Li Baizhu, Guo Wen, Shang Xiuli
Popular Republic of China (PRC), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Popular Republic of China (PRC), The First Hospital of China Medical University, Shenyang, China.
BMC Psychiatry. 2025 Nov 10;25(1):1071. doi: 10.1186/s12888-025-07383-1.
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.
精神疾病的误诊会导致医疗资源的浪费以及正确诊断后治疗的延误。识别被误诊为精神疾病的器质性神经障碍，并拓宽以精神症状为首发或主要表现的疾病谱。
这是一项回顾性横断面研究。研究时间为2020年1月1日至2023年12月1日。选取辽宁省中国医科大学附属第一医院精神科门诊和住院部的患者。纳入标准为先前被诊断患有精神疾病的成年人（年龄>18岁）。共有298例患者被诊断为精神疾病，其中197例仅被诊断为精神疾病且接受了有效的对症治疗，予以排除。收集临床特征、检查、检验、符合精神疾病诊断标准的情况以及最终诊断的数据。
我院共有101例最初被诊断为精神疾病的患者符合精神疾病诊断标准，年龄中位数（四分位间距）为46岁（18 - 69岁），78%为女性。对症治疗后，疾病进展促使通过补充病史、特殊实验室检查和影像学序列进行重新评估，发现了明确的异常。正确诊断包括自身免疫性脑炎（LGI1）（20%）、自身免疫性脑炎（NMDAR）（17%）、自身免疫性脑炎（GABABR）（16%）以及其他：胶质纤维酸性蛋白2%、代谢型谷氨酸受体5 1%、谷氨酸脱羧酶65 1%（4%）、单纯疱疹病毒性脑炎（22%）、克雅氏病（3%）、一氧化二氮滥用（14%）、梅毒（3%）以及桥本脑病（2%）。
精神疾病病因多样，医学技术的进步拓宽了以精神症状为表现的疾病谱。认识到许多精神症状的生物学基础有助于及时、有效地进行治疗。精神疾病诊断比神经疾病诊断背负更多的污名。先前符合精神疾病诊断标准的患者现在可能发现存在器质性神经病因。神经疾病诊断的警示信号包括对症治疗无效和临床症状恶化。因此，早期区分精神疾病和器质性神经疾病至关重要。利用特殊的MRI序列、实验室检查、脑脊液检查、脑电图及特定方法有助于减少误诊，防止治疗延误，并优化医疗资源的使用。准确诊断精神疾病对于最大限度减少漏诊和误诊以及改善伴有精神症状的器质性神经疾病的预后至关重要。
