Quote: Too often, doctors' first assumption is that symptoms are drug-induced or psychosomatic, when that should be the assumption of last resort, after all the other possible causes have been eliminated. [/QUOTE]

It can go either way. I knew of a situation where a man was judged to have a sudden onset of psychotic depression. He was getting psychotherapy everyday and getting worse. It turned out that he had toxicity of the brain from the antibiotics he was taking. When those were stopped, his mind went right back to normal . . . and high-functioning normal at that. It was astonishing.

They kept thinking he had a psych problem, and the psychiatrist confirmed that he did. At last, an infection disease specialist guessed that the whole thing was due to the antibiotics. He was right.

I would agree that psychosomatic should be a diagnosis of last resort. Anything else is disrespectful to the patient. But the rule of thumb has always been that a complete physical assessment should be done prior to delving into serious psych issues. Actually, as a poster wisely said above, the physician should keep an open mind to any possibility, while gathering info to rule in or out whatever.