Study of the neuropsychic sphere

A full study of the patient's neuropsychiatric status can only be carried out if the doctor has an excellent knowledge of the symptomatology of nervous and mental illnesses and is proficient in the special research methods used in neurology and psychiatry.

Evaluation of the patient's mental status traditionally begins with an assessment of how well the patient navigates space, time and his own personality. As a rule, it is enough to ask a few clarifying questions: "Where are you now?", "What day of the week, month, year is it today?", "Please state your last name, first name, patronymic", "Where do you work?" etc. At the same time, it is noted whether the patient is sociable and whether he willingly communicates with the doctor.

After this, they move on to examining the cognitive, emotional and motor-volitional spheres. They pay attention to possible disturbances of perception (in particular, hallucinations), which can, for example, manifest themselves in the fact that the patient, being alone in the ward, actively gesticulating, has a lively conversation with "voices", sometimes covering his ears if the "voices" tell him unpleasant information, etc.

Questioning and conversation

During the conversation with the patient, it is also determined whether his attention is impaired and whether the patient is able to concentrate on one task for a long time. Possible memory impairments (for distant or current events) are noted.

When questioning a patient, based on the characteristics of the answers received, one can draw a conclusion about the state of his intellect, in particular, about the correspondence of the patient's intellect to the education he has received. Attention is paid to the presence or absence of various disturbances of thinking, which can be expressed in any delusional interpretations, the appearance of overvalued ideas, obsessive states.

The study of the patient's emotional sphere is assisted by an assessment of his appearance, clothing, and facial expression. Thus, the face of patients in a depressive state usually expresses melancholy and sadness. With emotional dullness, patients become very sloppy, indifferent to everything. With a manic state, patients with their entire appearance express an elevated mood, enthusiasm, and irrepressible joy.

Finally, when examining the patient’s voluntary or willful activity, they note the characteristics of his behavior, determine how the patient (independently or under duress from the staff) performs certain actions (including washing, eating, etc.), whether there is negativity in the actions (when the patient does the opposite of what he is asked to do), violations of normal drives (strengthening, weakening, etc.).

When identifying possible neurological complaints, first of all, attention is paid to headaches, which can often occur, including in patients with somatic diseases (hypertension, feverish conditions, intoxications, etc.). The classification of headaches is quite complex and involves identifying different types of cephalgia, i.e. headaches (migratory, vascular type, etc.).

The therapist's task when analyzing a complaint such as headaches is to clarify their nature (aching, pulsating, pressing), localization (in the occipital region, temporal region, in the form of a "hoop", etc.), to find out whether headaches are constant or whether they occur in attacks, whether they depend on the time of year, day, psycho-emotional factors, physical stress, and also to establish which medications (analgesics, antispasmodics, etc.) help to reduce them.

If the patient complains of dizziness, they try to find out how often it occurs, whether it is short-term (minutes, hours) or long-term, whether it is accompanied by nausea and vomiting, and what factors cause it (increased blood pressure, traveling in transport, climbing to a height, etc.). It should be borne in mind that non-systemic dizziness (a feeling of diffuse disturbance of spatial perception) is often observed in cases of anemia, aortic heart defects, hypertension, neuroses, etc., while systemic dizziness (with a feeling of rotational movement of surrounding objects or the patient himself in a certain direction) is usually associated with damage to the labyrinth or cerebellum.

When questioning patients, they also specify whether they have fainting spells, which are the most common form of short-term loss of consciousness. Fainting spells of reflex, neurogenic genesis may occur during prolonged motionless standing, during a sharp transition from a horizontal to a vertical position. Fainting spells associated with the development of cerebral ischemia occur with cardiac arrhythmia (Morgagni-Adams-Stokes syndrome), aortic heart defects, arterial hypertension, anemia, etc.

When questioning the patient, they also find out the nature and duration of his sleep, his state of health after waking up. Often, patients with various diseases (including therapeutic ones) are found to have various sleep disorders, which include difficulty falling asleep, repeated awakening in the middle of the night, early morning awakening, a feeling of fatigue and exhaustion after sleep, distressing dreams, pathological sleepiness, etc.

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

A detailed examination of all 12 pairs of cranial nerves is carried out by a specialist neurologist. However, a therapist should also be able to detect the most obvious symptoms indicating possible damage to the cranial nerves. These include, in particular, complaints of olfactory disorders, decreased visual acuity, central and peripheral vision disorders, pupillary response disorders to light, accommodation and convergence, unequal pupil sizes (anisocoria), dysfunction of the masticatory and facial muscles (in particular, smoothing of the nasolabial fold, distortion of the mouth), hearing loss, impaired balance and instability in the Romberg pose (in a standing position with closed eyes, bringing the toes and heels together), swallowing disorders, aphonia (loss of voice), tongue protrusion disorders, etc.

Various disorders of the motor sphere may consist of a limitation or complete absence of active movements, a limitation or, conversely, an excess of passive movements, a violation of the coordination of movements, an increase or decrease in muscle tone, and the appearance of violent movements.

An important section of neurological examination is the assessment ofthe reflex sphere. In various diseases of the nervous system, an increase or decrease in tendon reflexes (knee, Achilles, etc.), a decrease in skin reflexes, the appearance of pathological reflexes (Babinsky, Rossolimo, etc.) are noted.

There are special techniques for detecting changesin pain and temperature sensitivity. At the same time, patients themselves may complain of decreased or complete absence of sensitivity in various areas, the appearance of areas of increased sensitivity, various paresthesias (feeling of crawling ants, tightening, tingling, etc.). The above-mentioned disorders occur in polyneuritis (for example, in patients with chronic alcoholism), neuropathies.

When questioning, they note the possible presence of pelvic disorders (urination, defecation, sexual functions), which in some cases are of neurogenic origin. They pay attention to speech and writing disorders, which can be expressed in articulation disorders (dysarthria), loss of the ability to read (alexia) and write (agraphia), etc.

To assess the state of the autonomic nervous system, a study of dermographism is used. For this, light stroke irritations are applied to the skin with the end of a glass rod. Normally, a white stripe associated with capillary spasm immediately appears on the skin of healthy people. With stronger pressure, a red stripe is formed due to the expansion of capillaries (red unstable dermographism). The long-term (persistent) red dermographism that occurs in such cases will indicate a decrease in capillary tone and their expansion. On the contrary, long-term white dermographism indicates a persistent spasm of the capillaries.

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