78 Mental Disorders Due to a Medical Condition

Mental Disorders Due to a Medical

Condition
This terminology is designed to describe psychiatric symptoms that are part of
the clinical presentation of a non-psychiatric illness.

I. DSM-IV Diagnostic Criteria for Mental Disorder Due to a Medical

Condition
A. There is evidence from the history, physical exam, or laboratory studies
that the symptoms are a direct physiological consequence of a general
medical condition.
B. The disturbance is not better accounted for by another mental disorder.
C. The disturbance is caused by delirium.
II. Psychotic Disorder Caused by a General Medical Condition
A. Diagnostic Criteria. The patient meets the criteria for a mental disorder
due to a general medical condition and there are prominent hallucinations
or delusions
B. Clinical Features of Psychotic Disorder Due to a General Medical
Condition
1. Hallucinations caused by a medical condition include visual, olfactory
and tactile elements more often than in primary psychotic disorders.
2. Temporal Lobe Epilepsy is a common medical condition associated
with olfactory hallucinations.
3. Somatic and persecutory delusions are the most common types of
delusions associated with a medical condition.

Common Disorders Associated with Psychosis

Addison's disease Multiple sclerosis

CNS infections Myxedema
CNS neoplasms Pancreatitis
CNS trauma Pellagra
Cushing's disease Pernicious anemia
Delirium Porphyria
Dementias Lupus
Folic acid deficiency Temporal lobe epilepsy
Huntington's chorea Thyrotoxicosis

C. Differential Diagnosis of Psychotic Disorder Due to a General

Medical Condition
1. Primary Psychotic Disorders
a. The onset of illness in a primary psychotic disorder is usually earlier
(before age 35), with symptoms beginning prior to the onset of the
medical illness.
b. Complex auditory hallucinations are more characteristic of primary
psychotic disorders. Non-auditory hallucinations (eg, tactile hallucina-
tions) are more commonly seen in general medical conditions.
 Mental Disorders Due to a Medical Condition 79

2. Substance Induced Psychotic Disorder

a. When psychosis is associated with recent or prolonged substance
use, withdrawal from a substance is the likely cause.
b. Blood or urine screens for suspected substances may be helpful in
establishing this diagnosis.
c. Common substances that can cause psychosis include:
Anticholinergics, steroids, amphetamines, cocaine, hallucinogens, L-
dopa, and disulfiram.
D. Treatment of Psychotic Disorder Due to a General Medical Condition
1. The underlying medical conditions should be corrected.
2. A trial of antipsychotic medication may be necessary to manage
symptoms while the patient's medical condition is being treated.
III. Mood Disorder Due to a General Medical Condition
A. Diagnostic Criteria. Meets criteria for a mental disorder due to a general
medical condition, and the presence of a prominent and persistent mood
disturbance characterized by either or both of the following:
1. With depressed mood or lack of pleasure in most, if not all, activities.
2. Elevated, expansive, or irritable mood.
B. Clinical Features of Mood Disorder Due to a General Medical
Condition
1. The mood symptoms cannot be a psychological reaction to being ill.
2. Subtypes include:
a. Mood disorder due to a general medical condition with depressive
features
b. Mood disorder due to a general medical condition with major
depressive-like episode
c. Mood disorder due to a general medical condition with manic features
d. Mood disorder due to a general medical condition with mixed features

Common Diseases and Disorders Associated with Depressive

Syndromes

Addison's disease Influenza

AIDS Malignancies
Asthma Malnutrition
Chronic infection (mononucleosis, Anemia
tuberculosis) Multiple sclerosis
Heart failure Porphyria
Cushing's disease Rheumatoid arthritis
Diabetes Syphilis
Hyperthyroidism Lupus
Hypothyroidism Uremia
Infectious hepatitis Ulcerative colitis

C. Differential Diagnosis of Mood Disorder Due to a General Medical

Condition
1. Primary Mood Disorder. If a clear causative physiological explana-
tion cannot be established between mood symptoms and the medical
condition, a primary mood disorder should be diagnosed. Fluctuation
of mood symptoms during the course of medical illness is indicative
of a disorder due to a medical condition.
80 Mental Disorders Due to a Medical Condition

2. Substance-Induced Mood Disorder

a. When the mood disorder is associated with recent or prolonged
substance use or withdrawal from a substance and psychotic
symptoms, a substance-induced mood should be diagnosed.
b. Blood or urine screens may be helpful in establishing this
diagnosis.
c. Common substances that can cause depressive syndromes
include antihypertensives, hormones (cortisone, estrogen,
progesterone), antiparkinsonian drugs, benzodiazepines, alcohol,
chronic use of sympathomimetics, and withdrawal from
psychostimulants.
3. Treatment of Mood Disorder Due to a General Medical Condition
The underlying medical condition should be corrected.