Neurologic and Psychiatric Emergencies

Introduction:

Because of the fundamental relationship between the neurologic system and psychological well-being, we will discuss disorders of these “systems” together in this module. We refer to disorders of thought, mood, and behavior as psychiatric disorders, and disorders of speech, senses, and motor function as “organic disorders.” There are commonly conditions that present as organic in origin but turn out to be psychiatric: usually a diagnosis of exclusion. There are times as well that patients present with what seems to be a psychiatric problem, particularly if they have a history of a psychiatric illness, and it turns out that they actually have an acute organic (medical) condition. Paying attention to the patient’s complaints and making sense of supporting tests will help you avoid the trap of being sent down a path of an inappropriate working or final diagnosis. In this module we will first build some foundational knowledge regarding the neurologic system, then go over a broad array of disorders (pathophysiologic processes) involving this system. We will then move to psychiatric disorders and recognize that we have limited knowledge of the organic basis of thought, mood, and behavior, and that we have serious limitations in the manner in which we can evaluate and manage these disorders. The evaluation of psychiatric patients, then, often becomes more subjective than all other evaluations we do. This provides unique challenges to the provider and requires unique plans of care.