Assessment for subtle neurological signs

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Publication Details

Author list: Bombin I
Publisher: Cambridge University Press
Place: Cambridge
Publication year: 2010
Start page: 333
End page: 343
Number of pages: 11
ISBN: 978-113901691-9
Languages: English-Great Britain (EN-GB)


Most psychiatric disorders are characterized by alterations of brain
function and/or structure. The causes of such alterations range from
changes in physiology secondary to environmental, genetic, or
interactive conditions, as well as to structural alterations, which are
related to developmental or acquired factors, and may produce persistent
chemical and functional disorders. Over the last 50 years, there have
been an increasing number of neuroanatomical, neuroimaging,
neurophysiological, and neuropsychological studies investigating the
structural, functional and cognitive correlates of brain insult(s),
which could ultimately lead to a better understanding of the complex
etiopathophysiology of neuropsychiatric disorders. This has been
especially so for the most severe forms of psychiatric disorders, such
as schizophrenia and other psychoses, for which changes in brain
structure and function have been demonstrated through different research
approaches. A direct, easily administered, and inexpensive way of
investigating brain dysfunction is the study of subtle neurological
signs (SNS; see Table 22.1). Neurological abnormalities include both
“hard” signs and “subtle” (or “soft” signs). Hard signs refer to
impairments in basic motor, sensory, and reflex behaviors. Hard signs
are often indicative of a specific abnormality in the central nervous
system. In contrast, SNS are described as non-localizing neurological
abnormalities that cannot be related to impairment of a specific brain
region, or are not believed to be part of a well-defined neurological
syndrome [1]. This distinction may be artificial, and reflects the state
of our understanding of the brain–behavior relationships that underlie
the presence of SNS [1]. Moreover, SNS are frequently clustered in
categories according to their putative neuroanatomical localization (see
Table 22.1). These distinctions between hard and soft neurological
signs led to the hard signs inclusion in the routine neurological
examination, with soft signs reserved for the examination of cognitive
and behavioral problems.


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Last updated on 2019-13-08 at 00:45