Article

Psychiatric diagnoses are frequent in memory units, but most neurologists do not
feel comfortable about making the diagnosis of psychopathologic cognitive
complaint or disorder. The full diagnosis usually requires careful history taking
and a neuropsychological examination followed by a clear joint explanation to the
patient. There are no good validated clinical signs to distinguish organic memory
complaints from psychological disorders, but a nonorganic pattern, as seen in
somatic conversion disorder, can be suggestive of a "cognitivoform" disorder.
Cognitive doubt is a frequent symptom of anxiety. Bradypsychia is a frequent
symptom of depression. We report 50 patients attending their first neurological
memory consultation in university hospital for whom a de novo diagnosis of
psychopathologic disorder was established on the basis of the clinical setting,
observation, examination and neuropsychological tests. These psychopathologic
disorders accounted for 40.3% of first-consultation diagnoses. In 76% of cases,
the neuropsychological examination was normal. Nine subjects had mild cognitive
impairment, concerning executive functions in six and several domains in three.
Simulation with atypical neuropsychological pattern was distinguished in three
patients. The diagnoses were:psychosis (n=9), traumatic stress (n=5), depression
(n=7), anxiety or obsession/compulsion (n=13), hypochondria and "cognitivoform"
disorders (n=13). In this study, few patients consulted with a known psychiatric
diagnosis. Psychiatric co-morbidity was common. In the memory unit, listening
carefully to ascertain the psychic, somatic and social situation of each
individual patient appears to be as important as evaluating cognition. The
neurologist can rule out organic disorders or an exaggeration of somatic symptoms
and determine the precise etiology in order to build a rationale for treatment.
The neurologist can also avert an overconsumption of complementary explorations.
In conclusion, this study shows first that psychopathologic disorders are
commonly encountered in a neurological memory unit, emphasizing the need for
training for the neurologist and collaboration with a psychiatrist, and secondly
that the role of the memory unit cannot be limited to the diagnosis of
Alzheimer's disease.
CI - Copyright (c) 2012 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS