Potential Mental Illness can
represent as physical symptoms.
In general it’s not ok but ok to have medical condition, but
with mental illness stigma is a big barrier in the way of seeking help. Diagnosis of Mental illness is bit challenging due to the fact that not having a definite labs test or imaging study which could diagnose condition with certainty.
In addition to that mental illness can present with physical symptoms to further complicate the picture. In those cases physical test and exhaustive studies bring negative results.
Here is an examples of typical case of panic disorder. Who presented with chest pain.
A 30 year old married male had history of childhood trauma and had family history of anxiety disorder gradually developed anxiety symptoms, after prolonged stressful work condition and financial difficulties. He had palpitation, sweating, breathlessnes without chest discomfort and feels like going to die, and heart pounding. He drove himself to the ER. ER Physician after having his ECG and labs negative kept him for observation overnight adding agony to the patient and family (had small children), while only positive finding were 300 CPK levels (which could be due to physical exercise). Next day he was discharge with thousands of AED Hospital bill. He himself referred to the mental health clinic and found out having panic disorder and is being successfully treated. He was symtpoms free for many month untill last seen.
In above example if there was psychiatric consult in the ER,
result might have been different.
Mental illness more often than not present with physical
symptoms and pt himself not aware of nature of symptoms usually go to the
general practitioner and get treatment for the physical complaints when in
actual it is associated mental health issue.
In another example 25 year old unmarried female presented to the clinic with chronic severe pain and was on narcotics for pain. She had her parents divorced (high conflict)when she was 6-7 years old, later she was moved from one parents to other and witnessing parents arguments and fighting all along, her younger brother not only dies in car crash but he was burned and she was called upon to identify the body when she was 22 year old. Few months later she started experiencing nightmares, flashbacks, startle response and multiple aches and pain the body including spine and muscle pain. She also reported pain in the abdomen and other GI (gastrointestinal symptoms) like nausea vomiting. There are some reports of her mother having history of chronic pain. She sought help of General practitioner and was referred to pain clinic and was treated with pain medication, continuous pain complaints led to her being treated with narcotics and later on surgical implantation of self controlled analgesia pump. CT, MRI, labs and nerve conduction study were non significant. No physical cause of pain founded.
In this example history presentation and chronology of
symptoms point out to the PTSD (post traumatic stress disorder) and
( This case report was Authored and Published by the writer in American Journal of Neuropsychiatry and Neuroscience, 2010)
A 14 year old boy with 1-2 year history of attention problems, feeling depressed, decreased school performance social isolation, using marijuana and not taking care of self and isolates in his room at times paranoid ideation. Presented to the general practitioner who thinking that patient
has ADHD because poor focus and also substance abuse, he was started on
Wellbutrin 150 mg daily, 3 days later patient became severely psychotic
paranoid and was standing in his home driveway with baseball in his hand and
defending himself of unknown creature. Few days later he stopped eating
drinking thinking food are poisoned and became dehydrated and needed I/V
transfusion. He was admitted to psychiatric unit Wellbutrin was stopped and he was given Intramuscular zyprexa injections and showed slow but gradual
improvement of psychotic symptoms.
Careful evaluation in good hands might have avoided the above mentioned complication. If we carefully review the history and symptoms,
it does not point toward ADHD; instead this is an example of first break psychosis. Which should be treated accordingly.
In thsese above examples It is imeprative to look at the bigger picture and not to ignore mental health aspect of the illness. In somatic disorders uaully pt has to go through Rule out medical causes, But in panic disorder and First break psychosis there was very clear hint toward the diagnosis ( If considered carefully by the mental health professional and could have saved extra trouble of time, money and resources)