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This review covers six medical conditions—acute intermittent porphyria, anti-NMDA receptor encephalitis, lupus, Lyme disease, neuroendocrine tumors, and syphilis—that can masquerade as psychiatric disorders. These illnesses often show up with psychiatric symptoms like anxiety, psychosis, or mood changes, mixed with physical signs such as rashes, abdominal pain, or heart irregularities. Getting the right diagnosis is essential since many cases improve with medical treatment, though you may still need to provide psychiatric care for lingering symptoms. It’s a reminder to stay curious when symptoms don’t quite fit the usual psychiatric picture.

Dr. Gabriela Gilmour offers practical insights into diagnosing and managing functional neurologic disorder (FND) and recommends retiring the term "conversion disorder." She emphasizes that FND is no longer a diagnosis of exclusion, thanks to improved diagnostic tools, and stresses that accurate identification is essential to avoid unnecessary treatments.

Dr. Poyurovsky offers practical guidance for identifying and treating akathisia, a movement disorder marked by inner restlessness. He highlights the importance of psychoeducation, gradual dose adjustments, and the use of propranolol or low-dose mirtazapine for relief. He underscores the importance of distinguishing akathisia from other conditions, like psychotic agitation, to avoid unnecessary increases in antipsychotic doses.

Factitious disorder occurs when people intentionally produce or fake symptoms without clear external incentives, like financial gain or avoiding legal trouble. The goal is to adopt the “sick role” to gain attention or sympathy. It’s a tricky condition to diagnose since patients’ symptoms mimic real medical conditions. Take a nonjudgmental approach, practice supportive confrontation, and coordinate with your multidisciplinary team to ensure the patient receives appropriate care, though treatment adherence and outcomes are often poor.

By successfully completing the test you will be awarded a certificate for 2 CME credit.