How would you manage a patient with secondary progressive multiple sclerosis manifesting with increased neuropsychiatric manifestations (ex. psychosis) with no recent changes on brain MRI?  

Exclude the usual suspects such as infections, electrolyte abnormalities, and polypharmacy. If nothing pans out and nutritional causes or deficiencies have been excluded I would direct such patients to psychiatric care. I will also make sure that the patient is not suicidal by doing a Beck Depressio...