Neuropsychiatric Manifestations of Systemic Medical Conditions

Abstract

Systemic medical conditions frequently present with neuropsychiatric symptomatology that may be misattributed to a primary psychiatric disturbance. A broad spectrum of systemic medical conditions can mimic primary neuropsychiatric processes. The most common medical mimics include autoimmune, endocrine, infectious, metabolic, iatrogenic, and neoplastic processes. These processes occur at a higher frequency in the geriatric population. Thus, in evaluating older adults presenting with neuropsychiatric symptoms, a wide differential diagnosis is required in order to avoid incorrect and potentially dangerous attribution to primary psychiatric disorders as the chief cause of the presentation. There are no pathognomonic signs or symptoms that reliably indicate a systemic medical condition versus a psychiatric disorder. In addition, robust presentations that are typically described as “classic” features of a number of common systemic medical disorders are less likely to be seen in older adults; thus it is imperative to ensure a careful workup to rule out an underlying or contributory medical condition. Involvement of colleagues from appropriate medical specialities is essential to timely and appropriate workup and management of patients with atypical, seemingly treatment-refractory, or progressive neuropsychiatric symptomatology.