14 Mai 2017
The Hidden Medical Causes of Mental Disorders by William Matteson, Ph. D. Missing The Diagnosis: The Hidden Medical Causes Of Mental Disorders. Learning Objectives.
The AMSN conference will update you on new and hot topics in medical-surgical nursing by learning in-depth information during concurrent sessions. Obesity Definition Obesity is an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. Obesity is associated with increased. A1C A form of hemoglobin used to test blood sugars over a period of time. ABCs of Behavior An easy method for remembering the order of behavioral components.
This is an intermediate. After taking this course, mental health professionals will be. List and. discuss four medical causes of mental disorders. Describe how. mood disorders can be triggered by the immune system. Explain how. genetic predispositions may increase the probability of mental illnesses. Describe. how medications and polypharmacy may trigger cognitive and emotional. Discuss how. social and emotional malfunctioning may be triggered by toxins in the.
List. metabolic disorders and the data supporting them. Discuss. ethical and legal considerations in providing information about. Troubleshoot. mental disorders which have been previously labeled, “treatment.
Work. effectively with patients, primary care physicians and psychiatrists. Course Outline PART I: Underlying Causes. Missing it. The Mind/Body Dilemma. PART II: 8 Important Areas of Evaluation. Brain Development. The Immune System. Thyroid. Pathogens.
Toxins. Clostridium Difficile. Medications. The Endocrine System. Central Nervous System Pathologies. Medical Illnesses Linked to Mental Problems. References. PART I: Underlying Causes“A number. In ancient times. Other. societies believed that these behaviors were due to possession by incubi and.
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More recent. theories included organ malfunction, such as the belief that hysteria was caused. Others touted Hippocrates’ imbalance of humors. More. recent theories have included suppressed memory, trauma, poor parenting, and refrigerator. The most wildly held belief of mental maladies today is that they. For the last. several decades, the field of mental health has been dominated by two major. Up until a. century ago, mental illnesses were diagnosed and treated by medical doctors.
It. wasn’t until about 1. Medical. illnesses can cause people to experience a baffling array of emotional. People suffering from these problems are. If there are accompanying medical problems. In addition, psychological reactions to.
Whenever a. patient presents a psychological problem, there is a very real possibility that. Understanding the role that. Although most patients will not have a causative underlying medical condition. While. psychotherapists should not live in fear of missing an unsuspected medical. This course will.
Naturally, it is not. It will, however, lay the groundwork to allow a therapist. Although not every mental. Missing it“Many. mental hospitals are living museums of undiscovered bodily disease.”FMR Walshe, MD “The more that is understood about how the human mind processes complex information, the more it becomes clear that certain situations are particularly susceptible to less than optimal outcomes because of these errors.”Antoinette Laskey, M. D., M. P. H. Consider this. A family comes to a psychotherapist for help because the middle child. He refuses to go to bed at night.
During the. day, he is hyper- reactive and non- compliant. This often leads to family. As the. therapist works with the family, it becomes clear that the fights are. Although the family. It is a. baffling situation. Neither the therapist nor the family members are aware that. This medical condition, not his emotional.
Without a physical and lab. Although many. psychotherapists are aware of the possibility that underlying physical. As a result, they can easily miss the signs that might lead. Even. internists and physicians at hospitals often miss the underlying medical causes. Despite advances in medical technology, there.
At best, medical. When. the patient's symptoms do not correspond precisely to the reference books or to. The challenge. of finding potential underlying medical causes is complex. This makes failure. Bias in diagnosis: How We Miss It“The.
Helen Le- Niculescu, Ph. D. Searching for causes“We intend to forget the richness of our ignorance – how much we don’t know and how essentially we learned what we do now.“Dan Agin Ph. D. Biological Psychology. For most. psychotherapists, a good proportion of clients come for help in coping with the. These may include unwanted moods, uncomfortable thoughts. Outpatient. psychotherapy, couples therapy, and family therapy are some of the many. Family therapists routinely work.
While psychologists and other mental health professionals in. There is no. doubt that many family therapies and psychotherapies can be useful and. Family therapy, couples therapy. Although. people may leave therapy feeling better, problems often recur. Even couples or. families who leave your office thanking you profusely may reappear at your door. People with chronic depression inevitably relapse.
These. events suggest that, beneath a presenting problem, may lay an undetected. Most psychotherapists. Nevertheless, all. In the last. few years, incredible developments in neuroscience, genetics. We see that. for which we look“I’ll see. I believe it.”Thane Pittman, Ph.
D. Psychotherapists. To diagnose means to observe, identify, and determine the cause of a disease or. To make a differential diagnosis means to distinguish between. The diagnosis. of a mental disorder is most often done by observing signs and symptoms which. Diagnostic and Statistical Manual (DSM). Although. these techniques have value, they seldom address the cause of the mental.
In his book, A. Dose of Sanity, psychiatrist Sydney Walker points out that “a label is not. DSM- V has included a category named the neurocognitive disorder, which was formally known in DSM- IV as 'dementia, delirium, amnestic, and other cognitive disorders.'We know what. We use words. like reactive depression, endogenous depression, or organic mental. The truth is. that many medical disorders manifest themselves by psychological symptoms and organic. We diagnose what we believe. Getting. caught in the presentation.
An initial. evaluation usually begins with an interview about the person’s major complaint. As they are. doing so, we listen carefully for signs and symptoms. If he tells us that he has racing thoughts and difficulty sleeping. This strategy is useful, but.
Getting. caught in the story. Once we begin. to feel confident that we have the diagnosis, we get a history of Mr. We. are looking for pieces of his history that fit our theory. When he tells us.
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Oftentimes, we do not question the veracity of what we. Getting. caught in the theory. All mental. health professionals are trained in certain theories of diagnosis and. They come to believe, for example, that depression is caused by.
One of the. pitfalls of effective psychological intervention is theoretical bias. All of us have specific training, received from professors who had their own. Although being trained in a certain type of. I was struck. by this many years ago while in graduate school. One on my professors – who.
He felt confident that, once these feelings came to. He told us that, after four.
Unfortunately, in this case, the problem was not well- suited for. As the years rolled by and the patient became older, the. Pet theories come. Some have value, some are fads, and some are simply bizarre. In 1. 98. 7. author Whitley Strieber wrote Communion, an allegedly non- fiction book. After reading his book, dozens of people flocked to the fast- growing. John Mack, a well- known psychiatrist and.
Harvard professor, set the diagnostic criteria for alien abduction syndrome. During this. period, there was another spate of unusual encounters – an upsurge in cases. At the time, I was on the treatment staff of three psychiatric. Each of these hospitals had opened a special unit for people who had. All subsequently developed multiple personality disorder. I listened. carefully to the experts at the hospital as they explained the origin of these.
However, I begin to be skeptical as I saw people coming in with a. In one. hospital, treatment protocols dictated that all patients attend group therapy.
If these memories and personalities. With their high level of anxiety and need to. Many patients. left the hospital with much more severe pathology than they had had when they. This prompted me to become skeptical about how diagnoses were made. The Abduction Enigma: The Truth. Behind the Mass Alien Abductions of the Late Twentieth Century.
There are few African- Americans, Hispanics, or Asians. One of the. unexpected events that followed the release of this book was the anger and. I received a large volume of hate mail, filled with threats. Rather than disagreement or discourse. This level of. bias is unfortunately common enough that it is one of the primary reasons.
If you are in private practice, you know that many. However, you. also are aware that some of your clients did not get significantly better. At. times, when people do not improve with treatment, we label them treatment resistant. Couples. therapy and family therapy are useful in increasing the quality of family life.
As a result, one. Research on couples and family. Problem solving and empathy training will not fix these. When a mental. illness is involved, we may send the person to a physician for a prescription. This sometimes helps, but sometimes does not. In. that event, rather than labeling the outcome treatment failure or treatment.
It may well be that the outbursts of anger Mr. Johnson. exhibits will not remit until the malfunction of his adrenal glands is addressed. Ironically. even if overstressed adrenal glands must now be managed before Mr.
Johnson can. resolve his marital problems, the marital problems may have contributed to his existing. Stress hormones are higher in the conflicted couple even when they. The quality. of a marriage is a strong predictor of physical health. A study by Janice. Kiecolt- Glaser and her colleagues looked at the levels of norepinephrine in the. They found that couples who had divorced by ten years had already. Distressed marriages can cause effects on the immune system.
These findings. suggest that personal relationships become translated into health outcomes.
Overview, Hyperemesis Gravidarum, Acute Fatty Liver of Pregnancy. The incidence of viral hepatitis A, B, and C is the same in pregnancy as it is for the general population, but the incidence of hepatitis E is much higher in pregnancy. Hepatitis AIn the United States, the incidence of hepatitis A is 9/1. It is transmitted through oral- fecal exposure, and children play a key role in transmission, as many have asymptomatic and unrecognized infections. The virus can remain in the environment for several months and may contaminate food after cooking, often after unhygienic handling of food. Symptoms in pregnancy are the same as those seen in nonpregnant patients, including malaise, fatigue, nausea, vomiting, right upper quadrant pain, and pruritus, which may be more severe in pregnancy (secondary to elevated levels of estrogen).
The diagnosis of acute hepatitis A infection is made with the detection of hepatitis A Ig. M antibodies. Intrauterine transmission with infection during the first trimester has been reported. This was diagnosed by elevated levels of hepatitis A Ig.
G in the infant at 6 months of life. If it is given 2 or more weeks after exposure, it is not effective in preventing the infection or improving symptoms. If the patient is infected in the third trimester, the newborn should receive passive immunoprophylaxis within 4. The overall case fatality rate is less than 1%.
The virus is transmitted through multiple routes, including mucosal, parenteral, sexual, and vertical exposure. Although the virus has been detected in multiple body fluids, it is only infectious in saliva, serum, and semen. Sexual contact is an efficient method of spreading the virus.
The likelihood of developing a chronic infection is inversely related to the age at which the infection is acquired. The risk of chronic infection is 9. Patients may also present with jaundice and pruritus. Patients often have elevated transaminase levels, usually greater than 1. U/L. Diagnosis of acute hepatitis B infection is made with detection of hepatitis B surface antigen (HBs.
Ag) and Ig. M antibodies to hepatitis B core antigen (Hbc. Ag). Patients who clear the initial infection develop anti- hepatitis Bs antibodies when they are clearing Hbs. Ag. During this “window” phase, infection can be detected by testing for anti- hepatitis B core antigen. The chronic carrier state is represented by the presence of Hbs.
Ag and the absence of anti- HBs. Another indicator of not only active infection but also increased infectivity is the presence of hepatitis B e antigen (Hbe. Ag). All pregnant women should be screened for hepatitis B by testing for HBs. Ag in the first trimester. A patient with any risk factors, including a recent or remote history of injection drug use, having had multiple sexual partners in the previous 6 months, having a sexual partner who is positive for HBs.
Ag, or previous treatment for a sexually transmitted disease in pregnancy should be tested upon admission to labor and delivery. Patients who test positive should be reported to the state or local health department as per the local law requirements. The patient should be counseled about the modes of transmission, prevention of hepatitis B, neonatal concerns, and all household contacts should be immunized.
No specific treatment exists for acute hepatitis B, but supportive care is recommended. All women who are Hbs. Ag positive should be enrolled in an appropriate case management program to ensure that the neonate is treated appropriately. The risk of perinatal transmission from mothers who are Hbs. Ag positive is 1. In the presence of Hbe. Ag, the neonatal transmission risk without neonatal prophylaxis is 9.
The risk of perinatal transmission also depends upon when the infection occurred during pregnancy. The risk is greatest during the third trimester, likely due to peripartum transmission, and is approximately 9. Postexposure immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B virus vaccine can help prevent 8. Preterm infants weighing less than 2.
Hbs. Ag positive require an additional vaccine dose, and the first dose should not be counted due to the potentially reduced immunogenicity in these patients. All infants should be tested for anti- HBs. Ag and HBs. Ag 9- 1.
One study demonstrated a 1. L versus 6. 8% in patients with a viral load greater than 1. L. Lamivudine is an antiviral medication that decreases viral replication in the mother, but there is concern that antiviral monotherapy can predispose to viral mutations and thus resistance to therapy. Although the study was small, with only 8 subjects, no adverse effects were noted, and when used in treatment to prevent transmission of human immunodeficiency virus (HIV), the most frequently reported adverse events were mild anemia and prematurity. Ninety- two subjects delivered 7. Of the 6. 8 infants that completed the study, there were 2 episodes of hepatitis B virus transmission, and the only adverse effect likely directly attributed to lamivudine was an elevation in serum creatinine kinase levels in one patient. The results were compared to a control group receiving no treatment.
The mothers in the treatment group experienced a significant decrease in HBV viral load greater than 4. It can also be prevented with hepatitis B immunoglobulin and hepatitis B vaccine. HBIg is used for postexposure prophylaxis and provides temporary protection for 3- 6 months. It is generally given in a single dose of 0. L/kg intramuscularly. It is not effective if given more than 2 weeks after exposure.
Two approved vaccines with various dosing schedules exist, but, most commonly, adolescents and adults receive doses at 0, 1, and 6 months. Risk factors for hepatitis C include transfusion of unscreened blood products and intravenous drug use. Less common routes of transmission include sexual contact, transmission from an infected mother, and needle- stick injuries. With screening of blood products, the risk of infection has decreased to 1 per 1,0. The remainder of the patients have asymptomatic infections. Generally, 7. 5- 8. B- cell lymphomas and cryoglobulinemia.
Of the patients who develop chronic disease, 6. The antibody may not be detected until 6- 1. C RNA can be identified soon after infection. Presence of both anti- HCV and HCV RNA demonstrate presence of a current infection. Chronic infection does not seem to alter the course of a pregnancy and does not place the mother at an increased risk of preterm labor, preeclampsia, or gestational diabetes. Currently, screening all pregnant women for hepatitis C is not recommended.
Only those with risk factors should be screened, including HIV infection, prior or current intravenous drug use, a history of partners with intravenous drug use, and blood transfusion or organ transplantation prior to 1. Patients who test positive should be counseled regarding methods to decrease the risk of transmission to others, including not donating any blood, semen, or serum and covering all open wounds. According to the Centers for Disease Control and Prevention (CDC), those involved in a monogamous relationship should be aware of the low, although possible, risk of transmission but do not necessarily need to change their practices. Patients with hepatitis C should also be counseled about the risk of chronic liver disease and the need for possible treatment, as well as ways to protect their liver. No vaccine for hepatitis C exists, and primary prevention is necessary in order to avoid infection. Treatment of hepatitis C with ribavirin and .
In pregnancies with no detectable levels of HCV RNA, vertical transmission is rare. Additional risk factors for neonatal transmission include HIV coinfection (1. If coinfection with HIV is present, antiretroviral treatment of HIV can decrease the transmission rate of HCV to levels of those who are not coinfected. No difference was found in the transmission rate between vaginal and cesarean deliveries, .
Although the virus can be detected in breast milk, a recent review for the United States Preventative Task Force (USPTF) of 1. It can either be acquired at the time of HBV infection (coinfection) or after HBV infection (super- infection). It is transmitted through percutaneous or mucosal contact with blood. Chronic infection produces more severe disease than the other forms of hepatitis, as 7.
D develop cirrhosis and portal hypertension. It can progress very rapidly from infection to cirrhosis within 2 years. It can be transmitted at the time of delivery, but postexposure treatment of hepatitis B is effective in decreasing the transmission rates. Hepatitis EHepatitis E has a higher incidence and mortality rate in pregnancy than in the nonpregnant state. It is rare in the United States but endemic in developing countries, including areas of Asia, Africa, and Central America. Similar to hepatitis A, it is primarily transmitted through oral- fecal exposure, often through contaminated water supplies. Person- to- person transmission is uncommon, but vertical transmission does occur.
Clinical presentation can range from asymptomatic infection to fulminant hepatitis with hepatic encephalopathy that can be confused with acute fatty liver of pregnancy. The incubation period is approximately 4.
No association exists with chronic hepatitis or cirrhosis. Pregnant women have higher infection rates than the general population during epidemics. In one epidemic, the attack rate of nonpregnant women and men was 2.
Infection during pregnancy is associated with a higher rate of fulminate hepatitis and mortality, up to 2. One small study out of India demonstrated fulminate disease in 6. Infection during pregnancy is also associated with increased rates of abortion, stillbirth, and neonatal deaths.
It is diagnosed by the presence of anti- hepatitis E antibody, and active infection is indicated in the presence of HEV- RNA. One study demonstrated that up to 7. HEV antibodies were asymptomatic, .
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