textbook of clinical neuropsychiatry

[...]... 3/10/08 5:51 PM Page xiii Preface This second edition of the Textbook of Clinical Neuropsychiatry, like the first, is a practical, clinically oriented text that is designed to equip readers to diagnose and treat the multitude of neuropsychiatric disorders they encounter It is divided into three parts: Part 1 describes the diagnostic assessment of patients and details the interview, mental status examination,... Neuroimaging 3 5 10 17 1.1 DIAGNOSTIC INTERVIEW Lord Brain (1964) noted that ‘in the diagnosis of nervous diseases the history of the patient’s illness is often of greater importance than the discovery of his abnormal physical signs’, a sentiment echoed by Russell DeJong (1979) who asserted that ‘a good clinical history often holds the key to diagnosis’ Obtaining the history, however, as noted by DeJong (1979),... loosening of associations had little or no recognition of their incoherence, the aphasic patients often seemed at least somewhat aware of their difficulty It has been this author’s experience that these differences, although often present, are not sufficiently reliable to make the differential between loosening of associations and aphasia, and that it is much more useful to look for the presence of more... auditory agnosia (the inability to recognize common sounds), topographagnosia (a loss of a sense of direction), simultanagnosia (an inability to visually ‘grasp’ the whole of a scene to see all of its parts simultaneously), and asomatagnosia (a denial of the ‘ownership’ of a body part, as may be seen in some cases of hemiparesis) Neglect Neglect, discussed in Section 2.10, is characterized by an involuntary... be used to follow the progress of the disease and may indeed reveal clinically ‘silent’ lesions Furthermore, recently activated plaques may be detected by gadolinium enhancement before there is any clinical evidence of their presence (Kermode et al 1990; Miller et al 1988) MRI has revolutionized the diagnosis of multiple sclerosis and no evaluation of a patient suspected of harboring this dreaded disease... disturbances may be found in schizophrenia and in certain cases of aphasia p 01.qxd 3/10/08 9:33 AM Page 8 8 Diagnostic assessment Thought blocking is characterized by an abrupt termination of speech, sometimes in the middle of a sentence, as if the train of thought had suddenly been ‘blocked’ This is not a matter of simply running out of things to say, but rather an uncanny experience wherein thoughts... some choices, for example, ‘a hotel, hospital or office building’, and ask them to choose one Orientation to time is determined by asking patients the date, including the day of the week, the month, day of the month, and year If patients Memory is discussed in detail in Section 5.4 and, as noted there, the most important type of memory from a clinical point of view is memory for events and facts, and it... observation of eye and facial movements, speech, movement of the extremities, gait, etc For most findings, further detail on, and a consideration of, the differential diagnosis of the finding may be found in the appropriate chapter, as noted below General appearance In some cases, the overall appearance of the patient may immediately suggest a possible diagnosis Examples include the moon facies of Cushing’s... and subsequently to show the teeth In cases of unilateral voluntary facial paresis note must be made of which divisions of the facial nerve are involved: the upper (controlling forehead wrinkling), the lower (controlling elevation of the side of the mouth), or both At times facial weakness may be quite subtle, manifesting perhaps only with a slight flattening of the nasolabial fold on one side After voluntary... the foot is plantar flexed: with each step, the leg is circumducted around and the front of the foot is often scraped along the floor In very mild cases of hemiplegia, the gait, to casual inspection, may not be abnormal; however, when patients walk ‘on the outside’ of their feet, one often sees dystonic posturing of the upper extremity on the involved side Parkinsonian gait is described in Abnormal movements, . Textbook of Clinical Neuropsychiatry qxd 3/10/08 5:51 PM Page i This page intentionally left blank Textbook of Clinical Neuropsychiatry Second edition David P Moore MD Associate Clinical. Clinical Professor, Department of Psychiatry, Associate Clinical Professor, Department of Neurosurgery (Division of Physical Medicine and Rehabilitation), University of Louisville School of Medicine,. second edition of the Textbook of Clinical Neuropsychiatry, like the first, is a practical, clinically oriented text that is designed to equip readers to diagnose and treat the multitude of neuropsychiatric