• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Blogs » The Carlat Psychiatry Blog » What to Know When Diagnosing Parkinsonism

The Carlat Psychiatry Blog
The Carlat Psychiatry Blog RSS FeedRSS

What to Know When Diagnosing Parkinsonism

June 7, 2019
In addition to antipsychotics, parkinsonism symptoms can also develop through the use of non-psychiatric medicines, particularly metoclopramide (Reglan), an anti-nausea medicine. Neurologist David M. Kaufman, MD, of Montefiore Medical Center, Bronx, NY. Dr. Kaufman offered the following information in an Expert Q&A from The Carlat Psychiatry Report:

What other disorders might cause parkinsonism?
In addition to parkinsonism being related to antipsychotics and other medications, psychiatrists need to consider the possibility that parkinsonism can be a manifestation of neurologic illnesses, including Lewy Body Dementia, Wilson disease, drug abuse, or Huntington disease. These particular illnesses are especially important because they cause mood and thought disorders, as well as parkinsonism, and thus a patient developing one of them may see a psychiatrist before any other specialist.

How do we determine whether parkinsonism is due to the use of antipsychotics or Parkinson disease?
It could be both, especially in the case in older adults. If older patients have been receiving antipsychotics and develop parkinsonism, a psychiatrist might consider the possibility that these patients may have been developing idiopathic Parkinson disease and that the psychiatric symptoms may have been related. It is not always easy to tell the difference between the disease and its adverse effects. The first thing to do, if possible, is to stop the antipsychotic agent and wait 3 weeks to 3 months to see if the symptoms resolve.

How should we examine patients who appear to have parkinsonism?
To start, observe whether the patient has reduced facial and limb expressions and gestures. For example, they may show decreased smiling and decreased affect. They will not gesture with their hands. They will also characteristically have fewer eye blinks and tend to stare, which neurologists call a “reptilian stare.” In most cases, patients with parkinsonism will have a tremor of one or both hands. If it is unilateral or asymmetric, a resting tremor suggests idiopathic Parkinson disease, but if it is symmetric, we really cannot say whether it is idiopathic or medication-induced.

After we make those observations, what should we do next?
Neurologists rotate the hand around the wrist and see if there is cogwheel resistance. Both wrists need to be tested. In individuals who have a tremor on one side, that wrist ought to have rigidity, and the other one will not. Another maneuver is the so-called “pull test.” With the patient standing, the physician stands behind, puts hands on the patient’s shoulders, and says, “At the count of three, I’m going to pull you back a little.” During this, a normal healthy patient will take a step back or bend the shoulders backwards to keep their balance when pulled back. In contrast, someone with Parkinson disease will either take many steps backwards (“retropulsion”), or just topple over like a statue (“falling en bloc”). Another simple thing we do is watch people walk while seeing if they have normal arm swing. A lack of normal swinging on one or both sides is consistent with parkinsonism.

Subscribers to The Carlat Psychiatry Report can read the full Q&A here. Not a subscriber? Join here.
Carlat Total Access Subscriptions: Get access to every article on the website.

Complete access to every article you search on the website.

Shop for Total Access
Free Psychiatry Updates
The latest unbiased psychiatric information sent to your inbox.
Specify Your Interests
Featured Book
  • HospPsychiatry_Spiral_Binding_Sm.png

    Hospital Psychiatry Fact Book, First Edition (2025) - Spiral Bound

    This comprehensive guide is designed to be a valuable resource for professionals working in...
    READ MORE
Featured Video
  • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
    General Psychiatry

    KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

    Read More
Featured Podcast
  • shutterstock_2622607431.jpg
    General Psychiatry

    Should You Test MTHFR?

    MTHFR is a...
    Listen now
Recommended
  • Join Our Writing Team

    July 18, 2024
    WriteForUs.png
  • Insights About a Rare Transmissible Form of Alzheimer's Disease

    February 9, 2024
    shutterstock_2417738561_PeopleImages.com_Yuri A.png
  • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

    May 24, 2024
    DEA_Checkbox.png
  • Join Our Writing Team

    July 18, 2024
    WriteForUs.png
  • Insights About a Rare Transmissible Form of Alzheimer's Disease

    February 9, 2024
    shutterstock_2417738561_PeopleImages.com_Yuri A.png
  • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

    May 24, 2024
    DEA_Checkbox.png
  • Join Our Writing Team

    July 18, 2024
    WriteForUs.png
  • Insights About a Rare Transmissible Form of Alzheimer's Disease

    February 9, 2024
    shutterstock_2417738561_PeopleImages.com_Yuri A.png
  • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

    May 24, 2024
    DEA_Checkbox.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report
  • The Carlat Psychotherapy Report

Contact

carlat@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.