Multiple neurological conditions can manifest primarily with psychiatric symptoms. The physical signs and symptoms may be much delayed. We have summarized seven clinical presentations of psychiatric symptoms, which were finally diagnosed as neurological conditions, including Huntington’s disease, brain tumors (glioblastoma multiforme, glioma and meningioma), progressive supranuclear palsy (PSP), neurosyphilis and anti-N-Methyl-DAspartate (NMDA) Receptor Encephalitis. These cases highlight that the practicing physician and psychiatrist be cognizant of the differential diagnosis spectrum of presenting symptoms. Conducting appropriate physical examinations, ordering relevant laboratory and imaging tests will clinch an organic versus a psychiatric diagnosis. Such diagnostic acumen will not only improve the quality of life for the patient, but also limit further morbidity.