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With every patient, the psychiatrist should consider a thorough neurological examination, especially for hospitalized patients. Patients who have a history of neurological disturbances, such as strokes, seizure disorders, central nervous system neoplasms, dementias and movement disorders, should be carefully evalu-ated, perhaps by a neurologist. The neurological examination should be particularly designed to rule out any lateralizing neu-rological signs which would point toward the presence of a fo-cal lesion. Unilateral weakness or abnormalities in pupil size or eye movements might suggest a focal neoplasm, infection (such as toxoplasmosis), intracranial bleeding, or a stroke, which may explain such psychiatric symptoms as confusion, sudden onset of speech difficulties, psychosis, or even depression. Stiffness and cogwheel rigidity are classical signs of Parkinson’s disease, a dis-order which may be associated with such psychiatric symptoms as depression, psychosis and dementia.
Patients with acquired immunodeficiency syndrome should also be carefully evaluated neurologically because many neurologi-cal manifestations of advanced HIV-related illness (including HIV-associated dementia and CNS opportunistic infections) and the medicines administered to treat these illnesses may produce psy-chiatric symptoms, including depression, delirium, mania and psy-chosis. Gait should be carefully examined in psychiatric patients be-cause certain neurological conditions in which gait disturbances are prominent, such as normal-pressure hydrocephalus, tertiary syphi-lis (tabes dorsalis) and combined system disease (caused by vitamin B12 deficiency) may produce a variety of psychiatric symptoms.
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