a male patient was referred to a physician in a clinic with the chief complaint of abdominal pain for 2  3 days . the patient 's sister noted that the patient was a psychiatric patient diagnosed with depression , anxiety as well as drug addiction .
the patient 's sister also noted that the patient had no verbal communication due to intentional omitting of speaking and denying all drugs for 7 days . considering the patient 's history ,
the patient also presented agitation , sleeplessness and increased appetite at that period , which matched the description of amphetamine withdrawal .
this case was examined by the physician in charge and he found that the patient had voluntary abdominal guarding and poor cooperation with physicians .
the patient was firstly suspected to be a possible case of drug withdrawal , and the abdominal pain was treated by oral and intravenous antispasmodic drugs . however , the patient had no better symptom .
the patient was referred to the hospital and monitored at the emergency room for one more day . finally by observing the generalized guarding of abdomen and considering the laboratory results ( negative urinalysis , neutrophilia from complete blood count ) , the patient was diagnosed as a possible case of appendicitis .
acute appendicitis is a difficult - to - diagnose condition in many situations ( 4 , 5 ) .
the diagnosis of acute appendicitis can be delayed in many cases and can cause problems . in this report , this case presents difficulty in diagnosis .
the patient 's signs and symptoms of appendicitis are not classical and fully mimicked with the underlying psychiatric signs and symptoms .
indeed , the abdominal pain can be an important presentation in the drug withdrawal case ( 6 , 7 ) .
it should be noted for the importance of concealing a physical diagnosis by psychiatric history or mental states ( 3 , 8) . it is estimated that about one twentieth to one tenth of the psychiatric cases might have occulted somatic disorders ( 9 , 10 ) .
therefore , this case report suggests that general practitioners should be aware of possible undetected physical disorders in psychiatric cases .
 physical disorders can be seen in psychiatric patients . in addition 
 , a delayed diagnosis can cause a serious complication of the physical disorder among such patients . in this report , a case of appendicitis in a psychiatric case with drug withdrawal symptoms was reported . 
Case report
Discussion