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See also: Medical Rule Outs | Jane Leu Rekas, LCSW
Medical Rule Outs for Depression | Jane Leu Rekas, LCSW
Syndromes of Disrupted Homeostasis (and Video)
Anxiety Causes at Body Mind Spirit Success
CMHIMP Certified Integrative Mental Health Professional Nutrition
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In mental health assessments, ruling out medical conditions is critical because physical illnesses can mimic or exacerbate psychiatric symptoms. Here's a breakdown of how different organ systems and related medical issues can impact mental health:
1. Nervous System (Brain and Nerves)
Rule-Outs: Neurological conditions can directly affect mental health.
- Brain tumors
- Traumatic brain injury (TBI)
- Stroke
- Epilepsy
- Multiple sclerosis (MS)
- Neurodegenerative disorders (e.g., Parkinson's, Alzheimer's, Huntington's)
- Migraines
Symptoms: Mood changes, cognitive impairment, psychosis, or anxiety.
2. Endocrine System (Hormones)
Rule-Outs: Hormonal imbalances can mimic psychiatric disorders.
- Hypothyroidism or hyperthyroidism
- Diabetes
- Cushing's syndrome
- Addison’s disease
- Polycystic ovary syndrome (PCOS)
- Pheochromocytoma (adrenal gland tumor)
- Hyperparathyroidism or hypoparathyroidism
Symptoms: Fatigue, depression, anxiety, irritability, or psychosis.
3. Cardiovascular System (Heart and Blood Vessels)
Rule-Outs: Poor circulation or heart function affects brain function.
- Hypertension or hypotension
- Arrhythmias
- Congestive heart failure (CHF)
- Atherosclerosis
- Stroke or transient ischemic attack (TIA)
Symptoms: Fatigue, anxiety, panic attacks, or confusion.
4. Respiratory System (Lungs)
Rule-Outs: Oxygenation issues can influence brain health.
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Sleep apnea
- Pulmonary embolism
Symptoms: Fatigue, irritability, confusion, or panic attacks.
5. Digestive System (GI Tract and Liver)
Rule-Outs: Digestive health can affect neurotransmitters and mood.
- Irritable bowel syndrome (IBS)
- Celiac disease
- Crohn’s disease
- Ulcerative colitis
- Liver dysfunction (e.g., cirrhosis, hepatitis, hepatic encephalopathy)
- Vitamin deficiencies (e.g., B12, D, folate)
Symptoms: Anxiety, depression, irritability, or brain fog.
6. Renal System (Kidneys)
Rule-Outs: Kidney dysfunction impacts toxin clearance.
- Chronic kidney disease (CKD)
- Electrolyte imbalances
- Uremia
Symptoms: Cognitive impairment, irritability, or fatigue.
7. Immune System
Rule-Outs: Inflammation or autoimmune responses can mimic psychiatric symptoms.
- Lupus
- Multiple sclerosis (also affects the nervous system)
- Autoimmune encephalitis (e.g., anti-NMDA receptor encephalitis)
- Chronic infections (e.g., Lyme disease, HIV, syphilis)
Symptoms: Depression, anxiety, psychosis, or fatigue.
8. Musculoskeletal System (Bones, Muscles, and Connective Tissues)
Rule-Outs: Chronic pain and inflammation can impact mental health.
- Fibromyalgia
- Rheumatoid arthritis
- Chronic pain syndromes
Symptoms: Depression, irritability, or anxiety.
9. Hematological System (Blood)
Rule-Outs: Blood disorders can cause mental health symptoms.
- Anemia
- Polycythemia vera
- Leukemia
- Clotting disorders (e.g., DVT, PE leading to hypoxia)
Symptoms: Fatigue, brain fog, or irritability.
10. Integumentary System (Skin)
Rule-Outs: Skin conditions may indirectly affect mental health.
- Psoriasis
- Eczema
- Chronic infections
- Vitamin D deficiency (linked to sun exposure)
Symptoms: Depression, social anxiety, or body dysmorphia.
11. Reproductive System
Rule-Outs: Hormonal fluctuations can directly influence mood.
- Pregnancy-related conditions (e.g., postpartum depression, preeclampsia)
- Menstrual-related conditions (e.g., PMDD, endometriosis)
- Menopause
- Testosterone or estrogen imbalances
Symptoms: Mood swings, irritability, depression, or anxiety.
12. Sensory Systems (Eyes, Ears, and Balance)
Rule-Outs: Sensory impairments can mimic anxiety or psychosis.
- Vestibular disorders (e.g., Meniere's disease)
- Vision problems (e.g., Charles Bonnet syndrome)
- Tinnitus
Symptoms: Anxiety, irritability, or hallucinations.
Approach to Rule-Outs
Clinical Tools:
- Comprehensive history-taking
- Physical exam
- Lab tests (CBC, CMP, thyroid panel, hormone levels, etc.)
- Imaging (MRI, CT, or EEG)
Collaboration: Involve primary care physicians or specialists when necessary.
Each organ system has a role in overall well-being, and disruptions can lead to or worsen mental health symptoms. Ruling out these medical issues is critical before diagnosing or treating primary psychiatric conditions.
| REFLUX: This is where acid flows back from the stomach into the esophagus which unlike the stomach, is not lined in a way that resists acid, so damage and pain results. It may be thought that the sphincter has become incapitated. But the spincter is supposed to open when food goes from esophagus to stomach and close when the stomach contracts. The problem is one of mis-coordination, an autonomic problem. |
| ULCERS: Ulcers have long been associated with stress by everyday observation. In the modern era, where strong attempts are being made to rehabilitate stress as good, other causes are being blamed. |
| IBS, ETC: The basic cycle is between ischemia and reperfusion engorgement and inflammation. Think of the damage that arises when frostbitten tissue thaws. The ischemic periods are not recognized often and are seen as 'good' periods or remissions. The reperfusion periods cause irritation and diarrhea and intense pain, and are seen as the flare-ups. |
| INTERSTITIAL CYSTITIS: Most symptoms are ultimately from inflammation, which is caused by reperfusion after ischemia. |
| ASTHMA: Asthma has been intuitively understood to be related to stress for a long time. The exact mechanism is still obscure. Perhaps the bronchiolar walls are supposed to constrict and expand slightly rhythmically to aid the breathing mechanism, and if this gets out of balance, asthma results. Chronic hyperventilation also plays a part. |
| MITRO VALVE PROLAPSE: This can sometimes be a structural defect but is most commonly caused by a discoordination between the chambers of the heart, and high blood pressure. |
| FIBROMYALGIA: This is an extremely complex syndrome which is also extremely common. The progressive myofascial shortening and stiffening effects causing pain, and dorsal vagal symptoms are most credited, but impaired interpersonal relationships probably stem from unappreciated chronic fight or flight effects on the limbic system. |
| MIGRAINES: A period of vascular insufficiency (usually in one side of the brain) causes 'aural' symptoms and then vascular engorgement follows a s a rebound and causes the pain. Ironically, the aural symptoms would be worrisome for a stroke in todays contest of heightened awareness of early stroke signs, were they not to occur in this context. |
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