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Answer 4
  1. Determine what psychiatric medication the patient is taking. The patient’s history of mental health treatment and hearing voices suggests a psychotic disorder, such as schizophrenia. Therefore, the medication he describes may be a typical antipsychotic (eg, haloperidol, fluphenazine), in which case the patient may have neuroleptic-induced parkinsonism.1 It is necessary to find out whether the patient is taking an antipsychotic agent before a diagnosis of idiopathic Parkinson’s disease is made. Referral to a psychiatrist is not necessary because the patient is already receiving mental health treatment. Psychological testing would only be indicated if further evaluation suggests that the patient’s psychiatric diagnosis is unclear. Referral to an endocrinologist is not indicated in this case.

    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed., text revision. Washington (DC): The Association; 2000.

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