Neurological examinations for psychiatric patients: A systematic review

The neurological examination is a key part of the diagnostic evaluation of psychiatric patients. There is general agreement that the canonical neurological examination should be modified for psychiatric patients, however there is a lack of consensus around what this should entail. We reviewed the literature on proposed neurological examinations for a psychiatric clinical setting. A systematic review, following PRISMA guidelines, was conducted to identify all published neurological examinations aimed at adult psychiatric patients. Information on items, length and target population was extracted for each examination. A total of 20 proposed neurological examinations were identified (9 general adult; 4 older adult; 7 general and older adult). All examinations covered the broad components of a canonical neurological examination, including assessments of the upper limbs, lower limbs, and cranial nerves. In addition to this, inspection for involuntary movements and assessment of primitive reflexes were commonly included. Neurological examinations for older adults were typically lengthier, and frequently recommended testing for olfaction and functional ability. However, the strength of the evidence supporting all proposed examinations was low, relying heavily on expert opinion. Existing neurological examinations in psychiatry exhibit several weaknesses, which limit their use in routine psychiatric care. There is a need for a brief, evidence-based neurological examination that is feasible to implement in a psychiatric setting.