Somatic origins of psychiatric illnesses

During the general examination, it is important that you begin it by paying attention to the patient's general condition. Observe the way he presents himself. Is your patient losing weight? Does he sweat? Does he complain of intense fatigue? In case of severe fatigue, you should consider prescribing a blood test or ask to be seen by a general practitioner. There may be an organic problem behind this fatigue!

During the assessment, whether you are a doctor, psychologist, psychotherapist or other, it is very important that you ask the patient the right questions. Start by asking him if he has a history of hormonal disorders. Does he have hypothyroidism, hyperthyroidism, hypoparathyroidism or hyperparathyroidism? Hormonal disruption of these hormones can cause, due to excitement and in the case of hyperthyroidism, anxiety. Conversely, hypothyroidism can cause slowing down, sadness, weight gain, etc. In these cases, the treatment is not psychiatric or psychological at all.

You will have understood, it is really very important that you ask patients if there is not a hormonal disorder somewhere. The same goes for your patients. Do not hesitate to ask them if they are well regulated, if their periods are not too painful, if they are experiencing a significant mood change at the time of their period, etc. You have to make sure that there are no problems related to this. Same thing for your menopausal patients. Make sure that the anxiety in these patients did not manifest itself at the time of pre-menopause and that the anxiety is, in fact, linked to hormonal imbalance. In this case, hormone replacement therapy can resolve the anxiety problem in these menopausal patients.

Other pathologies should not be put aside, in particular neurological pathologies. A patient who presents with neurological disorders may have a psychiatric picture. You should remember to ask your patient if he does not have hydrocephalus, Niemann-Pick disease, a history of head trauma, cerebral hematomas (in particular epidural hematomas and especially chronic subdural hematomas). In these cases, psychiatric treatment is therefore not necessarily the solution.

This is another possible cause. If your patient is overweight, his or her partner complains that he or she snores a lot or that he or she stops breathing when sleeping, consider asking your patient if he or she has sleep apnea problems. Indeed, sleep apnea disorders, due to hypoxia which is caused during the night and the resulting disruption of sleep, will cause mood disorders, anxiety or even stress. Here too, psychiatric or psychotherapeutic treatment is not the solution. 

It is important to keep in mind that behind a psychological problem there may be a somatic disorder that requires neurosurgical treatment. All the questions that we have just stated are therefore very strongly recommended to be asked during the session. If you see that the patient is not in good health (sweating, thinness, fatigue, etc.) these questions are all the more essential, as well as a blood test.