Aphasic syndromes and "psychiatric" symptoms: diagnostic dilemmas

Behavioral syndromes that occur in patients with aphasic disorders without localizing neurologic signs may appear strikingly similar to psychiatric disorders. In the absence of abnormal physical findings, the predominance of psychiatric symptoms, such as avoidance/withdrawal, irritability/hostility, paranoia, or depression, can lead the busy primary care clinician and the unsuspecting psychiatrist away from an organic diagnosis. Through review of selected literature and case presentations, we provide guidelines for evaluating and correctly identifying aphasic disorders masked by complex behavioral syndromes.