“My Patient is Hysterical”

Chapter 13 describes a woman referred for psychiatric consultation for “catatonia” who eventually was found to have an adrenal tumor. A high index of suspicion of organic mental disorder is necessary in medically ill patients, even when there is symptomatic evidence of psychiatric disturbance accompanied by many psychosocial stressors. A history of psychological stresses, no matter how severe and multiple, does not warrant concluding that symptoms that might represent either psychiatric disturbance or a medical disease are psychogenic and represent a psychiatric disorder; adequate medical investigation to rule out medical disease must be undertaken.