Abstract / Summary
Abstract Changes in behaviour and cognition may arise from primary psychiatric disorders as well as systemic or organic illnesses. Misattributing medical pathology to psychiatric illness contributes significantly to morbidity and mortality. This case series illustrates the importance of thorough history taking and physical examination as safeguards in psychiatric practice. Three patients presenting with psychiatric like symptoms were evaluated in the psychiatry outpatient department, and detailed clinical assessment revealed underlying organic disease. The first case involved a 52 year old male with recurrent giddiness and amnesia, initially treated as epilepsy, who was found to have bradycardia with 2:1 atrioventricular block due to coronary artery disease; his symptoms resolved following percutaneous coronary intervention. The second case was a 44 year old female presenting with acute stress reaction and psychosis like features, in whom bradycardia with irregular pulse rhythm revealed complete heart block; permanent pacemaker implantation led to recovery. The third case was a 17 year old male with depressive symptoms and weight loss, ultimately diagnosed with disseminated tuberculosis involving the spine and lungs; antitubercular therapy resulted in complete remission. These cases underscore that careful clinical history and detailed physical examination remain indispensable in psychiatry to prevent medical mimics from being misdiagnosed and wrongly treated.