Neuropsychiatric Manifestations of Systemic Medical Conditions

Systemic medical conditions frequently present with neuropsychiatric symptomatology that may be misattributed to a primary psychiatric illness. 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 should be considered in order to avoid incorrect and potentially dangerous attribution to primary psychiatric disorders as the chief cause of presentation. Often there are no pathognomonic signs or symptoms that reliably indicate a non-psychiatric medical condition versus a psychiatric disorder. In addition, 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. Involvement of colleagues from appropriate medical specialties is essential for timely and appropriate workup and management of patients with atypical, seemingly treatment-refractory, or progressive neuropsychiatric symptomatology.