Psychiatric presentation of medical illness

A 37-year-old woman was seen in the emergency department for symptoms of depression. A careful mental status examination resulted in the discovery of an organic basis for the "psychiatric" presentation. As with any patient demonstrating behavioral abnormalities, this case illustrates the importance of an adequate history, physical, and mental status evaluation in ruling out organic etiology prior to labeling a patient's complaints as functional. Medical illnesses that can present as apparent psychiatric disease and the clinical clues that lead to the diagnosis of such cases are discussed.