Confusing Medical Ailments With Mental Illness

Confusing Medical Ailments With Mental Illness - WSJ.com

Interesting new book. I have read some of it today (Ch 9, Specific mental signs and symptoms), as it was available online at my university. I guess it's written for therapists - nontechnical and easily readable. If you ever wondered if your mental symptoms might have a physical basis, this is a recent book that may give you some answers.

It works both ways, I'm still amazed they prescribe antidepressants for many heart disease/surgery patients. My poor aunt (she's 92 now) had to go see a neurologist because she had an antidepressant prescribed for something non-depressing and no doctor remembered to consider it and tell her when to stop taking it; she ended up having blackouts/stroke-like symptoms! The neurologist was Chinese I think and difficult for her to otherwise understand but, "you stop taking that one" got through to her.

Thanks for the link. It brings up some things that I am often concerned about.

For example this part

"Common culprits include under- or over-active thyroid glands, which can cause depression and anxiety, respectively. Deficiencies of vitamins D, B-12 and folate, as well as hormonal changes and sleep disorders have also been linked to depression."

When I went to my GP and told him about my symptoms he never suggested to test for thyroid problems or vitamin deficiencies but recommended I rest and relax for a month or two. The first pdoc I saw immediately prescribed an AD without ordering any bloodwork.
Without a doc recommendation, I went to the lab and paid for the tests myself and it turned out I had hypothyroidism, vitamin deficiencies and elevated levels of a few hormones.

Now that I have a mi diagnosis, when I go to regular doctors they don't seem to take my symptoms seriously because they blame everything on the mi.

[quote]Some patients may benefit from both psychological counseling and medical help. Therapists need not turn patients away while medical issues are being explored, experts say. "Clinicians can say, 'While we work on these issues, let's also discuss any possible medical conditions that could be contributing, so we can at least rule them out,"' Dr. Pollak said.[end quote]

Confusing Medical Ailments With Mental Illness - WSJ.com

Yes, it's better to look at overall health and not just one aspect!! Much agreed!! Glad this one is written!!

As a neurological patient, I've learned that I still need to be aware of any other physical ailments, along with taking care of my emotional well being!

Thanks for sharing this!!!

Ohhhh I know what you mean!!!! I had severe pain one in my abdomen one year and they treated me like I was crazy and it was all in my head I had to pretty much demand certain tests and diagnose myself .....yeah it was an ovarion cyst that had burst....it pisses me off even more that my family does the same friggin thing...and even when they find out it was something else I get a brush off....grrrr

chocmouse, I think the GPs start with the least invasive/expensive suggestions first for broad symptoms like tiredness, aches and pains, sleep disturbances, etc. I think if you had come back for another appointment and said, "Well that didn't work, what else you got?" he would have suggested blood/urine tests that would show the thyroid/vitamin deficiencies. That is what happened to me. But they don't want to spend your money on tests when you have a problem that could resolve itself for nothing. Some people think they can just take a pill and solve all problems (my husband at times) but that's not necessarily the best way to deal with symptoms.

It works the other way too; I'm taking the thyroid pills and my numbers are normal so "why are you still complaining?" is often the attitude I get if I mention sleep, tiredness, etc.

Perna, yes I know how doctors seem to work but I am still frustrated because if one of their kids was in my situation I am sure they would have acted very differently. At one doctor I fainted while I was sitting on the chair and he didn't even take my blood pressure..The second time I went to my GP he sent me to the Pdoc. He probably thought I was a hypochondriac..why else would I ask for blood tests
As for the thyroid..What I learned so far is
1. Every person has his/her personal 'normal' range where he/she feels good. So you might have normal TSH/T3/T4 levels according to the average ranges and still feel crappy. Its crucial to have a sensitive doctor that you can work with in order to determine your ideal levels. Preferably a doctor who can see the TSH/T3/T4 in relation to eachother, as opposed to only looking at the TSH isolated from the rest.

2. Often the thyroid is treated without looking into the reason behind the hypo or hyperthyroidism. If no autoimmune disorder or iodine deficiency is found doctors seem to stop searching for a cause. But it would be very important to keep searching because sometimes thyroid problems are a sign of another bigger problem, like malfunction of another organ. These things are unfortunately often overlooked and the underlying problem continues to evolve.

Yeah, the book explictly warns about that kind of thinking about causality and how it should properly be addressed:

> If you do notice a physical sign in one of your patients, whether it is old or new, you want to be sure that you fully understand its cause and significance. It is crucial to be sure that a competent physician has eval- uated the finding within a reasonable time frame, given the evolution of the sign. Also, you will want to talk with that physician or obtain the medical records of the evaluation. You are looking for answers to the following questions: What is the etiology of the physical finding? Do the physical sign and the psychological presentation have anything to do with one another? And if they are related, how are they related? Are they both being caused by one underlying disorder? Is one causing the other? Or are two somewhat independent processes interacting in a complex way?

> When trying to sort out this issue of causality, there is the danger of being drawn too quickly to one of two poles. At one pole lies the danger of assuming that the physical sign has nothing to do with the psycho- logical presentation. At the other pole is the danger of assuming that the psychological problem is the sole cause of the physical sign via a psychosomatic process, stress, a masked depression, the consequences of the person’s lifestyle, or something of that sort. All practitioners, including primary care physicians, specialists, and psychotherapists, are vulnerable to these errors, especially when they are dealing with a patient who has a history of psychiatric hospitalization or in some other way looks like a “mental patient.”

(p106)

But wait... people pushing tort reform and malpractice liability caps have been trying very hard to convince us here in the states that doctors have to practice defensive medicine or something like that so they order 9 kinds of expensive tests because they are so afraid of malpractice suits.
What's wrong with this picture?
Back before all that began though... I had to see internists and specialists for physical symptoms/ailments while I was also undergoing treatment for depression/anxiety.
The doctors I saw were thorough and conscientious in the diagnostics phase.
Could there be double standards for gender?

Not an argument here, just smatterings: Let's see - the word hysteria comes from a female body part. More men succeed at suicide, but more women attempt. Etc, etc. Add to that men are paid more for the same job and have better jobs on average - and being male still gives you higher status. There are double standards for status, for sure, and male and female are part of that.

have gone thru the thyroid difficulties, watching sugar etc, in addition to MI, and the latest, I was recently found to have Vit D deficiency. One of my sis told me she was too. We have both been on extra supplementation for the last month or so and both noticed improvement in joint, body, muscle pain, etc. Just my two cents. And she'd also had the Vit B deficiency stuff. Interesting, all of it. There are also double standards for people with MI in general and folks who are aging, or have diabetes or any chronic conditions. Fortunately for the moment, I have several decent docs, thank goodness, and it makes a lot of difference!