psychiatric disorders
Medical Assessment of the Patient With Mental Symptoms
Introduction
Patients with mental complaints or concerns or disordered behavior present in a variety of clinical settings, including primary care and emergency treatment centers. Complaints or concerns may be new or a continuation of a history of mental problems. Complaints may be related to coping with a physical condition or be the direct effects of a physical condition on the brain. The method of assessment depends on whether the complaints constitute an emergency or are reported in a scheduled visit. In an emergency, a physician may have to focus on more immediate history, symptoms, and behavior to be able to make a management decision. In a scheduled visit, a more thorough assessment is appropriate. Medical assessment of patients with mental symptoms seeks to identify 3 things: Physical disordersmimickingmental disorders Physical disorderscaused bymental disorders or their treatment Physical disordersaccompanyingmental disorders Numerous physical disorders cause symptoms that mimic specific mental disorders (see table Selected Mental Symptoms Due to Physical Disorders ). Other physical disorders may not mimic specific mental syndromes but instead have an impact on mood and energy. Many drugs cause mental symptoms; the most common classes of drug causes are Central nervous system–active drugs (eg, Antiseizure Medications , Anticholinergics (eg, antihistamines) Corticosteroids Numerous other therapeutic drugs and drug classes have also been implicated; they include some classes that may not ordinarily be considered (eg, antibiotics, antihypertensives). Drugs of abuse, particularly Alcohol Toxicity and Withdrawal , Patients with a mental disorder may develop an unrelated physical disorder (eg, Overview of Meningitis , Do not assume that all mental symptoms in patients with a known mental disorder are due to that disorder. Patients presenting for psychiatric care occasionally have undiagnosed physical disorders that are not the cause of their mental symptoms but nonetheless require evaluation and treatment. Such disorders may be unrelated (eg, Hypertension , 