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Masquerading Symptoms: Uncovering Physical Illnesses That Present as Psychological Problems



Masquerading Symptoms: Uncovering Physical Illnesses That Present as Psychological Problems

Barbara Schildkrout

ISBN: 978-0-470-89065-3 May 2014 608 Pages

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The definitive resource to the signs, symptoms, and patterns of medical diseases that CAN present as psychological problems

This invaluable reference enables clinicians, as well as patients and their families, to become more familiar with these medical conditions and how they may masquerade as mental disorders.Part One of this book is organized so that it corresponds to the sections of the Standard Mental Status Exam. It is composed of clinical presentation descriptions that direct the reader to the medical diseases described inPart Two that may be contributing to the patient's discomfort.

Without medical jargon, Barbara Schildkrout lucidly explains how patients with each medical condition may end up seeking help from a mental health professional.

The conditions explored in this book include:

  • Alzheimer's disease
  • Brain tumors
  • Carbon monoxide poisoning
  • Diseases of the thyroid
  • Endocrine disorders
  • Hepatic encephalopathy
  • Hyperventilation syndrome
  • Hypoglycemia
  • Limbic encephalitis
  • Lyme disease
  • Syphilis
  • Thiamine deficiency
  • Traumatic brain injury

The book also describes a proven process for working with patients during and after the referral process, and integrating medical findings into ongoing therapeutic work. All mental health professionals need access to this information, and Masquerading Symptoms puts it all in a single, easily navigated reference. BARBARA SCHILDKROUT, MD,is an Assistant Clinical Professor of Psychiatry at Harvard Medical School. She has taught for many years at the Beth Israel Deaconess Medical Center. She has a Subspecialty Board Certification through the United Council for Neurological Subspecialties in behavioral neurology and neuropsychiatry and has maintained a private clinical practice in the Boston area for over 25 years.

Introduction xi

List of Diseases by Organ System or Disease Process xxv

Part I Signs and Symptoms 1

State of Consciousness 3

Delirium 7

Attention and Concentration 8

Mood, Affect, and Emotion 12

Thought Form 19

Thought Content and Experience of Reality 23

Delusional Thought Content 28

Hallucinations 31

Change in Personality or Behavior 34

Judgment 41

Insight 44

Dementia 46

Orientation 47

Memory 51

Speech and Language 55


Constructional Ability: Drawing, Copying,

Visuospatial Tasks 64

Fund of Knowledge 65

Calculation 66

Abstract Thinking 67

Executive Functions 69

General Physical Appearance 72

Motor Behavior 81


Disturbances of Sleep 98

Disturbances of Energy Level 106

Disturbances of Eating Behavior and Weight 108

Disturbances of Sexual Functioning 112

Notable Physical Symptoms and Possible

Associated Diseases 114

Part II: The Diseases 119

Disease #1: Acromegaly 121

Disease #2: Acute Intermittent Porphyria and Porphyria Variegata 127

Disease #3: Addison’s Disease 133

Disease #4: Alzheimer’s Disease 138

Disease #5: Arsenic Poisoning 145

Disease #6: Brain Tumors 150

Disease #7: Carbon Monoxide Poisoning 157

Exposure to High Levels of Carbon Monoxide 157

Chronic Exposure to Low Levels of Carbon Monoxide 157

Late-Appearing Neuropsychological Symptoms 157

Long-Term Disabilities from Carbon Monoxide

Poisoning 157

Disease #8: Charles Bonnet Syndrome 166

Disease #9: Chronic Subdural Hematoma 167

Disease #10: Chronic Traumatic Encephalopathy 171

Disease #11: Circadian Rhythm Disorders 172

Delayed Sleep Phase Syndrome 172

Advanced Sleep Phase Syndrome 172

Irregular Sleep/Wake Pattern (Free Running) 172

Non-24-Hour Sleep/Wake Disorder 172

Disease #12: Corticobasal Degeneration 177

Disease #13: Creutzfeldt-Jakob Disease 178

Transmissible Spongiform Encephalopathies 178

Disease #14: Cushing’s Syndrome 184

Disease #15: Dementia with Lewy Bodies 189

Disease #16: Frontotemporal Dementia 195

Pick’s Disease 195

Semantic Dementia 195

Progressive Nonfluent Aphasia 195

Frontotemporal Dementia with Motor Neuron

Disease 195

Disease #17: Hashimoto’s Encephalopathy 202

Disease #18: Hepatic Encephalopathy 204

Disease #19: HIV/AIDS (Infection with the Human

Immunodeficiency Virus) 210

Disease #20: Huntington’s Disease 216

Disease #21: Hyperparathyroidism, Primary (Including Hypercalcemia) 225

Disease #22: Hypersomnia, Idiopathic 229

Disease #23: Hypersomnia, Recurrent 232

Kleine-Levin Syndrome 232

Menstruation-Related Hypersomnia 232

Disease #24: Hyperthyroidism 237

Disease #25: Hyperventilation Syndrome 244

Disease #26: Hypoglycemia 249

Disease #27: Hypoparathyroidism (Hypocalcemia) 255

Disease #28: Hypothyroidism 259

Disease #29: Hypoxia (Insufficient Oxygen Supply to the Brain) 265

Hypoxic Brain Damage 265

Altitude Sickness 265

Disease #30: Lead Poisoning 270

Acute, High-Dose Exposure 270

Low-Level, Chronic Exposure 270

Subclinical Lead Poisoning 270

Disease #31: Limbic Encephalitis 277

Viral Encephalitis 277

Paraneoplastic Syndrome 277

Autoimmune Encephalitis 277

Disease #32: Lyme Disease 281

Disease #33: Manganese Toxicity 288

Disease #34: Mercury Poisoning 291

Acute, High-Dose Exposure 291

Chronic, Low-Dose Exposure 291

Disease #35: Migraine 296

Headache 296

Cluster Headaches 296

Disease #36: Mitochondrial Disorders 304

Specific Syndromes: MELAS, MERRF, LHON, MNGIE, KSS, NARP, Leigh Syndrome 304

Disease #37: Multiple Sclerosis 311

Disease #38: Multiple System Atrophy 318

Disease #39: Myasthenia Gravis 319

Disease #40: Narcolepsy 323

Narcolepsy with Cataplexy 323

Narcolepsy without Cataplexy 323

Secondary Narcolepsy 323

Disease #41: Neuro-BehÇet’s Syndrome 331

Disease #42: Neurofibromatosis Type 1 338

Disease #43: Nocturnal Eating: Night-Eating Syndrome (NES) 343

Disease #44: Nocturnal Eating: Sleep-Related Eating Disorder (SRED) 348

Disease #45: Normal-Pressure Hydrocephalus 354

Disease #46: Pancreatic Cancer 362

Disease #47: Parasomnias: Sleepwalking and Night Terrors 366

Disease #48: Parkinson’s Disease 371

Disease #49: Partial Seizures 377

Disease #50: Pellagra 387

Nicotinic Acid Deficiency or Niacin Deficiency 387

Disease #51: Periodic Limb Movements of Sleep 392

Disease #52: Pheochromocytoma 395

Disease #53: Postconcussion Syndrome 400

Disease #54: Premenstrual Dysphoric Disorder and Premenstrual Syndrome 404

Disease #55: Primary Progressive Aphasia 409

Disease #56: Progressive Supranuclear Palsy 410

Disease #57: REM Sleep Behavior Disorder 411

Disease #58: Restless Legs Syndrome 415

Disease #59: Sleep Apnea 418

Obstructive Sleep Apnea 418

Central Sleep Apnea 418

Mixed Sleep Apnea 418

Disease #60: Syphilis 425

General Paresis 425

Syphilitic Meningitis 425

Meningovascular Syphilis 425

Syphilitic Gummas 425

Disease #61: Systemic Lupus Erythematosus 434

Disease #62: Thallium Poisoning 439

Disease #63: Thiamine Deficiency 444

Wernicke’s Encephalopathy 444

Korsakoff’s Syndrome 444

Wernicke-Korsakoff’s Syndrome 444

Disease #64: Tourette Syndrome 451

Disease #65: Transient Global Amnesia 456

Disease #66: Traumatic Brain Injury: Long-Term

Consequences 460

Disease #67: Uremia (Chronic Kidney Disease) 470

Disease #68: Vascular Dementia 474

Disease #69: Vitamin B12 Deficiency (Including Pernicious Anemia) 478

Disease #70: Whipple Disease 484

Disease #71: Wilson’s Disease 488

Bibliography 493

Author Index 543

Subject Index 547

“Dr. Schildkrout takes aim against the factionalizing dualism inherent in our modern mode of psychiatric thought. Psychiatry, she reminds us, is not the stuff left over once the medical is ruled out. Far from it! With this compendium, she has created a pragmatic reference for neuro-psychiatric diagnosis from an often ignored, but important, perspective. The role of the psychotherapist is not the realm of the ‘mind’ alone: Dr. Schildkrout forces us to remember that not only can psychiatric symptoms impact medical conditions, but medical conditions can underlie psychiatric symptoms. In theory, as practitioners, we already know this; but, I would argue, we often struggle putting this knowledge into practice. This book will help us and our colleagues across disciplines to think in terms that, I would argue, are the future of psychiatry. It is one of those rare medical books that you feel you ought to reread at the beginning of each year to remind yourself to keep your eyes open and never stop searching for things hidden beneath the surface.”--Aaron J. Hauptman, MD; Department of Psychiatry, University of Texas Southwestern; Annals of Clinical Psychiatry, November 2014, Vol. 26 No. 4, pages 305-307