Complex Neuropsychiatric Presentations in Consultation-Liaison Psychiatry: Acute Psychosis, Delirious Mania, and Catatonia-View Presentation

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In a recent seminar, Drs. Venigala, Shibuk, Van Nostrand, and Safar from Leahy Hospital and Medical Center addressed the complex intersection of neuropsychiatry and consultation-liaison psychiatry. They explored several pertinent topics, including the differential diagnosis of delirium and its overlap with acute psychosis, the presentation and treatment of catatonia in inpatient settings, and the controversial syndrome known as delirious mania.<br /><br />Dr. Van Nostrand discussed the nuanced relationship between delirium and psychosis, emphasizing the importance of distinguishing between psychiatric and medical etiologies to inform treatment strategies appropriately. He outlined symptoms and diagnoses that might present similarly to delirium, such as disorganized psychosis, Ganser syndrome, and Lewy body dementia, each requiring specific treatment approaches that differ from those for delirium.<br /><br />Dr. Shibuk focused on catatonia, emphasizing its prevalence in psychiatric disorders, particularly bipolar disorder, and reviewing its management and treatment options, such as lorazepam challenges and ECT.<br /><br />Dr. Venigala presented on delirious mania, which combines symptoms of mania, delirium, and in some cases, catatonia. Despite its rarity and the controversies surrounding its nomenclature, effective management includes high-dose benzodiazepines and ECT.<br /><br />The seminar concluded with a Q&A session where clinical experiences were shared, emphasizing practical challenges such as distinguishing between psychiatric and medical causes of symptoms, and the nuances of diagnosing and treating complex neuropsychiatric presentations in clinical practice. The session highlighted the critical role of psychiatrists in evaluating and managing these overlapping syndromes to ensure appropriate care and to avoid unnecessary interventions.

Keywords

neuropsychiatry

consultation-liaison psychiatry

delirium

acute psychosis

catatonia

delirious mania

differential diagnosis

Ganser syndrome

Lewy body dementia

bipolar disorder

lorazepam

ECT

psychiatric disorders