DIAGNOSIS CHECKLIST
for Personality change

Why: to determine if acute or chronic. If onset is rapid and symptoms have been present for hours to weeks must consider delirium as possible cause of personality change. Delirium is an acute confusional state due to many causes e.g. infection, drug intoxication, alcohol withdrawal, liver failure, kidney failure, hypoxia, low blood sugar, stroke, heart attack or head injury. If the onset is slow and insidious and symptoms have been present for months to years a diagnosis of dementia, psychiatric illness or intellectual disability may be more likely.

Why: e.g. impulsivity, hyperactivity, aggression, paranoia, negativity, moody, irritability.

Why: Questions specifically about relationship, family, children, social support, occupation, general physical health and financial stresses. Significant stressors may cause personality change or moodiness or may increase the risk of depression and insomnia.

Why: e.g. it is common for the hormonal changes in puberty to cause moodiness and personality change; depression can have bizarre features in the elderly and may be misdiagnosed as dementia or psychosis. Agitated depression is the most frequent type of depression in the elderly. Other symptoms of depression in the elderly may include histrionic behavior, delusions and disordered thinking.

Why: may suggest premenstrual tension where mood changes begin from 2 to 14 days before menstruation and are relieved immediately when menstrual flow begins.

Why: Intermittent personality changes may suggest the possibility of epilepsy, phaeochromocytoma, insulinoma and drug or alcohol abuse.

Why: e.g. if symptoms are worse in the late afternoon and at night, delirium ( acute confusional state) is most likely. Dementia -type symptoms and acute psychosis have minimal variation over the course of 24 hours.

Why: it is important for the doctor to know if you are a suicide risk.

Why: medical illness is an important precipitant of personality change, moodiness and depression, especially in the elderly (e.g. depression with chronic fatigue syndrome may follow an illness such as glandular fever or influenza or may follow an operation or childbirth; low glucose levels in diabetes can cause personality change).

Why: Certain mental illnesses known to cause personality change include depression, anxiety, schizophrenia, mania and personality disorders.

Why: some medications may increase the risk of personality change e.g. beta-blockers, anti-Parkinson drugs, corticosteroids, anti-cancer drugs, non-steroidal anti-inflammatory medications, combined oral contraceptive pill, progesterone-only contraceptives.

Why: Cigarette smoking increases the risk of multi-infarct dementia and stroke which may be associated with personality change. Cigarette withdrawal may cause change in personality.

Why: Excess caffeine can cause anxiety like symptoms. Caffeine withdrawal may cause personality change.

Why: Alcohol abuse and withdrawal may cause personality change and also increase the risk of major depression and anxiety.

Why: dependence and withdrawal of many illicit drugs may cause personality change.

Why: suggesting anti-social personality disorder or drug abuse as cause of personality change.

Why: may determine risk of HIV and syphilis infection which may cause dementia and personality change.

Why: e.g. depression, anxiety, bipolar affective disorder, stroke, dementia, Wilson's disease.

Why: may suggest any infection that may cause delirium e.g. urinary tract infection, viral gastroenteritis, viral upper respiratory tract infection, ear infection, meningitis, encephalitis.

Why: Dementia causes impaired memory, impaired judgement and thinking, impaired verbal fluency and impaired ability to perform complex tasks. Personality may change, impulse control may be lost and personal care deteriorates. People with dementia may also have psychiatric symptoms such as delusions, paranoid ideas, hallucinations, mood disturbance and behavioral disturbance.

Why: may suggest brain cancer, acute stroke, meningitis or encephalitis. Headache may also occur among the range of physical symptoms experienced with depression and tend to mask the diagnosis of depression.

Why: e.g. depressed mood, crying spells, irritability, anhedonia (loss of interest or pleasure), increase or decrease in appetite (usually decreased), weight loss or gain, insomnia or increased sleeping (usually early morning waking), fatigue, loss of energy, feelings of worthlessness, feelings of excessive guilt, poor concentration, difficulty making decisions, low libido, thoughts of death or suicide attempt.

Why: e.g. episodes of depression (often psychotic in intensity) and at other times episodes of psychotic excitement (mania or hypomania). Symptoms of psychotic excitement may include elevation of mood, increased activity, grandiose ideas, irritability, disinhibition (which affects social, sexual and financial behavior), rapid speech and racing thought, delusions (persecutory or grandiose) and sometimes hallucinations.

Why: e.g. nervousness, shakiness, tremor, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination.

Why: e.g. hallucinations, delusions, disordered thought - may assist in differentiating schizophrenia, bipolar affective disorder and severe psychotic depression.

Why: e.g. headache, dementia, seizures, stroke-like symptoms, irritability, depression.

Why: e.g. hot flushes, night sweats, heart palpitations, lightheadedness, dry vaginal, dry skin, headaches - Menopause may also present with depression and irritability.

Why: e.g. impaired memory, impaired judgement and thinking, impaired verbal fluency and impaired ability to perform complex tasks. Personality may change, impulse control may be lost and personal care deteriorates. People with dementia may also have psychiatric symptoms such as delusions, paranoid ideas, hallucinations, mood disturbance and behavioral disturbance.

Why: e.g. limb weakness or paralysis, facial muscle weakness or paralysis, difficulty with speech and swallow.

Why: e.g. relentlessly progressive course of dementia, chorea (continuous flow of jerky movements, flitting randomly from one limb or part to another), personality change ( especially irritability), epilepsy.

Why: e.g. coarse hand tremor most marked at rest, rigidity of limbs, slowness in initiating and executing movements and speech, expressionless mask-like face and dementia.

Why: e.g. a group of physical, psychological and behavioral changes which begin from 2 to 14 days before menstruation and are relived immediately when menstrual flow begins. Symptoms may include depressed mood, irritability, tiredness, headache, bloating, breast tenderness, tension and aggression.

Why: e.g. fever, pallor, vomiting, lethargy, excessive irritability, personality change, stiff neck, photophobia (dislike of light).

Why: e.g. loud snoring, daytime sleepiness and fatigue, unrefreshed sleep, restless sleep, morning headache, nocturnal choking, mood changes, reduced libido.

Why: e.g. weight gain especially central abdominal, change of appearance, moon-like face, thin skin, easy bruising, excessive facial hair growth, acne, muscle weakness, lack of or rare menstrual periods, poor libido, psychosis, insomnia, frequent urination, excessive thirst - Cushing's syndrome may also present with depression and personality changes.

Why: e.g. loose bowel motions, intolerance to heat, sweating of hands, muscle weakness, increased appetite, weight loss, heart palpitations, emotional lability - Hyperthyroidism may also present with depression, anxiety and personality changes.

Why: e.g. husky voice, tiredness, weight gain, constipation, cold intolerance, loss of hair - Hypothyroidism may also present with depression and personality changes.

Why: e.g. headache, constipation, indigestion, weight loss, dry mouth, unusual pains or sensations in the chest and abdomen - not uncommonly occur with depression and tend to mask a diagnosis of depression. Depression can be associated with many illnesses but it is important to realize that these somatic symptoms may be the presentation of depressive illness.