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Mental Disorders Due to a Medical Condition

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									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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