Elaboration of a neurological diagnostic screening in the assessment of psychological disorders (pain intensity, affective and personality disorders) based on the degree of expression of patellar reflexes

Abstract

Introduction. The evaluation of tendon reflexes is one of the main components of the clinical examination of the nervous system. The neurologic examination is an important clinical bridge between mind and brain. Fundamentally, the tendon reflex response demonstrates a balance of signals between the cerebral cortex and the spinal cord. Although the history of reflexes shows that they were an indicator of organic pathology, in this study we intend to demonstrate that personality disorders, affective disorders (anxiety, depression) and the presence of pain syndrome induce varying degrees of expression of patellar reflexes. Aim of the study. Evaluation of the degree of expression of patellar reflexes and their correlation with pain intensity, affective and personality disorders in order to develop a screening algorithm for neurological examination. Materials and methods. Were evaluated 210 patients, who suffered from headaches, affective disorders and personality disorders. We identified 3 levels of the degree of pronunciation of patellar reflexes: reflexes diminished or absent, reflexes normal or augmented and reflexes very pronounced ("convulsive"). Patients completed the following questionnaires: SCL-90, Anxiety Spielberger, BECK Depression Questionnaire, Nijmegen, Vegetative Profile, PID (Personality Inventory Disorders), Somatoform disorders (which also included pain phenomenon). Results. The study included 210 patients, of which 54 men (25,7%) and 156 women (74,3%), 18-50 years old, with an average of 31,32 years. They were grouped according to the degree of pronunciation of patellar reflexes in 3 groups. The first group included 60 patients with diminished or absent reflexes (28,6% of the group), of which 28 men and 32 women. The second group included 46 patients (21,9%) with normal or augmented reflexes, of which 12 men and 34 women. The third group included 104 patients (49,5%) with very pronounced ("convulsive") reflexes, of which 14 men and 90 women. Patients in the study group were present with pain syndrome, thus 110 patients with migraine (52,4%), 66 patients with tensiontype headache (31,4%) and 34 patients (16,2%) did not report pain syndrome. Conclusions. Patients with personality disorders have the degree of pronation of patellar reflexes diminished until absent, and when applying the Jendrassik maneuver, this test amplifies the reflex response. While patients with affective disorders and pain syndrome present hyperreflexia. Thus, patellar reflexes can serve as an effective screening, with a degree of probability in the diagnosis of functional disorders of patients.