It sometimes happens
that a person will experience psychological problems as the result of an
underlying medical condition.
In some cases
it doesn’t take much thought to realize what’s happening, as, for
example, when a person who has had a heart attack becomes depressed. But
in other cases, such as thyroid disease or pancreatic cancer, a person can
have an illness and not even know it, because the only thing that seems out
of order may be a feeling of
depression
or
anxiety,
perhaps in conjunction with vague bodily pain. Only a competent investigation
into the cause of the psychological symptoms will lead to a discovery of
the medical condition.
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I’ve
presented the information that follows in the hope that you or someone you
know will take nothing for granted in regard to psychology. For your own
sake, if you ever feel emotionally out of order, get a complete medical check-up
before trying anything else. And, in fact, if you ever decide to start
psychotherapy, and if, in the first sessions, your psychotherapist doesn’t
ask some direct questions about your medical condition, then find another
psychotherapist—quick. |
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General Information
from the DSM-IV
The Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition (Washington, DC,
American Psychiatric Association, 1994) has several sections devoted to
Mental Disorders Due to a General Medical Condition.
If you don’t
know what a particular medical term means, copy the term and paste it into
a search engine search window; Google
usually gives good results.
Anxiety
/ Panic Symptoms can result from a variety
of conditions, such as
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endocrine conditions (such as
hyperthyroidism, hypothyroidism, pheochromocytoma, hypoglycemia,
hyperadrenocorticism) |
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• |
cardiovascular conditions (such as
congestive heart failure, pulmonary embolism, arrhythmia) |
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• |
respiratory conditions (such as pulmonary
disease, pneumonia, hyperventilation) |
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• |
metabolic conditions (such as vitamin
deficiency, porphyria) |
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• |
neurological conditions (such as
epilepsy, neoplasms, vestibular dysfunction, encephalitis) |
Impulse-Control
Symptoms can result from a variety of
conditions, such as
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• |
head injuries |
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• |
episodes of unconsciousness |
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• |
febrile seizures in childhood |
Mood
Symptoms can result from a variety of
conditions, such as
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• |
degenerative neurological conditions
(such as Parkinson’s disease, Huntington’s disease) |
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• |
cerebrovascular disease (such as
stroke) |
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• |
metabolic conditions (such as vitamin
deficiency) |
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• |
endocrine conditions (such as
hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoparathyroidism,
hyperadrenocorticism, hypoadrenocorticism) |
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• |
autoimmune conditions (such as systemic
lupus erythematosus) |
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• |
viral or other infections (such as
hepatitis, mononucleosis, HIV) |
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• |
certain cancers (such as carcinoma
of the pancreas) |
Personality
Changes can result from a variety of conditions,
such as
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• |
central nervous system neoplasms |
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• |
head trauma |
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• |
cerebrovascular disease |
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• |
Huntington’s disease |
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• |
epilepsy |
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• |
infectious conditions with central
nervous system involvement (such as HIV) |
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• |
endocrine conditions (such as
hypothyroidism, hyperadrenocorticism, hypoadrenocorticism) |
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• |
autoimmune conditions with central
nervous system involvement (such as systemic lupus erythematosus) |
Sexual
Dysfunction can result from a variety of
conditions, such as
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• |
neurological conditions (such as
multiple sclerosis, spinal cord lesions, neuropathy, temporal lobe
lesions) |
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• |
endocrine conditions (such as diabetes
mellitus, hypothyroidism, hyperadrenocorticism, hypoadrenocorticism,
hyperprolactinemia, hypogonadal states, pituitary dysfunction) |
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• |
vascular conditions |
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• |
genitourinary conditions |
Sleep
Disorders can result from a variety of
conditions, such as
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• |
degenerative neurological illnesses
(such as Parkinson’s disease, Huntington’s disease) |
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• |
cerebrovascular disease |
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• |
endocrine conditions (such as
hyperthyroidism, hypothyroidism, hyperadrenocorticism,
hypoadrenocorticism) |
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• |
viral and bacterial infections |
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• |
coughing or breathing problems related
to respiratory conditions (such as chronic bronchitis, asthma) |
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• |
pain from musculoskeletal disease
(rheumatoid arthritis, fibromyalgia) |
Chronic
Fatigue
Chronic
Fatigue
itself, usually called Chronic Fatigue Syndrome (CFS) or Chronic
Fatigue and Immune Dysfunction Syndrome (CFIDS), used to be called
neurasthenia. The syndrome is characterized by a wide variety of symptoms
such as fatigue, weakness, muscle and joint pain, headache, memory and
concentration difficulties, and difficulty sleeping. No one has yet found
a single cause for this syndrome; in fact, current research reveals that
CFS is a complex medical disorder with multiple causation. If CFS is diagnosed
early, new medical treatments can promote improvement.
A person who
is chronically fatigued can grow to become depressed simply over feeling
so miserable so much of the time. Therefore, one form of treatment can also
be psychological: learning how to cope with the frustration of symptoms that
are real and physical but have a mysterious cause and no single cure.
Psychodynamic psychotherapy can help you identify
and heal emotional conflicts from the past so that
unconscious resentments do not “feed” the
disease. Cognitive-behavioral treatment, especially
hypnosis and guided imagery, can help you learn
mental qualities such as perseverance and relaxed concentration so that you
do not succumb to feelings of panic and depression.
It
is rare, but sometimes other medical conditions that can cause generalized,
chronic malaise are misdiagnosed as Chronic Fatigue Syndrome. The following
(in alphabetical order) are some
examples:
Early
Menopause can cause symptoms such as fatigue,
sleep disturbance, irritability, mood instability, anxiety, and frequent
crying episodes. In young women (as young as 30), when menopause is not expected,
these symptoms can also be misdiagnosed as
depression.[1]
Hypothyroidism, a condition caused by
a thyroid secretion deficiency, is a common endocrine disorder. Symptoms
can include weakness, dry skin/hair, lethargy, forgetfulness, depression,
apathy, and constipation. If apathy is a symptom, the tendency to minimize
complaints can delay diagnosis. Hypothyroidism can be treated successfully
with medication.
Lyme
disease
can result from a tick bite, generally from a deer tick. You might know that
you’ve been bitten if you find the tick on your skin or if a red patch
on the skin develops following the bite. The redness does not always develop,
however, so some persons never realize that they have been bitten. The disease
can also be passed from an infected mother to her fetus. Besides general
malaise and fatigue, symptoms can include various muscle aches and
pain.
Morgellons
disease
is a new and somewhat mysterious disease that can be a complication to lyme
disease or other diseases, such as HIV, that compromise the autoimmune system.
Besides fatigue and cognitive impairment, this disease also produces fibers
in tissue and skin that cause pain and itching. The disease has often been
misdiagnosed as a delusional disorder.
Obstructive
Sleep Apnea (OSA) consists of repetitive
episodes of partial or complete upper airway obstruction during sleep, resulting
in an interrupted sleep pattern. As a result, excessive daytime fatigue can
be common with this disorder. It is also common to have this disorder and
not know it. Besides the fatigue and the tendency to fall asleep during the
day, one sign of OSA is loud snoring—but snoring can be caused by other
things than OSA; another sign is waking up to find your blankets and pillow
on the floor (from fitful sleep) and not have any idea how they got
there.[2]
Parasites such as hookworm
can infect unwary tourists through contact with contaminated soil, usually
from walking barefoot in the tropics. The infection begins with itching around
the area of infection and is followed by nagging gastro-intestinal
complaints.
Shiftlag, similar to jetlag, can result from weekly workshift
rotations that interrupt natural, biological circadian rhythms. Besides
general malaise and fatigue, workers can experience poor appetite and sleep
disturbance. Melatonin may be helpful in regulating sleep
rhythms—see your physician for
advice.[3]
Vibroacoustic
Disease (VAD), caused by loud noise (technically
known as large pressure amplitude and low frequency [LPALF] noise) can contribute
not just to fatigue but also to a whole host of medical problems, such as
heart disease, ulcers, seizures, dizziness, and hearing loss. Psychiatric
symptoms can include
noise intolerance,
verbal and physical aggressiveness, and
even
suicide. The best
treatment is prevention—avoidance and hearing protection—and many
unfortunate cases, such as aviation workers (even flight attendants) end
in
disability.[4]
Here
are some other conditions that can contribute to fatigue:
Anemia, a deficiency of hemoglobin
in the blood, most commonly results from inadequate iron intake, malabsorption
of iron (e.g., celiac disease), or chronic bleeding (e.g., due to colon cancer).
Other diseases (such as liver or bone marrow diseases) can also cause
anemia.
Altitude
sickness,
sometimes called mountain sickness, which results from a lack of oxygen
at altitude—known as hypoxia—can cause fatigue for climbers,
skiers, aviators, and vacationers. The immediate treatment is simple: get
to a lower altitude, take supplemental oxygen (if you have access to it),
and drink plenty of water (a higher than normal breathing rate due to hypoxia
can cause you to lose moisture from your lungs, leading to dehydration).
If your vacation plans involve being at a high altitude, plan a gradual ascent
(if possible) or allow a day or so of rest when you first arrive so that
your body can get acclimated to the lower level of oxygen in the
air.
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Airline passengers
may also experience some mild hypoxia; for more information, see the
Fear
of Flying page on this website. |
|
Dehydration can be one cause of fatigue that is often overlooked. In
all weather—hot or cold—you should always drink plenty of water.
The actual amount of water you need can vary, but a sure way to check is
to look at the color of your urine: if it is not a light straw color, you
are probably dehydrated. So remember that unless you have kidney problems,
you can never drink too much
water.[5] Also, be aware that caffeinated and sweetened drinks—as
well as alcohol—are not anywhere as good for you as plain water and
may actually contribute to dehydration.
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If
you believe that any of the above conditions may apply to you, discuss them
with your physician. |
|
Drug
Interactions
Medications are
meant to help you feel better, but many people are not aware that one medication
may interact with another one and cause new problems.
At the worst, drug
interactions can be fatal; but they can also cause psychiatric symptoms such
as confusion, memory impairment, anxiety, and depression.
Therefore,
if you are are taking more than one
medication,
you should make sure that at least one physician (if you have more than one)
knows everything you are taking. Some pharmacies also maintain computer
records that can check for adverse drug interactions—but they won’t
catch over-the-counter medications—or herbal remedies—mixed with
prescription medications. So what can I say? Be an informed and responsible
consumer. After all, it’s your life, and you only get one chance at
it.
No
advertising—no sponsor—just the simple truth . . .
|
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DID MY WORK help you? Have you found
insight into your behavior? Have you found information unlike anywhere else?
Then why not make a Quick & Easy donation to this freewill website
to express your gratitude for my labor in creating something substantial,
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Additional
Resources
Notes:
1. Berg JS,
Moore J. Early menopause presenting with mood symptoms in a student aviator.
Aviation, Space, and Environmental Medicine 2000; 71:251–254.
2. Chervin RD,
Guilleminault C. Obstructive sleep apnea and related disorders. Neuro
Clin 1996; 14:583–609.
3. Caldwell JL.
The use of melatonin: An information paper. Aviation, Space, and Environmental
Medicine 2000; 71:238–244.
4. Vibroacoustic
disease. Aviation, Space, and Environmental Medicine 1999; 70(3,
Suppl).
5. Well, actually,
if you really work at it, you can put yourself into a state of water intoxication
(hyposmolality/hyponatremia). But if you drink only a glass (8 oz—or
250 ml) of water per hour you would be well below the maximum recommended
½ qt/hr (500 ml/hr) in moderate temperatures and easy work load. See:
Kolka MA, Latzka WA, Montain SJ, Corr WP, O’Brien KK,
Sawka MN. Effectiveness of revised fluid replacement guidelines for military
training in hot weather. Aviation, Space, and Environmental Medicine
2003; 74:242–246.
Chronic Fatigue:
CFIDS
—“the CFIDS Association of America is the nation’s leading
charitable organization dedicated to conquering chronic fatigue and immune
dysfunction syndrome (CFIDS), also known as chronic fatigue syndrome
(CFS).”
Anemia
—from THE MERCK MANUAL, Hematology and Oncology.
Lyme disease —from THE MERCK MANUAL.
Morgellons disease
—the Morgellons Research Foundation is dedicated to finding the
cause of an emerging infectious disease.
Drug-Herbal
Interactions:
Alternative Medicine — Known or Potential Drug-Herb
Interactions from WellnessWeb
Herbal-Drug
Interactions from HealthCastle
General Medical
Information:
THE MERCK MANUALS,
Home Page
The Merck
Manual of Medical Information - Home Edition for Patients and
Caregivers
The Merck
Manual of Medical Information - for Healthcare Professionals
Virtual Naval
Hospital: Patients HomePage
Virtual Naval
Hospital: Providers HomePage
Related pages within A Guide to Psychology
and its Practice:
Medication
Issues
Posttraumatic Stress
Disorder
Psychology and
Psychiatry
Reasons to Consult
a Psychologist
CONTACT ME
INDEX of all subjects
on this website
SEARCH this
website
A Guide to Psychology
and its Practice
www.GuideToPsychology.com
Copyright © 1997-2008 Raymond Lloyd Richmond, Ph.D. All rights
reserved.
San Francisco, California USA
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