Department of Emergency Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2013 Feb;17 Suppl 1:86-99.
An exhaustive review on the organic illnesses presenting with psychiatric manifestations, properly defined pseudopsychiatric emergencies, is presented. A systematic classification of the numerous organic causes of psychiatric disorders, based on authors' experience and literature revision, is carefully analysed, and their suitable diagnostic management in emergency setting is proposed. Moreover, the role of bedside ultrasonography in Emergency Department is emphasized. The underlying pathogenetic mechanisms are separately discussed. A particular significance is given to "neuropsychological studies", displaying the complex connection between the central nervous system and the endocrine system. The role of immune system in influencing the central nervous system, explaining the model of "sickness behaviour" in inflammatory disease, is also described, according to recent reports of "psychoneuroimmunology". Moreover, the immune-mediated mechanism explaining how neoplasm can influence brain function in the "paraneoplastic syndromes" is shown. In order to facilitate the teaching method, organic illnesses presenting with acute psychic manifestations or mimicking specific psychiatric disorders are subdivided into three groups: (1) Endocrine and metabolic disorders and deficiency states; (2) Internal diseases; (3) Neurologic disorders.
本文对伴有精神表现的器质性疾病（确切定义为假性精神科急症）进行了全面回顾。基于作者的经验和文献复习，对大量精神障碍的器质性病因进行了系统分类，并对其在急诊环境中的适当诊断管理提出了建议。此外，还强调了床边超声检查在急诊科中的作用。分别讨论了潜在的发病机制。特别关注“神经心理学研究”，展示了中枢神经系统和内分泌系统之间的复杂联系。根据“心理神经免疫学”的最新报告，还描述了免疫系统对中枢神经系统的影响，解释了炎症性疾病中“疾病行为”的模型。此外，还展示了免疫介导的机制，说明肿瘤如何在“副肿瘤综合征”中影响大脑功能。为了便于教学，本文将表现为急性精神症状或模拟特定精神障碍的器质性疾病分为三组：（1）内分泌和代谢紊乱及缺乏状态；（2）内科疾病；（3）神经系统疾病。
