Physical Findings Your Psychiatrist is Looking For

Most people don’t think psychiatrists do physical exams because we avoid touching patients (to provide trauma informed care). That said, we are actually watching for a lot of things.

A therapist attentively listens and takes notes as a man expresses his emotions during a counseling session, providing support in a calm and empathetic environment.

Physical Findings Your Psychiatrist is Looking For:

For context: Dopamine regulates movement. Most stimulants increase dopamine use in the brain. Most antipsychotics decrease dopamine use in the brain.

➡️ Leg movements: Anything we prescribe that impacts dopamine can also impact movement. Lots of leg tapping and fidgeting may be a sign of ADHD or antipsychotic side effects. Needing to get up and pace is concerning for a side effect of antipsychotics called akathisia. It’s a terrible feeling of having to get up and pace.

➡️ Tremors: So much of what we prescribe has direct or indirect impacts on dopamine. A baseline tremor (without meds) could suggest essential tremor, Parkinson’s Disease, Lewy Body Dementia, or residual side effects from antipsychotic medications. We also want to monitor tremor with medications we prescribe to ensure we are not exacerbating anything. In the case of PD and LBD, we avoid most antipsychotics and stick to Quetiapine or Clozapine. Both stimulants and antipsychotics can cause tremors.

➡️ Facial movements: One of the feared complications of antipsychotics is something called tardive dyskinesia. It can be permanent, but does usually resolve with stopping the medication that caused it. Tics often present with facial movements. Stimulant medications can bring out tics or exacerbate them. We may not be able to avoid tics, but we try to. And oddly enough the treatment for tics is antipsychotics.

Side bar: Other types of medications (antidepr

essants) can definitely impact movement, but it’s far less often and these more notorious offenders.

#dopamine #adhd #lewybodydementia #mentalhealth #antipsychotics