DEPRESSION, ANXIETY, AND OTHER ABNORMAL PSYCHIC STATES
DEPRESSION, ANXIETY, AND OTHER ABNORMAL PSYCHIC STATES: Excerpt from Differential Diagnosis in Primary Care
It is simple enough to administer a sedative and refer the emotionally
distressed patient to a psychiatrist, but the astute diagnostician will want
to rule out an organic disease first. Almost every endocrine disease is
associated with emotional disturbances, all of which are potentially
curable. In addition, electrolyte and other metabolic disturbances, chronic
anoxia, or failure of any organ system may lead to anxiety, depression, or a
psychotic state. The mnemonic
VINDICATE will help to recall this important group of disorders.
V—Vascular diseases include myocardial infarction, CHF, cerebral
arteriosclerosis, and thrombosis.
I—Inflammatory diseases recall syphilis, encephalitis, tuberculosis,
brain abscess, influenza, pneumonia, and any prolonged infectious state,
particularly that of the hospitalized patient with tubes in every orifice.
N—Neoplasms include cerebral tumors, tumors of the endocrine glands,
and any neoplasm which is metastatic or which affects the metabolism of the
body by a hormone or enzyme which it secretes. Pancreatic carcinoma is
frequently associated with depression.
D—Degenerative diseases and deficiency diseases suggest
presenile and senile dementia, pellagra, Wilson disease, and atrophy of the
various endocrine glands.
I—Intoxication suggests lead poisoning, alcoholism, bromism,
hypercalcemia, hypocalcemia, manganese toxicity, hypokalemia, hypovolemia,
uremia, anoxia from pulmonary disease, anemia, heart disease, and
corticosteroid therapy, as well as many other drugs. Porphyria may cause
depression or a psychotic state.
C—Congenital suggests the depression associated with many congenital
neurologic diseases: epilepsy, muscular dystrophy, Friedreich ataxia,
myotonic dystrophy, and the depression associated with congenital heart
disease and congenital defects of many organ systems.
A—Autoimmune diseases include multiple sclerosis and lupus
erythematosus.
T—Traumatic disorders include the now well-recognized posttraumatic
neurosis or depression, neurocirculatory asthenia, and postconcussion
syndrome. Compensation neurosis should be mentioned here.
E—Endocrine diseases include hypopituitarism, acromegaly,
hypothyroidism, apathetic hyperthyroidism, hypoparathyroidism,
hyperparathyroidism, diabetes mellitus, insuloma, hypogonadism, menopause,
Cushing syndrome, and adrenal insufficiency.
Approach to the Diagnosis
The association of other symptoms and signs is all important. A
triiodothyronine (T3) level, total thyroxine (T4) level, and free
thyroxine index (FT4), a urine for porphobilinogen, serum electrolytes,
toxicology screen, lead level, 24-hour urine, 17-ketosteroid level, and
17-hydroxycorticosteroid level should be done on anyone suspected of having
endogenous depression. (Possibly all depressed patients should get this
screen.) Skull x-ray film, EEG, CT scan, and even a spinal tap (to rule out
multiple sclerosis [MS] and lues) may be worthwhile when other neurologic
signs are present.
case presentation #14
A 62-year-old white woman is brought to your office because the family
has noticed that she is depressed. The patient has insomnia, frequent
nightmares, and weight loss over the past 6 months despite the fact that she
has a good appetite.
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Dysthymia
More Medical Textbooks Online about Dysthymia
Review other book chapters online related to Dysthymia:
Medical Books Excerpts
- DEPRESSION
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Depression
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Depression
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Depression
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Surveys relating to Dysthymia
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
