Neuropsychiatric Assessment

by Yudofsky, Stuart C.; Kim, H. Florence, M.D.

• ISBN13: 9781585621774
• ISBN10: 1585621773
• Edition: 1st
• Format: Paperback
• Copyright: 2004-04-30
• Publisher: Amer Psychiatric Pub Inc

Summary

What is neuropsychiatry? This remarkable volume answers that question-and more. Neuropsychiatry, which focuses on assessment and diagnostic issues at the interface of psychiatry and neurology, is enjoying a renaissance, largely because of the technological innovations detailed in these five chapters. Here, 11 recognized experts have assembled an overview of the essential techniques, current research, and future trends in neuropsychiatric assessment, focusing on clinical applications for psychiatry patients. This eminently practical work begins with the cornerstone of any neuropsychiatric assessment, the physical examination and the medical and psychiatric history. Included here is a head-to-toe compendium of important signs and symptoms to elicit, along with the differential diagnoses of neuropsychiatric disorders to consider when faced with a particular constellation of signs and symptoms. Subsequent chapters discuss The critical importance of the neuropsychological examination, traditionally administered by neuropsychologists and thus often overlooked by psychiatrists in routine workups of their patients. Topics addressed include the clinical approach to the interview process, fixed- and flexible-battery approaches to assessment, interpretation pitfalls, and future trends. The authors illustrate how this essential tool can reveal the major cognitive domains that may be involved in neuropsychiatric disorders and show how specific patterns of deficits in certain domains may help determine a neuropsychiatric diagnosis. The relevance of electrophysiological testing, an underused but invaluable resource, to neuropsychiatric disorders. The authors discuss standard, topographic, and quantitative electroencephalography; cerebral evoked potentials, and polysomnography, providing recommendations for the application of these tools in certain clinical situations (e.g., cognitive decline, rapid-cycling bipolar disorder) and projections for broader uses of electrophysiological testing in the future. The key importance of laboratory testing, especially in view of the complex array of neurological and medical illnesses that may underlie the symptoms of neuropsychiatric patients. The lack of consensus guidelines for the use of conventional laboratory testing, chest X rays, and electrocardiograms in screening patients with neuropsychiatric symptoms continues to constrain our ability to help these patients. The potential of today's increasingly sophisticated neuroimaging approaches-from structural and functional magnetic resonance imaging and magnetic resonance spectroscopy to diffusion tensor imaging and positron emission tomography-to reveal the brain and its pathways with unprecedented clarity. The authors provide a fascinating overview of the techniques involved and the current research findings in schizophrenia, major affective disorder, and obsessive-compulsive disorder. Intended to bring us closer to our goals of early detection of, more specific treatments for, and, ultimately, prevention of psychiatric illness, this in-depth yet concise volume on the research and practice of neuropsychiatry will find a wide audience among students, residents, and clinicians.

Author Biography

Stuart C. Yudofsky, M.D., is D.C. and Irene Ellwood Professor and Chairman of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, in Houston, Texas. He is Chief of Psychiatry Service at The Methodist Hospital in Houston, Texas, and is also responsible for oversight of academic activities in psychiatry at The Menninger Clinic and Hospital, the Ben Taub General Hospital, the Houston Veterans Administration Medical Center, the St. Luke's Episcopal Hospital, and the Texas Children's Hospital.

H. Florence Kim, M.D., is Assistant Professor and Medical Director of Neuropsychiatry Programs in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston, Texas.

Table of Contents

Contributors	ix
Introduction to the Review of Psychiatry Series	xi
John M. Oldham, M.D., M. S.
Michelle B. Riba, M.D., M.S., Series Editors
Introduction	xv
Stuart C. Yudofsky, M.D.
H. Florence Kim, M.D.
Chapter 1 Neuropsychiatric Physical Diagnosis in Context	1	(38)
Fred Ovsiew, M.D.
Context	2	(3)
Taking the Neuropsychiatric History	5	(7)
Examining the Neuropsychiatric Patient	12	(17)
Conclusion	29	(1)
References	30	(9)
Chapter 2 Neuropsychological Examination of the Psychiatric Patient	39	(30)
Glen E. Getz, M.A.
Mark R. Lovell, Ph.D.
Goals of Neuropsychological Examination	39	(1)
Methodological Considerations	40	(4)
Approaches to Neuropsychological Assessment	44	(3)
Major Cognitive Domains and Selected
Neuropsychiatric Syndromes	47	(12)
Ecological Validity	59	(1)
Future Directions	60	(3)
References	63	(6)
Chapter 3 Electrophysiological Testing	69	(36)
Nashaat N. Boutros, M.D.
Frederick A. Struve, Ph.D.
Special Problems With Laboratory Testing in Neuropsychiatric Disorders	71	(2)
Electrophysiological Testing Modalities	73	(12)
Electrophysiological Assessment Considerations for Selected Clinical Presentations	85	(10)
Conclusion and Recommendations	95	(2)
References	97	(8)
Chapter 4 Neuropsychiatric Laboratory Testing	105	(50)
H. Florence Kim, M.D.
Stuart C. Yudofsky, M.D.
Screening Patients for Neuropsychiatric Disorders	108	(28)
Specific Clinical Indications for Laboratory Testing in Neuropsychiatry	136	(5)
Monitoring Medications	141	(6)
Investigational Biological and Genetic Markers	147	(1)
Conclusion	147	(5)
References	152	(3)
Chapter 5 Selected Neuroimaging Topics in Psychiatric Disorders	155	(36)
Thomas E. Nordahl, M.D., Ph.D.
Ruth Salo, Ph.D.
Magnetic Resonance Imaging Techniques	156	(6)
Magnetic Resonance Spectroscopy	162	(6)
Diffusion Tensor Imaging	168	(4)
Positron Emission Tomography	172	(10)
Conclusion	182	(1)
References	183	(8)
Afterword	191	(2)
Stuart C. Yudofsky, M.D.
H. Florence Kim, M.D.
Index	193