M⁴: Medicine, Mystery, Mayhem... and Sometimes Murder · M4 Podcast

Got Me Feeling So Crazy Right Now

December 10, 2025·46 min

This episode explores the critical issue of misdiagnosing psychiatric conditions like psychosis, hosted by experienced nurses Andrea Marziano and Crystal Miller. They examine how neurological or physical illnesses can be mistaken for mental disorders, with severe consequences for patients. The hosts draw heavily from journalist Susannah Cahalan's case, detailed in her book "Brain on Fire: My Month of Madness." At age 24, Cahalan's initial symptoms included fatigue, headaches, and paranoia, which escalated to hallucinations, seizures, and catatonia. She received misdiagnoses of bipolar disorder and alcohol withdrawal before neurologist Dr. Souhel Najjar identified the real issue. Dr. Najjar used a clock-drawing test, where Cahalan clustered numbers on one side, revealing right hemisphere brain dysfunction. A spinal tap confirmed she had anti-NMDA receptor encephalitis, a rare autoimmune disease attacking the brain. She became the 217th person globally diagnosed with this condition, which was treated with steroids and plasma exchange. Studies show nearly 60% of bipolar patients are initially misdiagnosed with schizophrenia, a more stigmatized and serious diagnosis. Substance use, infections, or even extreme sleep deprivation can induce psychosis-like symptoms, as Crystal shared from her personal experience of hallucinations after 12 days without sleep. A systematic review found only 28% of initial psychosis diagnoses by non-psychiatric doctors were accurate after specialist evaluation. The case underscores that psychosis is a syndrome with many potential causes, lacking definitive biological markers for diagnosis. Clinician bias and systemic pressures contribute to errors, with Black patients disproportionately over-diagnosed with schizophrenia. Misdiagnosis leads to unnecessary antipsychotic medications, which can cause permanent side effects like tardive dyskinesia, involving involuntary tremors and movements. Cahalan stated the scariest part was not losing control but the damaging labels that could affect her employment and self-worth. Early, correct diagnosis is crucial in conditions like autoimmune encephalitis, where "time is brain" and delays risk permanent damage. The hosts advocate for comprehensive first-episode evaluations, including blood tests and imaging, though they acknowledge profit-driven U.S. healthcare often limits this. They stress the importance of specialist collaboration, continuous bias awareness training for clinicians, and treating diagnoses as provisional, requiring reassessment. The tone is conversational and educational, blending personal nursing anecdotes with researched case studies and data. The style is empathetic and advocacy-focused, emphasizing patient and family empowerment in navigating complex medical systems. Listeners interested in medical mysteries, neuroscience, and healthcare system critiques will find this episode compelling. Those seeking light entertainment or definitive medical advice might prefer to skip it.

As heard by us

A careful medical mystery about when psychosis is not what it seems.

This episode keeps its focus on psychosis, neurologic disease, and the need for different specialties to talk to each other. The nurses make the discussion practical. Psychiatric symptoms can overlap with neurologic illness, and antipsychotic drugs need careful use.

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Why you'd press play

You want a psychosis mystery that keeps widening the diagnostic net.

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