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The Great Pretenders
Permission graciously given by the author to reproduce this paper: 
Dan Stradford, Safe Harbor 
Copyright © 2005 

The Great Pretenders

Medical Problems That Can Produce Symptoms
Associated with Mental Disorders

Anxiety Emergency Conditions Depression Psychosis Nutritional and Metabolic

These are medical conditions that often have anxiety as one of their symptoms.

• Neurological illnesses (represent 25% of medical causes of anxiety symptoms)

     - Cerebral vascular insufficiency
     - Anxiety states and personality change following head injury 
     - Infections of the central nervous system
          o Meningitis
          o Neurosyphilis

• Degenerative disorders

     - Alzheimer's dementia
     - Multiple sclerosis
     - Huntington's chorea

• Toxic disorders

     - Lead intoxication
     - Mercury intoxication
     - Manganese intoxication
     - Organophosphate insecticides (similar to nerve gas) from chemical or 
        insecticide exposure

• Partial complex seizures 

• Endocrine disorders (represent another 25% of medical causes of 
  anxiety symptoms

     - Hyperthyroidism (increased thyroid hormone)
     - Adrenal hyperfunction or Cushing's syndrome 
     - Hypoglycemia (decreased blood glucose)
     - Hypoparathyroidism (decreased parathyroid hormone)
     - Menopausal and premenstrual syndromes. 

• Cardiopulmonary disorders

     - Angina
     - Pulmonary embolus
     - Arrhythmias (irregularities of heart beat)
     - Chronic obstructive pulmonary disease (COPD) 
     - Mitral valve prolapse (generally harmless) 

• Medications for Pheochromocytoma (epinephrine-secreting tumors) 

     - Watch for asthmatic combinations of sympathomimetics and 
        xanthines (e.g.,aminophylline, theophylline)
     - Watch for ephedrine in allergy patients
     - Watch for hypoglycemic insulin reaction in diabetic patients
     - Watch for thyroid preparations for thyroid disease or following thyroid surgery 

• Non-psychotropic medications

     - Sympathomimetics (often found in non-prescription cold and allergy 
       medications): epinephrine, norephinephrine, isoproteronol, levodopa, 
       dopamine hydrochloride, dobutamine, terbutaline sulfate, ephedrine, 
     - Xanthene derivatives (asthma medications, coffee, colas, over-the-counter 
       pain remedies): aminophylline, theophylline, caffeine
     - Anti-inflammatory agents: indomethacin
     - Thyroid preparations 
     - Insulin (via hypoglycemic reaction)
     - Corticosteroids
     - Others: nicotine, ginseng root, monosodium glutamate

• Drug withdrawal: caffeine, nicotine

• Psychotropic medications can cause anxiety symptoms

     - Antidepressants (including MAO-inhibitors), drugs for treatment of attention 
       deficit disorders (on rare occasions cause anxiety-type syndromes)
     - Tranquilizing drugs: benzodiazepines (paradoxical response most common
        in children and in elderly), antipsychotics (akathisia may present as anxiety)
     - Anticholinergic medications can cause a delirium which, in early stages,
       may easily be confused with anxiety: scopolamine and sedating 
       antihistamines (found in over-the-counter sleep preparations) 
       antiparkinsonian agents, tricyclic antidepressants, antipsychotics 

• Drugs – licit and illicit can cause anxiety symptoms

     - Caffeine – intoxication or withdrawal
     - Nicotine – withdrawal even more than acute intoxication
     - Stimulants – cocaine, amphetamines, etc.
     - Alcohol or alcohol withdrawal 
     - Drug withdrawal (common cause of anxiety-type syndromes) 

Medical Emergencies that can have sypmtoms looking like a psychiatric illness

• Hypoglycemia (low blood sugar)
• Diabetic Ketosis or non-ketotic hyperosmolarity (blood sugar so high that it 
   upsets body chemistry)
• Wernickes-Korsakoff's syndrome (acute thiamine [vitamin B1] deficiency so
   severe it can cause rapid brain damage)
• DT's (delirium tremens)
• Hypoxia (low blood oxygen)
• Meningitis (infection of the covering of the brain)
• Subarachnoid hemorrhage (rapid arterial bleeding into the brain)
• Subdural hematoma (bleeding from veins under the outside covering of 
   the brain,  which compresses the brain over hours to weeks or even longer)
• Anticholinergic (atropine) poisoning

These are medical conditions that often have depression as one of itheir symptoms.

• Post viral depressive syndromes.  Especially:

     - Influenza
     - Infectious mononucleosis
     - Viral hepatitis
     - Viral pneumonia
     - Viral encephalitis

• Cancer of:

     - Pancreas (commonly presents as depression)
     - Lung Cancer, especially oat cell carcinoma
     - Brain tumors, either primary tumors or metastastic, may present 
       with depression

• Cardiopulmonary disease with hypoxia (decreased oxygen in the blood)

• Sleep disturbances and sleep apnea

• Endocrine disease

     - Hypothyroidism 
     - Hyperthyroidism or thyrotoxicosis (overactive thyroid)
     - Adrenal hypofunction (Addison's Disease)
     - Adrenal hyperfunction (Cushing's Disease)
     - Hyperparathyroidism: usually from small tumors of the parathyroid glands
     - Post-partum, post menopausal, and premenstrual syndromes.

• Collagen-vascular diseases (Example:  Systemic lupus erythematosus [SLE])

• Central nervous system disease

     - Multiple Sclerosis
     - Brain tumors and other intracranial masses (masses inside of the skull) 
       such as subdural hematomas (bleeding under the dural sack that surrounds 
       the brain): masses, especially in the frontal and temporal areas

• Complex partial seizures

• Medications can cause depression

     - Antihypertensive medications (drugs used to control high blood 
       pressure):reserpine and alpha-methyldopa are probably the worst, 
       but propranolol has been implicated and all antihypertensives are suspect
     - Digitalis preparations, along with a variety of other cardiac medications
     - Cimetidine: used for gastric ulcer disease 
     - Indomethacin and other non-steroidal anti-inflammatory medications
     - Disulfuram (Antabuse): usually described by patients as more a sense of 
       fatigue than true depression 
     - Antipsychotic medications: can cause an akinesia or inhibition of 
        spontaneity that can both feel and look like a true depression
     - Anxiolytics: all sedative hypnotics from the barbiturates to the 
       benzodiazepines have been implicated both in causing depression and 
       making it worse in susceptible individuals 
     - Steroids, including prednisone and cortisone 
     - Drugs of abuse can cause depression
     - Alcohol: very commonly a cause of depression, as well as a reaction to 
     - Stimulant withdrawal 

These are medical conditions that often have psychosis  as one of their symptoms.

• Progressive neurological diseases 

     - Multiple sclerosis
     - Huntington's chorea 
     - Alzheimer's disease and Pick's disease 

• Central nervous system infections

     - Encephalitis
     - Neurosyphilis
     - Typhus
     - Lyme Disease
     - HIV infections 

• Space-occupying lesions within the skull 

    - Brain tumors 
    - Bleeding within the skull 
    - Brain abscesses 

• Metabolic disorders 

     - Accumulation of toxins from severe liver or kidney disease
     - Disturbances in electrolytes, either too low a serum level of sodium or 
       too high a serum level of calcium 
     - Acute intermittent porphyria (disease of porphyrin metabolism)
     - Wilson's disease 
     - Systemic lupus erythematosis (autoimmune disease)
     - Caisson disease (“the bends”)

• Endocrine disorders

     - Myxedema (underactive thyroid gland)
     - Cushing's syndrome (overactive adrenal gland or overactive pituitary gland)
     - Hypoglycemia

• Deficiency states

     - Thiamine (B1) deficiency: Wernicke-Korsakoff amnestic syndrome
     - Pellegra (B3 deficiency) and other B complex deficiencies
     - Zinc deficiency 

• Temporal lobe epilepsy (or partial complex seizure disorder)

• Drugs – legal and illegal.  Examples:

     - L-DOPA
     - Amphetamine
     - LSD

Commonly Overlooked Conditions that Can Cause Mental Symptoms.  Any of these can have syndromes of Depression (including Bipolar Disorder), Anxiety or Psychosis.

• Hypoglycemia (including subclinical)
• Allergies and sensitivities to food, inhalants, and other substances
• Celiac disease
• Dysbiosis (overgrowth of unfriendly gut organisms, including candida)
• Nutrient deficiency
• Nutrient overload
• Copper/Zinc imbalance
• Poor diet
• Malabsorption of nutrients
• Mercury toxicity
• Other heavy metals toxicity 
• Toxins (carbon monoxide, pesticides, etc.)
• Excitotoxins  (Aspartame©, monosodium glutamate, etc.)
• Subclinical hypothyroidism
• Adrenal insufficiency
• Reproductive hormone imbalance
• Histamine imbalance
• Pyroluria
• Lack of exercise
• Lack of sunlight
• Electromagnetic influence
• Suppressed pain
• Musculo-Skeletal misalignment
• Hearing problems
• Visual problems
• Sleeping disorders
• Head injury
• Sensory Integration Dysfunction
• Dental and orthodontic problems
• Parasites
• Psychotropic and other drugs
• Drug withdrawal
• Any chronic physical stress