overview of mental health care
mental health disorders
Personality and Behavior Changes
During the initial evaluation, doctors try to determine whether symptoms are due to a mental or physical disorder. The following information can help people decide when a doctor’s evaluation is needed and help them know what to expect during the evaluation. In people with changes in personality or behavior, certain symptoms and characteristics are cause for concern. These warning signs include Symptoms that appear suddenly Attempts to harm themselves or others or threats to do so Confusion or delirium Fever Severe headache Symptoms that suggest malfunction of the brain, such as difficulty walking, balancing, or speaking or vision problems A recent head injury (within several weeks) People who have warning signs should be seen by a health care practitioner as soon as possible. Law enforcement may need to be called if people are violent. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination, including a Neurologic Examination with a Questionsinclude when symptoms began. Many mental disorders begin in a person's teens or 20s. If a mental disorder begins during middle age or later, especially if there is no obvious trigger (such as loss of a loved one), the cause is more likely to be a physical disorder. A physical disorder is also more likely to be the cause when mental symptoms change significantly during middle age or later in people with a chronic mental disorder. If changes began recently and suddenly in people of any age, doctors ask about conditions that can trigger such changes. For example, they ask whether people have just started or stopped taking a prescription or recreational drug. Doctors ask about other symptoms that may suggest a cause, such as Palpitations: Possibly an overactive thyroid gland or use or withdrawal of a drug Tremors: Parkinson disease or withdrawal of a drug Difficulty walking or speaking: Multiple sclerosis, Parkinson disease, stroke, or intoxication from an opioid or a sedative Headache: Brain infection, brain tumor, or bleeding in the brain (hemorrhage) Numbness or tingling: A stroke, multiple sclerosis, or a vitamin deficiency People are also asked whether they have previously been diagnosed and treated for a mental or seizure disorder. If they have been treated, doctors ask whether they have stopped taking their drugs or decreased the dose. However, because people with mental disorders may also develop physical disorders, doctors do not automatically assume that any new abnormal behavior is caused by the mental disorder. Doctors ask about physical disorders people have (such as diabetes) and about their lifestyle (such as their marital status, job situation, educational background, use of alcohol, tobacco, and recreational drugs, and living arrangements). Doctors also ask whether family members have had any physical disorders that can cause mental symptoms (such as multiple sclerosis). During thephysical examination,doctors look for signs of physical disorders that can cause changes in mental status, particularly the following: Fever and/or a rapid heart rate (suggesting an infection, alcohol withdrawal, or use of amphetamines orcocainein high doses) Confusion or delirium (suggesting drug intoxication or withdrawal) Abnormalities during the neurologic examination, such as difficulty forming words or understanding language (possibly suggesting a brain disorder) Confusion and delirium are more likely to result from a physical disorder. People with mental disorders are rarely confused or delirious. However, many physical disorders that cause changes in behavior do not cause confusion or delirium, but they often cause other symptoms that may appear to be a mental disorder. Doctors bend the person's neck forward. If doing so is difficult or painful, meningitis may be the cause. Doctors check the legs and abdomen for swelling, which may result from kidney or liver failure. If the skin or whites of the eyes look yellow, the cause may be liver failure. Doctors may examine the interior of the eyes with a handheld device that looks like a small flashlight (called an Ophthalmoscopy ). If doctors see swelling in part of the optic nerve ( Typically, tests include the following: Measurement of the oxygen level in the blood using a sensor clipped to the person's fingertip (called pulse oximetry) Blood tests to measure sugar (glucose) levels Blood tests to measure levels of alcohol and levels of any Antiseizure medications the person is taking Urine tests to check for drugs A complete blood count (CBC) Sometimes blood tests to measure electrolyte levels and to evaluate kidney function For most people known to have a mental disorder, no further testing is needed if their only symptoms are worsening of their typical symptoms, if they are awake and alert, and if results of these tests and their physical examination are normal. For most other people, blood tests to check for HIV infection are usually done. Other tests are done based mainly on the symptoms and examination results (see table Some Causes and Features of Personality and Behavior Changes ). Tests may include Computed Tomography (CT) (CT) or A Spinal Tap (lumbar puncture): If people have symptoms of meningitis or if results of CT are normal in people with a fever, a headache, or delirium Blood tests to evaluate thyroid function: If people are takinglithium, have symptoms of a thyroid disorder, or are over 40 years old and have personality or behavior changes that have just started (particularly people with a family history of thyroid disorders and women) Chest x-ray: If people have a fever or a productive cough or they cough up blood Blood cultures (to check for bacteria in the bloodstream): If people are very ill and have a fever Blood tests to evaluate liver function: If people have symptoms of a liver disorder, such as jaundice (a yellowish discoloration of the skin and whites of the eyes), or a history of alcohol or drug use disorder, or if specific information about them is not available 