Psychiatric Presentations of Medical Disease
Physical and psychiatric illnesses are closely interwoven (1,2). Both medical and psychiatric physicians should know the specifics of these interrelations.
Of patients needing mental health care, 60% are being treated by medical physicians.
From 50% to 80% of the patients treated in medical clinics have a diagnosable psychiatric illness, and 10% to 20% of medical patients primarily have an emotional disorder.
Of patients in psychiatric clinic populations, 50% have undiagnosed medical conditions.
Of self-referred psychiatric patients, 10% have symptoms solely due to a medical illness.
Always evaluate psychiatric patients medically. Be particularly alert to patients first seen with depression, confusion, memory loss, anxiety, personality changes, psychosis of rapid onset, visual hallucinations, and illusions. Always be suspicious of symptoms of sudden onset in a patient, particularly one older than 35 years, who previously had been problem free. Recognize that patients (or their physicians) often can identify a “precipitating event” for even the most organic of psychiatric conditions—do not be fooled.
Always consider psychiatric possibilities for physical symptoms in medical patients. Take a good history, including past emotional problems. Why is the patient coming for help now?
PSYCHIATRIC SYMPTOMS
Only a few typical psychiatric presentations exist, and many different medical illnesses can cause them. Some of the most common associations are listed later, although almost any physical condition can contribute to symptom production (Table 14.1).
Table 14.1 ▪ Common Associations for Psychiatric Symptoms | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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MEDICAL DISEASES
No medical illness produces pathognomonic psychiatric symptoms, yet each has a typical range of presentations. Some of the most characteristic are listed, but more comprehensive sources are available. In many of these diseases, psychiatric pathology develops before any medical signs or symptoms are noticed.
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