Mental Disorders Due to a Medical Condition This terminology is designed to describe psychiatric symptoms that are part of the clinical presentation of a non-psychiatric illness. I. DSM-IV Diagnostic Criteria for Mental Disorder Due to a Medical Condition A. There is evidence from the history, physical exam, or laboratory studies that the symptoms are a direct physiological consequence of a general medical condition. B. The disturbance is not better accounted for by another mental disorder. C. The disturbance is caused by delirium. II. Psychotic Disorder Caused by a General Medical Condition A. Diagnostic Criteria. The patient meets the criteria for a mental disorder due to a general medical condition and there are prominent hallucinations or delusions B. Clinical Features of Psychotic Disorder Due to a General Medical Condition 1. Hallucinations caused by a medical condition include visual, olfactory and tactile elements more often than in primary psychotic disorders. 2. Temporal Lobe Epilepsy is a common medical condition associated with olfactory hallucinations. 3. Somatic and persecutory delusions are the most common types of delusions associated with a medical condition. Common Disorders Associated with Psychosis Addison's disease Multiple sclerosis CNS infections Myxedema CNS neoplasms Pancreatitis CNS trauma Pellagra Cushing's disease Pernicious anemia Delirium Porphyria Dementias Lupus Folic acid deficiency Temporal lobe epilepsy Huntington's chorea Thyrotoxicosis C. Differential Diagnosis of Psychotic Disorder Due to a General Medical Condition 1. Primary Psychotic Disorders a. The onset of illness in a primary psychotic disorder is usually earlier (before age 35), with symptoms beginning prior to the onset of the medical illness. b. Complex auditory hallucinations are more characteristic of primary psychotic disorders. Non-auditory hallucinations (eg, tactile hallucina- tions) are more commonly seen in general medical conditions. 2. Substance Induced Psychotic Disorder a. When psychosis is associated with recent or prolonged substance use, withdrawal from a substance is the likely cause. b. Blood or urine screens for suspected substances may be helpful in establishing this diagnosis. c. Common substances that can cause psychosis include: Anticholinergics, steroids, amphetamines, cocaine, hallucinogens, L- dopa, and disulfiram. D. Treatment of Psychotic Disorder Due to a General Medical Condition 1. The underlying medical conditions should be corrected. 2. A trial of antipsychotic medication may be necessary to manage symptoms while the patient's medical condition is being treated. III. Mood Disorder Due to a General Medical Condition A. Diagnostic Criteria. Meets criteria for a mental disorder due to a general medical condition, and the presence of a prominent and persistent mood disturbance characterized by either or both of the following: 1. With depressed mood or lack of pleasure in most, if not all, activities. 2. Elevated, expansive, or irritable mood. B. Clinical Features of Mood Disorder Due to a General Medical Condition 1. The mood symptoms cannot be a psychological reaction to being ill. 2. Subtypes include: a. Mood disorder due to a general medical condition with depressive features b. Mood disorder due to a general medical condition with major depressive-like episode c. Mood disorder due to a general medical condition with manic features d. Mood disorder due to a general medical condition with mixed features Common Diseases and Disorders Associated with Depressive Syndromes Addison's disease Influenza AIDS Malignancies Asthma Malnutrition Chronic infection (mononucleosis, Anemia tuberculosis) Multiple sclerosis Heart failure Porphyria Cushing's disease Rheumatoid arthritis Diabetes Syphilis Hyperthyroidism Lupus Hypothyroidism Uremia Infectious hepatitis Ulcerative colitis C. Differential Diagnosis of Mood Disorder Due to a General Medical Condition 1. Primary Mood Disorder. If a clear causative physiological explana- tion cannot be established between mood symptoms and the medical condition, a primary mood disorder should be diagnosed. Fluctuation of mood symptoms during the course of medical illness is indicative of a disorder due to a medical condition. 2. Substance-Induced Mood Disorder a. When the mood disorder is associated with recent or prolonged substance use or withdrawal from a substance and psychotic symptoms, a substance-induced mood should be diagnosed. b. Blood or urine screens may be helpful in establishing this diagnosis. c. Common substances that can cause depressive syndromes include antihypertensives, hormones (cortisone, estrogen, progesterone), antiparkinsonian drugs, benzodiazepines, alcohol, chronic use of sympathomimetics, and withdrawal from psychostimulants. 3. Treatment of Mood Disorder Due to a General Medical Condition The underlying medical condition should be corrected.
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