Page 25 - Complementary and Alternative Medicine Treatments in Psychiatry

The Comprehensive Medical Exam in Psychiatry | 25

3. The patient has a past history of:
a. A physical illness that can impair organ function
(neurologic, endocrine, renal, hepatic, cardiac, or
pulmonary).
b. Recent falls or head trauma with unconsciousness.
c. Alcohol or drug abuse.
d. Taking several over-the-counter drugs.
4. The patient has a family history of:
a. Inheritable metabolic disease (diabetes, porphyria).
b. Degenerative or inheritable brain disease.
5. Certain mental signs are present:
a. Altered level of consciousness.
b. Fluctuating mental status.
c. Any cognitive impairment.
d. Visual, tactile or olfactory hallucinations.
e. Episodic, recurrent, or cyclical symptoms interspersed
with periods of being well.
6. Certain physical signs are present:
a. Signs of major organ impairment, e.g., ascites, edema.
b. Any focal neurological deficit.
c. Diffuse subcortical dysfunction, e.g., slowed speech,
mentation or movement, dysarthria, ataxia,
incoordination, tremor, chorea, asterixis.
d. Cortical dysfunction, e.g., dysphasia, apraxia, agnosia,
visiospatial deficits, defective cortical sensation.
7. Response to appropriate psychiatric treatment is poor.
(Rethink the diagnosis, re-examine the patient, and
consider seeking the advice of a consultant.)
Additionally, the following are reported characteristics of
patients with physically-caused psychiatric symptoms (Hall
1980):
− A history of anxiety or unusual behavior present since
childhood or adolescence.
− The patient evidences a multiplicity of symptoms that
involve several organ systems.