With every patient, the psychiatrist should
consider a thorough neurological examination, especially for hospitalized
patients. Patients who have a history of neurological disturbances, such as
strokes, seizure disorders, central nervous system neoplasms, dementias and
movement disorders, should be carefully evalu-ated, perhaps by a neurologist.
The neurological examination should be particularly designed to rule out any
lateralizing neu-rological signs which would point toward the presence of a
fo-cal lesion. Unilateral weakness or abnormalities in pupil size or eye
movements might suggest a focal neoplasm, infection (such as toxoplasmosis),
intracranial bleeding, or a stroke, which may explain such psychiatric symptoms
as confusion, sudden onset of speech difficulties, psychosis, or even
depression. Stiffness and cogwheel rigidity are classical signs of Parkinson’s
disease, a dis-order which may be associated with such psychiatric symptoms as
depression, psychosis and dementia.
Patients with acquired immunodeficiency syndrome
should also be carefully evaluated neurologically because many neurologi-cal
manifestations of advanced HIV-related illness (including HIV-associated
dementia and CNS opportunistic infections) and the medicines administered to
treat these illnesses may produce psy-chiatric symptoms, including depression, delirium,
mania and psy-chosis. Gait should be carefully examined in psychiatric patients
be-cause certain neurological conditions in which gait disturbances are
prominent, such as normal-pressure hydrocephalus, tertiary syphi-lis (tabes
dorsalis) and combined system disease (caused by vitamin B12
deficiency) may produce a variety of psychiatric symptoms.