It is the idea that behind a patient who is depressed, who is anxious, who has a mood instability can hide a somatic disorder, an organic disorder. That is to say, a medical or surgical pathology to be treated.
During the general examination, it is important that you begin it by paying attention to the patient’s general condition. Observe the way he or she presents. Is your patient thin? Is he sweating? Does he or she complain of intense fatigue? If you have severe fatigue, consider ordering a blood test or ask to be seen by a general practitioner. There may be an organic problem behind this fatigue!
During the assessment, whether you are a physician, psychologist, psychotherapist or other, it is very important that you ask the patient the right questions. Start by asking if they have a history of hormonal disorders. Does he have hypothyroidism, hyperthyroidism, hypoparathyroidism or hyperparathyroidism? The hormonal disturbance of these hormones can cause, due to excitement and in the case of hyperthyroidism, anxiety. Conversely, hypothyroidism can cause slowing down, sadness, weight gain, etc. In these cases, the treatment is not at all psychiatric or psychological.
Hormonal disorder in your patients
As you can see, it’s really important that you ask patients if there’s a hormonal disorder somewhere. Same for your women patients. Don’t hesitate to ask them if they are well regulated, if their periods are not too painful, if they experience a significant mood change around period time etc. We have to make sure that there are no problems related to this. Same thing for your menopausal patients.. Make sure that the anxiety in these patients did not occur during pre-menopause and that the anxiety is, in fact, related to hormonal dysregulation. In this case, hormone replacement therapy may address the anxiety problem in these postmenopausal patients.
Other pathologies should not be overlooked, notably neurological pathologies. A patient with a neurological disorder may have a psychiatric picture. You should consider asking your patient about hydrocephalus, Niemann-Pick disease, a history of head trauma, cerebral hematomas (especially epidural hematomas and especially chronic subdural hematomas). In these cases, psychiatric treatment is not necessarily the solution.
Sleep apnea disorders
This is another possible cause. If your patient is overweight, or if his or her partner complains that he or she snores a lot or stops breathing when sleeping, consider asking your patient if he or she has sleep apnea. Indeed, sleep apnea disorders, due to hypoxia that is caused during the night and the resulting sleep disturbance will cause mood disorders, anxiety or stress. Here again, psychiatric or psychotherapeutic treatment is not the solution.
It is important to keep in mind that behind a psychological problem may be a somatic disorder that requires neurosurgical treatment. All the questions we have just mentioned are therefore strongly recommended to be asked during the session. If you see that the patient is not in good health (sweating, thinness, fatigue, etc.) these questions are all the more essential, as is a blood test.
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