Occam's razor cuts out the mind-body dichotomy

Psychiatric symptoms are among the most common manifestations of endocrine disorders. We present a case of Schmidt's syndrome, or polyglandular type II failure. Due to a florid psychiatric presentation, the initial endocrine diagnosis was missed, and a diagnosis of a nonorganic psychotic illness was made. This impacted on the treatment and appropriate placement of the patient. This case is presented to illustrate the importance of the organic work-up and follow-up on abnormal laboratory results in patients with dementia. In the elderly, a new onset of psychosis is usually associated with an organic cause. Furthermore, the presence of either a fixed or intermittent change in cognitive function suggests a strong likelihood of organicity. These features were present, but not noted, leading to management problems that are described here to illustrate the need for careful clinical scrutiny.