Neuropsychiatric Features of Medical Disorders (Critical Issues in Psychiatry)

When Critical Issues in Psychiatry was conceived, there were several sub­ jects I considered to be of crucial importance in a series devoted to residents and clinicians in psychiatry, as well as to other mental health professionals. Of prominence was the pressing need for an in-depth and scholarly exam­ ination of the interface between medicine and psychiatry. I had been amazed to find that not a single book, to my mind, adequately addressed the psy­ chological symptoms and manifestations of both common and rare medical illness. It seemed to me that there was a need for a work which would achieve the following goals: First, it would assist in the differential diagnosis of functional psychiatric symptoms versus symptoms secondary to recog­ nized or unrecognized medical illness; second, it would elucidate the psy­ chological symptoms resulting from pharmacologic and other therapeutic interventions in medical illness; and third, it would examine the use of psychopharmacological agents in the presence of medical illness and the drugs used to treat that illness. Dr. Jefferson is Board Certified in both internal medicine and psychiatry, and both Drs. Jefferson and Marshall have extensive clinical experience from their many years of consultation/liaison work in psychiatry. Their experience and expertise have resulted in what I believe to be a monumental contri­ bution to the literature.

1 Physical Illness and Psychiatric Symptoms.- Overview.- Representative Psychiatric Symptoms.- Anxiety.- Depression.- Fatigue.- Hallucinations.- References.- 2 Cardiovascular Disorders.- Heart Failure.- General Considerations.- Clinical Features.- Arrhythmias.- Palpitations.- Arrhythmias and the Cerebral Circulation.- Diagnosis of Arrhythmias.- Blood Pressure.- Hypotension.- Hypertension.- Atherosclerotic Heart Disease.- Angina Pectoris.- Myocardial Infarction.- Syncope.- Cardiac Tumors.- Infective (Bacterial) Endocarditis.- Functional Cardiac Disorders.- Mitral Valve Prolapse Syndrome (MVPS).- Impotence.- Thoracic Outlet Syndrome.- Carotidynia.- Giant Cell Arteritis, Temporal Arteritis, Polymyalgia Rheumatica.- Neuropsychiatric Effects of Cardiovascular Drugs.- Digitalis.- Antiarrhythmic Drugs.- Antihypertensives.- Vasopressors.- Anticoagulants.- Comment.- Cardiovascular Drug-Induced Sexual Dysfunction.- Psychotropic Drugs and Cardiovascular Disorders.- Antipsychotic Drugs.- Antianxiety Drugs.- Antidepressants—Tricyclics.- Antidepressants—Monoamine Oxidase Inhibitors.- Lithium.- References.- 3 Respiratory Disorders.- Respiratory Failure.- General Considerations.- Clinical Features.- Treatment.- Acute (Adult) Respiratory Distress Syndrome.- Hyperventilation (Respiratory Alkalosis).- General Considerations.- Causes.- Pathophysiology.- Clinical Features.- Diagnosis.- Treatment.- Dyspnea.- General Considerations.- Causes.- Pathophysiology.- Clinical Features.- Asthma.- General Considerations.- Pathophysiology.- Clinical Features.- Assessment.- Pulmonary Embolism.- General Considerations.- Pathophysiology.- Clinical Features.- Diagnosis.- Fat Embolism.- Hiccup.- General Considerations.- Pathophysiology.- Etiology.- Treatment.- Diaphragmatic Flutter (Respiratory Myoclonus, Leeuwenhoek Disease).- General Considerations.- Clinical Features.- Diagnosis.- Etiology.- Treatment.- Psychotropic Drugs and Respiratory Disorders.- Antipsychotic Drugs.- Antidepressants—Tricyclics.- Antidepressants—Monoamine Oxidase Inhibitors.- Antianxiety Drugs.- Lithium.- Neuropsychiatric Effects of Respiratory Drugs.- Beta-adrenergic Stimulants—Isoproterenol, Ephedrine, Metaproterenol, Terbutaline, and Salbutamol.- Xanthine Bronchodilators—Theophylline, Aminophylline.- Cromolyn—Disodium Cromoglycate.- Steroids.- References.- 4 Renal Disorders.- Renal Failure.- Uremia.- Chronic Failure and Hemodialysis.- Renal Disease and Sexual Dysfunction.- Psychotropic Drugs and Renal Disorders.- Barbiturates.- Benzodiazepines.- Tricyclics.- Antipsychotic Drugs.- Lithium Carbonate.- References.- 5 Gastrointestinal Disorders.- Alimentary Tract Disorders.- Vomiting.- Dysphagia.- Globus Hystericus.- Gastric and Intestinal Disorders.- Psychotropic Drugs and Alimentary Tract Disorders.- Neuropsychiatric Effects of Alimentary Tract Drugs.- Pancreatic Disorders.- Carcinoma.- Pancreatitis.- Hepatic Disorders.- Hepatic Encephalopathy.- Posthepatitis Syndrome.- Psychotropic Drugs and the Liver.- References.- 6 Endocrine Disorders.- Adrenal Disorders.- Hyperadrenalism.- Hypoadrenalism.- Mechanisms of Neuropsychiatric Symptom Production.- Thyroid Disorders.- Laboratory Findings.- Hyperthyroidism.- Hypothyroidism.- Mechanisms of Neuropsychiatric Symptom Production.- Psychotropic Drugs and the Thyroid.- Parathyroid Disorders.- Hyperparathyroidism.- Hypoparathyroidism.- Mechanisms of Neuropsychiatric Symptom Production.- Psychotropic Drugs and Parathyroid Disorders.- Hypoglycemic Disorders.- Clinical Features.- Laboratory Findings.- Fasting Hypoglycemia.- Reactive Hypoglycemia.- Treatment.- References.- 7 Fluid-Electrolyte,Acid—Base Disorders.- Acid—Base Disorders.- General Considerations.- Metabolic Acidosis.- Metabolic Alkalosis.- Respiratory Acidosis, Respiratory Alkalosis.- Sodium.- General Considerations.- Volume Depletion.- Hypernatremia.- Hyponatremia.- Potassium.- General Considerations.- Hyperkalemia.- Hypokalemia.- Magnesium.- General Considerations.- Hypermagnesemia.- Hypomagnesemia.- Calcium.- Phosphorus.- General Considerations.- Hyperphosphatemia.- Hypophosphatemia.- Psychiatric-Drug-Induced Fluid—Electrolyte Disorders.- References.- 8 Metabolic Disorders.- Porphyria.- Clinical Features.- Laboratory Findings.- Neuropsychiatric Features.- Treatment.- Wilson Disease (Hepatoenticular Degeneration).- Clinical Features.- Pathogenesis.- Diagnosis.- Treatment.- Neuropsychiatric Manifestations of Drugs Used to Treat Wilson Disease.- Use of Psychotropic Drugs in Patients with Wilson Disease.- References.- 9 Connective Tissue Disorder (Systemic Lupus Erythematosus).- Clinical Features.- Laboratory Findings.- Neuropsychiatric Features.- Neurological Features.- Treatment.- References.- 10 Striated Muscle Disorder (Myasthenia Gravis).- Definition.- Clinical Features.- Exacerbations.- Initial Manifestations.- Typical Features.- Clinical Classification.- Neuropsychiatric Features.- Pathogenesis.- Diagnosis.- Differential Diagnosis.- Treatment.- Anticholinesterase Drugs.- Steroids.- Thymectomy.- Other.- Neuropsychiatric Effects of Antimyasthenic Drugs.- The Use of Psychotropic Drugs in Patients with Myasthenia Gravis.- References.- 11 Vitamin Disorders.- Hypervitaminosis A.- General Considerations.- Clinical Features.- Diagnosis.- Treatment.- Thiamine (Vitamin B1) Deficiency.- General Considerations.- Clinical Features.- Diagnosis.- Treatment.- Niacin (Nicotinic Acid) Deficiency.- General Considerations.- Clinical Features.- Diagnosis.- Treatment.- Vitamin B6 Deficiency.- General Considerations.- Clinical Features.- Diagnosis.- Treatment.- Vitamin B12 and Folic Acid Deficiencies.- General Considerations.- Clinical Features.- Neuropathology.- Diagnosis.- Treatment.- Ascorbic Acid (Vitamin C) Deficiency.- General Considerations.- Clinical Features.- Diagnosis.- Treatment.- References.- 12 Infectious Disorders.- Viral Encephalitis.- Clinical Features.- Laboratory Findings.- Neuropsychiatric Features.- Diagnosis.- Postencephalitic Changes.- Slow Viruses and Other Syndromes.- Treatment.- Infectious Mononucleosis.- Neuropsychiatric Features.- Chronic Sequelae.- Neuropsychiatric Effects of Infectious Disease Drugs.- Amantidine.- Antibiotics.- Penicillin.- References.- 13 Toxin Disorders.- Mercury.- Clinical Features.- Neuropsychiatric Features.- Lead.- Clinical Features.- Laboratory Findings.- Neuropsychiatric Features.- Treatment.- Bismuth.- Arsenic.- Clinical Features.- Laboratory Findings.- Neuropsychiatric Features.- Bromides.- Pharmacology and Pathophysiology.- Bromide-Containing Preparations.- Clinical Features.- Misdiagnosis.- Diagnosis.- Treatment.- Organophosphate.- Clinical Features.- Laboratory Findings.- Neuropsychiatric Features.- References.- 14 Skin Disorders.- Burn Delirium.- Clinical Findings.- Significance of Burn Delirium.- Etiology of Burn Delirium.- Treatment.- Psychotropic Drug-Induced Dermatologic Disorders.- References.- 15 Reproductive and Sexual Function Disorders.- Premenstrual Syndrome.- Menstrual Cycle Hormonal Changes.- Clinical Features.- Neuropsychiatric Features.- Etiology.- Treatment.- Oral Contraceptives.- Depression.- Psychotic Reactions.- Sexual Dysfunction (Impotence).- Diagnostic Evaluation of Impotence.- Recent Developments in the Diagnosis and Treatment of Organic Impotence.- References.- 16 Sleep and Arousal Disorders.- Diagnostic Classification.- Specific Disorders.- Narcolepsy.- Sleep Apnea Syndrome.- Miscellaneous Conditions.- Delayed Sleep Phase Syndrome (Sleep Onset Insomnia).- Nocturnal Myoclonus.- Conclusion.- References.- 17 Substance Abuse Disorders.- Caffeine.- Pharmacology.- Manifestations of Caffeine Use, Abuse, and Withdrawal.- Use of Caffeine in Psychiatric Patients.- Caffeine and Psychiatric Drugs.- Conclusion.- Alcohol.- Pharmacology.- Manifestations of Alcohol Abuse and Withdrawal.- Use of Alcohol in Psychiatric Patients.- Alcohol and Psychiatric Drugs.- Conclusion.- Amphetamines and Amphetamine-like Drugs.- Pharmacology.- Manifestations of Amphetamine Abuse and Withdrawal.- Amphetamine-like Drugs.- Use of Amphetamines in Psychiatric Patients.- Amphetamines and Psychiatric Drugs.- Conclusion.- Cannabis (Marijuana).- Pharmacology.- Manifestations of Cannabis Use and Withdrawal.- Use of Cannabis in Psychiatric Patients.- Cannabis and Psychiatric Drugs.- Conclusion.- Opiates and Synthetic Analgesics (Opioids).- Pharmacology.- Manifestations of Opioid Use, Abuse, and Withdrawal.- Use of Opioids in Psychiatric Patients.- Opioids and Psychiatric Drugs.- Conclusion.- Hallucinogens and Phencyclidine.- Pharmacology.- Manifestations of Hallucinogen and PCP Use.- Use of Hallucinogens and PCP in Psychiatric Patients.- Hallucinogens and PCP and Psychiatric Drugs.- Conclusion.- References.