THE NEUROLOGIC EXAMINATION IN ADULT PSYCHIATRY - FROM SOFT SIGNS TO HARD SCIENCE

Of the proliferating approaches to neuropsychiatric assessment, a rela tively neglected technique is the venerable, accessible, noninvasive, and inexpensive neurologic examination. This article organizes and syn thesizes the literature on neurological findings in adult psychiatric patients. Problems in conducting and interpreting research in this are a are examined, clinically pertinent empirical findings are surveyed, and directions for future investigation are outlined. Most of the ''so ft signs'' can be reliably evaluated, and many have been validated aga inst other techniques. Several psychiatric diagnoses are associated wi th impaired neurologic performance. Prognosis and treatment selection may also be informed by neurologic findings. The neurologic exam shoul d be regarded as a collection of neurobiologic probes rather than as a single irreducible variable. Future work must better establish interr ater and test-retest reliability of individual elements of the neurolo gic exam in psychiatric populations and focus on developing the clinic al utility of individual and combined elements of the neurologic exam.