Is it medical or psychiatric? Here's where things get confusing.

Is it medical or psychiatric? Here's where things get confusing.
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The mind-body connection is real. I could spend hours talking about the amazing examples of this, with something medical that was actually psychiatric in origin or something psychiatric that was actually medical in origin. So where does your body end and your mind begin? I think the simplest answer is that it doesn’t.

Having worked as a consulting psychiatrist in the medical wards, I would frequently see ailments that were puzzling to the medical doctors. A lot of times, these issues would be more responsive to treatment once we looked at things through a psychiatric lens, understanding how depression or anxiety might be worsening the picture. However, not every case is purely psychiatric; in fact, many of my patients who struggle with physical ailments often will find that there is a medical cause for their issues.

Pain is a perfect example of the med-psych interface. Pain is a purely subjective experience. For example, somebody might look happy and carefree, although she may be experiencing a 10/10 level of pain. It is difficult for providers to look at a patient and have an objective sense of their pain without the patient’s self-report. However, pain is very real to the sufferer. A known relationship exists between depression and physical pain, since depression somehow sensitizes the body and causes a worse experience of pain. So if we treat the depression, the person might actually even be better able to cope with his pain.

I have seen psychiatric issues disguised as incredible physical manifestations, such as seizures, headaches, strokes and heart attacks. Please don’t think that I am suggesting that all people who experience these symptoms should first consider them to be psychiatric; on the contrary, anyone who experiences such serious medical ailments should first get checked out emergently to rule out a medical cause. But once those are ruled out, many times that’s when the psychiatrist is called to evaluate the patient.

Psychiatric patients frequently also have significant medical issues. There are lots of reasons why this could happen. Often times it is not at all related to the psychiatric illness. But other times, it is. Some psychiatric medications could contribute to weight gain, kidney dysfunction or tremors. Or sometimes people who suffer from chronic depression simply cannot motivate themselves or find the energy to get up and exercise or engage in other forms of self-care, and as a result they gain weight or have other medical issues. Further, there is a high rate of comorbidity between psychiatric issues and substance-use disorder, which carries its own set of medical consequences.

On the other hand, many medical issues can manifest as psychiatric issues or can at least worsen psychiatric symptoms. For example, hypothyroidism can present as depression. Hallucinations can be a hallmark sign of delirium, which is a fluctuating state of altered mental consciousness often seen in hospitalized or elderly patients. Low vitamin D levels, often seen during the winter time and particularly in people who are in the northern areas of the country, can contribute to worsening mood and seasonal affective disorder.

So what is a doctor’s responsibility when the patient has medical symptoms? All medical issues should be taken seriously, by both the patient and the doctor. Sadly, this is not always the case, with studies clearly indicating that psychiatric patients typically get worse medical care. And in situations that are more complicated, where the medical doctor feels that there may be an element of depression or other psychiatric issue that could be contributing to the symptoms, maybe it’s best to get a mental health professional involved. And for us psychiatrists, we often will routinely check thyroid levels and vitamin D levels, amongst other blood tests, just to make sure there isn’t an underlying medical issue that may be contributing to the person’s presentation.

In recent times, the medical community is becoming more and more aware of just how powerful the mind-body connection is. As a result, medical and psychiatric providers are suggesting yoga, exercise and medication at an unprecedented rate, thereby encouraging their patients to explore and support a healthy connection within that mind-body framework. It is a wonderful thing, because where there is a healthy mind, often a healthy body will follow.

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