Beyond Primary Psychiatry: Medical Causes of Neuropsychiatric Symptoms and an Interdisciplinary Diagnostic Approach
TL;DR
Findings indicate that the differential diagnosis of neuropsychiatric symptoms should not rely exclusively on psychiatric phenomenology, and a structured approach integrating temporal evolution, neurological and systemic warning signs, targeted complementary testing, and interdisciplinary evaluation may improve the recognition of potentially reversible medical causes, facilitate appropriate treatment, and reduce diagnostic delay.
Abstract
Neuropsychiatric manifestations associated with medical diseases represent a major diagnostic challenge because cognitive, behavioral, affective, psychotic, and consciousness-related symptoms may closely resemble primary psychiatric disorders. This review aimed to analyze the principal medical conditions associated with neuropsychiatric manifestations, identify clinical warning signs that suggest a secondary medical origin, evaluate the diagnostic tools used for differential diagnosis, and examine the role of interdisciplinary management. A descriptive and analytical integrative review was conducted using the Scientific Method as the methodological framework. Twenty scientific publications addressing neurological, autoimmune, endocrine, metabolic, nutritional, infectious, and systemic conditions were analyzed. The most frequently represented etiological group was autoimmune/neurological disorders (40%), followed by endocrine diseases (20%), metabolic/nutritional conditions (15%), other general medical conditions (15%), systemic autoimmune diseases (5%), and infectious conditions (5%). Cognitive impairment was the most frequently identified neuropsychiatric manifestation (75%), followed by behavioral changes (70%), psychosis (65%), mood disturbances (60%), and altered consciousness or delirium (50%). The main clinical red flags were acute or subacute onset (60%), neurological abnormalities (55%), altered consciousness (50%), seizures (45%), and rapid cognitive decline (45%). Laboratory studies and neuroimaging were the most frequently represented diagnostic tools, while neurology, psychiatry, and internal medicine showed the greatest interdisciplinary participation. These findings indicate that the differential diagnosis of neuropsychiatric symptoms should not rely exclusively on psychiatric phenomenology. A structured approach integrating temporal evolution, neurological and systemic warning signs, targeted complementary testing, and interdisciplinary evaluation may improve the recognition of potentially reversible medical causes, facilitate appropriate treatment, and reduce diagnostic delay.