The intersection of psychiatry and medicine: Diagnostic and ethical insights from case studies

Francesco Monaco ^1,2* Annarita Vignapiano ^1,2 Martina D'Angelo ³ Fabiola Raffone ⁴ Valeria Di Stefano ^3* Antonella Boccia ¹ Anna Longobardi ¹ Benedetta Di Gruttola ¹ Michele Fornaro ⁵ Giulio Corrivetti ¹ Luca Steardo ^6,7 Luca Steardo ³

• ¹ Department of Mental Health, Azienda Sanitaria Locale Salerno, Salerno, Italy
• ² European Biomedical Research Institute of Salerno (EBRIS), Salerno, Italy
• ³ Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Calabria, Italy
• ⁴ Department of Mental Health, ASL Napoli 1 Centro, Naples, Campania, Italy
• ⁵ Section of Psychiatry, School of Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
• ⁶ Department of Physiology and Pharmacology, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Lazio, Italy
• ⁷ Department 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 medicinepsychiatry 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 patientcentered approach that integrates clinical observation, research insights, and a nuanced understanding of mindbody dynamics.