Tricky cases - Hypercalcemia
A 52 years old teacher was brought to hospital by her relatives with a history of abnormal behaviour. She was apparently well until 3 weeks back, when she became increasingly forgetful. Over the next week she became over talkative and aggressive. She was seen by a psychiatrist in the private sector and was started on treatment for bipolar affective disorder. A CT scan of the brain, TSH and basic investigations were normal. Despite initial treatment her symptoms got worse. At the time of admission she was restless and agitated. Her hemodynamic parameters and neurological examination was normal. What non-psychiatric condition should be considered in a patient presenting with psychiatric manifestations? Electrolyte abnormalities/ hyper/hypoglycemia Endocrine diseases Cushing syndrome Thyroid disorders Central nervous system causes Infections Tumors Autoimmune encephalitis Vasculitis Drugs and toxins Alcohol! Upon the suspicion of encephalitis LP and EEG wer