Study on the final diagnosis of nervous system diseases with psychiatric symptoms as manifestation onset

Misdiagnosis of psychiatric disorders can lead to waste of medical resources and delay of treatment after correct diagnosis.  Identify organic neurological disorders misdiagnosed as psychiatric disorders, and broaden the spectrum of disorders with psychiatric symptoms as the first or main manifestation.

This is a retrospective cross-sectional study. From January 1, 2020 to December 1, 2023. Patients in the psychiatric outpatient and inpatient department of the First Affiliated Hospital of China Medical University, Liaoning Province.  Inclusion criteria were adults (age >18 years) with a previously diagnosed psychiatric disorder. A total of 298 patients were diagnosed with psychiatric disorders, of which 197 patients with only diagnosed psychiatric disorders and effective symptomatic treatment were excluded. Collect data on clinical features, tests, examinations, meeting criteria for psychiatric disorders, and final diagnosis.

A total of 101 patients initially diagnosed with psychiatric disorders at our hospital met the psychiatric diagnostic criteria, with a median (IQR) age of 46 years (18-69), and 78% were women. Following symptomatic treatment, disease progression prompted a reassessment with additional medical history, special laboratory tests, and imaging sequences, revealing clear abnormalities. Correct diagnoses comprised autoimmune encephalitis (LGI1) (20%), autoimmune encephalitis (NMDAR) (17%), autoimmune encephalitis (GABABR) (16%), and others: GFAP 2%, mGLUR5 1%, GAD65 1% (4%), herpes simplex virus encephalitis (22%), Creutzfeldt-Jakob disease (3%), N2O abuse (14%), syphilis (3%), and Hashimoto's encephalopathy (2%).

Psychiatric disorders have diverse etiologies, and advances in medical technology have broadened the spectrum of diseases manifesting with psychiatric symptoms. Recognizing the biological bases of many psychiatric symptoms allows for timely, effective treatments. Psychiatric diagnoses carry much more stigma than Neurology diagnosis. Patients who previously met the diagnostic criteria for psychiatric disorders may now have an organic neurologic etiology to be found. Red flags for neurology diagnoses include ineffective symptomatic treatment and worsening clinical symptoms. Hence, early differentiation between psychiatric and organic neurological diseases is essential. Utilizing special MRI sequences, laboratory tests, cerebrospinal fluid examinations, EEG and specific methods helps reduce misdiagnosis, prevent treatment delays, and optimize medical resource usage. Accurate diagnosis of psychiatric disorders is essential to minimize missed diagnosis and misdiagnosis and to improve the prognosis of organic neurological disorders with psychiatric symptoms.