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Patient Presentations Related to the Nervous System and Mental Health
Patient presentations span all ages and gender identities, reflecting patients from diverse backgrounds, cultures, and abilities and their reasons for presenting to osteopathic physicians in varied clinical settings.
| 4.1 Anxiety | |
| 4.2 Disturbances of Mood/Depressive Disorders | |
| 4.3 Cognitive Disturbances | |
| 4.4 Disturbances of Behavior and Perception | |
| 4.5 Life Adjustment and Stressors | |
| 4.6 Disturbances of the Special Senses | |
| 4.7 Headache | |
| 4.8 Speech and Language Disturbances | |
| 4.9 Movement Disturbances | |
| 4.10 Seizures | |
| 4.11 Sensory Disturbances and Pain | |
| 4.12 Sleep Disturbances | |
| 4.13 Substance Use Disorders | |
| 4.14 Nervous System Trauma | |
| 4.15 Weakness and Paralysis | |
| 4.16 Physical Exam Findings Related to the Nervous System and Mental Health | |
| 4.17 Laboratory and Diagnostic Testing Related to the Nervous System and Mental Health |
Clinical presentations in this category may include, but are not limited to, the following conditions or situations prompting patients to present for osteopathic medical care:
| Anxiety disorders | agoraphobia • breath-holding spells • generalized anxiety disorder • illness anxiety disorder • panic disorder • separation anxiety disorder • social anxiety disorder • specific phobia |
| Autoimmune disorders | Guillain-Barré syndrome • multiple sclerosis • myasthenia gravis |
| Bipolar and related disorders | bipolar I disorder • bipolar II disorder • cyclothymic disorder |
| Brain tumors | astrocytoma • ependymoma • medulloblastoma • meningioma • oligodendroglioma • schwannoma |
| Cerebrovascular disorders | amaurosis fugax • stroke • transient ischemic attack |
| Consciousness disorders | coma • delirium • locked-in syndrome • somnolence |
| Depressive disorders | disruptive mood dysregulation disorder • major depressive disorder • persistent depressive disorder • premenstrual dysphoric disorder • suicidal ideation |
| Disruptive, impulse-control, and conduct disorders | conduct disorder • intermittent explosive disorder • oppositional defiant disorder |
| Dissociative disorders | amnesia • depersonalization/derealization disorder • dissociative identity disorder |
| Ear and auditory disorders | acoustic neuroma • benign paroxysmal positional vertigo • cerumen impaction • eustachian tube dysfunction • hearing loss • labyrinthitis • Ménière disease • neoplasms • otosclerosis • tinnitus • tympanic membrane perforation |
| Elimination disorders | encopresis • enuresis |
| Encephalopathies | chronic traumatic encephalopathy • Reye syndrome • Wernicke-Korsakoff encephalopathy |
| Entrapment neuropathies | anterior interosseous syndrome • carpal tunnel syndrome • cubital tunnel syndrome • meralgia paresthetica • pronator teres syndrome • radiculopathy • tarsal tunnel syndrome • thoracic outlet syndrome |
| Eye and vision disorders | blepharitis • cataracts • corneal abrasion • floaters • glaucoma • iritis • nystagmus • orbital floor fracture • refractive error • strabismus • subconjunctival hemorrhage • uveitis |
| Facial/cranial nerve dysfunction | Bell palsy • Ramsay Hunt syndrome |
| Feeding and eating disorders | anorexia nervosa • binge-eating disorder • bulimia • pica |
| Gender dysphoria | in children • in adolescents • in adults • nonbinary |
| Head and spinal cord injuries | brain concussion • diffuse axonal injury • epidural hematoma • mild traumatic brain injury • spinal cord injury • subarachnoid hemorrhage • subdural hemorrhage • traumatic brain injury |
| Headache syndromes | cluster headache • migraine • tension-type headache |
| Movement disorders | ballism • chorea • dystonia • essential tremor • myoclonus • restless legs syndrome • Tourette syndrome |
| Nervous system infections | encephalitis • Lyme disease • meningitis • toxoplasmosis |
| Neurodegenerative disorders | amyotrophic lateral sclerosis • Creutzfeldt-Jakob disease • dementia (Alzheimer disease, frontotemporal dementia, Lewy body dementia, mild cognitive impairment, vascular neurocognitive disorder) • Horner syndrome • Huntington disease • multiple system atrophy • normal pressure hydrocephalus • Parkinson disease |
| Neurodevelopmental disorders | attention deficit hyperactivity disorder • autism spectrum disorder • cerebral palsy • intellectual disabilities • selective mutism • specific learning disorders |
| Neuropathic pain disorders | complex regional pain syndrome • postherpetic neuralgia • trigeminal neuralgia |
| Obsessive-compulsive disorders | body dysmorphic disorder • excoriation disorder • hoarding • obsessive-compulsive disorder • trichotillomania |
| Personality disorders | antisocial • avoidant • borderline • dependent • histrionic • narcissistic • obsessive-compulsive • paranoid • schizoid • schizotypal |
| Schizophrenia spectrum | brief psychotic disorder • catatonia • delusional disorder • schizoaffective disorder • schizophrenia • schizophreniform disorder |
| Seizure disorders | absence seizures • epilepsy • febrile seizures |
| Sleep disorders | circadian rhythm sleep disorders • hypersomnolence • insomnia • narcolepsy • night terrors • obstructive sleep apnea • parasomnias • somnambulism |
| Somatic symptoms and related disorders | conversion disorder • factitious disorder • illness anxiety disorder • malingering • somatic symptom disorder |
| Spinal cord disorders | anterior cord syndrome • cauda equina syndrome • syringomyelia |
| Substance-related and addictive disorders | alcohol (including withdrawal) • caffeine • cannabis • gambling • hallucinogens • inhalants • opioids • sedatives • stimulants • tobacco |
| Trauma and stressor-related disorders | acute stress disorder • adjustment disorder • grief reaction • posttraumatic stress disorder • reactive attachment disorder |
| Voice disorders | traumatic dysphonia • vocal cord paralysis |
CONSTITUTIONAL SIGNS AND SYMPTOMS
- anorexia
- chills
- fatigue
- fever
- generalized weakness
- jaundice
- malaise
- night sweats
- unintentional weight loss
PHYSICAL EXAM FINDINGS AND EVALUATIONS
- abdominal reflex
- acalculia
- action tremor
- agnosia
- agraphia
- akinesia
- alexia
- anomia
- aphasia
- apraxia
- ataxia
- athetosis
- audiologic testing
- Brudzinski sign
- Chapman reflexes
- clonus
- cognitive function testing
- cogwheel rigidity
- corneal reflex
- cremasteric reflex
- deep tendon (muscle stretch) reflexes
- dysarthria
- dysdiadochokinesia
- dyskinesia
- dysphasia
- funduscopic abnormalities
- Glasgow coma scale scoring
- heel-to-shin test
- Hoffmann sign
- Kernig sign
- muscle tone testing
- nuchal rigidity
- orthostatic hypotension
- pallor
- plantar reflex (Babinski sign)
- pupillary light reflex
- red reflex
- Romberg sign
- slit-lamp examination
- tender points
- tuning-fork testing
- viscerosomatic/
somatovisceral reflexes - visual acuity testing
LABORATORY AND DIAGNOSTIC TESTING
- angiography
- audiologic testing
- autoimmune marker blood testing
- cerebrospinal fluid analysis
- CT scanning
- electroencepha-
lography - MRI
- nuclear medicine imaging
- PET scanning
- self-report questionnaires
- serum creatine kinase level
- transcranial Doppler ultrasonography
- vitamin levels (e.g., vitamin B12, folate)