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Medical Factors
Affecting Psychology

 

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Page Contents: General Information from the DSM-IV / Chronic Fatigue / Drug Interactions

 

 
SOMETIMES, a person will experience psychological problems as the result of an underlying medical condition.

In some of these cases it doesn’t take much thought to realize what’s happening, as, for example, when a person who has had a heart attack becomes depressed. But in other cases, such as thyroid disease or pancreatic cancer, a person can have an illness and not even know it, because the only thing that seems out of order may be a feeling of depression or anxiety, perhaps in conjunction with vague bodily pain. Only a competent investigation into the cause of the psychological symptoms will lead to a discovery of the medical condition.

  

I’ve presented the information that follows in the hope that you or someone you know will take nothing for granted in regard to psychology. For your own sake, if you ever feel emotionally out of order, get a complete medical check-up before trying anything else. Moreover, if you ever decide to start psychotherapy, and if, in the first sessions, your psychotherapist doesn’t ask some direct questions about your medical condition, then find another psychotherapist—quick.

  

  
General Information from the DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Washington, DC, American Psychiatric Association, 1994) has several sections devoted to Mental Disorders Due to a General Medical Condition.

If you don’t know what a particular medical term means, copy the term and paste it into a search engine search window.

 
Anxiety / Panic Symptoms can result from a variety of conditions, such as

endocrine conditions (such as hyperthyroidism, hypothyroidism, pheochromocytoma, hypoglycemia, hyperadrenocorticism)

cardiovascular conditions (such as congestive heart failure, pulmonary embolism, arrhythmia)

respiratory conditions (such as pulmonary disease, pneumonia, hyperventilation)

metabolic conditions (such as vitamin deficiency, porphyria)

neurological conditions (such as epilepsy, neoplasms, vestibular dysfunction, encephalitis)

 
Impulse-Control Symptoms can result from a variety of conditions, such as

head injuries

episodes of unconsciousness

febrile seizures in childhood

 
Mood Symptoms can result from a variety of conditions, such as

degenerative neurological conditions (such as Parkinson’s disease, Huntington’s disease)

cerebrovascular disease (such as stroke)

metabolic conditions (such as vitamin deficiency; e.g. vitamin D3)

endocrine conditions (such as hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoparathyroidism, hyperadrenocorticism, hypoadrenocorticism)

autoimmune conditions (such as systemic lupus erythematosus)

viral or other infections (such as hepatitis, mononucleosis, HIV)

certain cancers (such as carcinoma of the pancreas)

environmental factors (such as EMF radiation)

 
Personality Changes can result from a variety of conditions, such as

central nervous system neoplasms

head trauma

cerebrovascular disease

Huntington’s disease

epilepsy

infectious conditions with central nervous system involvement (such as HIV)

endocrine conditions (such as hypothyroidism, hyperadrenocorticism, hypoadrenocorticism)

autoimmune conditions with central nervous system involvement (such as systemic lupus erythematosus)

 
Sexual Dysfunction can result from a variety of conditions, such as

neurological conditions (such as multiple sclerosis, spinal cord lesions, neuropathy, temporal lobe lesions)

endocrine conditions (such as diabetes mellitus, hypothyroidism, hyperadrenocorticism, hypoadrenocorticism, hyperprolactinemia, hypogonadal states, pituitary dysfunction)

vascular conditions

genitourinary conditions

 
Sleep Disorders can result from a variety of conditions, such as

degenerative neurological illnesses (such as Parkinson’s disease, Huntington’s disease)

cerebrovascular disease

endocrine conditions (such as hyperthyroidism, hypothyroidism, hyperadrenocorticism, hypoadrenocorticism)

viral and bacterial infections

coughing or breathing problems related to respiratory conditions (such as chronic bronchitis, asthma)

pain from musculoskeletal disease (rheumatoid arthritis, fibromyalgia)

  
Chronic Fatigue

Chronic Fatigue itself, usually called Chronic Fatigue Syndrome (CFS) or Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), used to be called neurasthenia. The syndrome is characterized by a wide variety of symptoms such as fatigue, weakness, muscle and joint pain, headache, memory and concentration difficulties, and difficulty sleeping. No one has yet found a single cause for this syndrome; in fact, current research reveals that CFS is a complex medical disorder with multiple causation. If CFS is diagnosed early, new medical treatments can promote improvement.

A person who is chronically fatigued can grow to become depressed simply over feeling so miserable so much of the time. Therefore, one form of treatment can also be psychological: learning how to cope with the frustration of symptoms that are real and physical but have a mysterious cause and no single cure. Psychodynamic psychotherapy can help you identify and heal emotional conflicts from the past so that unconscious resentments do not “feed” the disease. Cognitive-behavioral treatment, especially hypnosis and guided imagery, can help you learn mental qualities such as perseverance and relaxed concentration so that you do not succumb to feelings of panic and depression.

 

SOMETIMES other medical conditions that can cause generalized, chronic malaise are misdiagnosed as Chronic Fatigue Syndrome. The following (in alphabetical order) are examples: 

 
Coeliac (or celiac) disease, is a disorder that primarily affects the small intestine. Symptoms include gastrointestinal problems such as chronic diarrhea and abdominal distention; loss of appetite and inability to gain weight; chronic fatigue; dermatitis; and mental distractibility or confusion. Furthermore, in childhood, symptoms can include growth delay or pubertal delay. The disease is caused by a reaction to gluten, and treatment is a strict lifelong gluten-free diet.

Early Menopause can cause symptoms such as fatigue, sleep disturbance, irritability, mood instability, anxiety, and frequent crying episodes. In young women (as young as 30), when menopause is not expected, these symptoms can also be misdiagnosed as depression.[1]

Hypothyroidism, a condition caused by a thyroid secretion deficiency, is a common endocrine disorder. Symptoms can include weakness, dry skin/hair, lethargy, forgetfulness, depression, apathy, and constipation. If apathy is a symptom, the tendency to minimize complaints can delay diagnosis. Hypothyroidism can be treated successfully with medication.

Lyme disease can result from a tick bite, generally from a deer tick. You might know that you’ve been bitten if you find the tick on your skin or if a red patch on the skin develops following the bite. The redness does not always develop, however, so some persons never realize that they have been bitten. The disease can also be passed from an infected mother to her fetus. Besides general malaise and fatigue, symptoms can include various muscle aches and pain.

Morgellons disease is a new and somewhat mysterious disease that can be a complication to lyme disease or other diseases, such as HIV, that compromise the autoimmune system. Besides fatigue and cognitive impairment, this disease also produces fibers in tissue and skin that cause pain and itching. The disease has often been misdiagnosed as a delusional disorder. 

Obstructive Sleep Apnea (OSA) consists of repetitive episodes of partial or complete upper airway obstruction during sleep, resulting in an interrupted sleep pattern. As a result, excessive daytime fatigue can be common with this disorder. It is also common to have this disorder and not know it. Besides the fatigue and the tendency to fall asleep during the day, one sign of OSA is loud snoring—but snoring can be caused by other things than OSA; another sign is waking up to find your blankets and pillow on the floor (from fitful sleep) and not have any idea how they got there.[2]

Parasites such as hookworm can infect unwary tourists through contact with contaminated soil, usually from walking barefoot in the tropics. The infection begins with itching around the area of infection and is followed by nagging gastro-intestinal complaints. 

Shiftlag, similar to jetlag, can result from weekly workshift rotations that interrupt natural, biological circadian rhythms. Besides general malaise and fatigue, workers can experience poor appetite and sleep disturbance. Melatonin may be helpful in regulating sleep rhythms—see your physician for advice.[3] 

Vibroacoustic Disease (VAD), caused by loud noise (technically known as large pressure amplitude and low frequency [LPALF] noise) can contribute not just to fatigue but also to a whole host of medical problems, such as heart disease, ulcers, seizures, dizziness, and hearing loss. Psychiatric symptoms can include noise intolerance, verbal and physical aggressiveness, and even suicide. The best treatment is prevention—avoidance and hearing protection—and many unfortunate cases, such as aviation workers (even flight attendants) end in disability.[4]

 

HERE ARE some other conditions that can contribute to fatigue:

Anemia, a deficiency of hemoglobin in the blood, most commonly results from inadequate iron intake, malabsorption of iron (e.g., celiac disease), or chronic bleeding (e.g., due to colon cancer). Other diseases (such as liver or bone marrow diseases) can also cause anemia.

Altitude sickness, sometimes called mountain sickness, which results from a lack of oxygen at altitude—known as hypoxia—can cause fatigue for climbers, skiers, aviators, and vacationers. The immediate treatment is simple: get to a lower altitude, take supplemental oxygen (if you have access to it), and drink plenty of water because a higher than normal breathing rate due to hypoxia can cause you to lose moisture from your lungs, leading to dehydration. If your vacation plans involve being at a high altitude, plan a gradual ascent (if possible) or allow a day or so of rest when you first arrive so that your body can get acclimated to the lower level of oxygen in the air.

  

Airline passengers may also experience some mild hypoxia; for more information, see the Fear of Flying page on this website. 

  

 
Dehydration can be one cause of fatigue that is often overlooked. In all weather—hot or cold—you should always drink plenty of water. The actual amount of water you need can vary, but a good way to check is to look at the color of your urine: if it is not a light straw color, you are probably dehydrated. So remember that unless you have kidney problems, it can be difficult drink too much water.[5] Also, be aware that caffeinated and sweetened drinks—as well as alcohol—may actually contribute to dehydration.

 

  

If you believe that any of the above conditions may apply to you, discuss them with your physician.

  

 
Drug Interactions

Medications are meant to help you feel better, but many people are not aware that one medication may interact with another one and cause new problems. At the worst, drug interactions can be fatal; but they can also cause psychiatric symptoms such as confusion, memory impairment, anxiety, and depression. Therefore, if you are are taking more than one medication, you should make sure that at least one physician (if you have more than one) knows everything you are taking. Some pharmacies also maintain computer records that can check for adverse drug interactions—but they won’t catch over-the-counter medications—or herbal remedies—mixed with prescription medications. So what can I say? Be an informed and responsible consumer. After all, it’s your life, and you only get one chance at it.
 

 


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Notes:

1. Berg JS, Moore J. Early menopause presenting with mood symptoms in a student aviator. Aviation, Space, and Environmental Medicine 2000; 71:251–254.
 
2. Chervin RD, Guilleminault C. Obstructive sleep apnea and related disorders. Neuro Clin 1996; 14:583–609.
 
3. Caldwell JL. The use of melatonin: An information paper. Aviation, Space, and Environmental Medicine 2000; 71:238–244.
 
4. Vibroacoustic disease. Aviation, Space, and Environmental Medicine 1999; 70(3, Suppl).
 
5. Well, actually, if you really work at it, you can put yourself into a state of water intoxication (hyposmolality/hyponatremia). But if you drink only a glass (8 oz—or 250 ml) of water per hour you would be well below the maximum recommended ½ qt/hr (500 ml/hr) in moderate temperatures and easy work load. See:
    Kolka MA, Latzka WA, Montain SJ, Corr WP, O’Brien KK, Sawka MN. Effectiveness of revised fluid replacement guidelines for military training in hot weather. Aviation, Space, and Environmental Medicine 2003; 74:242–246.

 
Additional Resources
 
Chronic Fatigue:
CFIDS  —“the CFIDS Association of America is the nation’s leading charitable organization dedicated to conquering chronic fatigue and immune dysfunction syndrome (CFIDS), also known as chronic fatigue syndrome (CFS).”
Anemia  —from THE MERCK MANUAL, Hematology and Oncology.
Lyme disease  —from THE MERCK MANUAL.
Morgellons disease  —the Morgellons Research Foundation is dedicated to finding the cause of an emerging infectious disease.
 
Drug-Herbal Interactions:
Alternative Medicine — Known or Potential Drug-Herb Interactions  from WellnessWeb
Herbal-Drug Interactions  from HealthCastle
 
General Medical Information:
THE MERCK MANUALS, Home Page
The Merck Manual of Medical Information - Home Edition for Patients and Caregivers
The Merck Manual of Medical Information - for Healthcare Professionals
Virtual Naval Hospital: Patients HomePage
Virtual Naval Hospital: Providers HomePage
 
Related pages within A Guide to Psychology and its Practice:
Medication Issues
Posttraumatic Stress Disorder
Psychology and Psychiatry
Reasons to Consult a Psychologist
 
CONTACT ME
 
INDEX of all subjects on this website
 
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Psychology is a complex subject, and many issues are interrelated. And so, even though you may find a topic of interest on one particular page, an exploration of the other pages will deepen your understanding of the human mind and heart.

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Throughout this website, my goal is simply to help you realize that although life can be painful, unfair, and brutal, it doesn’t have to be misery.
 
The practice of good clinical psychology involves something—call it comfort—which does not mean sympathy or soothing, and it certainly doesn’t mean to have your pain “taken away.” It really means to be urged on to take up the cup of your destiny, with courage and honesty.

 

 

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