NEUROPSYCHIATRIC COUNTERFEITS OF ORGANIC VISCERAL DISEASE

Visceral disease may be masked by a variety of neuropsychiatric manifestations. Patients may present themselves with pains referred to the extremities and the trunk, especially with sciaticas and backaches, bearing the earmarks of nerve or cord involvement, but which are due to underlying visceral disease. More frequently there are patients referred as "psychoneurotic" in whom the outstanding symptoms are emotional and whose numerous bizarre and variable complaints cannot be explained by objective organic phenomena. Even more commonly a combination of peripheral pains and psychoneurotic manifestations are encountered forming a bewildering clinical picture difficult to disentangle. Psychotic states may conceal underlying visceral disease and may be the earliest manifestation of visceral disease, as in the four cases of pancreatic tumors reported by one of us.¹

The following are illustrative cases in which patients with unrecognized somatic disease were referred to the neuropsychiatric service as presenting neurologic conditions. These cases were