Physical or Mental Illness?


Last year—The Year of the Beast—while I was a patient in Crouse Hospital I had multiple episodes in which I was fully conscious but unresponsive. Following severely stressful events I could hear what was happening around me but I could not open my eyes, speak or move any body part. The episodes would clear spontaneously within three or four hours. When I requested a neurological consult, the hospitalist said, “You don’t have a brain tumor and you’re not having a stroke, so you don’t need a neurologist.”

What follows here is a 30-year-old article about how to assess for a physical disturbance when a person is presenting with symptoms of mental disorder. I think that this organized approach to evaluation is still valuable today. Also, the doctor who wrote it does some very straight talking about why physicians treat so badly people who have psychiatric diagnoses.

HOW TO TELL IF SOMEONE DIAGNOSED WITH A MENTAL ILLNESS, HAS ANOTHER MEDICAL DISORDER (THAT MAY HAVE LED TO A MISDIAGNOSIS)
by
DR. RON DIAMOND
(This is not medical advice. Do not rely on it Discuss with your doctor. )

Doctors often do not take enough time with patients to get to the root cause of their issues. This article from early 1980s (in four parts) may help individuals think though if what is presenting as schizophrenia, depression, or anxiety disorder is really caused by some other physical illness. It will also help you better understand whether someone correctly diagnosed as having a mental illness may also have an underlying undiagnosed medical illness. It will point to questions you should ask your doctor.

It is based entirely on information in a paper by Dr. Ron Diamond, who was kind enough to let us use it. D.J. Jaffe edited this paper for families. This information should not substitute for a consultation with your doctor and some of it may now be out of date. We thank Dr. Diamond.

SECTION 1: WHAT TO LOOK FOR IF YOU EXPECT SOMEONE WITH AN NBD HAS AN UNDERLYING MEDICAL ILLNESS
SECTION 2: HOW TO INVESTIGATE
SECTION 3: HOW TO INVOLVE THE PHYSICIAN AND FEED BACK
SECTION 4: MEDICAL CONDITIONS THAT CAN MIMIC PSYCHOTIC DISORDERS
SECTION 5: MEDICAL CONDITIONS THAT CAN MIMIC DEPRESSION
SECTION 1: WHAT TO LOOK FOR IF YOU EXPECT SOMEONE WITH AN NBD HAS AN UNDERLYING MEDICAL ILLNESS

There is a very real possibility that what seems to be a psychiatric problem is caused by some physical illness. How common is this problem? Very…and not very. Most people will not have a medical disease masquerading as a neurobiological disorder (“NBD”, formerly known as ‘mental’ illness). So doctors get sloppy and stop looking for underlying physical causes. This is especially true if the doctor dislikes the patient. Yet, these often-sicker individuals are more likely to have an undiagnosed organic brain syndrome than others.

The medical causes of psychiatric symptoms should always be considered. If you and your doctor don’t look for an underlying physical problem, you won’t find any.

You need to know enough about these medical illnesses and how to look for them to decide whether a further medical assessment is necessary. In addition, doctors also often miss physical disorders that are significant, but unrelated to the ‘mental’ disorder so you should look for those as well.
Be suspicious of “medical clearance”.

Just because a doctor says there is no underlying medical problem (i.e., the patient has “medical clearance”), don’t believe it. Physicians are often uncomfortable around people with NBD and may tend to dismiss the complaints of psychiatric patients or blame the complaints on the fact that the person has an NBD. In addition, at times patients may behave in ways that make evaluation more difficult, either by being unwilling to give a full history, unable to give an accurate description of symptoms, or too frightened to allow a full physical examination.

People with schizophrenia get sick, just like other people. The fact that someone is actively psychotic does not mean that they do not also have a serious medical illness.

Even in patients who clearly have schizophrenia or some other diagnosable mental illness and who have had an excellent medical workup in the past, it is important to consider whether their current complaints or recent change in behavior could be related to a recent medical illness. In fact, because psychotic patients are more difficult to evaluate, if they do happen to have a serious medical illness, it is more likely to get missed.

Following are common assumptions that lead to missed diagnosis by M.D.s:
• Mistaking symptoms for their causes
• Listening without fully considering all possibilities;
• Equating psychosis with schizophrenia
• Relying on a single information source

SECTION 2: HOW TO INVESTIGATE AND FEED WHAT YOU FIND TO THE DOCTOR.
LOOK FOR SOMETHING SPECIFIC RATHER THAN GROPE RANDOMLY.
There are a list of diagnosis which could mimic schizophrenia, depression, and anxiety or cause their own issues. What follows below is how a lay person can look for signs of the medical disorders that may mimic psychiatric disorders, record them, and bring them to doctors attention if found.
The following observations are often possible for a consumer to determine, or can be done by a family member (even on a completely uncooperative person). They should be done to help determine if what is being diagnosed as ‘psychosis’, is actually another organic disorder masquerading as psychosis:

The following factors make medical illness more likely:
• A person over 40 with no previous psychiatric history:
• No history of similar symptoms
• Coexistence of chronic disease
• History of head injury
• Change in headache pattern
• A patient who gets worse when given antipsychotic or anxiolytic medications
• Visual disturbances, either double vision or partial visual loss
• Speech deficits, either dysarthrias (problems with the mechanical production of speech sounds) or aphasias (difficulty with word comprehension or word usage).
• Abnormal autonomic signs (blood pressure, pulse, temperature)
• Disorientation and/or memory impairment
• Fluctuating or impaired level of consciousness
• Abnormal body movements
• Hallucinations that are visual and vivid in color and change rapidly
• Olfactory (smell) hallucinations
• Illusions (misinterpretations of stimuli)
• Blood or pus in the urine,
• High blood pressure
• Symptoms of chest pain while at rest,
• Headaches associated with vomiting
• Loss of control of urine or stool
You should ask about each of these and try to determine if they are present. Take specific notes to bring to the doctor.
Look for the following information if you are looking for an underlying physical ailment . . . http://www.mentalillnesspolicy.org/coping/misdiagnosis.html

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About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
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