Investigation of the neuropsychic sphere

A full-fledged study of the patient's neuropsychic status can be carried out only if the doctor knows the symptomatology of nervous and mental illnesses well, knows well the special research methods used in neurology and psychiatry.

Assessment of the patient's mental status traditionally begins with an assessment of how correctly the patient is oriented in space, time and self. As a rule, for this it is enough to ask a few clarifying questions: "Where are you now?", "What is the day of the week, month, year?", "Please state your surname, name, patronymic," "Where do you work? " etc. At the same time, it is noted whether the patient is contactable and whether he is willing to enter into communication with the doctor.

After this, they pass on to the study of the cognitive, emotional and motor-volitional spheres. Pay attention to possible violations of perception (in particular, hallucinations), which can, for example, manifest themselves in that the patient, being alone in the ward, actively gesticulating, conducts a lively conversation with "voices", sometimes clamping his ears if "voices" report to him unpleasant information, etc.

Dissemination and conversation

During the conversation with the patient, it is also found out whether his attention has been violated and whether the patient is able to concentrate for a long time on one case. Mark possible memory violations (to remote or current events).

When a patient is questioned on the basis of the characteristics of the answers received, one can draw a conclusion about the state of his intelligence, in particular, about the compliance of the patient's intellect with the education he has received. Pay attention to the presence or absence of various disorders of thinking, which can be expressed in any delusional interpretations, the appearance of supervalued ideas, obsessions.

The study of the emotional sphere of the patient helps evaluate his appearance, clothes, facial expressions. Thus, the face of patients who are in a depressed state usually express sadness and sadness. With emotional dullness, patients become very slovenly, indifferent to everything. In the manic state, patients with all their appearance express an upbeat mood, enthusiasm, irrepressible joy.

Finally, investigating the patient's willful or arbitrary activity, note the peculiarities of his behavior, determine how the patient (independently or by coercion of the personnel) performs certain actions (including washing, eating, etc.), is there any negativity in actions (when the patient does the opposite of what he is being asked for), violations of normal drives (gain, weakening, etc.).

Investigate the possibility of neurological complaints, first of all pay attention to the headaches, which can often occur, including in patients with medical conditions (hypertension, fever, intoxication, etc.). Classification of headaches is quite complex and involves the allocation of different types of cephalgia, i.e. Headache (migrnosic, vascular type, etc.).

The therapist's task in analyzing such a complaint as headaches is to clarify their character (noisy, pulsating, pressing), localization (in the occipital region, temporal region, in the form of a "hoop", etc.) whether the headaches are constantly or they occur paroxysmally, whether they depend on the time of the year, day, psychoemotional factors, physical stress, and also to establish which medications (analgesics, antispasmodics, etc.) contribute to their reduction.

In the presence of patient complaints for dizziness, they try to find out how often it occurs, is short-term (minutes, hours) or prolonged, accompanied by nausea and vomiting, and what factors cause it (blood pressure rise, transportation trip, rise to height and other). It should be borne in mind that non-systemic dizziness (sensation of a diffuse violation of the perception of space) is often observed in anemia, aortic heart disease, hypertension, neurosis, etc., while system dizziness (with a sense of rotational movement of surrounding objects or the patient itself in a certain direction) is usually associated with a lesion of the labyrinth or cerebellum.

When questioning patients, they also specify the presence of fainting, which is the most frequent form of a short-term disorder of consciousness. Fainting of a reflex, neurogenic genesis can occur with prolonged motionless standing, with a sharp transition from a horizontal position to a vertical one. Fainting associated with the development of cerebral ischemia occurs in disorders of the heart rhythm (Morgagni-Adams-Stokes syndrome), aortic heart disease, arterial hypertension, anemia, etc.

Asking the patient, find out also the nature and duration of his sleep, well-being after awakening. Often patients with various diseases (including therapeutic ones) are diagnosed with various sleep disorders, such as difficulty falling asleep, re-awakening in the middle of the night, early morning awakening, a feeling of fatigue and weakness after sleep, painful dreams, pathological drowsiness, etc.

Sleep disorders are very characteristic of neurotic conditions, but can also occur in various diseases of the cardiovascular system, respiratory and digestive organs, especially if they occur with severe pain, severe dyspnoea, etc. Pathological drowsiness is observed with various endogenous intoxications (for example, with chronic renal and hepatic insufficiency, diabetes mellitus), but it can also be noted with obesity, fatigue, avitaminosis.

A detailed study of all XII pairs of cranial nerves is performed by a neuropathologist. Nevertheless, the therapist should be able to detect the most vivid symptoms, which indicate the possible defeat of the cranial nerves. These include, in particular, complaints of smell disorders, decreased visual acuity, violations of central and peripheral vision, pupillary reaction to light, accommodation and convergence, unequal pupil sizes (anisocoria), dysfunction of masticatory and facial muscles (in particular, antialiasing nasolabial folds, distortion of the mouth), hearing loss, imbalance and instability in Romberg's posture (standing with eyes closed, bringing socks and heels together), swallowing disorders, presence of aphonia (loss of the head sa), violation of tongue sticking out, etc.

Various violations of the motor sphere may consist in limiting or completely absent active movements, limiting or, conversely, the excessiveness of passive movements, impaired coordination of movements, increasing or decreasing muscle tone, the appearance of violent movements.

An important part of neurological research is the evaluation of the reflex sphere. In various diseases of the nervous system, tendon reflexes (knee, Achilles, etc.) increase or decrease, skin reflexes decrease, and pathological reflexes (Babinsky, Rossolimo, etc.) appear.

There are special methods for detecting changes in pain and temperature sensitivity. In this case, patients themselves can complain of a decrease or a complete lack of sensitivity in various areas, the appearance of areas of increased sensitivity, a variety of parasthesia (a feeling of crawling, cramping, tingling, etc.). These disorders occur in polyneuritis (for example, in patients with chronic alcoholism), neuropathies.

When questioning, note the possible presence of pelvic disorders (violations of urination, defecation, sexual functions), which in some cases are neurogenic in nature. Pay attention to speech disorders and letters, which can be expressed in violation of articulation (dysarthria), loss of ability to read (alexia) and write (agraphy), etc.

To assess the state of the autonomic nervous system, dermographism is used. For this purpose, the end of the glass rod is applied to the skin with light dashed stimuli. Normally, healthy people on the skin immediately appear a white band, associated with a spasm of capillaries. With a stronger pressure, a red band is formed due to the expansion of the capillaries (red unstable dermographism). The long (persistent) red dermographism arising in such cases will indicate a decrease in the tone of the capillaries and their expansion. On the contrary, prolonged white dermographism indicates a persistent spasm of capillaries.

[1], [2],