At the 24th edition of the L’Encéphale Congress, a psychiatry conference held in Paris, France, speakers highlighted the diagnostic and therapeutic challenges of conditions that lie at the intersection of psychiatry and organ-based medical specialties.

The presentation focused on Takotsubo syndrome, frontotemporal dementia, disorders of gut-brain interaction, and tinnitus, underscoring how psychiatric comorbidity can obscure underlying cardiac, neurologic, gastrointestinal, or otologic pathology and can delay appropriate care.

Takotsubo Syndrome

Takotsubo syndrome, often referred to as “broken heart disease,” typically occurs following intense emotional or physical stress and mimics acute myocardial infarction but is pathophysiologically distinct.

Olivier Dubourg, MD, professor emeritus, research director and head of the Department of Cardiology, Assistance Publique - Hôpitaux de Paris (AP-HP) Paris, described the most frequent presentation of Takotsubo syndrome as retrosternal chest pain with acute, reversible apical left ventricular wall motion abnormalities in the absence of significant coronary stenosis on angiography. Electrocardiography may show ST segment elevation, and laboratory testing often reveals modest elevations in cardiac enzymes and troponin, without clear evidence of myocarditis or pheochromocytoma.

“It must be suspected in any postmenopausal woman presenting with acute coronary syndrome after intense stress,” Dubourg said.

In 2018, the European Society of Cardiology developed a diagnostic scoring system for Takotsubo syndrome. Psychiatric disorders account for 11 points within the scale, although Dubourg noted that this category includes heterogeneous conditions, such as anxiety, depression, and schizophrenia.

“Takotsubo, a condition at the intersection of the heart and the brain, is not benign,” he said. “It must be managed as acute coronary syndrome. The role of psychiatrists in prevention and follow-up is crucial to prevent stress from becoming fatal or recurrent.”

Diagnostic Pitfalls

David Wallon, MD, PhD, neurologist at the Centre Hospitalier Universitaire de Rouen and the Centre Mémoire de Ressources et de Recherche de Rouen, questioned the continued use of the term frontotemporal dementia, favoring the broader designation major neurocognitive disorders.

This neuropathologic entity belongs to the spectrum of neurodegenerative disorders that preferentially affect the frontal and temporal cortex. According to the 2011 criteria, the disease is clinically, neuropathologically, and genetically heterogeneous.

“The challenge is diagnostic,” Wallon said. “Frontotemporal dementia is often confused with primary psychiatric disorders because of overlapping semiology, especially as the two situations may coexist.”

However, an incorrect psychiatric diagnosis, such as major depressive disorder, bipolar disorder, or late-onset schizophrenia, leads to delayed diagnosis, inappropriate care, and an increased burden on caregivers.

The diagnostic strategy relies on converging clinical arguments, including detailed history, structured tools such as the DAPHNE scale and Ducharme checklist, family history, comprehensive neuropsychologic assessment including social cognition, and paraclinical evaluation including brain imaging. Wallon emphasized the need for collaboration among neurologists, psychiatrists, and geriatricians.

Gut-Brain Axis

The terminology used to describe functional gastrointestinal disorders remains debatable. Chloé Melchior, MD, PhD, gastroenterologist from the Department of Gastroenterology at Rouen University Hospital in Rouen, France, noted that no consensus exists regarding French terminology and that the word functional is perceived as stigmatizing.

Since 2016, the preferred term has been disorders of gut-brain interaction. These conditions may involve the esophagus, biliary tract, intestine, gastroduodenal region, anorectal region, or central nervous system, including central abdominal pain syndrome.

Comprehensive diagnostic standards for functional gastrointestinal disorders are presented in the Rome IV Criteria, with Rome V expected in May 2026. Melchior advocated establishing a diagnosis promptly rather than multiplying investigations and prolonging diagnostic uncertainty.

She highlighted the role of the gut-brain axis, citing disproportionate pain signaling and a high prevalence of anxiety, depression, and insomnia among affected individuals.

“Close collaboration with psychiatrists and psychologists is necessary for comprehensive management, including dietary, pharmacologic, and behavioral approaches,” she said. The person’s predominant symptom profile and psychosocial comorbidities should guide treatment discussions, particularly when certain therapies are not reimbursed or unavailable in France.

Tinnitus Tolerance

Tinnitus affects approximately 15% of the population. Objective tinnitus, typically related to middle ear pathology, accounts for approximately 1% of cases, whereas subjective tinnitus represents the majority. Approximately 80% of individuals with tinnitus tolerate the condition.

Although no universally accepted definition exists, recent proposals emphasize that tinnitus does not necessarily imply distress and that intolerance represents a distinct factor requiring assessment.

Alain Londero, MD, ENT specialist, Department of Otorhinolaryngology, Hôpital Lariboisière-Fernand Widal, AP-HP, said distinguishing tinnitus from the intolerance it provokes has implications for classification systems such as the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

“The inclusion of this disorder in the DSM-5 is the subject of conflicting debates among otolaryngologists,” he said. Clarifying what drives distress and quality of life impairment brings psychological and psychiatric considerations to the forefront.

Better recognition of the interactions between psychopathologic disorders and tinnitus could lead to improved prevention and management of tinnitus. Such progress will depend on close collaboration among ENT specialists, psychiatrists, and cognitive behavioral psychologists, as Londero concluded.

Dubourg and Londero reported having no relevant financial relationships. Wallon reported having no relevant conflicts of interest related to this presentation. Melchior reported having relationships with Opella, Reckitt Benckiser Health Limited, Mayoly Spindler, Biocodex, Viatris, Nestlé Health Science, Ipsen, Tillotts Pharma, Norgine, and Kyowa Kirin.

This story was translated from Medscape’s French edition.