Psychiatric Presentations/Manifestations of Medica

Authors: Jack Castro Stephen Billick

Publish Date: 2013/03/03

Volume: 84, Issue: 3, Pages: 351-362

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Abstract

Psychiatry is clearly an integral part of medicine With a history and physical exam called the mental status exam in psychiatry appropriate laboratory or imaging studies a differential diagnosis is made If a specific DSMIVTR diagnosis is made then the treatment will naturally follow The diagnoses are scientifically established with good validity specificity sensitivity and interrater reliability Similarly the treatments are established through scientific research However sometimes medical illnesses may present with symptoms seemingly pointing to a psychiatric origin Making a misdiagnosis can be quite problematic and dangerous for the patient The opposite is also true that psychiatric illnesses may present with symptoms implying a medical diagnostic origin Finally psychiatric patients may have more than one psychiatric diagnosis and in addition a medical diagnosis too A high degree of suspicion should always be entertained by the diagnosing physician psychiatric or nonpsychiatric This paper reviews the literature regarding these situations and then presents several clinical cases where this conundrum was present Making the correct diagnosis was critical in the successful treatment outcome of each of the clinical cases When asked to consult on a patient by nonpsychiatric physicians the psychiatrist must be careful to also look for nonpsychiatric origins for the referring symptoms It is important for psychiatrists to build on their medical knowledge from medical school and internship and continue to be kept abreast of confounding symptomatology

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