When caring for patients with psychopathological problems, sometimes the clinician must consider whether the patient has an underlying neurological condition. When should we order diagnostic studies (brain imaging and others) in #Psychiatry? Here are some general recommendations:
1) Abnormal neurological examination. A neurological clinical exam showing abnormal sensitive, motor or autonomic signs.
As an example: a woman had a new onset of psychotic #depression. The presence of visual impairment was the clue to indicate a MRI, which showed a brain tumor
As an example: a woman had a new onset of psychotic #depression. The presence of visual impairment was the clue to indicate a MRI, which showed a brain tumor
2) Focal neuropsychologic syndromes. Presence of cognitive deficits with a well-known neurological basis (aphasia, apraxia, agnosia, amnesia, dysexecutive syndrome, Balint syndrome, Gertsmann syndrome, etc)
Below: a man had behavioral disturbances, aphasia, and a brain abscess
Below: a man had behavioral disturbances, aphasia, and a brain abscess
3) Atypical psychiatric patterns. Atypical phenomenology in the context of a common psychiatric syndromes, and/or uncommon age of onset (for instance, a case of first episode mania after age 50)
4) Psychiatric syndromes suggesting a neurological condition (part A): Some psychopathologic syndromes are always indicative of the need to assess neurological or general medical conditions (delirium, dementia, Klüver-Bucy syndrome, etc),
Below, a case of Klüver-Bucy syndrome
Below, a case of Klüver-Bucy syndrome
4) Psychiatric syndromes suggesting a neurological condition (part A): other psychopathologic syndromes increase the probability of finding underlying neurological conditions but may also be seen in primary psychiatric conditions (Capgras, Cotard, Ekbom syndrome, etc)
5) Unexpected therapeutic response. Lack of therapeutic response or worsening after adequate therapeutic procedures (psychotherapy & pharmacotherapy, or other biological treatments as ECT).
6) Additional Presence of red flags. Data that increase the suspicion of an underlying neurological condition in patients with psychopathologic patterns. Fever, infectious syndrome, headache, seizures, autonomic abnormalities and abnormal movements.
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