Endocrine psychiatry — structured clinical viva

Open with an axis map, not one label. Cover thyroid excess/deficiency (including myxoedema psychosis as rare extreme), Cushing neuropsychiatry, adrenal insufficiency/crisis, and exogenous steroid toxicity as distinct drivers that can coexist with primary psychiatric illness.^[1][4][7][8]

Case 1 — Cushing depression. Name major depression as the dominant comorbidity in classic series; assess suicide risk; prioritise definitive hypercortisolism treatment with endocrine/neurosurgery pathways; use antidepressants as adjuncts only; warn that residual mood/cognition can persist after cure.^[3][4]

Case 2 — Steroid mania/psychosis. Temporal link to high-dose prednisolone; Warrington/Dubovsky framing; reduce steroids if medically allowed; short-term low-dose antipsychotic for danger; avoid lifelong bipolar label from a single episode.^[1][2]

Case 3 — Lithium–thyroid. Check TSH/free T4 now; educate that lithium causes hypothyroidism commonly and hyperthyroidism in an under-recognised systematic-review association; co-manage replacement or further endocrine work-up.^[6][7]

Crisis pearl. If any stem turns into Addison crisis (shock, hyponatraemia, delirium), state parenteral hydrocortisone and fluids first per Endocrine Society guidance.^[5]

Close. Shared care, capacity during organic states, and longitudinal diagnostic humility after endocrine correction.^[1][4][5]