Page 22 - Complementary and Alternative Medicine Treatments in Psychiatry

22 | Complementary and Alternative Medicine Treatments in Psychiatry

2. The Comprehensive Medical Exam in

Psychiatry

Dan Stradford

Virtually every medical student has been taught, “When you
hear hoofbeats, don’t expect to see a zebra,” a phrase coined by
Dr. Theodore Woodward in the late 1940s (Soto 1991). The gist is
that when a physician sees symptoms, he should consider
routine diagnoses, not exotic ones.
Psychiatrists are often taught the same phrase regarding
psychiatric symptoms that are created by non-psychiatric
medical disorders—that although they exist, these conditions
are, in fact, rare and unlikely. Unfortunately, this line of
thinking has caused many serious medical conditions to go
undiagnosed. Factually, physically-created mental and
behavioral symptoms are not uncommon and certainly not as
rare as a zebra running wild in the Western Hemisphere.
From 5–40% of psychiatric patients are found to have medical
ailments that would adequately explain their symptoms (Allen
1995). Additionally, up to 25% of mental health patients are
found to have medical conditions that exacerbate psychiatric
symptoms (Christensen 2009).
In older patients with first-time psychiatric symptoms, the
likelihood of underlying physical contributors is even greater. In