Depression , one of the most commonly diagnosed psychiatric disorders, is diagnosed in increasing numbers in various segments of the population worldwide. Depression in the United States alone affects 17.6 million Americans each year or 1 in 6 people. Depressed patients are at high risk for type 2 diabetes, cardiovascular disease, and suicide. In the next twenty years, depression is expected to be the second leading cause of disability in the world and a major cause in high-income countries, including the United States. In about 75% of completed suicides, people have seen a doctor in the previous year before their death, 45-66% in the previous month. About a third of those who completed suicide had contact with mental health services in the previous year, the fifth in the previous month.
There are many psychiatric and medical conditions that can mimic some or all of the symptoms of depression or may occur comorbidities. A disorder of either psychiatry or medicine that shares symptoms and other disorder characteristics, and perhaps the actual cause of the emerging symptoms is known as the differential diagnosis.
Many psychiatric disorders such as depression are diagnosed by health professionals allied with little or no medical training, and are made on the basis of presenting symptoms without proper consideration of the underlying cause, adequate screening of adequate screening is often not done. According to one study, "non-medical mental health care providers may be at a higher risk of not recognizing masked medical diseases in their patients."
Misdiagnosis or false diagnosis can lead to a lack of ineffective and potentially harmful treatment or treatment that can aggravate underlying cause disorders. Conservative estimates are that 10% of all psychological symptoms may be due to medical reasons, with one study showing that about half of individuals with serious mental illness "have generalized medical conditions that are largely undiagnosed and untreated and can cause or aggravate psychiatric symptoms ".
In the case of a misdiagnosis reported in Newsweek, a writer received treatment for depression for many years; during the last 10 years of depression, the symptoms worsened, resulting in several suicide attempts and mental hospital treatment. When MRI is finally performed, it indicates a tumor. However, he was told by a neurologist that it was benign. After a worsening of symptoms, and after the second opinion of another neurologist, the tumor has been removed. After surgery, she no longer suffers from depressive symptoms.
Video Differential diagnoses of depression
Autoimmune disorders
- celiac disease; is an autoimmune disorder in which the body can not digest the gluten found in various food grains, especially wheat, and also rye and barley. Current research has shown that neuropsychiatric symptoms may manifest asymptomatic gastrointestinal symptoms.
- "However, more recent studies have emphasized that a broader spectrum of neurologic syndromes may be an extraintestinal manifestation of gluten sensitivity with or without intestinal pathology."
- Lupus: Systemic lupus erythematosus (SLE), is a chronic autoimmune connective tissue disease that can affect any part of the body. Lupus can cause or worsen depression.
- Lyme disease; is a bacterial infection caused by Borrelia burgdorferi, a bacterium spirochete transmitted by deer mites (Ixodes scapularis). Lyme disease is one of a group of diseases that have earned the name "big imitators" for their tendency to mimic the symptoms of various medical and neuropsychiatric disorders. Lyme disease is an undiagnosed disease, partly as a result of the complexity and unreliability of serological testing.
- "Due to the rapid increase of Lyme borreliosis nationally and the need for antibiotic treatment to prevent severe neurological damage, mental health professionals need to be aware of the possibility of psychiatric presentation.
- Syphilis; The prevalence is on the rise, is one of the "great imitators", which if untreated can develop into neurosyphilis and affect the brain, may present with only neuropsychiatric symptoms. "This case emphasizes that neurosyphilis should still be considered in the differential diagnosis in the context of psychiatric conditions and disease.Because of current epidemiological data and difficulties in diagnosing syphilis, routine psychiatric screening tests are necessary."
- Neurocysticercosis (NCC): is an infection of the brain or spinal cord caused by the larval stage of the pork tapeworm, Taenia solium . NCC is the most common worm infestation (parasitic worm) of the central nervous system worldwide. Humans develop cysticercosis when they swallow pork tapeworm eggs through contact with contaminated feces or eat infected vegetables or undercooked pigs. "While cysticercosis is endemic in Latin America, it is an emerging disease with increasing prevalence in the United States." "The rate of depression in those with neurocysticercosis is higher than in the general population."
- Toxoplasmosis; is an infection caused by Toxoplasma gondii intracellular protozoal parasites. Humans can be infected in 3 different ways: swallowing tissue cysts, swallowing oocysts, or utero infections with tachyzoites. One of the main methods for transmission to humans is contact with dirt from host species, pet cats. Toxoplasma gondii infects about 30% of the world's human population, but causes clear clinical symptoms only in the small segment of those infected. Exposure Toxoplasma gondii (seropositive) without developing Toxoplasmosis has been shown to alter the various characteristics of human behavior as well as being a contributing factor in some cases of depression; in addition, studies have linked seropositive with increased suicide rates
- West Nile Virus (WNV); which can lead to encephalitis have been reported to be a contributing factor in developing depression in 31% of those infected in the study conducted in Houston, Texas and reported to the Centers for Disease Control (CDC). The main vectors for transmission of disease to humans are various species of mosquitoes. WNVs endemic to Southern Europe, Middle East Africa and Asia were first identified in the United States in 1999. Between 1999 and 2006, 20,000 confirmed cases of reported WNV were reported in the United States, with estimates of up to 1 million infected. "WNV is now the most common cause of epidemic virus encephalitis in the United States, and is likely to remain an important cause of neurological disease for the foreseeable future."
- Anemia: is a decrease in the normal amount of red blood cells (RBC) or less than the normal amount of hemoglobin in the blood. Symptoms of depression are associated with anemia in the general population of elderly living in the community.
- Fructose malabsorption and lactose intolerance; transport of fructose is deficient by duodenum, or by enzyme deficiency, lactase in the mucosal lining, respectively. As a result of this malabsorption the saccharide reaches the large intestine and is digested by bacteria converting it into short chain fatty acids, CO
2 , and H 2 . About 50% of those affected exhibit physical signs of irritable bowel syndrome. - "Fructose malabsorption may play a role in the development of depressed moods.fructose malabsorption should be considered in patients with severe depressive symptoms...."
- "The reduced fructose and sorbitol diet in subjects with fructose malabsorption not only reduces gastrointestinal symptoms but also increases mood and early signs of depression."
Maps Differential diagnoses of depression
Virus-virus parasite infection
Blood Disorder
Chronic fatigue syndrome
Between 1 and 4 million Americans are believed to have Chronic Fatigue Syndrome (CFS), but only 50% have consulted physicians for symptoms of CFS. In addition, individuals with CFS symptoms often have undiagnosed medical or psychiatric disorders such as diabetes, thyroid disease or substance abuse. CFS, at one time considered psychosomatic, is now considered a valid medical condition in which early diagnosis and treatment can help in alleviating or resolving the symptoms completely. While often misdiagnosed as depression, differences have been noted in cerebral blood flow rates.
CFS is undiagnosed in more than 80% of people who have it; at the same time, is often misdiagnosed as depression.
Dietary disorders
Endocrine system disorder
Dysregulation of the endocrine system may present with a variety of neuropsychiatric symptoms; deviations in the hypothalamus-pituitary-adrenal (HPA) axis and the hypothalamus-pituitary-thyroid (HPT) axis have been demonstrated in patients with primary depression.
Adrenal Gland
Addison's disease: also known as chronic adrenal insufficiency, hypocortisolism, and hypocortism) is a rare endocrine disorder in which the adrenal glands, located above the kidneys, produce inadequate steroid hormones (glucocorticoids and often mineralocorticoids). "Addison's disease that has psychiatric features in the early stages has a tendency to be ignored and misdiagnosed."Thyroid and parathyroid glands
- Graves' disease: an autoimmune disease in which the thyroid is overactive, resulting in hyperthyroidism and thyrotoxicosis.
- Hashimoto's thyroiditis: also known as chronic lymphocytic thyroiditis is an autoimmune disease in which the thyroid gland is gradually destroyed by various cells and antibodies that mediate the immune process. Hashimoto's thyroiditis is associated with thyroid peroxidase and thyroglobulin autoantibodies
- Hashitoxicosis
- Hypothyroidism
- Hyperthyroidism
- Hypoparathyroidism; can affect calcium homeostasis, a supplementation that has completely resolved cases of depression in which hypoparathyroidism is a single causal factor.
Pituitary tumor
Pituitary gland tumors are quite common in the general population with estimates starting as high as 25%. Most tumors are considered benign and are often the incidental findings found during autopsies or during neuroimaging in which case they are nicknamed "incidentalomas". Even in benign cases, pituitary tumors can affect cognitive, behavioral and emotional changes. Pituitary microadenomas are less than 10 mm in diameter and are generally considered benign, but the presence of microadenomas has been positively identified as a risk factor for suicide.
"... patients with pituitary disease are diagnosed and treated for depression and show little response to treatment for depression".
Pancreas
- Hypoglycemia: excess insulin production causes a decrease in blood glucose levels. In one study of patients recovering from acute lung injury in intensive care, patients with hypoglycemia while hospitalized showed increased rates of depression.
Neurological
CNS Tumor
In addition to pituitary tumors, tumors at various locations in the central nervous system can cause depressive symptoms and are misdiagnosed as depression.
Post syndrome syndrome
Post-concussion syndrome (PCS), is a set of symptoms that a person may experience for weeks, months, or sometimes years after a concussion with 38-80% prevalence in traumatic brain injury light. , may also occur in cases of moderate and severe traumatic brain injury. Diagnosis can be made when symptoms of concussion, depending on the criteria, last for more than three to six months after injury, in this case called postconcussive persistent syndrome (PPCS). In a study of the prevalence of post-concussion syndrome symptoms in patients with depression utilizing the British Columbia Postconcussion Symptom Inventory: "About 9 out of 10 patients with depression met the liberal self-report criteria for post-concussion syndrome and more than 5 out of 10 met the conservative criteria for diagnosis. "Self-reported rates are significantly higher than those obtained in scheduled clinical interviews. Normal control has shown symptoms of PCS as well as those seeking psychological services. There is considerable debate about the diagnosis of PCS in part because of its medico-legal consequences and thus monetarily receiving the diagnosis.
Pseudobulbar affects
Pseudobulbar Influencing (PBA) is an affective disinhibition syndrome that is largely unknown in clinical settings and is thus often untreated due to ignorance of clinical manifestations of disorders; may be misdiagnosed as depression. It often occurs secondary to various neurodegenerative diseases such as amyotrophic lateral sclerosis, and can also result from head trauma. PBA is characterized by an unintentional and inappropriate explosion of laughter and/or cries. PBA has a high prevalence rate with an estimated 1.5-2 million cases in the United States alone.
Multiple sclerosis
Multiple sclerosis is a chronic demyelinating disease in which the cells of myelin cells in the brain and spinal cord are repaired repaired. Symptoms of depression are very common in patients at all stages of the disease and may be exacerbated by medical care, especially interferon beta-1a.
Neurotoxicity
Various compounds have been shown to have many neurotoxic effects that have been implicated as having a causal relationship in the development of depression.
Cigarette smoking
There are studies that show a correlation between smoking and depression. The results of one recent study suggest that smoking cigarettes may have a direct causal effect on the development of depression. There are various studies conducted showing a positive relationship between smoking, suicidal ideation and suicide attempts.
In a study conducted among nurses, those who smoked between 1-24 cigarettes a day had twice the risk of suicide; 25 cigarettes or more, 4 times the risk of suicide, than those who never smoked. In a study of 300,000 US Army troops, a definitive relationship between suicide and smoking was observed with those who smoked on a pack a day had twice the rate of non-smoker suicide.
Medication
Various drugs have been suspected of having a causal relationship in the development of depression; this has been classified as "organic mood syndrome". Some classes of drugs such as those used to treat hypertension, have been recognized for decades as having a definitive relationship with the development of depression.
Monitoring of those taking drugs that have been shown to be associated with depression is often indicated, as well as the necessity of factoring in the use of such drugs in the diagnostic process.
- Topical Tretinoin (Retin-A); derived from Vitamin A and used for various medical conditions such as topical solutions used to treat acne vulgaris. Although applied externally to the skin, it can enter the bloodstream and cross the blood-brain barrier where it may have neurotoxic effects.
- Interferon; proteins produced by the human body, three types have been identified alpha, beta and gamma . The synthetic version is used in a variety of drugs used to treat different medical conditions such as the use of interferon-alpha in the treatment of cancer and the treatment of hepatitis C. All three classes of interferon can cause depression and suicidal ideation.
Chronic exposure to organophosphates
The neuropsychiatric effects of chronic organophosphate exposure include mood disorders, suicidal thoughts and behaviors, cognitive impairment and chronic fatigue.
Neuropsychiatric
Bipolar disorder
- Bipolar disorder is often misdiagnosed as severe depression, and is thus treated with antidepressants that not only are not efficacious but are often contraindicated as they may aggravate hypomania, mania, or cycling between moods. There is an ongoing debate about whether this should be classified as a separate disorder because individuals diagnosed with severe depression often experience some hypomanic symptoms, suggesting a continuum between the two.
Lack of nutrition
Nutrition plays a key role in every aspect of maintaining proper physical and psychological health. Inadequate or inadequate nutrition can have a major impact on mental health. The emerging field of nutritional neuroscience explores the various relationships between diet, neurological function and mental health.
- Vitamin B 6 : pyridoxal phosphate (PLP), active form B 6 , is a cofactor in the dopamine serotonin pathway, vitamin B deficiency 6 can cause symptoms of depression.
- Folate (vitamin B 9 ) - Vitamin B 12 cobalamin: Low blood plasma and especially red blood cell folate and reduced vitamin B 12 have been found in patients with depressive disorders. "[W] e suggests that oral doses of both folic acid (800 Ã,Âμg/(mcg) daily) and vitamin B12 (1 mg daily) should be attempted to improve treatment outcomes for depression."
- Long-chain fatty acids: higher omega-6 levels and lower levels of omega-3 fatty acids have been linked to depression and behavioral changes.
- Vitamin D deficiency is associated with depression
Sleep disorder
- Insomnia: While the inability to fall asleep is often a symptom of depression, it can also in some cases serve as a trigger for developing depressive disorders. Can be transient, acute or chronic. This can be a primary disorder or co-morbid disease.
- Restless legs syndrome (RLS), also known as Wittmaack-Ekbom syndrome, is characterized by an irresistible urge to move one's body to stop an uncomfortable or strange sensation. The most commonly affects the foot, but it can also affect the arm or body, and even limbs. Restless Leg syndrome is associated with major depressive disorder. "Odds ratios are adjusted for the diagnosis of major depressive disorder... suggesting a strong association between restless legs syndrome and major depressive disorder and/or panic disorder."
- Sleep apnea is a sleep disorder characterized by stopping breathing during sleep. Each episode, called apnea, lasts long enough for one or more missed breaths; Such episodes occur repeatedly throughout the sleep cycle. Undiagnosed sleep apnea can cause or contribute to the severity of depression.
- Circumcision of circadian rhythm, which is rarely known by some clinicians, is often not handled or treated inappropriately, such as when one is diagnosed as primary or as a psychiatric condition.
See also
- Rosenhan's Trial
- The Seasonality Pattern Assessment Questionnaire
References
Bibliography
- Sanity Dosage: Mind, Medicine, and Misdiagnosis by Sydney Walker. John Wiley & amp; Sons, 1997. ISBNÃ, 0-471-19262-7
External links
- Strategies to Reduce Bipolar-Charles M. Bowden Mdiagnosis Misdiagnosis M.D.
- Differential Diagnosis and Treatment of Lyme Borelliosis End of Neuropsychiatric Stage
- Toxoplasmosis Parasites Can Trigger Schizophrenia And Bipolar Disorder
Source of the article : Wikipedia
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