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The main targets of the traditional British “neurological examination” may be elementary motor and sensory processes, but any adequate assessment of “brain function” must take account of cognition and behaviour.The notion many of us bring to neurology—that only a minority of neurological disorders has a significant psychological or psychiatric dimension—is almost certainly wrong.All illness has both psychological and physical dimensions.This may seem a startling claim, but on reflection it is uncontroversial.Some patients become inert and aspontaneous, others anxious and restless, leading to a diagnosis of depression or anxiety disorder.

Neuroacanthocytosis is frequently associated with cognitive and behavioural features: Recent research suggests that neuropsychiatric features also occur quite commonly in many inherited disorders regarded as firmly “neurological”—for example, hereditary spastic paraparesis and inherited spinocerebellar ataxia.Diseases don’t come to doctors, patients do—and the processes by which patients detect, describe, and ponder their symptoms are all eminently psychological. If we adopt a “bio-psycho-social” approach to illness generally, one which recognises the biological, psychological, and social aspects of our lives, we become less likely to neglect the treatable psychological origins of many physical complaints (from globus hystericus to full blown conversion disorder) and the treatable psychological consequences (such as depression and anxiety) of much physical disease.Neurology has an especially close relationship with psychology and psychiatry, as all three disciplines focus on the functions and disorders of a single organ, the brain.We cannot possibly discuss all the neurological disorders which can be mistaken as psychiatric in this short article: we have picked out an illustrative assortment to convey the broad approach we recommend.Throughout the text, you will encounter the words enclosed in “scare quotes”.

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