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Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios

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Abstract

As clinical psychiatry has evolved to mirror the patient care model followed in other medical specialties, psychiatrists are called upon increasingly to utilize general medical skills in routine practice. Psychiatrists who practice in academic settings are often required to generate broad differential diagnoses that include medical and neurologic conditions and, as a result, benefit from incorporating physical examination into their psychiatric assessments. Physical examination allows psychiatrists to follow and to teach patient-informed clinical practices and comprehensive treatment approaches. In this commentary, the authors encourage routine use of a targeted physical examination and outline common scenarios in which physical examination would be useful for the academic psychiatrist: delirium, toxidromes, and unexplained medical conditions (e.g., somatic symptom disorders).

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References

  1. Vergare MJ, Binder RL, Cook IA, Galanter M, Lu FG, For the Work Group on Psychiatric Evaluation. Practice guideline for the psychiatric evaluation of adults. 2nd ed. Washington: American Psychiatric Association; 2006.

    Google Scholar 

  2. Hall RC, Popkim MK, Devaul RA, Faillace LA, Sitckney SK. Physical illness presenting as psychiatric disease. Arch Gen Psychiatry. 1979;35:1315–20.

    Article  Google Scholar 

  3. Koranyi EK. Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population. Arch Gen Psychiatry. 1979;36:414–9.

    Article  CAS  PubMed  Google Scholar 

  4. Garden G. Physical examination in psychiatric practice. Adv Psychiatr Treat. 2005;11:142–9.

    Article  Google Scholar 

  5. Miller A, Pratt H, Schiffer RB. Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments. Expert Rev Neurother. 2011;11:1077–88.

    Article  PubMed  Google Scholar 

  6. Bruton CJ, Stevens JR, Frith CD. Epilepsy, psychosis, and schizophrenia: clinical and neuropathologic correlations. Neurology. 1994;44:34–42.

    Article  CAS  PubMed  Google Scholar 

  7. Caplan R, Siddarth P, Gurbani S, et al. Psychopathology and pediatric complex partial seizures: seizure-related, cognitive, and linguistic variables. Epilepsia. 2004;45:1273–81.

    Article  PubMed  Google Scholar 

  8. Patterson CW. Psychiatrists and physical examinations: a survey. Am J Psychiatry. 1978;135:967–78.

    Article  CAS  PubMed  Google Scholar 

  9. Krummel S, Kathol RG. What you should know about physical evaluations in psychiatric patients. Results of a survey. Gen Hosp Psychiatry. 1987;9:275–9.

    Article  CAS  PubMed  Google Scholar 

  10. Hughes S. The physical examination in psychiatry. Psychiatr Bull. 1991;15:615–6.

    Article  Google Scholar 

  11. Hodgson R, Adeyemo O. Physical examination performed by psychiatrists. Int J Psychiatry Clin Pract. 2004;8:57–60.

    Article  PubMed  Google Scholar 

  12. Patten S. The physical examination in psychiatry. Jefferson J Psychiatry. 1988;6:1–21.

    Google Scholar 

  13. Norton J. The importance of the physical examination in a psychiatry residency program. Acad Psychiatry. 2001;25:236–7.

    Article  PubMed  Google Scholar 

  14. Guy W. Abnormal Involuntary Movement Scale (AIMS), in ECDEU Assessment Manual for Psychopharmacology. Washington: US Department of Health Education and Welfare; 1976. p. 534–7.

    Google Scholar 

  15. Chouinard G, Ross-Chouinard A, Annable L, Jones B. Extrapyramidal symptom rating scale. Can J Neurol Sci. 1980;7:234.

    Google Scholar 

  16. Jenkyn LR, Walsh DB, Walsh BT, Culver CM, Reeves AG. The nuchocephalic reflex. J Neurol Neurosurg Psychiatry. 1975;38:561–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Strawn JR, Keck PE, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatr. 2007;164:870–6.

    Article  PubMed  Google Scholar 

  18. Kellam AM. The (frequently) neuroleptic (potentially) malignant syndrome. Br J Psychiatry. 1990;157:169–73.

    Article  CAS  PubMed  Google Scholar 

  19. Birmes P, Coppin D, Schmitt L, Laugue D. Serotonin syndrome: a brief review. CMAJ. 2003;168:1439–42.

    PubMed Central  PubMed  Google Scholar 

  20. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352:1112–20.

    Article  CAS  PubMed  Google Scholar 

  21. Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The hunter serotonin toxicity criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635–42.

    Article  CAS  PubMed  Google Scholar 

  22. Levine M, Brooks DE, Truitt CA, et al. Toxicology in the ICU: part 1: general overview and approach to treatment. Chest. 2011;140:795–806.

    Article  CAS  PubMed  Google Scholar 

  23. Feinstein A. Conversion disorder: advances in our understanding. CMAJ. 2011;183:915–20.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Hoover CF. A new sign for the detection of malingering and functional paresis of the lower extremities. JAMA. 1908;LI:1309–10.

    Article  Google Scholar 

  25. Greer S, Chambliss L, Mackler L, Huber T. Clinical inquiries. What physical exam techniques are useful to detect malingering? J Fam Pract. 2005;54:719–22.

    PubMed  Google Scholar 

  26. Aybek S, Kanaan RA, David AS. The neuropsychiatry of conversion disorder. Curr Opin Psychiatry. 2008;21:275–80.

    Article  PubMed  Google Scholar 

  27. Stone J, Smyth R, Carson A, et al. Systematic review of misdiagnosis of conversion symptoms and “hysteria.”. BMJ. 2005;331:989.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Reich P, Gottfried LA. Factitious disorders in a teaching hospital. Ann Intern Med. 1983;99:240–7.

    Article  CAS  PubMed  Google Scholar 

  29. McIntyre J, Romano J. Is there a stethoscope in the house (and is it being used)? Arch Gen Psychiatry. 1977;34:1147–51.

    Article  CAS  PubMed  Google Scholar 

  30. Geschwind N. The borderland of neurology and psychiatry: some common misconceptions. In: Benson DF, Blumer D, editors. Psychiatric aspects of neurological disease. New York: Grune & Stratton; 1975.

    Google Scholar 

  31. Raney L. Integrated care: the evolving role of psychiatry in the era of health care reform. Psychiatr Serv. 2013;64:1076–8.

    Article  PubMed  Google Scholar 

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The authors disclosed no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Correspondence to Pierre N. Azzam.

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Azzam, P.N., Gopalan, P., Brown, J.R. et al. Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios. Acad Psychiatry 40, 321–327 (2016). https://doi.org/10.1007/s40596-015-0334-9

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  • DOI: https://doi.org/10.1007/s40596-015-0334-9

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