[When psychiatric symptoms mask a neurological cause: A case report of epilepsy in geriatric psychiatry].

Atypical neuropsychiatric presentations in older adults pose significant diagnostic challenges, particularly when psychiatric symptoms predominate early in the clinical course. We report the case of a 68-year-old woman referred to geriatric psychiatry for depressive symptoms associated with fluctuating cognitive complaints, brief paroxysmal episodes of confusion and language disturbance, and atypical somatic and motor manifestations. Initial investigations, including brain imaging and laboratory testing, were unremarkable, leading to preliminary consideration of primary psychiatric or functional etiologies. However, the longitudinal evolution, stereotyped episodic phenomena, and some clinical findings prompted further neurological assessment. Video-EEG monitoring ultimately documented epileptic activity consistent with temporal lobe seizure, providing a unifying explanation for the patient's symptoms. Introduction of anticonvulsant therapy resulted in marked improvement in mood, anxiety, somatic complaints, and motor manifestations, supporting an underlying neurological cause. This case highlights the diagnostic complexity of conditions at the interface of psychiatry and neurology and illustrates the risk of premature psychogenic attribution when standard investigations are normal. It underscores the importance of longitudinal diagnostic reasoning, vigilance for atypical features, and close interdisciplinary collaboration to minimize diagnostic delay and inappropriate treatment. Improved characterization of diagnostic trajectories in complex neuropsychiatric presentations among older adults may enhance diagnostic accuracy, optimize care pathways, and ultimately improve clinical outcomes.