Medical Clearance and Screening

Primer

See also the Medical Psychiatry section: Medical Psychiatry

Psychiatrists play a critical role in detecting and diagnosing medical etiologies of psychiatric presentations.

Medical Screening

Neuroimaging

Although most guidelines recommend patients with psychiatric symptoms and no neurological symptoms to not have neuroimaging,[1] there are many case reports of neurologic lesions masquerading as psychiatric illness in the absence of neurological symptoms. This is especially true in those with atypical psychiatric symptoms.

Psychosis

NMDAR Encephalitis

Rheumatological/Autoimmune

  • Ask about rashes, skin changes other than acne, ulcers, joint pain, joint swelling, hair loss, dry eyes, dry mouth, muscle pain, and cardiovascular, GI, or respiratory symptoms.
  • Other phenomena such as Raynaud syndrome should also be asked on history
  • Personal or family history of autoimmune disease
  • Unusual rashes
  • Abnormal weight loss
  • Oral ulcers, uveitis, iritis, fevers, alopecia, arthritis or other joint pain concerns
  • Fibromyalgia symptoms

Anxiety

Depression

Clues to medical versus psychiatric causes of behavioural symptoms Fig. ##

Resources

“Now that I have full-blown, raging, impossible-to-miss Parkinson's disease, I really resent all those preceding years with the “depression” diagnosis: all those fleeting episodes of loss of balance, the tripping, falling, stumbling, spilling, dropping things; all those psychotropic drugs that never made a single bit of difference in my “mood disorder.” Dopamine is always prominently listed alongside serotonin as a brain chemical, and yet they bombarded my brain with increasingly toxic psychiatric concoctions. Never mind that I had long before lost my sense of smell. Never mind that I described “shaking inside” before the tremors were visible on the outside. Nowadays, I take a hit of dopamine and the relief is indescribable. Not only does the tremoring stop for a little while, but the onset of momentary happiness … I think it's happiness. I can't be fully certain. It was gone from my life for so long, so many years. Really, it's not at all difficult to assess.”
– New York Times Reader Comment ("Cassidy"), from NYT: When Anxiety or Depression Masks a Medical Problem

References

1) Albon, E., Tsourapas, A., Frew, E., Davenport, C., Oyebode, F., Bayliss, S., ... & Meads, C. (2008). Structural neuroimaging in psychosis: a systematic review and economic evaluation.