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General examination © SPMM Course 3. Physical examination of a psychiatric patient General examination SIGNS Relevant conditions Argyll-Robertson pupil Neurosyphilis; the more common cause is diabetes. Checker-board abdomen Multiple surgical scars in factitiou...

Neurological examination in psychiatry © SPMM Course Neurological examination in psychiatry Cranial nerves examination: No. Name Main clinical examination technique I Olfactory Smell – each side separately II Optic Test visual acuity using Snellen’s charts (ne...

Other neurological signs © SPMM Course Other neurological signs  Absent ankle jerks, upgoing plantars: This is an odd combination - UMN lesion of corticospinal tracts is expected to cause exaggerated ankle reflex (i.e. clonus) with upgoing plantar normally. B...

Bedside cognitive examination tools © SPMM Course Bedside cognitive examination tools (This section is best read in conjunction with the section on neuropsychological tests in the Applied Neuroscience chapter and the chapter on Rating Scales) MMSE: The Mini-Me...

4. Imaging of the nervous system © SPMM Course 4. Imaging of the nervous system Computed Tomography – CT  The most widely available scan in clinical practice  CT scanners effectively take a series of head X-ray pictures from 360 degrees around a patient's he...

Functional Magnetic Resonance Imaging (fMRI) © SPMM Course Magnetic Resonance Spectroscopy –MRS  MR spectroscopy can detect several biologically important nuclei with an odd number of protons and neutrons.  H-1 proton spectroscopy can be used to quantify Nac...

Single Photon Emission Computed Tomography - SPECT © SPMM Course sequence. This is called Blood Oxygen Level Dependent (BOLD) technique. This process is the basis for functional MRI.  fMRI is a proxy measure of tissue activity that depends on relative changes...

1. Mood and Affect:

Aspects of Affect:

Coexisting features of mood disturbance: © SPMM Course Mood and Affect: The terms affective disorder and mood disorder are used interchangeably in clinical practice. The difference between mood and affect has been variously described. It is generally accepted...

Pain symptoms: © SPMM Course Mixed states: It is long appreciated that between the extremes of mania and depression various mixed states exist. In fact, mixed states are commoner than pure mania or depression, according to the recent literature. s. no Type Moo...

Anhedonia & Alexithymia:

Mood and perception of time: © SPMM Course For somatoform pain, head and neck are the most common sites. In somatisation disorder, musculoskeletal symptoms are the commonest. In hypochondriasis gastrointestinal symptoms predominate. Anhedonia & Alexithymia: An...

2. Disorders of perception © SPMM Course 2. Disorders of perception Perception consists of two parts – receiving information from a sensory modality (bottom up) and interpretation or processing of the sensation instantaneously using cognitive faculties (top do...

Imagery & Illusions © SPMM Course The above table has been pictorially represented below: Imagery & Illusions The imagery is not a perception because there is no stimulus involved and no object perceived; it is essentially a fantasy. Imagery refers to images p...

Pseudohallucinations: © SPMM Course Type of illusion Context Quality Effect of concentration Example Affect illusion Prevailing emotional state leads to misperceptions Often fearful, emotion provoking. Disappears on focussing the object with extra concentratio...

Hallucinations © SPMM Course They are intermediate between fantasy (imagery) and hallucinations. Like fantasy they are in subjective space, lack quality of concrete reality, have quality of idea and so not sought in other modalities simultaneously (not searche...

Synaesthesia: © SPMM Course Reflex hallucinations: These are hallucinations in one modality provoked reflexively by a stimulus in another modality e.g. seeing an angel whenever listening to music. They are similar to functional hallucinations in that there is ...