Frontier Psychiatrist is sick today, and has been off work. Ordinarily I might enjoy a day in front of the television working through a box set of Prison Break but I’ve been feeling really low all day. I knew things weren’t right when I got up this morning and and simply stared at my toast rather than eating it.
But what better time to examine physical illnesses (‘organic causes’) that cause psychiatric symptoms?
Psychiatry and physical medicine have a complicated relationship. Psychiatric and physical disease can occur at the same time by chance or physical disease can cause psychiatric symptoms and vice versa. Psychiatric medications also have a large number of side effects.
Whenever a patient comes into the hospital with psychiatric problems, a full ‘work-up’ should include looking for a physical cause for the problem. Psychiatrists were a bit rubbish at doing this, but are getting better; the hospital where I work audits whether patients admitted have a physical examination whilst they are on the ward. Patients usually get blood tests and often a CT scan, especially if the presentation is atypical.
Depression has a lot of organic causes: cancer, infection, neurological disorders including dementia, diabetes, thyroid disease, Addisons disease, and systemic lupus erythematosis. Just having one of these diseases in themselves may be a cause for depression as they can result in substantial disability. Psychiatry blogger Lake Cocytus tells a tale of delayed diagnosis of metastatic breast cancer due to confusion with depression.
Anxiety also has a number of organic causes: hyperthyroidism, hyperventilation, phaeochromocytoma, neurological disorders and drug withdrawal.
Finally, psychosis may also be triggered by an organic cause and these include neurological conditions (e.g. epilepsy and strokes), metabolic conditions (e.g. porphyria), endocrine conditions (e.g. hyper- or hypothyroidism), renal failure, electrolyte imbalance (especially calcium), or autoimmune disorders.