Symptoms are not always what a healthcare professional believes them to be, which is a major problem.

While working as a consultant at a residential facility for older adults, I entered the room of an elderly woman and was taken aback by her surprising proposal. She began, "Dr. Farrell, you and I will go into business together. I have a special recipe I brought from Europe, and we will make it and sell it to all the big supermarkets."

When I tried to help her understand that this would not be something we could plan on, she met my attempt with pleasant resistance and reassurance. The woman was in her middle 90s and had never had a mental health disorder, nor was she taking any psychotropic medication.

Frankly, her level of enthusiasm and clarity regarding how we might accomplish this new business venture dismayed me. She assured me that I would be the CEO. Fortunately, as it happens in many healthcare settings, a seasoned nursing supervisor saw what was happening and called me aside.

"She has a UTI, and this is something that we see often. It presents as a component of bipolar disorder, even though she doesn't have a mental disorder."

In my professional life, I would observe cases where physicians would misdiagnose a medical issue as a mental health disorder. I remember an older man who was diagnosed with major depression. The psychiatrists admitted him to a partial care program and prescribed medication. The staff saw him as an unpleasant, angry man and avoided interacting with him as much as possible.

One day, his wife decided he needed a second opinion, and she took him to another physician, not affiliated with the mental health center; the man had a serious cardiac condition. As we know, this condition is often associated with and confused with major depressive disorder. He was, of course, taken out of the partial care program and given appropriate medical care and surgery for his medical disorder.

Another patient that I heard of via a physician I knew was in a psychiatric hospital, and this physician had some concerns about the diagnosis. He asked the psychiatrist in charge if the man had any changes in the hat size he would wear. The psychiatrist confirmed, "Yes, he needs a bigger hat." Further medical testing revealed that the man had an unusual form of gout. He wasn't the only misdiagnosed patient in that facility because another patient, who had also been diagnosed with major depression, suffered from diabetes. How could they have overlooked that if they had ordered bloodwork on him?

A young college student was referred to me for an evaluation for behavior that appeared to be bipolar disorder. She had a sterling record as a student and was involved in several campus activities, and her parents were extremely concerned because she seemed to be easily distracted. I, too, found her activities to be somewhat manic in nature, but I asked a simple question: When did she have her last medical exam?

She had not undergone a medical evaluation in a few years, and I recommended that she have one before completing any evaluation for a mental health disorder. When she had the medical workup, it was discovered that she had lupus.

Years ago, I wrote a chapter on misdiagnosing a medical illness as a psychiatric disorder. The book chapter was entitled "Psychological disorders and medical illness in the elderly: A double-edged sword.” Indeed, it can be a double-edged sword and one that can have a serious impact on someone's life.

I thank all the healthcare professionals who helped me amass the disorders I outlined in that chapter. Since the book is no longer available, let me outline several outstanding medical illnesses that can easily mimic mental health disorders in individuals of any age.

Neurologic disorders: Conditions like brain tumors, MS, and epilepsy can cause psychiatric symptoms such as mood swings, psychosis, and memory loss. Neuroimaging and neurological exams are very important for ruling these options out.

Metabolic Disorders: Metabolic disorders like diabetes, thyroid dysfunction, vitamins (like B12 aka folate deficiency), and electrolyte imbalances can cause mood swings, and confusion. For these conditions to be found and treated, thorough lab tests are needed.

Autoimmune Disorders: Autoimmune diseases such as lupus and rheumatoid arthritis can have an effect on the central nervous system, which can lead to mental health problems like psychosis, mood disorders, and problems with thinking and memory. Rheumatologists and psychiatrists may need to collaborate to ensure they provide the appropriate evaluation and treatment.

Infectious Diseases: Lyme disease, syphilis, and HIV are just a few of the infections that can affect the brain and lead to mental health problems like sadness, anxiety, and psychosis. Neuroimaging and testing for infectious illnesses can help with the correct diagnosis and treatment.

Side effects of medicines: Psychiatric symptoms can happen as a side effect of some medications, such as antibiotics, steroids, antihypertensives, and anticonvulsants. When assessing patients with psychiatric presentations, clinicians should look at their past medication histories and possible side effects.

Exposure to harmful substances: There are a number of substances that can cause mood changes, memory impairment, sleep disorders, and even angry outbursts. Any evaluation needs to include an investigation of employment and areas of the environment that may cause a problem.

Readers may know that “Alice in Wonderland" has a creature called the Mad Hatter. Men working in the hat industry in the United States were exposed to dangerous fumes from the mercury used to form the hats. This toxic material also affects their brain health.

I saw a young man whose wife was extremely concerned about his slight stability disorder, sleep dysfunction, and changes in mood. I asked what type of work he did. He was a landscaper exposed to a variety of noxious chemicals.

If you're worried about your mental health, it's a good idea to evaluate your diet, surroundings, work environment, and exposure to any harmful (think cleaning products) substances. It's important to remember that not everything that appears to be a mental health disorder is actually one. There are many things that first need to be ruled out prior to making a diagnosis.