Medical Evaluation Of A Patient With Mental Symptoms

In medical evaluation of patients with psychological symptoms is trying to identify three things: Physical disorders that mimic mental disorders Physical illness, mental disorders accompanying physical illnesses that are caused by mental disorders or their treatment cause many physical disorders symptoms specific mental disorders mimic (s. Selected psychological symptoms due to physical illness). Although other physical illnesses like pretend no specific psychological syndromes, but instead lead to changes in mood and energy. Many drugs cause psychological symptoms; the most common groups of medical causes are CNS-active drugs anticholinergics, corticosteroids Numerous other therapeutic agents and drug classes were also included (eg, anticonvulsants, antidepressants, antipsychotics, sedatives / hypnotics, stimulants.) (eg antihistamines.); these include some classes of substances that are normally might not be taken into account (eg., antibiotics, antihypertensives). Abused Drugs / drug, in particular alcohol, amphetamines, cocaine, hallucinogens and phencyclidine (PCP), are, v. a. in overdose, also common causes of mental symptoms. Withdrawal from alcohol, barbiturates or benzodiazepines, in addition to the physical withdrawal symptoms, cause psychological symptoms (eg. As anxiety). Patients with a mental disorder can develop a physical illness (eg. As meningitis, diabetic ketoacidosis), which causes new or worsened psychological symptoms. Thus, a physician should not assume that all psychological symptoms in patients are due to a known mental disorder in this disease. The doctor may need to address proactively any physical causes of mental symptoms, particularly in patients who can not describe their physical health because they have a psychosis or dementia. Patients who present for psychiatric care, occasionally have undiagnosed physical illnesses that are not the cause of their psychological symptoms, but require yet the evaluation and treatment. Such disturbances can in no relation to the mental disorder are (z. B. hypertension, angina pectoris) or through (e. B. malnutrition by exhaustion due to a chronic psychosis) caused by or on the treatment is returned (z. B. hypothyroidism due to lithium, hyperlipidemia as a result of atypical antipsychotics). Selected psychological symptoms due Mental of physical illness symptom Physical illness * confusion, delirium, disorientation Cerebral arteritis, incl. Those caused by SLE CNS infection (eg. As encephalitis, meningitis, toxoplasmosis) Complex partial seizures dehydration overdose of drugs / medicines incl. prescription drugs electrolyte abnormalities fever hypoglycemia hypothermia hypothyroidism hypoxia liver failure mass (eg., tumor, hematoma) kidney failure sepsis thyroid disease vascular infarction vitamin deficiency Cognitive impairment, behavioral instability Alzheimer’s and other dementias HIV / AIDS Lyme disease lesion Multiple Sclerosis neurosyphilis Parkinson subdural hematoma SLE Schilddrüsnerkrankungen vascular infarction vitamin deficiency delusions multiple sclerosis abuse of many substances seizure disorders Depression Brain Turmorbehandlungen, incl. Interferon Cushing’s disease dementia diabetes mellitus Hypothyroidism Multiple sclerosis sarcoidosis sleep euphoria, mania Brain tumor Multiple Sclerosis abuse of many substances hallucinations encephalitis mass migraine abuse of many substances seizure disorders insomnia disorders of the circadian rhythm dyspnea or hypoxia Gastroesophageal reflux disease (GERD) hyperthyroidism Periodic Limb Movement Disorder and Restless Legs Syndrome pain syndromes irritability painkiller withdrawal multiple sclerosis Vitamin B12 lack memory disorders alkohola busus hypothyroidism multiple sclerosis vitamin deficiency-related mood symptoms HIV / AIDS hypothyroidism multiple sclerosis stroke substance abuse personality change mass multiple sclerosis seizure disorders SLE psychosis (eg. As hallucinations) brain tumor dementia electrolyte abnormalities Migraine Multiple sclerosis abuse of many substances sarcoidosis Sensory failures SLE syphilis * In addition, many drugs / medicines and toxins can cause psychological symptoms. Clarification Medical judging by history, physical examination, and often brain imaging and laboratory tests are required in patients with New encountered psychological symptoms (ie no history of similar symptoms) High different or unexpected symptoms (ie, in a patient with a known or stable mental disorder) psychological symptoms that begin in an unexpected age target is to diagnose the physical basic and accompanying diseases, rather than provide a specific psychiatric diagnosis. History In the medical history of existing disease, the type of symptoms and their onset (z. B. trauma, presence or discontinuation of a drug should be considered, especially if the symptoms have suddenly or gradually used and whether they occurred on possible triggers out or an abused substance). The doctor should ask whether the patient had previous episodes with similar symptoms if a mental disorder was diagnosed and treated, and if so, whether the patients have stopped taking their medication. In reviewing the organ systems, searching for signs that speak for possible causes: vomiting, diarrhea, or both: dehydration, electrolyte imbalance palpitations: hyperthyroidism, drug / drug effects including withdrawal, polyuria and polydipsia. Diabetes mellitus tremors: Parkinson’s disease, withdrawal syndromes difficulty walking or speaking: multiple sclerosis, Parkinson’s disease, stroke, headache: CNS infection, complex migraine, bleeding, mass fever, cough, dysuria, vomiting or diarrhea: Systemic infection weight loss: infection, cancer, inflammatory bowel disease, hyperthyroidism paresthesia and weakness: vitamin deficiency, stroke, demyelinating disease Relapsing neurological symptoms: multiple sclerosis, vasculitis The Anamn ese should identify known chronic physical diseases that can cause psychological symptoms (eg. B. thyroid, liver or kidney disease, diabetes, HIV infection). All prescription and non-prescription medicines should be reviewed and the patient will be asked for any use of alcohol or illegal drugs (amount and duration). The family history with respect. Physical diseases, particularly thyroid disease and multiple sclerosis, is levied. Risk factors for infection (eg. As unprotected sex, sharing needles, recent hospitalization, institutionalization) The vital signs are checked vermerkt.Körperliche investigation, particularly regarding fever, tachypnea, hypertension and tachycardia. The mental status is evaluated (test of mental status), in particular with respect. Signs of confusion or inattention. It is performed a complete physical examination, although the focus on signs of infection (eg. As neck stiffness, lung congestion, lateral tenderness), neurological examination (incl. Examination of the hallway and weakness) and fundoscopy to detect signs of increased intracranial pressure ( z. B. papilledema, lack of venous pulsations) lies. Signs of liver disease (eg. As jaundice, ascites, spider angioma) must be observed. The skin is carefully respect. Self-inflicted wounds or other signs of external trauma (eg. As bruising) inspiziert.Interpretation the findings The findings from the history and physical examination contribute to the interpretation of possible causes and conduct additional testing and treatment , Confusion and inattention (reduced clarity of awareness of the area- delirium) show particular with sudden onset and / or fluctuating course of the existence of a physical illness to. However, the converse is not true (i. E., A clear sensorium not confirmed that the cause is a mental disorder). Other findings in favor of a physical cause, Abnormal vital signs (eg., Fever, tachycardia, tachypnea) Meningeal signs anomalies that are detected during the neurological examination, incl. Aphasia gait and / or balance disorders incontinence are based Some findings, the assuming a specific cause, v. a. if the symptoms and complaints come into being or have changed from a long-standing base of state. Dilated pupils (in particular together with reddened, hot, dry skin) indicate anticholinergic drug reactions. Constricted pupils speak for opioid effects or pontine hemorrhage. A rotary or a vertical nystagmus indicates a PCP intoxication, a horizontal nystagmus often accompanies a diphenylhydantoin toxicity. Unintelligible speech or the inability to speech production suggests brain damage (eg., Stroke). A medical history of relapses of neurological symptoms, v. a. when a plurality of nerve appears to be involved, suggests multiple sclerosis or vasculitis. Paresthesias with a stocking-glove distribution pattern can speak for thiamine or vitamin B12 deficiency. In patients with hallucinations of the type of hallucination is not particularly diagnostic conductive, with the exception of command hallucinations or voices that comment on the patient’s behavior and probably represent a mental disorder. Symptoms that have been used shortly after a significant trauma or after the application of a new drug may be zurückzufühen to these events. Drug or alcohol abuse may be the cause of psychological symptoms or not; about 40-50% of patients with a mental disorder also run substance abuse (dual diagnosis) .Tests Patients should typically obtained pulse oximetry Capillary blood glucose measurement determining therapeutic drug levels Urine drug screen blood alcohol blood count urinalysis ways patients with a known mental disorder worsening of their typical symptoms and they have no medical problems, a normal sensorium and a normal physical examination (incl. vital signs, pulse oximetry and capillary blood glucose measurement), they need no further laboratory tests generally. Most other patients should receive HIV test Many doctors also determine serum electrolytes (incl. Ca and Mg), blood urea nitrogen and creatinine erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) electrolyte and renal function tests may be diagnostic conductive and Information for subsequent medication management contribute (z. B. respect. medicines that need to be adjusted in patients with renal insufficiency). Further tests are usually carried out based on specific findings: CT of the head: (. Eg weakness in a limb) patients with new-onset mental symptoms or with delirium, headache, a recently had taken place trauma or fokalneurologischen findings spinal tap (lumbar puncture (spinal tap) ): patients taking lithium, patients with symptoms or signs of thyroid disease and patients> 40 years with newly occurring psychological symptoms (especially women or patients with a family history: patients with meningitis signs or with normal CT head plus fever, headache or delirium thyroid function tests with thyroid disease) chest X-ray: patients with low oxygen saturation, fever, productive cough hemoptysis or blood cultures: Critically ill patients with fever L eberfnktionstests: Patients with symptoms or signs of liver disease, with a history of alcohol or drug abuse, or patients whose medical history is not going to get less frequently, the findings may suggest tests for SLE, syphilis, demyelinating disease, Lyme disease or vitamin B12 – or thiamine deficiency, particularly in patients with signs of dementia perform.

Health Life Media Team

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