Dr. Kimberly Nordstrom, a psychiatrist, discusses the importance of considering medical factors in psychiatric illness. Topics include red flags for medical contributions to psychiatric illness, common medical-psychiatric conditions, recognizing and treating schizophrenia, directed testing and collaboration in psychiatry, advocating for patients with neurological symptoms, analyzing patient cases, the importance of vital signs, and the overlap between NMS and catatonia.
Recognizing medical contributions to psychiatric illness is essential in comprehensive evaluations and holistic care.
Thorough history-taking, physical examination, and collaboration with appropriate specialists are key in identifying medical contributors to psychiatric illness.
A comprehensive medical workup should be conducted before reaching a psychiatric diagnosis, and collaboration between healthcare providers is crucial to avoid overlooking medical contributions to psychiatric symptoms.
Deep dives
Importance of Medical Contributions to Psychiatric Illness
Psychiatry emphasizes the significance of considering medical contributions to psychiatric illness, acknowledging the role of physicians in comprehensive evaluations. It is crucial to recognize when a patient's psychological distress and psychiatric symptoms stem from identifiable biological processes that require medical attention. While a biopsychosocial approach is foundational, medical factors should not be neglected. Collaboration with other medical teams is essential in advocating for patients and providing holistic care.
The Role of History and Physical Examination
Thorough history-taking and physical examination play crucial roles in identifying medical contributors to psychiatric illness. Gathering collateral information from bystanders, identifying personal belongings, and utilizing electronic health records can aid in obtaining relevant history. Paying attention to vital signs and conducting a comprehensive physical examination, including neurological assessments, is key. In cases of altered mental status, it is important to consider potential underlying medical conditions and involve appropriate specialists in the diagnostic process.
Autoimmune Encephalitis and the Importance of Directed Testing
Autoimmune encephalitis, a common cause of non-infectious encephalitis, occurs when the body produces antibodies that affect the brain. It can present with various neurological symptoms such as altered mental status, psychosis, seizures, and movement or language changes. Early identification requires thorough history-taking, physical examination, and directed testing, including relevant blood work and neuroimaging. Collaboration with neurologists and the appropriate medical team is crucial for accurate diagnosis and management.
The Importance of Comprehensive Medical Workup in Psychiatry
When evaluating a patient with first-episode psychosis or other psychiatric conditions, it is crucial to conduct a thorough and comprehensive medical workup before reaching a psychiatric diagnosis. This ensures that potential medical causes, such as red flags or underlying conditions, are properly ruled out. For patients with a lifetime psychiatric diagnosis, conducting a detailed workup at least once, documenting thoughts and interpretations, becomes increasingly important. Collaboration between different healthcare providers, including primary care physicians, therapists, and psychiatrists, is essential to ensure a holistic approach to patient care and avoid overlooking medical contributions to psychiatric symptoms.
Considering Context and Collaboration in Assessing Depressive Symptoms
When evaluating a patient with low mood or depression, it is crucial to consider the context and severity of the symptoms and conduct a comprehensive assessment. Exploring potential overt causes, such as recent events or loss, is important in understanding the patient's current situation. Conducting a review of systems allows for the consideration of medical contributors to depressive symptoms, such as thyroid abnormalities or blood sugar issues. Collaboration between mental health professionals and primary care physicians helps ensure a comprehensive approach and prevents the oversight of additional factors influencing the patient's psychological and psychiatric well-being.
Dr. Kimberly Nordstrom, Past President of the American Association for Emergency Psychiatry and Associate Clinical Professor of Psychiatry at the University of Colorado, discusses the process of considering medical contributions to psychiatric illness. We discuss red flags that should guide clinicians to start thinking medically, explain the importance of systematically approaching a differential diagnosis, and provide a brief introduction to a few common medical-psychiatric conditions including autoimmune encephalitis, neuroleptic malignant syndrome (NMS), and serotonin toxicity ("serotonin syndrome").