Physical causes of mental illness
There is a field within psychiatry which looks specifically at illnesses of the brain and body that can have psychological and neurological symptoms - this is known as organic psychiatry.
Some of the symptoms that are described by people experiencing psychiatric illness are also seen in patients with a range of physical illnesses. For this reason there is the possibility that the two types of illnesses (physical and psychiatric) may be confused or misdiagnosed as each other, or that medication taken for one condition, may have neurological side-effects which mimic a psychiatric illness.
How do you know whether your symptoms are from a physical or psychiatric illness? - a doctor or psychiatrist should be able to diagnose your illness by examining you. It may be helpful to take along a friend or relative who knows you well and can help describe your symptoms and how they affect you. The doctor will ask for details about how the illness started and how it has progressed. During diagnosis an appropriate physical examination is essential.
Huntington’s chorea
A disease of the brain. Surveys have shown that the first diagnosis is wrong in at least a third of all cases, and amongst the most commonly misdiagnosed is schizophrenia.
Head Injury
Damage to the brain. Damage may be accompanied by personality changes and/or schizophrenia-like symptoms. It is generally agreed that the risk of suicide is substantially increased among head-injured patients, although the reason for this is not clear.
Neurosyphilis
This illness is so variable in its presentation that there is a case for testing all patients admitted to psychiatric wards. If this practice is not followed, tests should certainly be performed for all psychiatric patients with symptoms or signs signalling organic brain disease. Symptoms may include personality changes, depression, delusions, and less commonly, mania and schizophrenia.
Encephalitis
Due to a number of infections, symptoms may include depression and personality disorders.
Encephalitis lethargica
An infection of the brain which is sometimes associated with personality change, but can develop to a state resembling schizophrenia.
Cerebral abscess
An infection of the brain which can be associated with symptoms of depression.
Tuberculosis meningitis
A rare infection of the brain which can present as a change in personality.
Subarachnoid haemorrhage
This is a bleed into the brain. A high incidence of mental disorder has been reported after subarachnoid haemorrhage. Organic psychiatric problems and adverse personality changes are common, as well as significant depressive symptoms.
Cerebrovascular accident
Depressive symptoms are common after this type of injury.
Cerebral tumours
In psychiatric practice, cerebral tumours are easily overlooked. Changes in personality can be indicative of a tumour.
Multiple sclerosis
A condition of the nervous system. In the early stages symptoms may be mistakenly diagnosed as conversion or dissociative disorder. Mood disorder has also been found in about 50% of sufferers.
Hyperthyroidism
Occasionally a psychosis can be triggered if there is too much thyroid hormone.
Hypothyroidism
lack of thyroid hormones will produce mental effects which can mean psychiatrists may be easily led to a mistaken diagnosis of dementia / depressive disorder. More rarely, other patients may develop a schizophrenia disorder. Paranoid features are said to be common.
Addison’s disease
Also known as hypoadrenalism. Addison’s disease may be misdiagnosed as dementia. Occasionally a depressive or schizophrenic episode will occur with Addison’s disease.
Cushing’s syndrome
Also known as hyperadrenalism, usually diagnosed from physical symptoms. Depressive symptoms are the most frequent psychiatric manifestations of Cushing’s syndrome, paranoid symptoms are less common and appear mainly in patients with severe physical illness.
Corticosteroid treatment
Psychiatric symptoms can be brought on by corticosteroid treatment, and are similar to Cushing’s syndrome.
Hypopituitarism
90% of patients with hypopituitarism have some psychological symptoms, whilst half are likely to have severe symptoms. Most common is depression, but in severe cases symptoms may be more like dementia.
Hyperparathyroidism
Psychological symptoms are common and among the most frequent is depression. Few patients first present with psychiatric symptoms.
Hypoparathyroidism
Usually due to removal of, or damage to the parathyroid glands at Thyroidectomy. Complications can include psychiatric conditions including depression, but extreme reactions like bipolar affective disorder and schizophrenic disorders are rare but possible.
Insulinomas
At times, the clinical features of this illness may resemble those of almost any psychiatric syndrome. The important diagnostic clue is the recurrence of the attacks.
Liver disease
Psychiatric features of liver failure such as hallucinations, are sometimes known as hepatic encephalopathy.
Acute Porphyria
This condition may resemble psychosis. Psychiatric symptoms occur during the attack in a quarter to three-quarters of cases, and at times dominate the clinical picture. They include depression and disturbed behaviour. Delusions and hallucinations often occur. The diagnosis is made by the detection of substances in the urine. Porphyria is not common, but is often missed when it presents in psychiatric practice. It should be considered whenever there is a long history of intermittent physical and psychological complaints.
Vitamin B deficiency
Depression is often seen and sometimes a paranoid hallucinatory state.
Epilepsy
Particular difficulty may be experienced in distinguishing complex forms of epilepsy from certain kinds of psychiatric disorder. Epileptic patients can sometimes have an abnormal personality, and it may be unclear if this is an expression of a personality disorder.
