Sherlock Holmes-ing It: C-L Psychiatrists as Neuropsychiatric Detectives Across the Lifespan

Background: The consultation-liaison (C-L) psychiatrist is often called into action when a patient presents with an overlap in neurologic and psychiatric symptoms. In these cases, the diagnosis often hinges on identifying a real or metaphorical "lesion" or crucial piece of information. Neurologic and psychiatric symptoms overlap in different ways at different stages of development. As C-L psychiatrists, we are tasked to be detectives, sifting through a patient's history, performing a thoughtful examination, and obtaining important collateral to guide work-up and solve these diagnostic conundrums.

Approach: This Neuropsychiatry SIG-sponsored workshop will allow participants to work through three different cases at the intersection of neurologic and psychiatric illness. Each case presentation and discussion will demonstrate different diagnostic conundrums of overlapping neurologic and psychiatric symptoms in individuals across the developmental lifespan. Throughout the case presentations, we will use digital audience polling to assess participants' understanding, glean their insights on appropriate work-up and management, and guide interactive discussion about neuropsychiatric presentations across the lifespan.

Format:
--10 min: Dr. Sivaraman will introduce the workshop and review the goals of the session. She will also orient the audience to the use of digital polling and how the polling would be used to guide the discussion.
--20 min: Dr. Becker, a pediatric consultation-liaison psychiatrist, will lead participants through a case of a child with a developmental disorder and new onset change in behavior.
--20 min: Dr. Merideth, an adult consultation-liaison psychiatrist, will navigate the audience through a case of a middle-aged patient with a known psychiatric disorder who developed new neurologic findings and challenge participants to refine a broad differential diagnosis.
--20 min: Dr. Nicolson, a consultation-liaison psychiatrist with a focus on the geriatric population, will lead participants through a case of a geriatric patient with acute mental status change in the setting of an unclear neuropsychiatric baseline.
--20 min: Dr. Sivaraman will coordinate an interactive discussion and question-and-answer session to reflect on the case presentations, linking threads that run across the cases, while highlighting differences in approaching information-gathering across the life course.

Conclusions:
Participants will leave the session having learned about evaluating and treating complex neuropsychiatric disease in patients across the lifespan, equipped with diagnostic and clinical pearls to bring to their own clinical practice.

References:
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