulsive symptoms in patients with Sydenham chorea (SC). Subsequently, a precipitating streptococcal infection in children with sudden onset of OCD symptoms but no chorea led to the coining of PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus). This association has furthered interest in studying immune parameters in non-PANDAS OCD as well. This article will review the neuropsychiatric findings in OCD and Tourette syndrome (TS) with emphasis placed on PANDAS, and its association with SC, and a review of the existing studies that have assessed immunologic measures in patients with OCD and TS.
{"title":"Obsessive compulsive disorder: is there an association with childhood streptococcal infections and altered immune function?","authors":"T. Murphy, J. Petitto, K. Voeller, W. Goodman","doi":"10.1053/SCNP.2001.26990","DOIUrl":"https://doi.org/10.1053/SCNP.2001.26990","url":null,"abstract":"During the last few years, an increased interest in the possibility of immune mediated pathophysiology of obsessive compulsive disorder (OCD) and related disorders has been seen. In the late 1980s, the National Institute of Mental Health reported an increase of obsessive compulsive symptoms in patients with Sydenham chorea (SC). Subsequently, a precipitating streptococcal infection in children with sudden onset of OCD symptoms but no chorea led to the coining of PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus). This association has furthered interest in studying immune parameters in non-PANDAS OCD as well. This article will review the neuropsychiatric findings in OCD and Tourette syndrome (TS) with emphasis placed on PANDAS, and its association with SC, and a review of the existing studies that have assessed immunologic measures in patients with OCD and TS.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"6 4 1","pages":"266-76"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58316218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Substantial morphologic and functional evidence exists that supports the reciprocal interactions that occur between the nervous and immune systems. The nervous and immune systems have been increasingly found to use a common chemical language in the form of neuropeptides, cytokines, and hormones. Sophisticated immunologic techniques such as the identification and detection of immune cell surface markers enable researchers to determine the origin and activity of diverse cells in the blood and central nervous system. These techniques have elucidated the activity of immune cells in the central nervous system (CNS) that was previously thought to be privileged from immune surveillance in the presence of an intact blood brain barrier. Immune cells in the CNS play a central role in several degenerative diseases such as Alzheimer's disease, Huntington's disease, Multiple sclerosis, AIDS dementia complex, and nerve destruction associated with trauma. Immune cells also play a role in demyelinating peripheral nerve disorders. Cytokines and neuropeptides secreted by peripheral immune cells have profound effects on behavior that is mediated by the CNS. The close integration between immune and nervous system responses is being increasingly recognized in physiologic and pathologic conditions.
{"title":"Interactions between the nervous and immune systems.","authors":"W. Fehder, S. Douglas","doi":"10.1053/SCNP.2001.26994","DOIUrl":"https://doi.org/10.1053/SCNP.2001.26994","url":null,"abstract":"Substantial morphologic and functional evidence exists that supports the reciprocal interactions that occur between the nervous and immune systems. The nervous and immune systems have been increasingly found to use a common chemical language in the form of neuropeptides, cytokines, and hormones. Sophisticated immunologic techniques such as the identification and detection of immune cell surface markers enable researchers to determine the origin and activity of diverse cells in the blood and central nervous system. These techniques have elucidated the activity of immune cells in the central nervous system (CNS) that was previously thought to be privileged from immune surveillance in the presence of an intact blood brain barrier. Immune cells in the CNS play a central role in several degenerative diseases such as Alzheimer's disease, Huntington's disease, Multiple sclerosis, AIDS dementia complex, and nerve destruction associated with trauma. Immune cells also play a role in demyelinating peripheral nerve disorders. Cytokines and neuropeptides secreted by peripheral immune cells have profound effects on behavior that is mediated by the CNS. The close integration between immune and nervous system responses is being increasingly recognized in physiologic and pathologic conditions.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"6 4 1","pages":"229-40"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58316365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Rogers, M. Szuba, J. Staab, Dwight L. Evans, D. Dinges
The complex and intimate interactions between the sleep and immune systems have been the focus of study for several years. Immune factors, particularly the interleukins, regulate sleep and in turn are altered by sleep and sleep deprivation. The sleep-wake cycle likewise regulates normal functioning of the immune system. Although a large number of studies have focused on the relationship between the immune system and sleep, relatively few studies have examined the effects of sleep deprivation on immune parameters. Studies of sleep deprivation's effects are important for several reasons. First, in the 21st century, various societal pressures require humans to work longer and sleep less. Sleep deprivation is becoming an occupational hazard in many industries. Second, to garner a greater understanding of the regulatory effects of sleep on the immune system, one must understand the consequences of sleep deprivation on the immune system. Significant detrimental effects on immune functioning can be seen after a few days of total sleep deprivation or even several days of partial sleep deprivation. Interestingly, not all of the changes in immune physiology that occur as a result of sleep deprivation appear to be negative. Numerous medical disorders involving the immune system are associated with changes in the sleep-wake physiology--either being caused by sleep dysfunction or being exacerbated by sleep disruption. These disorders include infectious diseases, fibromyalgia, cancers, and major depressive disorder. In this article, we will describe the relationships between sleep physiology and the immune system, in states of health and disease. Interspersed will be proposals for future research that may illuminate the clinical relevance of the relationships between sleeping, sleep loss and immune function in humans.
{"title":"Neuroimmunologic aspects of sleep and sleep loss.","authors":"N. Rogers, M. Szuba, J. Staab, Dwight L. Evans, D. Dinges","doi":"10.1053/SCNP.2001.27907","DOIUrl":"https://doi.org/10.1053/SCNP.2001.27907","url":null,"abstract":"The complex and intimate interactions between the sleep and immune systems have been the focus of study for several years. Immune factors, particularly the interleukins, regulate sleep and in turn are altered by sleep and sleep deprivation. The sleep-wake cycle likewise regulates normal functioning of the immune system. Although a large number of studies have focused on the relationship between the immune system and sleep, relatively few studies have examined the effects of sleep deprivation on immune parameters. Studies of sleep deprivation's effects are important for several reasons. First, in the 21st century, various societal pressures require humans to work longer and sleep less. Sleep deprivation is becoming an occupational hazard in many industries. Second, to garner a greater understanding of the regulatory effects of sleep on the immune system, one must understand the consequences of sleep deprivation on the immune system. Significant detrimental effects on immune functioning can be seen after a few days of total sleep deprivation or even several days of partial sleep deprivation. Interestingly, not all of the changes in immune physiology that occur as a result of sleep deprivation appear to be negative. Numerous medical disorders involving the immune system are associated with changes in the sleep-wake physiology--either being caused by sleep dysfunction or being exacerbated by sleep disruption. These disorders include infectious diseases, fibromyalgia, cancers, and major depressive disorder. In this article, we will describe the relationships between sleep physiology and the immune system, in states of health and disease. Interspersed will be proposals for future research that may illuminate the clinical relevance of the relationships between sleeping, sleep loss and immune function in humans.","PeriodicalId":79723,"journal":{"name":"Seminars in clinical neuropsychiatry","volume":"6 4 1","pages":"295-307"},"PeriodicalIF":0.0,"publicationDate":"2001-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58316680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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