Indications for neurologic and psychiatric eval discussion

Inexplicable or ill defined upper extremity complaints may reflect an undiagnosed neurologic or psychiatric disorder. Slowly progressive nervous system diseases or psychiatric disorders may show little in the way of objective abnormalities on examination, but may result in unexplained difficulties with coordination, sensation, or pain. Stress in the workplace is also increasingly recognized as a contributing, if not primary explanation for many painful work related complaints. Formal neuropsychiatric evaluation may be indicated in patients with bizarre or inexplicable complaints. This is not to provide a verdict that there is nothing wrong with the patient, but to survey for cognitive problems which impact the patient's work-place safety and identify uncommon progressive neurologic disorders (such as a brain tumor) which might have a limited window of opportunity for cure.

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