Integration of neuropsychological and behavioral neurological assessment in psychiatry: a case example involving brain injury and polypharmacy.
We present a case example that highlights the need for careful neurologic and neuropsychological reevaluations of psychiatric patients who sustain head injuries, and also illustrates the concept that psychopharmacological interventions may impair cognitive performance, especially in a brain-damaged person. As in a previous paper (Weinstein et al. 1991), we emphasize the importance of a multidisciplinary diagnostic and treatment approach that carefully considers psychodynamic, cultural, and neurobiological data. In our experience, a neuropsychological approach is particularly helpful in cases: (1) where brain dysfunction is suspected but focal neurological signs are not identified, and (2) where frank symptoms of medication toxicity are absent but cognitive impairment is greater than expected.
Weinstein
C S
CS
Harvard Medical School, Department of Psychiatry, Deaconess Hospital, Boston, MA 02115.
Seidman
L J
LJ
Ahern
G
G
McClure
K
K
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D064420:Drug-Related Side Effects and Adverse Reactions; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D001523:Mental Disorders / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D009460:Neurologic Examination; D009483:Neuropsychological Tests