An elderly woman’s sudden depression turns out to be a side effect of her high blood-pressure medication.
A new mother’s exhaustion and disinterest in her baby seem like postpartum depression—but actually signal a postpartum thyroid imbalance that medication can correct.
A middle-aged manager has angry outbursts at work and frequently feels “ready to explode.” A brain scan reveals temporal-lobe seizures, a type of epilepsy that can be treated with surgery or medication.
More than 100 medical disorders can masquerade as psychological conditions, according to Harvard psychiatrist Barbara Schildkrout, who cited these examples among others in “Unmasking Psychological Symptoms,” a book aimed at helping therapists broaden their diagnostic skills.
Studies have suggested that medical conditions may cause mental-health issues in as many as 25% of psychiatric patients and contribute to them in more than 75%.
Untangling cause and effect can challenge even seasoned clinicians, and the potential for missed diagnoses is growing these days, said Dr. Schildkrout, who has more than 25 years of clinical practice in the Boston area. Most mental-health counselors rely on primary-care doctors to spot medical issues, but those physicians are increasingly time-pressed and may not know their patients well. Neither do the psychiatrists who mainly write prescriptions and see patients only briefly, she said in an interview.
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