MEDICAL CONDITIONS WITH PSYCHIATRIC PRESENTATION:
Many medical conditions can present with psychiatric features.
Among the common conditions are:
1)Neurological conditions: Parkinson's disease, Stroke, Brain trauma, Brain infections.
2)Metabolic imbalance.
3)Hormonal imbalance: Hypoglycemia, Hyperglycemia, Hypothyroidism, Hyperthyroidism.
4)Sepsis and many other conditions.
Hence it is very important to rule out all possbile medical causes before deciding that the patient is suffering from a Psychiatric Disorder.
PARKINSON'S DISEASE:
There are many Psychiatric aspects to Parkinson’s disease. Generally, the 3 main groups of mental disturbances noted can be classified into (Mjones):
1) Personality changes
2) Cognitive changes
3) Affective changes and Psychoses.
Personality changes may be due to the increasing disability of Parkinson’s disease that results in restriction of activities and dependence upon others. Patient may show egocentricity, querulousness, suspicion etc. Commonly his premorbid personality will be accentuated, e.g. becomes more obsessive or anxious. Some may show hypochondriacal features.
Cognitive changes include memory impairment, mental sluggishness and difficulty to focus. Cortical and subcortical causes are suspected in contributing to these cognitive deficits.
Affective changes especially Depression is clearly established in many studies. Depression is often a reaction to the Parkinson’s disease although there are indications that depression may bear a more integral relationship to the disease process itself. Treatment with antidepressant medication can be highly effective in relieving both mental and physical symptoms of depression associated in Parkinson’s disease.
Sometimes the patient may show features of psychoses such as florid delusions, auditory and visual hallucinations. The reason is debatable although many believe it is due to iatrogenic causes: over-medication, effect of levodopa and atropine, which also has the tendency to cause confusion and delirium in the elderly population.