Chapter 33 - The clinical assessment of neuropsychiatric disorders

Question 1

What is the primary objective of the neuropsychiatric clinical assessment?

Answer 1

to
make a comprehensive and accurate diagnosis and to set up a plan of
management or care. p. 693

Question 2

Quick pros and cons of neuropsychological assessments?

Answer 2

These are examples:
Pro: the greater the care taken in the
clinical assessment, the greater the probability of obtaining the correct
diagnosis.
Cons: over-investigating can be expensive and stressful for
the patient.

Question 3

What are the steps of a FULL neuropsychological assessment?

Answer 3

1) The clinical interview p. 694
2) Collateral clinical history (detailed history) p. 695f
3) Mental state examination
4) Assessment of cognitive state
5) Physical examination
6) Neuropsychological assessment
7) Investigations; excluding or establishing and quantifying the pathology-
bloodtest, EEG, Structural imaging and functional imaging.

Question 4

Can you elaborate what the purpose of The clinical interview is? And what it should contain?

Answer 4

To establish a connection - a therapeutic relationship, and possibly to get unknown information revealed. p. 693

Question 5

Can you elaborate what the purpose of Collateral clinical history is? And what it should contain?

Answer 5

A detailed history from close relatives or friends is required to establish the mode of onset of the disorder, the nature and duration of symptoms
and their subsequent course.

Question 6

Can you elaborate what the purpose of Mental state examination is? And what it should contain?

Answer 6

The mental state examination begins with appearance and general
behaviour.
- Pallor, weight loss, disorders of facial expression, posture and movement and standards of self-care draw attention to the possibility
of an organic disorder.
Is the patient impulsive, disinhibited, or insensitive?
Or are they slow, hesitant or unable to understand? Alllllll that jazz needs to be evaluated (p. 696f)

Question 7

Can you elaborate what the purpose of Assessment of cognitive state is? And what it should contain?

Answer 7

The neuropsychiatrist’s assessment of cognitive state is essentially a
screening procedure. If abnormalities are found they, combined with the
clinical history, should help to focus the referral for neuropsychological
assessment by a psychologist

Question 8

Can you elaborate what the purpose of Physical examination is? And what it should contain?

Answer 8

It is important to examine the patient’s face as ‘there’s no art to find
the mind’s construction in the face’. A great deal of information can
be obtained about mood, perplexity, trust and an impression of
character from the face.
The head should be examined for signs: scars, unusual head shape.
The hands may also reveal useful information about the patient’s
health and lifestyle. Is there a tremor, palmar erythema and
leuconychia, nicotine staining, clubbing or calluses? Are the nails
long, broken, bitten or unclean?
The blood pressure must always be measured and the pulse should
be taken.

Question 9

Can you elaborate what the purpose of Neuropsychological assessment is? And what it should contain?

Answer 9

neuropsychological
assessment has three main purposes.
1) The first is to help with diagnosis in the context of other observations
and findings from the background history, clinical and mental state
examination and the results of physical investigations
2) The second main purpose is to identify and quantify the pattern and
severity of cognitive impairments.
3) The third main purpose of assessment is to plan strategies of
cognitive rehabilitation and/or cognitive behaviour therapy:

Question 10

Can you elaborate what the purpose of the Investigations are? And what they should/could contain?

Answer 10

Investigations are primarily directed towards excluding or establishing
and quantifying organic pathology.
Could as before mentioned be blood tests, EEG, structural imaging and functional imaging.

Question 11

When concluding the neuropsychiatric assessment, what steps are smart to reappraise again?

Answer 11

◆ Was part of the history missed?
◆ Is there any reason to suspect that the patient may be malingering or
embellishing symptoms?
◆ Is the patient depressed or suffering from excessive daytime
sleepiness (pseudodementia)?
◆ Head injury?
◆ Alcohol