Organic Mental Syndromes (Organic Causes of Psychiatric Symptoms)

recover until the underlying cause has been treated. Symptomatic treatment with psychotropic drugs may be required before the medical disorder has been treated. They also may be needed if the medical condition is untreatable (e.g. carcinoma), or if psychiatric symptoms persist after successful treatment of the medical condition (e.g. epilepsy). 

2. Psychiatric illness occurring as an indirect result of organic illness:

Medical illness is often distressing. It is not surprising therefore that psychiatric illness often occurs as a result. The consequences of medical illness most likely to cause this are shown in figure 1.

Patient at risk of psychiatric illness, such as those with a family history or past psychiatric history, are more likely to develop a psychiatric illness when medically ill, just as they are more likely to when faced with adverse life event (bio-psycho-social interaction in causation).  It is important to remember that medical illnesses will have different consequences for different patients. For example, MI in a heavy goods vehicle driver will leave them unable to return to their previous job, raising the risk of depression. A stomach inflammation in a patient whose father died of gastric cancer might present with hypochondriasis or panic attacks.

Once a psychiatric illness has developed, it can often exacerbate symptoms of the physical illness which precipitated it. For instance, depression often results in an exacerbation of pain. Patients’ general level of function, which is often reduced as a result of their medical illness, may be reduced further as a result of psychiatric symptoms such as lethargy, anxiety or loss of confidence.

The risk of psychiatric consequences of medical illness are reduced by giving patients a full explanation of the illness and what can be done to help them, paying particular attention to any specific fears the patient may have. Practical advice about how they can cope with the illness is also useful. Involving patients’ families in this process will clarify the support they need to give the patient and allow them to voice concerns of their own. All this is best carried out by members of the medical team (rather than a referral to a mental health worker) dealing with the patient and assigning in some specialist services, such as diabetic clinics, a member of staff designated to carry out this.

In addition to the general measures, specific treatments for the psychiatric disorders will be required in some cases. Standard treatment should be used, provided they are not contra-indicated by the medical illness. This is most likely to be the case for drug treatments and a list of medical conditions which can be exacerbated by the psychotropic drugs is given below. The list includes only few medications and the focus is their antimuscarinic effect:

Cardiovascular disease. Glaucoma Constipation Prostatism Dementia

It is also important to be aware of the potential drug interactions in patients receiving treatment for physical and psychiatric illness (e.g. fatal in some cases, as in patient with lithium and some diuretics)  

3. Organic and psychiatric illness occurring together by chance:

Organic and psychiatric illness are both common and so it is not surprising that they both often occur together by chance. When they do occur together ,each can make the other worse. The physical and psychiatric conditions should be treated in the usual way, bearing in mind the side effects and the interactions of both.

4. Psychiatric side-effects of medication

As mentioned above and with the example of the antimuscarinic side effect with many of the psychotropic medications. If such side effects occur the dose should be reduced or an alternative drug should be used. Occasionally, the risk of doing this outweighs the benefit and in such cases the psychiatric symptoms may require separate treatment.

References:

1. Stevens L, Rodin I, Psychiatry: An illustrated colour text, Churchill Livingstone 2001

2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

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