Patients often present to emergency departments (ED) with altered behavior. In a busy ED, evaluation of these patients can be difficult and time-consuming. Sometimes there is a perceived urgency to arrive at a disposition, bringing premature closure to the diagnostic evaluation.13 This is a potentially dangerous practice because serious and frequently reversible medical and surgical diseases may be missed. A 1978 publication found a medical cause for psychiatric symptoms in 9.1 of patients and emphasized the need for a careful medical evaluation.20 This evaluation includes a thorough history and physical examination, as well as laboratory and radiologic investigation to rule out an underlying medical cause for the patients altered behavior. The Diagnostic and Statistical Manual of Mental Disorders defines a psychiatric presentation of a medical illness as a mental disorder due to a general medical condition. This is characterized as the presence of mental symptoms that are judged to be the direct physiological consequence of a general medical condition. Additionally, the disturbance is not better accounted for by another mental disorder.1 It is, therefore, important to understand the common psychiatric presentations and the medical diseases that can cause them. Some diseases can cause more than one type of psychiatric presentation. This article briefly defines commonly seen behavioral presentations and then discusses in detail some of the medical diseases that cause them.

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