Case Report: The intersection of psychiatry and medicine: diagnostic and ethical insights from case studies, 2025, Monaco

[Dolphin]

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1576179/full

Case Report: The intersection of psychiatry and medicine: diagnostic and ethical insights from case studies

Francesco Monaco1,2†Annarita Vignapiano1,2†Martina D’Angelo3Fabiola Raffone4Valeria Di Stefano3*

Antonella Boccia1Anna Longobardi1Benedetta Di Gruttola1Michele Fornaro5Giulio Corrivetti1,2

Iolanda Martino6Luca Steardo7,8Luca Steardo Jr3

• 1Department of Mental Health, Azienda Sanitaria Locale (ASL) Salerno, Salerno, Italy
• 2European Biomedical Research Institute of Salerno (EBRIS), Salerno, Italy
• 3Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
• 4Department of Mental Health, Azienda Sanitaria Locale (ASL) Napoli 1 Centro, Napoli, Italy
• 5Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Dentistry, Federico II University of Naples, Naples, Italy
• 6Department of Medical Sciences, Institute of Neurology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
• 7Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University of Rome, Rome, Italy
• 8Department of Clinical Psychology, University Giustino Fortunato, Benevento, Italy

The intersection of psychiatry and medicine presents unique diagnostic and ethical challenges, particularly for conditions involving significant brain-body interactions, such as psychosomatic, somatopsychic, and complex systemic disorders.

This article explores the historical and contemporary issues in diagnosing such conditions, emphasizing the fragmentation of medical and psychiatric knowledge, biases in clinical guidelines, and the mismanagement of complex illnesses.

Diagnostic errors often arise from insufficient integration between general medicine and psychiatry, compounded by the reliance on population-based guidelines that neglect individual patient needs.

Misclassification of conditions like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Lyme disease, and fibromyalgia as psychosomatic or psychogenic has led to stigmatization and delayed care.

While these conditions are referenced as emblematic examples of misclassified and poorly understood disorders, the five clinical cases discussed in this article do not directly illustrate these diseases.

Instead, they exemplify shared diagnostic and ethical dilemmas at the medicine–psychiatry interface, including uncertainty, fragmentation, and the risk of epistemic injustice.

The article critically examines terms like medically unexplained symptoms and functional disorders, highlighting their limitations and potential for misuse.

Case examples underscore the consequences of diagnostic inaccuracies and the urgent need for improved approaches.

Ethical considerations are also explored, emphasizing respecting patient experiences, promoting individualized care, and acknowledging the inherent uncertainties in medical diagnosis.

Advances in technologies such as brain imaging and molecular diagnostics offer hope for bridging the gap between psychiatry and medicine, enabling more accurate assessments and better patient outcomes.

The article concludes by advocating comprehensive training at the medicine-psychiatry interface and a patient-centered approach that integrates clinical observation, research insights, and a nuanced understanding of mind-body dynamics.

https://twitter.com/user/status/1914663566029836787

 

[Dolphin]

Flaws in guidelines often stem from biased or inadequate research. When well-meaning physicians follow these flawed recommendations, patient care can suffer (19). Examples include guidelines addressing myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Lyme disease, and medically unexplained symptoms (MUS) (20). A lack of understanding of ME/CFS, even following the Institute of Medicine’s report, has left many patients feeling ignored or mistreated (21, 22). Over 80% of ME/CFS patients go undiagnosed, with 65% spending more than a year seeking an accurate diagnosis (23). Flawed recommendations, such as those from the PACE trial, erroneously suggested ignoring symptoms and relying on cognitive behavioral therapy (CBT) and graded exercise therapy for recovery (24). These approaches were not supported by robust evidence, and subsequent reviews, including by Cochrane, deemed the research inadequate. Revised guidelines have since improved patient management.

https://twitter.com/user/status/1914664987030687759

 

[rvallee]

No matter how many times I see it, I have no idea what anyone ever means when they try to separate psychiatry, a medical specialty, from medicine. It's just incoherent, like drugs and alcohol. A political distinction, arbitrary and nonsensical. It means absolutely nothing.

Misclassification of conditions like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Lyme disease, and fibromyalgia as psychosomatic or psychogenic has led to stigmatization and delayed care.

And although this paper seems sympathetic, it just so badly misses the mark here. Psychosomatic ideology has "led to stigmatization and delayed care" in a similar way as a forced famine killing millions has led to hunger pains and delayed meals. It sure would, but that's not the relevant part. Millions of lives have been destroyed by this ideology. Destroyed. Obliterated. Might as well have bombed them to pieces. Tens of millions. To reduce this to stigma and "delayed" care is orders of magnitude out of touch.

Revised guidelines have since improved patient management.

They have not. They have in fact been soundly rejected, and aren't any more advanced than the best that could have been done 40 years ago. In fact care is just as bad as it ever was: there isn't any. And we are facing a huge anti-disability backlash because governments have amplified the problem of Long Covid instead of dealing with it, with medicine being fully complicit in the act. Things are not even close to be getting better until there is a research breakthrough. Everything else is irrelevant. Not because it should, but because it's the only way it will happen.

The article concludes by advocating comprehensive training at the medicine-psychiatry interface and a patient-centered approach that integrates clinical observation, research insights, and a nuanced understanding of mind-body dynamics.

None of this matters or will make a difference. Either the idea of "mind-body dynamics" dies, or millions keep suffering and dying needlessly. It's that simple: belief, or reason. Belief has won every single day so far. And belief has to be buried in the deepest underground cave in the world before anything good happens to us.

 

[SNT Gatchaman]

The intersection of psychiatry and medicine presents unique diagnostic and ethical challenges, particularly for conditions involving significant brain-body interactions, such as psychosomatic, somatopsychic, and complex systemic disorders.

No matter how many times I see it, I have no idea what anyone ever means when they try to separate psychiatry, a medical specialty, from medicine. It's just incoherent

Yes that seemed quite a jarring introduction. I haven't read the paper, but they might be using "medicine" here to mean the medical specialty "medicine", ie what is often labelled as "General Medicine" or "Internal Medicine". This would be similar to using the phrase "the intersection of orthopaedic surgery and medicine", where both are understood to be specialties that are part of Medicine. Another way of describing this would be considering the labels of the people involved: psychiatrists and physicians (and orthopaedic surgeons) etc.