Disorders due to a General Medical Condition
·
Psychiatric symptoms occur in a
wide range of medical conditions
· Neurological:
o Degenerative: Parkinson‟s, Huntington‟s, Wilson‟s ®
depression, dementia, psychosis
o Epilepsy: 30 – 50 % have psychiatric illness at some stage, can be due
to medication
o Brain tumours: especially frontal lobe or limbic system
o Head injury
o Demyelinating disorders: eg MS
· Infectious:
o Herpes simplex encephalitis ® changed personality, psychosis
o Rabies, syphilis, CJD, Kuru (in PNG)
o HIV
·
Autoimmune: Systemic lupus
erythmatosus: eventually 50% have psych symptoms
· Endocrine:
o Hyperthyroid ® confusion, anxiety, agitated depression, manic, delusions, with weakness and muscle loss
o Hypothyroid ® if severe then hypomania, depression, hallucinations
o Hypercalcaemia (due to PTH disorder) ® delirium, changed personality, apathy, ¯cognitive function
o Hypocalcaemia (due to PTH disorder) ® delirium, changed personality,
eventually tetany
o Hypoadrenocorticism (Addison‟s) ® apathy, depression
o Hyperadrenocorticism (Cushing‟s) ® agitated depression
o Total pituitary failure ® hypothyroid and hypoadrenocorticism
· Metabolic:
o Hepatic encephalopathy ® ¯memory, ¯LOC, changed personality
o Uraemia encephalopathy: renal failure ® ¯memory, ¯orientation,
¯LOC
o Hypoglycaemia: agitation/restlessness
o Ketoacidosis ® easy fatigue
o Acute intermittent porphyria ® porphyrins (components of haemoglobin synthesis): acute colicky abdominal pain, motor polyneuropathy, psychosis, anxiety, insomnia, lability of mood, depression. Barbiturates absolutely contraindicated. 0.2 – 0.5 % psych patients have undiagnosed porphyria
·
Nutritional:
o Niacin deficiency
o Thiamine deficiency
o B12 deficiency ® neuro degeneration ® depression, irritability, moodiness
·
Toxins:
o Mercury: depression, irritability, psychosis, tremour, weakness
o Lots of others
·
Cancers Eg carcinoma of the
pancreas
·
Medication:
o Mood disturbances from: stimulants, steroids, L-dopa, etc
o A previous condition (eg major depressive disorder) can be triggered by
medication with the capacity to cause depressive symptoms
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