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MissingTheDiagnosis:TheHiddenMedicalCausesof
MentalDisorders
byWilliamMatteson,Ph.D.

8CEHours$199
Lastrevised: 06/25/2015
Coursecontentcopyright20102015byWilliam
Matteson,Ph.D.Allrightsreserved.

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LearningObjectives
Thisisanintermediatelevelcourse.Aftertakingthiscourse,mentalhealthprofessionalswillbeable
to:
Listanddiscussfourmedicalcausesofmentaldisorders.
Describehowmooddisorderscanbetriggeredbytheimmunesystem.
Explainhowgeneticpredispositionsmayincreasetheprobabilityofmentalillnesses.
Describehowmedicationsandpolypharmacymaytriggercognitiveandemotionalproblems.
Discusshowsocialandemotionalmalfunctioningmaybetriggeredbytoxinsinthe
environment.
Listmetabolicdisordersandthedatasupportingthem.
Discussethicalandlegalconsiderationsinprovidinginformationaboutmedicationstoclients.
Troubleshootmentaldisorderswhichhavebeenpreviouslylabeled,treatmentresistant.
Workeffectivelywithpatients,primarycarephysiciansandpsychiatrists.

CourseOutline

PARTI:UnderlyingCauses
Missingit
TheMind/BodyDilemma
PARTII:8ImportantAreasofEvaluation
BrainDevelopment
TheImmuneSystem
Thyroid
Pathogens
Toxins
ClostridiumDifficile
Medications
TheEndocrineSystem
CentralNervousSystemPathologies
MedicalIllnessesLinkedtoMentalProblems
References

PARTI:UnderlyingCauses
Anumberofthosewhoareexposedtostressfullifeeventsbecomeill,butmostdonot.Conversely,
itispossibletofallilldespitelivingalifeofunruffledstability.
PaulMartin,Ph.D.TheHealingMind
Sincethedawnofcivilization,mentalillnesshasfascinatedus.Inancienttimes,unusualandbizarre
behaviorswerethoughttobecausedbygods.Othersocietiesbelievedthatthesebehaviorswere
duetopossessionbyincubianddemons.
Morerecenttheoriesincludedorganmalfunction,suchasthebeliefthathysteriawascausedbya
wanderinguterus.OtherstoutedHippocratesimbalanceofhumors.Morerecenttheorieshave
includedsuppressedmemory,trauma,poorparenting,andrefrigeratormothers.Themostwildly
heldbeliefofmentalmaladiestodayisthattheyareamanifestationofunrulyneurotransmitters.
Forthelastseveraldecades,thefieldofmentalhealthhasbeendominatedbytwomajor
paradigms:psychotherapyandpsychotropics.
Upuntilacenturyago,mentalillnesseswerediagnosedandtreatedbymedicaldoctors.Itwasnt
untilabout1948whenthespecialtyofneuropsychiatrywasdividedintotwofields:neurology(which
dealtwithphysicaldiseasesofthebrain)andpsychiatry(whichfocusedonemotionalandbehavioral
problems).Soonafterward,psychotherapydeliveredbynonmedicalprofessionalsbegantobe
consideredavalidwaytotreatmentaldisorders.
Medicalillnessescancausepeopletoexperienceabafflingarrayofemotional,cognitive,and
behavioralproblems.Peoplesufferingfromtheseproblemsareusuallyunawareoftheirmaladies.If
thereareaccompanyingmedicalproblems(e.g.,diabetes,cardiovasculardisease),theymayexhibit
apoorresponsetotherapyand/orpsychotropicmedication.Inaddition,psychologicalreactionsto
knownmedicalproblemscancomplicatemedicalmanagementandtreatment.
Wheneverapatientpresentsapsychologicalproblem,thereisaveryrealpossibilitythatan
underlyingmedicalconditionmaybeafactoreitherasanoutcomeofthepsychologicalcondition
orastheoriginalcause.Understandingtherolethatbiologicalprocessesplayinthatdisordercan
oftenhelpyourecognizetelltalesignsofmedicalcausesofbehavioral,cognitive,andemotional
disturbances.
Althoughmostpatientswillnothaveacausativeunderlyingmedicalcondition,thegrowingimpactof
environmentaltoxins,druginteractions,anddegenerativediseaseshaveincreasedthepossibility

thatthereisamedicaloriginforthecondition.
Whilepsychotherapistsshouldnotliveinfearofmissinganunsuspectedmedicalorigin,itis
importanttohaveadequateknowledgeofthemedicalissuesthatcouldpotentiallyrelatetotheir
patients'conditions.Thiscoursewillprovideanoverviewandsourceofreferencetohelpmakea
basicassessmenttodeterminewhethermedicalconsultationmightaddinsighttoacase.Naturally,
itisnotintendedtoprovidepsychotherapistswiththetoolsneededtodiagnosethesemedical
conditions.Itwill,however,laythegroundworktoallowatherapisttospeakinaknowledgeableway
withconsultingphysiciansandimprovethelikelihoodofagoodevaluationforthepatient.
Althoughnoteverymentalhealthproblemismaskingaprimarymedicalcondition,onethingis
certainwhenthereisanunderlyingmedicalcomponent,psychotherapistswhodonotconsiderthe
possibilityarecertaintomissthediagnosis.

Missingit
Manymentalhospitalsarelivingmuseumsofundiscoveredbodilydisease.
FMRWalshe,MD
Themorethatisunderstoodabouthowthehumanmindprocessescomplexinformation,themore
itbecomesclearthatcertainsituationsareparticularlysusceptibletolessthanoptimaloutcomes
becauseoftheseerrors.
AntoinetteLaskey,M.D.,M.P.H.
Considerthisscenario:Afamilycomestoapsychotherapistforhelpbecausethemiddlechildhas
beendefiantanddifficult.Herefusestogotobedatnight.Duringtheday,heishyperreactiveand
noncompliant.Thisoftenleadstofamilysquabbles,whichfrequentlymorphintoarguments
betweentheparents.Asthetherapistworkswiththefamily,itbecomesclearthatthefightsare
exacerbatedbythehusband'sangryoutburstsandboutsofrage.Althoughthefamilyworkshardto
improveitscopingskills,communication,andproblemsolvingabilities,theconflictspersist.
Itisabafflingsituation.Neitherthetherapistnorthefamilymembersareawarethatthefather,who
livesonadietoffastfood,hasdevelopedextremelylowlevelsofomega3fattyacids.Thismedical
condition,nothisemotionalprofile,istherootcauseofhisangerandrage.Withoutaphysicaland
labtesting,thisproblemwilllikelynotbedetected.
Althoughmanypsychotherapistsareawareofthepossibilitythatunderlyingphysicalconditionscan
causeorexacerbateemotionalissues,therealityisthatamajorityofmentalhealthpractitioners
spendmostoftheirtimetreatinguncomfortablefeelingsorsocialproblemsnotmentaldisorders,
muchlessmedicalproblems.Asaresult,theycaneasilymissthesignsthatmightleadthemto
recommendaprofessionalmedicaldiagnosis.
Eveninternistsandphysiciansathospitalsoftenmisstheunderlyingmedicalcausesofmentaland
emotionalissues.Despiteadvancesinmedicaltechnology,thereisstillnotesttodefinitivelyidentify
mentaldisorders.Atbest,medicalevaluationscanprovidecluesandhelpeliminatesomeofthe
variables.Whenthepatient'ssymptomsdonotcorrespondpreciselytothereferencebooksorto
similarcasestheyhavepersonallyencounteredinthepast,aphysicianmaymakeamisdiagnosis
aseasilyasapsychotherapistmight.
Thechallengeoffindingpotentialunderlyingmedicalcausesiscomplex.Thismakesfailureto
recognizeanddiagnoseanunderlyingconditioninapatientareasonablycommonoccurrence.

Biasindiagnosis:HowWeMissIt
Therelianceonpatientselfreportofsymptomseverity,andontheclinicians'impression,isarate
limitingstepineffectivetreatment.

HelenLeNiculescu,Ph.D.
Searchingforcauses
Weintendtoforgettherichnessofourignorancehowmuchwedontknowandhowessentially
welearnedwhatwedonow.
DanAginPh.D.BiologicalPsychology
Formostpsychotherapists,agoodproportionofclientscomeforhelpincopingwiththeproblemsof
life.Thesemayincludeunwantedmoods,uncomfortablethoughts,personalproblems,relationship
problems,and/orfamilystrife.
Outpatientpsychotherapy,couplestherapy,andfamilytherapyaresomeofthemanytechniques
designedtoaddressthesewoes.Familytherapistsroutinelyworkwithquarrelingcouplesand
troubledchildrenamidwhatareoftencalleddysfunctionalfamilies.Whilepsychologistsandother
mentalhealthprofessionalsinprivatepracticealsoaddressfamilydynamics,theyaremorelikelyto
spendtimeworkingwithpersonalorphaseoflifedifficulties,aswellastreatingsymptomsof
depression,anxiety,andpanicattacks.
Thereisnodoubtthatmanyfamilytherapiesandpsychotherapiescanbeusefulandeffectivein
amelioratingtheseproblems.Familytherapy,couplestherapy,grouptherapy,cognitivebehavioral
therapy,andothertechniqueshavebeenshowntobequiteeffectiveinattenuatingmooddisorders,
relationshipproblems,andsocialquandaries.
Althoughpeoplemayleavetherapyfeelingbetter,problemsoftenrecur.Evencouplesorfamilies
wholeaveyourofficethankingyouprofuselymayreappearatyourdoorsixmonthslater.People
withchronicdepressioninevitablyrelapse.Theseeventssuggestthat,beneathapresenting
problem,maylayanundetected,chronicpathologythatistherootcauseoftheirwoes.Most
psychotherapistsarenotmedicaldoctors,researchscientists,orgeneticists.Nevertheless,all
mentalhealthprofessionalstodaymusthaveaworkingknowledgeofhowthebodyworksandhow
theworldweliveinaffectsbrainfunction.
Inthelastfewyears,incredibledevelopmentsinneuroscience,genetics,epigenetics,physiology,
pharmacology,theimmunesystem,toxicology,andnutritionindicatethatmanymentalproblemscan
becaused,exacerbated,andtreatedbyalterationsinbiologicalandbiochemicalprocesses.
Weseethatforwhichwelook
IllseeitwhenIbelieveit.
ThanePittman,Ph.D.
Psychotherapistsaretaughthowtodiagnosementaldisordersanddeliverpsychotherapy.To
diagnosemeanstoobserve,identify,anddeterminethecauseofadiseaseordisorder.Tomakea
differentialdiagnosismeanstodistinguishbetweendisorderswithsimilarpresentationsby
comparingtheirsignsandsymptoms.
Thediagnosisofamentaldisorderismostoftendonebyobservingsignsandsymptomswhichfit
thediagnosticcriteriaintheDiagnosticandStatisticalManual(DSM).Practitionersalsousetests
andassessmentsasdiagnosticstools.Althoughthesetechniqueshavevalue,theyseldomaddress
thecauseofthementaldisorder.
Inhisbook,ADoseofSanity,psychiatristSydneyWalkerpointsoutthatalabelisnotadiagnosis.
DSMVhasincludedacategorynamedtheneurocognitivedisorder,whichwasformallyknownin
DSMIVas'dementia,delirium,amnestic,andothercognitivedisorders.'

Weknowwhatdementia,depression,andcognitivedisorderlooklike,butweoftendonotknow
whatcausesthem.Weusewordslikereactivedepression,endogenousdepression,ororganic
mentaldisorders,butfewprofessionalsactuallyunderstandtheimplicationsoftheseterms.
Thetruthisthatmanymedicaldisordersmanifestthemselvesbypsychologicalsymptomsand
organicmentaldisordersarenotdistinguishableonthebasisofmentalandemotionalsymptoms.
Wediagnosewhatwebelieve
Gettingcaughtinthepresentation
Aninitialevaluationusuallybeginswithaninterviewaboutthepersonsmajorcomplaint.When
peoplecometousforhelp,theydescribetheirproblems.Astheyaredoingso,welistencarefullyfor
signsandsymptoms.Forexample,ifMr.Johnsontellsusheisnotsleepingwell,hasachesand
painsalloverhisbody,haslosthisappetite,andisfeelinghopeless,webegintothinkhemaybe
depressed.Ifhetellsusthathehasracingthoughtsanddifficultysleeping,webegintothinkhemay
havebipolardisorder.Thisstrategyisuseful,butofteninaccurate.
Gettingcaughtinthestory
Oncewebegintofeelconfidentthatwehavethediagnosis,wegetahistoryofMr.Johnson.We
wanttoknowabouthischildhood,hisfamily,hishopes,andhisfears.Wearelookingforpiecesof
hishistorythatfitourtheory.Whenhetellsusthathisfatherrepeatedlyabusedhim,wefeelwe
knowsomethingaboutthecauseofhisproblems.Oftentimes,wedonotquestiontheveracityof
whatwearetoldandhavenosoliddataotherthanhissubjectiveaccounttoindicatethatthismay
bethecauseofhiswoes,butsincethestorydoesfitourbeliefsystem,itbolstersourconfidence.
Gettingcaughtinthetheory
Allmentalhealthprofessionalsaretrainedincertaintheoriesofdiagnosisandtreatment.Theycome
tobelieve,forexample,thatdepressioniscausedbyfaultythinking,iscausedbylackofserotonin,
oriscausedbyrepressedtraumaorabuse.
Oneofthepitfallsofeffectivepsychologicalinterventionistheoreticalbias.Allofushavespecific
training,receivedfromprofessorswhohadtheirownpettheoriesofpsychopathology.Although
beingtrainedinacertaintypeofpsychotherapyhasvalue,italsocanleadacliniciantooverlook
anysignsandsymptomsthatdonotcoincidewithherbeliefsystem.
Iwasstruckbythismanyyearsagowhileingraduateschool.Oneonmyprofessorswhowas
trainedinclassicpsychoanalysisrecountedthecaseofawomaninhermidthirtieswhocouldnot
decideifshewantedchildren.Althoughherhusbandwasclearaboutwantingachild,shewas
ambivalentandworriedthatshewouldbeaninadequatemother.
Theprofessorstheorywasthathispatienthadsomedeep,repressedambivalenceaboutherown
mother.Hefeltconfidentthat,oncethesefeelingscametolight,thepatient'sindecisionwould
disappear.Hetoldusthat,afterfouryearsofpsychoanalytictherapy,shehadstillbeenunableto
makethedecision.Unfortunately,inthiscase,theproblemwasnotwellsuitedforpsychoanalysis.
Astheyearsrolledbyandthepatientbecameolder,theproblemwouldgraduallybecomemoot.
Pettheoriescomeandgo.Somehavevalue,somearefads,andsomearesimplybizarre.In1987,
authorWhitleyStrieberwroteCommunion,anallegedlynonfictionbookdescribinghisencounter
withalienswhomheclaimedhadabductedandsexuallymolestedhim.Afterreadinghisbook,
dozensofpeopleflockedtothefastgrowinggroupofalienabductiontherapists.JohnMack,awell
knownpsychiatristandHarvardprofessor,setthediagnosticcriteriaforalienabductionsyndrome,
whichincludednightmares,sleepparalysis,bruises,phobias,unexplainedscars,andfearofthe
dark.

Duringthisperiod,therewasanotherspateofunusualencountersanupsurgeincasesofpeople
allegedlysufferingfromyearsofsatanicritualabuse,whichpurportedlyresultedinposttraumatic
stresssyndromeandmultiplepersonalitydisorders.Atthetime,Iwasonthetreatmentstaffofthree
psychiatrichospitals.Eachofthesehospitalshadopenedaspecialunitforpeoplewhohadbeen
satanicallyabused.Allsubsequentlydevelopedmultiplepersonalitydisorder.
Ilistenedcarefullytotheexpertsatthehospitalastheyexplainedtheoriginofthesepathologies.
However,IbegintobeskepticalasIsawpeoplecominginwithavarietyofmentaldisorders,allof
whichweredeclaredtobecausedbysatanicabuse.
Inonehospital,treatmentprotocolsdictatedthatallpatientsattendgrouptherapy.Duringgroup
therapy,theywereencouragedtorememberanddisclosetheirsatanicabuseandtosharetheir
multiplepersonalities.Ifthesememoriesandpersonalitieshadnotemergedpriortoadmission,the
patientswereencouragedtomanifestthemthroughthetechniqueofsodiumamytalregression.
Noneofthepeopleinthishospitalwasconsideredtobeamemberofthegroupuntiltheydhad
theirsodium.
Iwasastonishedbyhowmalleablepeoplecanbe.Withtheirhighlevelofanxietyandneedtofitin,
itwaseasytoconvincethesepatientsthattheyhadbeenabductedbyaliensorsatanicallyabused.
Manypatientsleftthehospitalwithmuchmoreseverepathologythantheyhadhadwhentheywent
in.Thispromptedmetobecomeskepticalabouthowdiagnosesweremade,andresultedinmy
writingthebook,TheAbductionEnigma:TheTruthBehindtheMassAlienAbductionsoftheLate
TwentiethCentury.(AsmycoauthorKevinRandalpointedout,thereisalsoacultureboundbiasin
thediagnosisoftheseallegedmaladies.TherearefewAfricanAmericans,Hispanics,orAsiansin
thesatanicabuse,ormultiplepersonalitypopulation.)
Oneoftheunexpectedeventsthatfollowedthereleaseofthisbookwastheangerandoutrageit
spawned.Ireceivedalargevolumeofhatemail,filledwiththreatsandanimosity,from
psychotherapists.Ratherthandisagreementordiscourse,thesementalhealthprofessionalswere
protectiveoftheirfavoredtheoriesandoutragedthatanyoneshoulddisagreewiththeirbelief
systems.Thislevelofbiasisunfortunatelycommonenoughthatitisoneoftheprimaryreasons
peopledonotreceiveobjectivediagnosesandeffectivetreatments.Bytheway,since1987itseems
thatthenumberofabductionshasdeclinedsignificantly.
Wedeliverwhatweweretaught
WebstersMedicalDictionarydescribespsychotherapyas,Thetreatmentofabehaviordisorder,
mentalillness,oranyotherconditionbypsychologicalmeans.Psychotherapymayutilizeinsight,
persuasion,suggestion,reassurance,andinstructionsothatpatientsmayseethemselvesandtheir
problemsmorerealisticallyandhavethedesiretocopeeffectivelywiththem.
Therapyhashelpedthousandsofpeople.Ifyouareinprivatepractice,youknowthatmanyofyour
clientsaregratefulforthehelpyouhavegiventhem.However,youalsoareawarethatsomeofyour
clientsdidnotgetsignificantlybetter.Attimes,whenpeopledonotimprovewithtreatment,welabel
themtreatmentresistant.
Couplestherapyandfamilytherapyareusefulinincreasingthequalityoffamilylife.However,many
mentalhealthpractitioners,marriageandfamilytherapistsarenottaughttoscreentheirfamiliesfor
medicalillnesses.Asaresult,oneormorefamilymemberswithamedicalillnessmaydisplay
behaviorsthataresignificantlydisruptingtothefamilydynamic.Researchoncouplesandfamily
difficultiesareoftenspawnedbyabnormalitiesintheimmunesystemofoneormorefamily
members.Problemsolvingandempathytrainingwillnotfixtheseproblems.
Whenamentalillnessisinvolved,wemaysendthepersontoaphysicianforaprescriptionof
psychotropicmedication.Thissometimeshelps,butsometimesdoesnot.Inthatevent,ratherthan
labelingtheoutcometreatmentfailureortreatmentresistance,itisoftenmoreaccuratetorecognize
theproblemasthewrongdiagnosis.ItmaywellbethattheoutburstsofangerMr.Johnsonexhibits
willnotremituntilthemalfunctionofhisadrenalglandsisaddressed.

Ironically,evenifoverstressedadrenalglandsmustnowbemanagedbeforeMr.Johnsoncan
resolvehismaritalproblems,themaritalproblemsmayhavecontributedtohisexistingcondition.
Stresshormonesarehigherintheconflictedcoupleevenwhentheyaren'targuing,anditrepresents
achronicpatternofstressinthemarriages.
Thequalityofamarriageisastrongpredictorofphysicalhealth.AstudybyJaniceKiecoltGlaser
andhercolleagueslookedatthelevelsofnorepinephrineinthebloodofmarriedcouplesandthen
assessedeachcouplesmaritalstatustenyearslater.Theyfoundthatcoupleswhohaddivorcedby
tenyearshadalreadydisplayeda34percenthigherrateofnorepinephrineatthebeginningofthe
studythancoupleswhostayedmarried.
Distressedmarriagescancauseeffectsontheimmunesystem.Thesefindingssuggestthat
personalrelationshipsbecometranslatedintohealthoutcomes.Theresearchalsosuggeststhat
coupleswithhighlevelsofconflictaremorelikelytopresentwithphysicalillnesses.
Itsnotallinourheads
Alotofwhatpassesfordepressionthesedaysisnothingmorethanabodysayingthatitneeds
work.
GeoffreyNorman
Thediagnosisofamentaldisordermustincludeanevaluationofthepatientsphysicalcondition.It
isessentialtoavoidmissinganunderlyingmedicaldisorder.Mentalhealthprovidersshouldalways
ensurethatthephysicalhealthofthepatienthasbeenthoroughlyevaluatedbeforepsychotherapy
hascommenced.
Thebrainisacomponentofthebody.Itinteractswitheveryorgan,system,andtissue.Whenthe
bodyisnotworkingproperly,itimpactsthebrain.Therefore,amindthatisnotworkingproperlyis
oftenasignofamalfunctionofthebody.
Mentalhealthandphysicalhealthareintertwinedbothtypesofcareshouldbeprovidedandlinked
togetherwithinhealthcaredeliverysystems.
CraigW.Colton,PhDandRonaldW.Manderscheid,PhD.JohnsHopkins
Ithasbeenknownfordecadesthatpeoplewithmentaldisordersdieearlierthattheaverage
population.Inthelastfewdecades,themortalityratehasincreased.Inthe1990s,thementallyill
died1015yearsearlierthanmentallyhealthyadults.By2006,however,theshortenedlife
expectancywas25years.
Manyoftheseearlymortalitiesarethoughttobetheresultofthechangeinmedications.Second
generationantipsychoticmedicationshavebecomemorehighlyassociatedwithweightgain,
diabetes,dyslipidemia,insulinresistance,andmetabolicsyndrome.Butwhilemanyresearchers
believethatthehighmortalityrateinmentaldisordersiscausedbythepsychoactivedrugsgiven,
othersbelievethattheearlydemiseisbecauseofunknownphysicaldisordersthatwerenotlooked
for,detected,ortreated.
Psychotherapyseldombeginswithacompletephysical.Yetresearchsuggeststhatabouthalfofall
psychiatricpatientshaveanundetectedphysicalillness.Thisillnessmayormaynotbethecauseof
thementalsymptoms,butitmustbetakenintoconsideration.
Researchsuggeststhatabout80percentofphysicalillnessesaremissedduringinitialmentalhealth
assessments.Mostoftenthisoccursbecausetheclinicianhasnotspenttimetakingathorough
medicalhistory.Thedangerhereisthatmanypeoplewithemotional,mood,orthoughtdisorders
tendtoseekoutmentalhealthservicesbeforetheyconsideramedicalassessment.Itisnotuntil
theygetworseordevelopobservablephysicalillnessthattheyseekmedicalhelp.Unfortunately,by
thistimethediseasehasprogressedtoaseriouslevel.

Signsofmedicallyinducedpsychologicalsymptoms
Themedicalprofessionisunconsciouslyirritatedbylayknowledge.
JohnSteinbeck
Recognizingamedicalproblemthatiscontributingtoamentalillnessisdifficult,butthereare
certainredflagsthatsuggestphysicalcauses.Aftertheinitialquestion,"HowcanIhelp?"keep
thesefactorsinmind:
Treatmentresistance
Whenapersondoesnotrespondtowellknowntreatmentsforadisorder,themostlikely
explanationisthattheydonothavethedisorder.Thereisnoknownillnessthatis"treatment
resistant."Ratherthanblamethevictim,seekanotherdiagnosis,andifneeded,seekanother
treatment.Efficacystudiessuggestthataboutonehalfofpeoplewithpsychologicalproblemswill
benefitfrompsychotherapies,psychotropics,orboth.
Theabsenceofpersonalandfamilyhistoryofpsychiatricillnesses
Therearelotsofkidswithbehaviorproblemswhomayoutgrowthemontheirownwithout
medication,versustheminoritywithmentalillnessesthatneedtreatment.Familyhistoryisthe
quickestandcheapestwaytosortthatout.
RickNauertPhD.
Mostpeopleareawarethattheircurlyhaircamefromtheirgrandfatherandtheirbigearscamefrom
theirmom,buttheyseldomseetheirdarkmoods,pessimism,andshorttempersastraitshanded
downfromtheirUnclePhil.Infact,mostmentalillnessesdoruninfamilies,whichsuggestthatthey
haveageneticand/orperhapsenvironmentalcomponent.Manyfamilieshavelonghistoriesof
mentalproblems,ormedicaldisordersknowntocontributetomentalproblems.Forthisreason,an
intakeinterviewshouldalwaysincludeapersonalandfamilialhistoryofmedicalandmental
illnesses.Theabsenceofmentalillnessinafamilyisasignalthatthemaladyinthispersonhasa
higherprobabilityofbeingcausedorexacerbatedbyaphysicalailment.
Lateonsetsofinitialpresentation
Roughlyhalfofalllifetimementaldisordersstartbythemidteensandthreequartersbythemid
twenties.Thosewhodevelopmentaldisordersforthefirsttimeinlatelifearemorelikelytohave
medicalconditionsthatcontributetoorcausetheirproblems.Significantchangesoccurwithnormal
aging.Bodymass,hormones,nutrientabsorption,andvascularchangeshaveprofoundimpactson
brainfunction.Forexample,peopleoverfiftyaremorepronetodepressioncausedbynutritional,
arthritis,cardiovascular,andendocrinedisorders.
Arapidonsetofsymptoms
Mostmentaldisordersdevelopslowlyandgetworsewithtime.Therefore,thesuddenonsetofa
mentaldisorderisaredflagforbiologicalabnormalitiessuchasvasculardisease,strokes,
nutritionaldeficits,infections,hormoneirregularities,tumors,orexposuretotoxins.
Fluctuationofmentalsymptoms
Althoughmanymentaldisordersmayfluctuateovertime,volatilityofsymptomsisunusual.
Fluctuationofmentalstatusoftenindicatesadementia,delirium,ormetabolicdisarray.Deliriumcan
becausedbymanymedicaldisorders,particularlyinfectionsandinflammation.Bladderinfections
mayhavenoovertsymptomsotherthandeliriumandmaygoundetectedformonths.Exposureto
toxinsmayalsopresentwithwaxingandwaningmentalsymptoms.

Anatypicalpresentation
Asdiscussedearlier,mostmentaldisordersarediagnosedbytheirsymptoms.Forthisreason,when
apersondisplaysclassicsymptomsofamentalillness,butalsohassymptomsthatdonotfitthe
criteria,medicalproblemsshouldbeconsidered.
Unusualsleeppatterns
Peoplewhoworkswingornightshiftstendtohavemoreemotionalproblems.Theyoftenhavea
constantsleepdeficitwhichmakesthempronetomooddisordersandproblemswithmemoryand/or
concentration.Sleepdisorders,suchasapnea,maygoundetectedforyearsorbemisdiagnosedas
attentiondeficitdisorderordepression.
Unusualnutritionandeatingpatterns
Nutritionplaysasignificantpartinallmentalillnesses.Athoroughdietaryhistoryisessential.Eating
patternsalsoplayapartinmoodandbehavior.Forexample,childrenwhodonoteatbreakfastare
morelikelytobediagnosedwithattentiondeficithyperactivitydisorder.Getathoroughlistoffavorite
foods,favoritebrandnamefoods,andfavoritebeverages.Also,documentanyandallknownfood
allergiesorsensitivities.
Abnormalitiesinmovement
Becognizantofanyabnormalitiesinthemotorsystem.Thisincludesticsdisturbancesofgaitand
balanceclumsinessandproblemswithspeech,language,orenunciation.Allofthesesuggest
problemsinthemotorsystem.ThesecanbesignsofTourettesDisorder,basalgangliaproblems,or
motorneurondisturbances,allofwhichcanpresentasmentaldisorders.
Substanceuseorabuse
Undisclosedsubstanceabusemaybethecauseofthesymptomsyouobserve.Inmanycases,the
personusingthesesubstanceswillnotdiscloseoradmitsubstanceabuse,whichmakesany
diagnosisinvalidorsuspect.Othersdonotseetheconnectionbetweentheuseofthesubstance
andtheirproblems.Otherssimplydonotwanttostopusingitand,therefore,arereluctantto
disclosetheuseofthesubstance.
Medicationandsupplementinducedsymptoms
Stoppingamedication,changingmedications,andexperiencinginteractiveeffectsofmedications
canchangementalstatus.Inaddition,aspeopleage,medicationsmaybemetabolizeddifferently.A
medicationtheyhavebeentakingformanyyearsmaybegintocauseproblems.Thisistruenotonly
ofprescriptionmedications,butalsooverthecounterremedies.
Polypharmacyhasbecomeasignificantfactorinmentalhealth,particularlyinelderlyadults.The
worldofnutritionalsupplementsisexploding.Itislikelythatsomeofthepeopleyouseewillbe
takingmultiplesupplements,suchasvitamins,minerals,aminoacids,herbalextractsand
neuroactivefats,suchasomega3.Anyoneofthesesubstancescancausemetabolicchanges.
Theymayalsointeractwithmedications.Alwaysaskaboutointments,creams,cosmetics,
hairsprays,andotherchemicalsintheirenvironment.
Recentremodel,move,ortravel
Mentaldisordersarenotrareamongtravelers
WorldHealthOrganization

Travel,especiallytraveloutofthecountry,canalsocauseexposuretounfamiliartoxins,parasites,
andinfectionswhichmaypresentasemotional,cognitive,andbehaviordisorders.Askingabout
recentmoves,homeremodeling,andtravelisessential.Movingisstressful.Thisexperiencealone
cancauseenoughstresstodestabilizeamind.Moreover,thenewhomeortheneighborhoodmay
alsocontaintoxinsandenvironmentalloadsthatcontributetomentalproblems.Remodelingusually
meansexposuretopaints,carpets,adhesivesandotherchemicalswhichcancausemental
problems.
Exposuretotoxins
Unfortunately,neurotoxicityisbecomingamajorcontributortobothphysicalandmentalillnesses.
Thehighlevelsofcontaminantsinourenvironmentscannolongerbeignored.Itisimportanttoask
thepersonsvocation.Doestheirjobexposethemtotoxins?Athome,dotheyuseinsecticides,
herbicides,fertilizers,orroomdeodorizers?Doesyourclienthavepets?Arethepetsusingflea
spraysorothermedications?Familieswhoworkintheagricultureindustryhaveahighincidenceof
depression,anxiety,andsleepdisordersoftencausedorexacerbatedbypesticideexposure.
SocioeconomicStatus
Althoughaskingapersonhowmuchmoneytheymakemaybeinappropriate,socioeconomicstatus
isausefulpieceofdiagnosticinformation.Ingeneral,lowsocioeconomicstatusincreasestheriskof
psychologicaldisorders.Infact,oneofthemostconsistentlyreplicatedfindingsinsocialscience
researchisthenegativerelationshipofsocioeconomicstatuswithmentalillness.Lessincomemay
resultinlivinginaneighborhoodwhichhashighercrimeratesandhigherlevelsoftoxins.Itmay
dictatewhichgroceriesarepurchased.Itmayalsogiveyouinformationaboutthepersonsvalues,
beliefsystems,andcopingskills.
Doctorshopping
Getathoroughhistoryofvisitstodoctorsandmentalhealthclinicians.Whatweretheoutcomes?
Hastherebeenarecentphysical?Athoroughphysicalisanessentialpartofdiagnosingand
treatinganymentaldisorder.Thedifficultyhereisthattherearehundredsofmaladiesandmetabolic
anomaliesthatcancausementalproblems.Ageneralphysicalcannotassessallmaladies.Unlessa
personissufferingfromacommonphysicalillness,itisnotunusualthatthecorrectmedical
diagnosiswillbemissedoveraspanofseveralyears.Infact,thereasonforthepersonsvisittoyou
maybebecausephysicianshavefailedtofindabiologicalcauseofthepresentingproblemand,
therefore,havelabeledthemaladyamentaldisorder.
Aneurologicalexamisuseful,butrarelydoneunlessapersonhassignificantlyunusualbehaviors.
Conditionsthatinvolvesubcorticalregionsofthetemporallobearecommonlyassociatedwith
delusions,unusualsexualbehavior,andparanoia,butaroutinephysicalwillnotincludetestssuch
asanEEGorbrainscan.
Abnormalvitalsignsorlabtests
Abnormallabresultsmaysuggestamedicalcauseofamentalsymptom,butkeepinmindthatlab
levelsarenorms,notpeople.ProblemssuchasB12deficiencyandthyroidproblemsoftenoccur
evenwhenlabscomebacknormalandare,therefore,frequentlydiagnosedasmentalillness.
Subclinicalabnormalitiesofcalciumormagnesiummaynotreachlevelsthatwouldbediagnosable
asabnormal,butmaycausesignificantproblemsinthecentralnervoussystem.
Religiousandspiritualhistory
Religionandspiritualityplayasignificantpartinmentalhealth.Theyshapeapersonsbeliefsystem
diet,andlifestyle.Researchshowsthatreligiosityiscorrelatedwithbrainstructure.Researchalso
showsthat,ingeneral,peoplewithwelldevelopedreligiousbeliefstendtobehealthierthanthose

whoarenot,whilehyperreligiosityissometimestiedtomentalproblems,particularlyseizures,
depression,mania,paranoia,andpsychosis.
Smoking
Alwaysaskifyourclientisorhaseverbeenasmoker.Smokinghaslongbeenlinkedtodepression.
Ithasbeenfoundthatdepressedteensaremorethantwiceaslikelytobecomemoderatetoheavy
smokers.Teensthatarenotdepressed,butbecomeheavysmokers,arefourtimesmorelikelyto
becomedepressedlaterinlife.
Nicotinealsoaffectsthelocuscoeruleus,locatedinthebrainstemwhichregulatesbrainregions
responsibleforemotionandmood.Researchersbelievethatitisthenicotineintobaccothatmimics
theeffectsofdrugsthatproduceantidepressanteffects.Longtimesmokershaveapproximately60
percentlowerlevelsoftheproteintyrosinehydroxylaseand40percentlowercountsofalpha2
adrenoceptorsinthebrain.Tyrosinehydroxylasehelpstomanufacturenoradrenalineanddopamine.
Bupropion(marketedasWellbutrinandZyban)isanantidepressantthatalsohelpssmoking
cessation.Itactsasanorepinephrineanddopaminereuptakeinhibitorandnicotinicantagonist.(Be
awarethatBupropionisknowntocauseseizures.)
Thereisalsoevidencethatsmokingcandamagethethyroid,causingorworseningthyroid
problems.
Tobaccosmokecontainscyanide,whichinthebodyisconvertedtothiocyanate,whichthenactsas
anantithyroidagent,directlyinhibitingiodideuptake,interferingwithhormonesynthesis.
Youshouldalsoaskiftheirmothersmokedduringherpregnancy.Thereisalsoevidencethat
maternalsmokingcanaffectthefetalbrain.Smokingduringpregnancyiscorrelatedwithlowbirth
weight,butitisalsoassociatedwithlowscholasticachievement,conductdisorder,andattention
deficithyperactivitydisorder.Inaddition,maternalsmokingduringpregnancyisalsoassociatedwith
earlierageofoffspringinitiationofsmokingandonsetofregularsmoking.
Knownunderlyingmedicalconditions
Sincesomanymedicalillnessesmanifestthemselvesasmentalillnesses,athoroughmedical
historyisessential.Ifyourclienthasknownmedicalconditionsatthetimeyouseeher,startthere.
Exploretheknownpsychologicalsymptomsthataccompanythisdisorder.Unfortunately,a
comprehensivephysicalexamisseldomdone.Psychotherapyandpsychotropicsareless
expensive.Thetechnicaltermforthepresenceofamentaldisorderandmedicaldisorderoccurring
togetheriscomorbidity.Whatismissedisthat,attimes,themedicalproblemisthemajorcauseof
thementaldisorder.Forexample,comorbidityiscommoninanxietyanddepressivedisorders,
particularlyincardiovasculardisease,skinproblems,anddiabetes.
Afamilyhistoryofmedicalillnesses
Themainriskfactorsidentifiedfordevelopingdepressivedisorderswere:beingfemale,over40
yearsoldandbeingmarried.
HernndezBentezCT,GarcaRodrguezA,LealUgarteE,PeraltaLealV,DurnGonzlezJ.
Manymedicalconditionsincludingheartdisease,breastcancer,prostatecancer,diabetes,
alcoholismandAlzheimer'sdiseasehavebeenshowntobepasseddownthroughfamilies.
Physicalillnessesorvulnerabilityforillnessesrunsinfamilies.Theseillnesspatternscanbecaused
bygenetics,butalsoarerelatedtoidiosyncraticfamilydiets,lifestyles,exposuretotoxins,
geographiclocation,andsocioeconomicstatus.
Lookforearlyfamilydeaths.Peoplewithmentalillnesstendtodieyoung,butsodotheirfamilies.A
primeexampleofafamilialpatternofmentalillnessistheconnectionbetweenheartdiseaseand

depressioninfamilies(whichispresentedbelow).Relativesofpeoplewithearlyonsetmajor
depressiondieyoungerthanthenormalpopulationanaverageofeightyearsyoungerthannormal
lifeexpectancy.Morethan40percentoffirstdegreerelativesdiebeforereachingage65.Thereis
alsoafivefoldincreaseininfantmortalityrates.Olderfamilymembershaveagreaterthanaverage
incidenceofAlzheimer's.
Isthereasignificantlevelofosteoporosisinthefamily?Majordepressioncommonlycooccurswith
decreasedbonemineraldensity.
Familyhistory,familymedicalrecords,deathcertificates,obituaries,andoldfamilyletterscanbe
valuablesourcesformedicalhistories.Evenoldfamilyphotoscansometimesprovidevisualcluesto
diseasessuchasobesity,osteoporosis,andhairorskinproblems.Athoroughmedicalhistorycan
alsogiveyoudataaboutfamilygeneticsandgeneticfallout.

TheMind/BodyDilemma
Yourbackboneconnectedtoyourshoulderbone.Yourshoulderboneconnectedtoyourneck
bone.
Yourneckboneconnectedtoyourheadbone.IhearthewordoftheLord.
DemDryBones

SomaticSymptomandRelatedDisorders
See,ItoldyouIwassick!
Patient

SomaticSymptomandRelatedDisorders
Signsofsomaticdisorders
Stomachpain

SomatoformMimics
Visualnerveinjury

Constipation,loosebowels,ordiarrhea
Nausea,gas,orindigestion

Lupus
Multiplesclerosis

Backpain
Chestpain

Hearingloss
Cerebrovasculardisease

Paininarms,legs,orjoints
Menstrualcramps

Fluidorelectrolyteimbalances
Huntington'schorea

Painduringsexualintercourse
Headaches

Hypercarbia

Dizziness
Faintingspells
Heartpoundsorraces
Shortnessofbreath

ThefiftheditionoftheDiagnosticandStatisticalManualofMentalDisorders(DSM5),changedthe
termsomatoformdisorderstosomaticsymptomandrelateddisordersandfurthermodified
diagnosticlabelsandcriteria.
Somaticsymptomandrelateddisordersaredefinedaspersistentphysicalsymptomsthatcannot
befullyexplainedbyamedicalcondition,substanceabuse,orothermentaldisorder,andseemto
stemfrompsychologicalissuesorconflicts.Thesedisordersarebelievedtobequitecommon.
Studiesofhealthcareutilizationestimatethat2572percentofofficevisitstoprimarycaredoctors
involvepsychologicaldistressthattakestheformofsomatic(physical)symptoms.Anotherstudy

estimatesthatatleast10percentofallmedicaltreatmentsanddiagnosticservicesareorderedfor
patientswithnoevidenceoforganicdisease.
Theprobleminthiscategoryofdiagnosesisthatthereisnoscientificevidencethatthiscanoccur.
Inotherwords,todate,thereisnoknownphysicalmechanismbywhichemotionaldifficultiescanbe
somatized.ResearcherOliverOyamasuggests,Thesedisordersshouldbeconsideredearlyin
theevaluationofpatientswithunexplainedsymptomstopreventunnecessaryinterventionsand
testing.
Theproblemhereistwofold.Aslongaswelabelunusualmaladiesaspsychosomaticof
somatoform,weriskmissinganunderlyingillness.Althoughtestscanruleoutspecificmaladies,
thereisnomedicalassessmentthatcandiagnosetheabsenceofillness.
Inhisbook,HowDoctorsThink,physicianandHarvardprofessorJeromeGroopmanstatesthat
mostdoctorsbegintomakeadiagnosisinthefirstfewminutesoftheirassessment.Oncethis
processbegins,thedoctormaydismisssymptomsthatdonotfithispreliminarydiagnosis.
Groopmanstates:Clinicalalgorithmscanbeusefulforrunofthemilldiagnosisandtreatment
distinguishingstrepthroatfromviralpharyngitis,forexample.Buttheyquicklyfallapartwhena
doctorneedstothinkoutsidetheirboxes,whensymptomsarevague,ormultipleandconfusing,or
whentestresultsareinexact.Insuchcasesthekindsofcaseswherewemostneedadiscerning
doctoralgorithmsdiscouragephysiciansfromthinkingindependentlyandcreatively.Insteadof
expandingadoctor'sthinking,theycanconstrainit.
Groopmanalsoconfessesinthebeginningofhisbookthathehasnoideahowmentalhealth
practitionersmakeadiagnosis,becausethereisoftencompleteabsenceofanobservablephysical
abnormalitytoverifythepathology.
Onethirdofnewreferralstoneurologyclinicshavesymptomsthatarepoorlyexplainedby
identifiableorganicdisease.Itisnotuncommonforapersonwhohasanarrayofsymptomsthatdo
notfitanyparticulardiseasecriteriatobelabeledashavingsomatizationdisorder.Thepatientwill
thengodoctorshopping,whichwilleventuallygetthemthelabelofhypochondria.Oftentimes,the
suffererwilleventuallyfindadoctorwhoactuallyfindstheundetectedmedicaldisorder,orthe
personwillbecomesoillthatitbecomesclearthatamedicaldisorderisthecause.Diseasessuch
asLupus,multiplesclerosis,Lymedisease,parasites,orintestinalinfectionsareoftenmisdiagnosed
asmentalillness.(Allofthesearediscussedbelow.)

Conversiondisorder
Theconversionsymptomisacodethatconcealsthemessagefromthesenderaswellasfromthe
receiver.
MarcH.Hollender,MD
Thiscausallinkbetweenpsychologiceventsandphysiologicchangesmaybemuchmorecomplex
thanwehavebeenledtobelieve.Orthisassumedcausallinkmaynotexistatall:Concomitant
eventsarenotnecessarilycausallyrelated.
HerbertWeiner,MDPresidentialAddress,AmericanPsychosomaticSociety,1972

Medicalconditionsdiagnosedasconversiondisorders
Multiplesclerosis
Myastheniagravis
Periodicparalysis
Myopathies
Polymyositis
GuillainBarrsyndrome

TheDSMIVTRclassifiesconversiondisorderasoneofthesomatoformdisorderswhichwerefirst
classifiedasagroupofmentaldisordersin1980intheDSMIII.
ThenewdescriptionofsomaticsymptomdisorderinDSM5representsabigstepforward,because
thedecisionhasbeenmadetouse,forclassification,apositivecriterion,namelymaladaptive
reactiontoasomaticsymptom,insteadoftheearliernegativecriterion.
Theprimarycauseofconversiondisorderispurportedlyatraumaticeventorstressfulsituationthat
leadsthepatienttodevelopbodilysymptomsassymbolicexpressionsofapreexistingpsychological
conflict.Manymentalhealthpractitionersbelievethatphysical,emotional,and/orsexualabuseisa
contributingcauseofconversiondisorderinbothadultsandchildren.Infact,theseeventsareoften
correlated,butkeepinmindthatcorrelationisnotcauseandeffect.
Astudyof34childrenwhodevelopedpseudoseizuresshowedthat32percentofthechildrenhada
historyofdepressionorsexualabuse,and44percenthadrecentlyexperiencedaparentaldivorce,
death,orviolentquarrel.Butfamilialstudieshavealsoshownthatconversionsymptomsinfirst
degreefemalerelativesareupto14timesgreaterthaninthegeneralpopulation,suggestinga
geneticpredispositiontothesesymptoms.
Conversiondisorderisalsothoughttodevelopinadultsasalongdelayedaftereffectofchildhood
abuse.Oneteamofsurgeonsreportedacaseofapersonwhowentintoapsychogeniccoma
followingathroatoperation.Thesurgeonsfoundthatshehadbeenrepeatedlyrapedasachildby
herfather,whostifledhercriesbysmotheringherwithapillow.
Intheadultpopulation,conversiondisordermaybeassociatedwithmobbing,atermthatoriginated
amongEuropeanpsychiatristsandindustrialpsychologiststodescribepsychologicalabuseinthe
workplace.OneAmericanwomanwhoquitherjobbecauseofmobbingwasunabletowalkfor
severalmonths.Adultmalessometimesdevelopconversiondisorderduringmilitarybasictraining.
Oneproblemwiththisdiagnosisisthatconversiondisordersseemtobeculturebound.Mental
healthpractitionersintheMiddleEastandAsiahavereportedthatsymptomsofconversiondisorder
intheDSM5andICD10donotfitwiththesymptomsofthedisordermostfrequentlyencountered
intheirpopulations.
Mostconversionsymptomsafflictthelefthalfofthebody.Researchershypothesizethata
dysfunctionintherightamygdalaandparietallobecircuitsarethecauseofthedisorder.Brain
damageintheseareasoftencausesconversionsymptomsandbodyimagedistortions.Some
studiessuggestthatchangesintheseareascouldbecausedbytraumaticevents,whichresultin
changesinbodyimage,perception,andbehavior.
Unfortunately,thereisnowaytoprovethataconversiondisorderiscausedbypsychogenictrauma.
Beforethisdiagnosisisrendered,cliniciansshouldmakesuretheclienthashadacompletemedical
workup.Conversiondisordersmaybesignsofhypoglycemia,anundetectedneurologicaldisorder,
oraseizuredisorder.ResearcherIrajDerakhshanfoundin79consecutivepatientswithconversion
disorder,76percenthadunilateralcerebralabnormalitiesfoundinbrainscans,whileabnormalities
onEEGassessmentswerefoundin78percent.

Hypochondria
Psychologicalandsocialstressorsarearecentelementwhichwehavelearnedoftenprovokeour
bodiesintoanaccompanyinguproarlinkedtomerethought.
RobertSapolosky,1994

SymptomsofHypochondria
Lifetimehistoryofanxiety
Multiplesystemsomatic
symptoms
Unusualarrayofsymptoms

Unusualarrayofsymptoms
Atypicalresponseorpoor
responsetotreatment
Doctorshopping
Noncompliancewithtreatment
Absenceofconcernabout
symptoms
Symptomsexacerbatedby
certainsituations
Apparentsecondarygain
Hypochondriaistheinterpretationofbodilysymptomsassignsofaseriousillness.Frequentlythe
symptomsarenormalbodilyfunctions,suchascoughing,pain,sores,orsweating.
Althoughsomepeoplewillbeawarethattheirconcernsareexcessive,manybecomepreoccupied
bythesymptoms.Typically,thiswilltriggerfrequentvisitstodoctors.
Theyoftenarepreoccupiedwiththebeliefthattheyhaveaseriousillness,andhaveapenchantfor
bodilyfunctions.Theyoftenruminateaboutillnesses,haveanunrealisticfearofinfection,andhave
afascinationwithmedicalinformation.TheymayspendagreatdealoftimeontheInternetlooking
atdiseases,symptoms,andtreatments.
Hypochondriaisclassifiedasananxietydisorder.Thereislittledoubtthathypochondriaisaviable
diagnosis.However,itisalsoclearthatmanypeoplegiventhisdiagnosesactuallysufferfroman
undetectedmedicalcondition.Forexample,Lymediseaseisoftenmisdiagnosedashypochondria.
Inmanycases,afamilyhistorywillrevealthatmanyfamilymemberssufferfromsimilarmaladies.
CharlesDarwinandfiveofhissevenchildrenwerediagnosedassufferingfromeitherhypochondria
ordepression.Itappearsthatthemanwhocreatedthetheoryofnaturalselectionandinherited
traitsmayhavehadafamilialgeneticpredispositionformentalillness.

TheNature/NurtureDilemma
Genetics
Anevolutionaryperspectiveisnotpartofthethinkingrepertoireofapsychiatristwhenfacedwitha
mentallyillpatient."
HagopS.Akiskal,MD
Theworldofgenetestingisexploding.Today,therearedozensofcompaniesthatcandetect
geneticpredispositionstoillness.Asaresult,newtreatmentsareemergingwhichcanaltergene
expression.Thisistheworldofgenomics.Allhealthpractitionersneedtohaveaworkingknowledge
ofthisbreakthrough.
Themappingofthehumangenomehasrevealedamultitudeofgeneswhicharehighlycorrelated
withthepresenceofmentalillnesses.Therapiddevelopmentofgenetictestingcanreveala
personsvulnerabilitytomentaldisorders.
DNAisaseriesofmoleculeslinkedtogetherinamicroscopicspiralcalledachromosome.Humans
have23chromosomes,andeverycellinourbodyhastwoversionsofeachofthe23chromosomes
onefromeachparent.Thiscombinationiscalledadiploidgenome.
Thehumangenomecontainsatotalof30,000genes.FemaleshavetwoXchromosomes,while
maleshaveoneXandoneYchromosome.Weinherithalfofourgeneticprofilefromeachparent.
Bothmalesandfemalesretainoneoftheirmother'sXchromosomes,butfemalesretaintheir
secondXchromosomefromtheirfather.SincethefatherretainshisXchromosomefromhismother,

humanfemaleshaveoneXchromosomefromtheirpaternalgrandmotherandoneXchromosome
fromtheirmother.
Itisforthisreasonthatmanyofusresembleourparents,notonlyinappearance,butinpersonality,
demeanor,socialskills,andcopingskills.Inaddition,wealsomayinheritgenesthatcancauseor
increasetheriskofmedicaldisorders.
Theinterplaybetweenfraternalandmaternalgeneshasconsequencesformentalillnessesaswell.
Ithaslongbeenestablishedthatmostpeoplewithmentaldisordershaveageneticpredispositionto
theirwoes.Weknowthisbecausementaldisordersruninfamilies.However,itisnowevidentthat
thepredispositionstocertainmedicaldisordersarepredictorsofmentaldisordersinfamily
members,andthatfamilygeneticscontributetomood,behavior,andmentalwellbeing.
Recentbreakthroughsingenetictestinghavemadeitpossibletoplotapersonspaternaland
maternalgenesandtheircontributionstodiseasesseparately.Thesediscoverieshaverevealed
thatafundamentalcauseofmanyhumanmaladiesishowthesetwosetsofgenesinteract.
NinetyninepercentofallhumanDNAisidentical,butthatonepercentdifferenceisoftentheroot
causeofmentaldisorders.Thecompletemappingthehumangenomehasallowedresearchersto
scanDNAforgenesthatmaycause,contributeto,orevenpreventmentaldisorders.
Atthetimeofthiswriting,despitetheexplosionofgeneticresearch,onlyasmallnumberofthese
geneshavebeenidentified.Buteventhoughgeneresearchinmentalillnessisstillinitsinfancy,a
personcanstillgathersomeinformationabouttheirgeneticriskofphysicalandmentalillnesssimply
bylookingathisfamilytree.Moreover,lookingatthefamilyhistoryofcertainmaladiescanpredict
otherproblemsinfamilymembers.TheoldTalmudicadagefruitfallsnearthetreeisgenetically
true.Thesefamilialproblemscanbesaidtobefamilyfallout.

Familyfallout
Geneticinheritanceismerelythetemplateuponwhichwebuildouruniquelifeexperience.
JefferyBland,Ph.D.
Ithaslongbeenknownthatmentalproblemsruninfamilies.Whatisnotwellknownisthatthe
childrenandrelativesofpeoplewhohavementalormedicalillnessesarealsopronetoother
illnesses.Thepeopleyouworkwithwilltellyouabouttheirmentalsymptoms,buttheywillseldom
disclosetheirphysicalmaladies.Furthermore,withoutprompting,theywillnotdiscussthemedical
problemsoftheirfamily.Knowingafamilysmedicalandgenetichistorycanrevealtherootsof
pathologyinaclient.
Geneticpenetranceisthelikelihoodthatacertaingenewillresultinaspecificdisease.In2006,
researcherRogerWebb,attheUniversityofManchesterinEngland,showedthattheriskoffatal
birthdefectsishigherinthechildrenofparentswhohavebeenhospitalizedformooddisorders.
Thereisevenmoreriskisassociatedwithmaternalschizophrenia.Moreover,childrenofmothers
whohadpreviouslybeenadmittedtoahospitalforanytypeofpsychiatricdiagnosishadsignificantly
higherriskofdeathfrombirththroughearlyadulthood.Inaddition,therelativerisksassociatedwith
themothersillnessvariedsignificantlybythechildsageandweregenerallygreatestinthefirstyear
oflife,duringtheneonatal(earlyandlate)andpostneonatalperiods.Theriskofinfantdeathamong
childrenwithtwomentallyillparentswassignificantlyhigherthanthatassociatedwithhavingonly
oneaffectedparent.Familieswithfathersormotherswhohaveahistoryofpsychiatric
hospitalizationsalsodoubletheriskofsuddeninfantdeathsyndrome(SIDS)comparedwiththe
generalpopulation.Ifbothparentswerehospitalized,theriskofSIDSwasincreasedbyalmost
sevenfold.ThereisevidencethatSIDSmaybeinpartcausedbyabnormalitiesofserotonininthe
brainstem.

Depression

Beneaththeemotionalsurfaceofmoodanddepressioncanbearagingphysicalundercurrentof
hormonaldistortions,impairedimmunity,andinflammation.
WilliamDavis,MD,FACC
Thereisstrongevidenceofagenetictransmissionofrecurrentmajordepression.Infact,havinga
familymemberwithmajordepressionincreasesaperson'sriskeightfold.Heritabilityisconsidered
tobeabout3040percent.Ahistoryofdepressioninaparentisthestrongestriskfactorfor
depressioninachild.
ResearcherMyrnaWeissmanatNewYorkStatePsychiatricInstitutefoundhighratesofpsychiatric
disordersparticularlyanxietydisordersinthegrandchildrenoffamilieswithtwogenerationsof
majordepression.Fiftyninepercentofthesegrandchildren,withameanageoftwelveyears,were
sufferingfromapsychiatricdisorder.Atwinstudyfounda46percentconcordanceofdepressionin
identicaltwinsand20percentinfraternaltwins.Interestingly,inthisstudy,sharedfamily
environmenthadnoimpactondepression.Researchalsosuggeststhattheriskofdepressionis
associatedwithhavingoftwoormorefirstdegreerelatives(parents,siblings,orchildren)with
AlzheimersorParkinsonsdisease.
Thishighlevelofmortalityinfamilieswithdepressionmaybelinkedtoheartdisease.Asignificant
numberofstudiesshowarelationshipbetweendepressionandcardiovascularproblems.Studies
reporttheprevalenceofmajordepressionincardiacpatientsasbetween17percentand27percent
inhospitalizedpatients.
Serotoninmayplayapartindepression,butisalsocontributestocardiovasculardisorders.
Serotoninplaysaroleinplateletaggregation,andplateletserotoninlevelscorrelatenegativelywith
severityofdepression.InaclinicalstudyUniversityofPittsburgh,bloodplateletserotoninlevels
were39percentlowerinpatientswhohadmadeasuicideattempt.
Recently,scientistshavediscoveredagenethatcontributestodepression,calledtheserotonin
transportergene.Twoformsofthegenehavebeendiscovered,describedastheshortandlong
geneform.Somestudiessuggestthatinheritingtheshortformofthegenedoublestheriskof
depression,butrecentstudiesfoundnocorrelation.Thosewhocarrytwocopiesoftheshortversion
ofthegenearealsomorepronetoalcoholabuse.

Bipolardisorders
Ithaslongbeenknownthatbipolardisordersalsohaveahighgeneticpredisposition.Thegenetic
penetranceofbipolardisorderisabout70percent.Whatisnotaswellknownisthatbipolardisorder
hasalsobeengeneticallylinkedtocystickidneydisease,adisorderinwhichcystsgrowinginthe
centerofeachkidneycausethemtomalfunction.Inonestudy,outofsevenmemberswith
medullarycystickidneydisease,fivehadbipolarIdisorder,onehadunipolardepression,andone
hadahyperthymicphenotype.Twoknowngeneticlociofcystickidneydiseasearefoundinregions
ofchromosomes1and16areasthathavebeenpreviouslylinkedtobipolardisorderand
schizophrenia.
Thechildrenofparentsdiagnosedwithbipolardisorderaremorelikelytoexhibitdisruptivebehavior
disorders,separationanxietydisorder,generalizedanxietydisorder,socialphobias,ordepression.
Theseproblemsusuallyemergeinearlyormiddlechildhood.
HagopSourenAkiskal,thedirectoroftheInternationalMoodCenterinSanDiego,hasfound
temperamentdysregulationasanimportantfamilialgeneticfactorinthevulnerabilityformanic
depressiveepisodes.Hebelievesthatatraitknownashyperthymictemperamentisastateoften
foundinfamilieswithfullblownbipolardisorder.Thistemperamentischaracterizedbyupbeat,
highlyenergetic,andoverconfidence.Peoplewiththesetraitsdonotseekhelpformentalproblems
and,therefore,arerarelyseenbymentalhealthprofessionals.Theyoften,however,willseekhelp
formaritalproblems,jobinstability,orproblemswithimpulsecontrol.
Manythoughtsemergeinconsciousnesswithouthavingbeensummoned.

RalphE.Hoffman,MD
Theschizophreniasplagueaboutonepercentoftheworldspopulation.AccordingtotheNational
InstituteofMentalHealth,morethantwomillionAmericansareaffectedbysomeformof
schizophrenia.Thisarrayofillnessescanseverelyimpairaperson'sabilitytomanageemotions,
interactwithothers,andthinkclearly.Symptomsincludehallucinations,delusions,disordered
thinking,andsocialwithdrawal.
Althoughthereareseveraltreatmentsavailabletoday,themajorityofpeoplesufferingfromthese
maladieswillsufferchronicallyorepisodicallythroughouttheirlives.Evenwithtreatment,oneof
everytenpeoplewithschizophreniaeventuallycommitssuicide.
Thereseemtobegeneticandepigeneticcontributorstoschizophrenia.Theheritabilityof
schizophreniaisabout70percent.Severalstudiessuggestthatthereisanincreasedriskof
schizophreniainpeoplewitholderfathers.Theriskofschizophreniaisincreasedforbothmalesand
femalewithfathers55yearsorolder.
Thereisapeakinschizophreniaeverythreeorfouryears,occurringatthesamefrequencyasEl
Nio.Theseasonalpeakinschizophrenicbirthsincreasesthefurthernorthapersonresides.There
isevidencethatlackofUVlightandlowvitaminDmaycontributetoschizophrenia.
In2006,scientistsatColumbiaUniversityassertedthatuptoonefifthofallschizophreniacasesare
causedbyprenatalinfections.Interestingly,Cox2inhibitors,whicharepowerfulantiinflammatory
drugs,areaneffectivetreatmentforschizophrenia.
PatrickMcCann,attheUniversityofOklahoma,hasdevelopedadiagnosticbreathtestthatuses
laserstomeasuretheamountofcarbondisulphideinbreathofchildren.Carbondisulphideisknown
tobeathigherlevelsofinthebreathofpeoplewithschizophreniaevenininfants.Thisallowshim
tomakediagnosesdecadesbeforesymptomsoccur.
Familymembersofschizophrenicsbutwithoutthedisordersareathigherriskforotherproblems.
Forexample,idiosyncraticuseoflanguage(atraitsimilartothethoughtdisorderobservedin
schizophrenia)occursin37percentofclinicallyunaffectedfirstdegreerelativesofindividualswith
schizophrenia,aratealmostsixtimeshigherthanthepresenceofschizophreniainthesame
families.Otherresearchershavenotedthatfamilymembersofapersondiagnosedwith
schizophreniahaveahigherincidenceofseizuredisorders.
Whentheratesforthoughtdisorder,schizophrenia,andrelatedclinicalconditionsarecombined,the
proportionofpotentialgenecarryingrelativesiscloseto50percent,consistentwithadominant
gene,andmuchhigherthanthe6.5percentrateofschizophreniainthesamefamilies.Family
membersalsohavedifficultyfollowingaslowmovingtargetwithone'seyes,syntaxerrors,or
idiosyncraticuseoflanguage.Physically,theyoftenhavesubtleanomaliesinthemidlineoftheface,
andhavedifficultyfilteringoutnoisesandotherirrelevantstimuli,aconditionknownassensory
gating.
Althoughmethamphetaminedoesnotcauseschizophrenia,thegreaterfamilialincidencefor
schizophrenia,themorelikelyanamphetamineuserinthatfamilywoulddeveloppsychosisandthe
longerthatpsychosisislikelytolast.
Adverseexperiencesduringgestationsuchasmaternalstressandinfectionareknownriskfactors
forneurodevelopmentaldisorders,includingschizophrenia,autism,andattentiondeficit/hyperactivity
disorder.Prenatalinfluenzavirusinfectionhasbeenassociatedwithanincreasedriskof
schizophrenia.

WolframSyndrome
MentalsymptomsofWolframSyndrome
Depression
Violence

Anxiety
Panicattacks
Suicide
ChronicFatigue

PhysicalsymptomsofWolframSyndrome
Type1Diabetes(betweenages5and15)
Frequenturination
Constantthirst
Bedwetting
Visualimpairment
Colorblindness
Seizures
WolframSyndromewasfirstdescribedin1938asafamilialdisorderusuallypresentingwithType1
(juvenileonset)diabetesandvisionloss.Thesyndromeisanautosomalrecessivedisordermeaning
thatitonlyoccursinindividualswhohavereceivedonecopyofthegenefromeachparent.Itis
causedbyageneontheshortarmofchromosome4.Thefrequencyofcarryingtherecessive
genetictraitintheUSpopulationisapproximatelyonepercent.
Thesyndromeisalsocharacterizedbythepresenceofneurogenicbladder(frequenturination),
hearingdeficits,andotherneurologicalproblems.Amajorityofindividualswhohavetwomutant
WolframSyndromegeneshavethesedistinctivesymptoms.Despitethearrayofsymptoms,most
peoplewillhavethedisorderforseveralyearsbeforeanaccuratediagnosisismade.
WolframSyndromemayalsopresentwithpsychologicalsymptoms,suchasdepression,violentand
assaultivebehavior,chronicanxiety,panicattacks,andhallucinations.Manyattemptsuicide.Most
peoplewiththedisorderdieprematurelywithprogressive,widespreadatrophicchangesthroughout
thebrain.Unfortunately,60percentofthosewiththesyndromediebyage35.
Whileittakestwoaberrantgenestomanifestthefullblownsyndrome,thosewhocarryasingle
mutation,aconditioncalledWolframSyndromeHeterozygotes,havenodistinguishingphysical
characteristicsbutconstituteapproximatelyonepercentofthepopulation.
FamilymemberswhocarryasinglemutationintheWolframSyndromegeneare26timesmore
likelytorequirehospitalizationfordepressionandsuicideattemptsthanpeoplewhodonothavethe
gene.ResearchersRonnieandMichaelSwiftatNewYorkMedicalCollegeestimatethateven
thoughonlyonepercentofthegeneralpopulationcarriesthegeneabout25percentofthe
patientshospitalizedforpsychiatricdifficultiesmaybecarryingthegene.

Hemochromatosis
Unfortunately,wehavebeenmisledintothinkingthathereditaryhemochromatosisisrare,andwe
donotyetthinkofironoverloadasasomaticfactorintheetiologyofpsychiatricillness.
PaulCutler,MD

Mentalsymptomsofhemochromatosis
Lethargy
Chronicfatigue
Depression
Lossofsexdrive
Cognitiveandmemoryproblems

Mania

Physicalsymptomsofhemochromatosis
Historyofmultiplebacterialinfections
Painsinthefingers,knees,hips,andankles
Prematuremenopause
Abdominalpain,diarrhea,ornausea
Settingoffairportmetaldetectors
Lossofbodyhair
Browningofskinsimilartoasuntan
Heartproblems,suchasarrhythmias
Highserumglucose
Liverabnormalities
Hemochromatosisisageneticdisorderthatcausesironaccumulationinthebody.Peopleof
WesternEuropeandescentwithancestorsfromIreland,Wales,Scotland,orGreatBritainhavea
2040percentprobabilityofcarryingageneforhemochromatosis.AccordingtotheCentersfor
DiseaseControl,Type1hemochromatosisisthemostcommongeneticdiseaseintheUnited
States.
LikeWolframSyndrome,hereditaryhemochromatosisisanautosomalrecessivecondition.The
personmustinherittwomutatedgenes(calledHFE)onefromeachparent.Thistypeofthedisorder
isdeemedresponsibleforsexualdysfunctionin1040percentofmen.Theyexhibitlossoflibidoand
potency,andhavehighironandlowplasmalevelsoftestosterone.
However,insomecases,inheritanceofonlyonemutatedgenemayeventuallyleadtosignificant
ironaccumulation.Althoughthemajorityofthesepeoplewillneverknowthattheycarrythegene,
somewillbegintofeelachesandpainsandchangesinenergyandmood.Thisconditionisalso
thoughttocontributetowhatiscalledtreatmentresistantmentaldisorders.Astudybyresearchers
DavidFeifelandCorinnaYoungCaseyattheUniversityofCaliforniainSanDiegoshowedthat80
percentofpeoplewithtreatmentresistantbipolardisordercarriedonegeneandlackedafamily
historyforthisdisorder.Theyestimatedthatonepercentofpsychiatricpatientswerelikely
candidatesforironoverload.
Commonsymptomsofhemochromatosisarefatigue,achesandpains,disorientation,confusion,
andmemoryproblems.Inthesecases,thediagnosisisoftenmissedforseveralyears,assymptoms
aremistakenfordepressionordementia.Signsoftheillnessusuallyappearbetweenages40to60,
butsomepeopleshowsymptomsasearlyas20.Patientssufferingfromidiopathic
hemochromatosisexhibitlowplasmalevelsoftestosteronewithlossoflibidoandpotency.
ItwasEugeneWeinbergthatwasthefirsttolookattheeffectofironinourbodies.Hefoundthatthe
presenceofhighironcouldcausechronicinflammation.Hemochromatosiscausesinflammationin
theliver,joints,heart,lungs,pancreas,andthebrain,especiallyinthebasalganglia.Thispartofthe
brainisrichindopamine,andinthesecases,ironmaycausedamagetothedopaminesystem
contributingtomanyneurologicaldisorders,includingParkinson'sandAlzheimer'sdisease.The
geneisthoughttoacceleratetheonsetofAlzheimer'sdiseasebyfiveyears.
Inthepast,peoplewithhemochromatosisusuallydidnotsurvivepasttheirfortiesorfifties.Butasa
resultofbetterrecognitionandtreatment,mostpeoplewiththedisordernowhavenormallifespans.
Thishasresultedinanotherproblem,ironoverloadinthecentralnervoussystem.Recentstudies
suggestthathighironstoresarefarmorecommonintheelderlythanhadbeenpreviouslyrealized,
andmaybeariskfactorforAlzheimersdisease.
Bloodlettinghasbeenatreatmentforthisillnessforcenturiesandisstillthetreatmentofchoice.
Anothertreatmentischelationtherapy.Wenowknowthatloweringironisnotonlyusefulfor
hemochromatosis,butmayactuallybebeneficialtotheimmunesystem.Infectionsneedironto

survive.Whenapathogenentersthebody,theimmunesystemblockstheinfectionsaccesstothe
ironstoreinthesystemtopreventitsproliferation.Thehumanbodycontainsmanynatural
chelators.Forexample,mothersmilkcontainsasubstancecalledlactoferrin,aproteinthatprevents
bacteriafromabsorbingiron.

Wilson'sDisease
MentalsymptomsofWilson'sdisease
Personalitychange
Irritability
Aggression
Homicidalorsuicidalbehavior
Depression
Erraticbehavior
Paranoia
Delusionaldisorders
Unusualsexualbehavior(including
pedophilia)
Inappropriatebehavior(especiallysexual)
Cognitiveimpairment
Deterioratingperformanceatschool
Difficultyconcentrating
Insomnia
Fatigue
Wilson'sDiseaseaffectsapproximately1in30,000peopleworldwide,makingitararedisorder.
However,itisestimatedthatatleasthalfofthepeoplewithWilson'sDiseaseareneverdiagnosed,
andthereforewillsuffer,andsometimesdie,fromthedisease.
Wilson'sisageneticdisorderthatcausesthebodytoretaincopper.Theliverofapersonwhohas
thediseasecannotreleasecopperintobileasitshould.Overtime,thecopperreachesatoxiclevel
andinjureslivertissue.Eventually,thisdamagewillresultinhighlevelsofcopperinthe
bloodstream,whichleadstodamageinthekidneys,brain,andeyes.Untreated,highcopperwill
eventuallycauseliverfailureandbraindamage.
Wilson'sDiseaseoccursequallyinmenandwomen.AlthoughsomecasesofWilson'sDiseasecan
occurduetospontaneousgeneticmutation,mostcasesaretransmittedfromgenerationto
generation.TheresponsiblegeneiscalledATP7Bandislocatedonchromosome13.
Inordertoinheritthedisease,bothparentsmustcarrythegene.SiblingsofWilson'sDisease
patientshaveaoneinfourchanceofhavingthedisease.Sincebothofasiblings'parentsare
carriers,onefourthofthesiblings'childrenhavethedisease,onehalfarecarriers,andonefourth
arediseasefreeandcarrynoWilson'sDiseasegene.
ChildrenofWilsonspatientshaveaoneintwohundredchanceofhavingthedisease.Achildofa
Wilson'sDiseasepatienthasa100percentchanceofgettingoneabnormalgene.Thepatient's
spousehasaoneinonehundredchanceofcarryingtheabnormalWilson'sDiseasegene,andhalf
thetime,heorshewillpassiton.Forthisreason,allsiblingsandchildrenofWilson'sDisease
patientsshouldbetestedforWilson'sDisease.Otherrelativeswhohavehadsymptomsor
laboratoryteststhatindicateliverorneurologicaldiseasealsoshouldalsobetested.
BecauseWilson'sDiseaseisoftenmistakenforothermaladiessuchasmultiplesclerosis,
Parkinson'sdisease,orpsychiatricproblems,medicalspecialistsestimatethatonlyaboutone
thousandcasesperyearareeverdiagnosed.Intheearlystagesofthedisease,especiallywhen

psychologicalsymptomsoccur,thediagnosisisoftenmissed.Inastudyofmisdiagnosis,Wilsons
wasdiagnosedinonlyoneoutofonehundredtwentyfourpatients.Thedelaybetweensymptoms
anddiagnosisrangedfromonetofiveyears.
ThemostcommonofbehavioralsymptomsofWilsonsDiseaseincludepersonalitychanges,
especiallyirritabilityandalowthresholdtoanger.Depressionsometimesleadingtosuicidalideation
andsuicideattemptsiscommon.Deterioratingacademicandworkperformanceispresentinalmost
allpatients.Interestingly,manyWilson'sDiseasepatientsexhibitincreasedsexualpreoccupation
andreducedsexualinhibition.Itisalsolinkedwithpedophilia.
AbarriertothediagnosisofWilson'sDiseaseisthatmostpatientshavenofamilyhistoryofit.
Becausebothparentsmustcarrythegenetomanifestthedisorder,peoplewithonlyoneabnormal
geneusuallyhavenosymptoms,ormayhavemild,butmedicallyinsignificant,abnormalitiesof
coppermetabolism,anddonotbecomeill.
PeoplewithWilson'sDiseasemaynothaveanyoutwardsigns,symptoms,orevidenceofillness.
However,peoplewithmildornonapparentWilson'sDiseasewillbecomeseriouslyillandeventually
dieiftheyarenottreated.
SometimesWilsonsisdiagnosedbythepresenceofthepresenceofKayserFleischerrings,which
arerustybrowncoloredringinthecornea.Diagnosesareusuallymadebybloodandlivertests.
Chelationtherapyiscommonlyusedastreatment.Doctorswillalsorecommendavoidingfoodshigh
incoppersuchasliver,shellfish,mushrooms,nuts,chocolate,driedfruit,driedpeas,beansand
lentils,avocados,andbran.

KlinefeltersSyndrome
ScientistsbelievetheXXYconditionisoneofthemostcommonchromosomeabnormalitiesin
humans.AboutoneofeveryfivehundredmaleshasanextraXchromosome,butmanyhaveno
symptoms.Itislikelythatabout60percentofthecasesareundiagnosed.
KlinefeltersSyndromeistheXXYmalewithasetofobservablesymptoms.Symptomsdependon
howmanyXXYcellsamanhas,howmuchtestosteroneisinhisbody,andhisagewhenthe
conditionisdiagnosed.
Childrenwiththisconditionwilloftenexhibitattentiondeficitdisorder.Thesyndromeisnormally
diagnosedduringpuberty.Atthisage,thosewithKlinefelter'sSyndromeoftenhavelessfacialand
bodyhairandmaybelessmuscularthanotherboys.Theyareoftenshyandhavetroublefittingin
withpeers.
Maturemenwiththissyndromehaveseveraldistinguishingcharacteristics,suchastallstature,long
armsandlegs,lankybuild,feminizedphysique,littlechesthair,femalepatternedpubichair,
testicularatrophy,hypogonadism,osteoporosis,breastdevelopment,andlowlevelsoftestosterone.
Thelowtestosteroneaccountsforthelackofdevelopmentofmalesecondarysexcharacteristics.
Theymaybeinfertileandaremorelikelytohavecertainhealthproblems,suchasautoimmune
disorders,breastcancer,veindiseases,osteoporosis,andtoothdecay.
Behaviorally,theyexhibitreducedaggressionandlackofexploratorybehavior.Theyalsohave
troubleusinglanguagetoexpresstheirthoughtsandneeds,butexperienceincreasedlevelsof
emotionalarousal.Problemswithreading,troubleprocessingwhattheyhear,emotionalinstability,
andanorexianervosamayoccur.Themaintreatmentisforthissyndromeistestosterone.

Thyroiddisorders
Ithaslongbeenknownthatcertainfamiliesshowtendenciesforhyperthyroidismand
hypothyroidism.Whatisnotusuallyknownisthatmembersofsuchfamiliesarealsopronetoother
conditionsincludinginsulindependentdiabetes,perniciousanemia(lackofvitaminB12),premature
grayhair,vitiligo(whitespotsontheskin),arthritis,andallergicconditions,includingasthma,hives,
andhayfever.Thereisalsoanincreasedtendencyformembersofthesefamiliestohavevarious

typesofperceptuallearningproblemsanddyslexia.ResearcherLawrenceWoodsuspectsthis
relationshipismissedbecausewomeninthefamilytendtogetthyroidproblems,while
predominantlythemeninthefamilyhavelearningproblems,butareseldomseenbyfamily
physicians.(Seemoreonthyroidlaterinthisdocument.)

MitochondrialDNA
DNAisfoundineverycellofthebody.Anothertypeisfoundinapartofthecellcalledmitochondria.
UnlikecellularDNA,mitochondrialDNAisinheritedfromthemother.DNAinthemitochondria,
therefore,identifiesmaternalriskfactorsofmedicalandmentalillnesses.
Mitochondriaarespecializedorganellesfoundineverycellofyourbody,exceptredbloodcells.
Thereareapproximately1,700mitochondriaineachhumancell.Theyarevitaltotheproductionof
cellularenergy.Infactmitochondriaareresponsibleforcreatingmorethan90percentoftheenergy
neededbythebodytosustainhealth.Insidethemitochondria,ingestedsugarisbrokendowninthe
bodybyaprocessknownasglycolosis,whichchangesglucosetoacompoundcalledadenosine
triphosphate(ATP),whichisthenconvertedintopyruvate.Thepyruvatenextdeliveredtotiny
mitochondria.Whenthissystemfails,lessandlessenergyisgeneratedwithinthecell.Cell
malfunction,andevencelldeath,mayfollow.
Diseasesofthemitochondriaappeartocausethemostdamagetocellsofthebrain.Mitochondria
damagecontributestodevelopmentaldelay,mentalretardation,autism,dementia,seizures,atypical
cerebralpalsy,atypicalmigraines,strokeandstrokelikeevents,andotherpsychiatricdisturbances.
Inearly2000,researchersKatoTadafumiandKatoNobumasaattheUniversityinTokyoproposeda
mitochondrialdysfunctionhypothesisforbipolardisorder.Postmortemtissuesamplesextractedfrom
thehippocampiofthebrainsofnineindividualswithbipolardisordershowedsignificant
mitochondrialdepletion.AsearchformutantmitochondrialDNAinthetissuesamplesrevealedtwo
suspectgenes.
AClevelandClinicsurveyof38outpatientswithmitochondrialdiseasesfound70percentmetthe
criteriaformajormentalillness,including54percentwithlifetimedepression,17percentwith
lifetimebipolar,11percentwithlifetimepanic,and11percentwithcurrentgeneralizedanxiety.On
average,themitochondrialdiseasewasdiagnosedaboutfouryearsaftertheonsetofpsychiatric
symptoms,and14yearsafteraphysicianwasseenfordiagnoses.Genetictestinghashelped
significantlyinidentifyingmitochondrialriskfactors.

Epigenetics
Learningitselfconsistsofnothingmorethanswitchinggenesonandoff.
MattRidley
Outofour30,000genes,onlytwopercentofdeoxyribonucleicacid(DNA)codesforproteins.Until
veryrecently,muchofourDNAwasconsideredtobewhatresearcherscalljunkDNA.Thesegenes
wereconsideredtobethebyproductofmillionsofyearsofevolutiongeneswerestillinheritedbut
werenolongerused.Recently,however,scientistshavediscoveredthatsomeofthisjunkDNA
actuallyswitchesonRNAthatinteractswithothergenes.
Thefieldofresearchofthesephenomenaisepigenetics.Epigeneticsisthescienceofturninggenes
onandoffwithnutrientsandotherchemicals,resultinginchangesofexpressionofthosegenes.
Theprocessofsuppressingandenhancinggenesiscalledmethylation,achemicalprocessthat,
amongotherthings,aidsinthetranscriptionofDNAtoRNAandisbelievedtodefendthegenome
againstparasiticgeneticelementscalledtransposons.
TransposonsarespansofDNAthatthroughaprocesscalledtranspositioncanactuallymoveto
differentpositionswithinthegenomeofacell.

TranspositionwasfirstobservedbyresearcherBarbaraMcClintockthisdiscoveryearnedhera
NobelPrizein1983.Asaresultofherwork,geneticistsnowknowthatthisprocesscanbeactivated
bychangesindiet,drugs,andexposuretotoxins,andcanpermanentlychangeapersonsDNA.
Morefascinatingisthefindingthatthesemutationsmaybeinheritedbychildren.Environmental
toxinshavebeenshowntoaltertheactivityofgenesthroughatleastfourgenerationsafter
exposure.Forexample,womenwhosmokewhilepregnantdoubletheriskofasthmaintheir
grandchildren.
Forthisreason,notwobrainsarealike,includingthoseofidenticaltwins.Itisthoughtthatabout40
percentofourgenescanbemodifiedepigenetically.AlthoughidenticaltwinssharethesameDNA,
theirepigeneticmaterialcanbedifferent.Moreover,theolderthetwinsbecome,themore
discrepancieswilloccurintheirDNA.Fiftyyearoldtwinshavefourtimesasmanydifferentially
expressedgenesthanthreeyearoldtwins.
Evenmoreinterestingisthediscoverythatgenesareregulatedbymaternalcare.Thusfar,atleast
ninehundredgenescanbealteredbymaternalcare.Forexample,thepresenceofavariationinthe
monoamineoxidaseAgene(MAOA)combinedwithmaltreatmentpredictsantisocialbehavior.
Inmid2009,researcherMosheSzyfatMcGillUniversityreportedthatcommonlyused
pharmaceuticaldrugscancausesuchpersistentepigeneticchanges.SzyfandhiscoauthorAntonei
Csokapositthatdruginduceddiseases,suchastardivedyskinesiaanddruginducedlupus,are
epigeneticinnature.(MoreaboutLupusbelow.)Theyalsoproposethatepigeneticchangesfrom
pharmaceuticalsmaybeinvolvedinheartdisease,obesity,diabetes,infertilityandsexual
dysfunctions,aswellasneurologicalandcognitivedisorders.
Smokingcancausechangesingenefunction.Asstatedearlier,thereiscompellingevidencethat
prenatalsmokingincreasestheincidenceandseverityofADHD.TheriskofaseveretypeofADHD
greatlyincreasesinchildrenwhosemotherssmokedduringpregnancyandwhoalsohavevariants
ofoneortwogenesassociatedwithADHDoneonchromosome11andthesecondon
chromosome5.Interestingly,evenchildrenofmotherswhosmokedduringpregnancywhodidn'tfit
allofthecriteriaforADHDhadmoresymptomsofthedisorder.Thiswastrueiftheyhadbeen
exposedtocigaretteuseinuteroorhadgeneticvariationsrelatedtorisk.

PARTII:8ImportantAreasofEvaluation
BrainDevelopment
Weonlyusetenpercentofourbrain.
AttributedtoAlbertEinstein
Theearlyhumanembryoconsistsofthreecelllayers:themesoderm,endoderm,andectoderm.
Themesodermformsmuscleandbone.Theendodermcreatesthecellsliningthedigestiveand
respiratorysystem.Theectodermformstheskin,hair,fingernails,olfactorysystem,andneuralcells,
includingthebrain.Thisisintriguing,sincepeoplewithhair,skin,nail,andolfactoryproblemsseem
tobemorepronetomentaldisorders,whichwillbediscussedlater.
Thebrainbeginsfromaminisculelayeroftissuecalledtheneuralplate.Asthefetuscontinuesto
grow,thereisneuronalmigrationuptheplatetothehead.Theaveragehumanbabygeneratesan
astonishing50,000neuronspersecondduringgestation.
Inthedevelopedbrain,therearetwoessentialtypesofcellsneuronsandglia.(Thewordgliais
derivedfromtheGreekwordforglue).Althoughweusuallythinkofneuronproblemswhenwelook
atmentaldisorders,90percentofbraincellsareglialcellsonly10percentareneurons.Unlike
manyneurons,glialcellsareabletodivideandreproducerapidly.Glialcellssurroundneuronsand
holdtheminplace,supplynutrientsandoxygentoneurons,insulateoneneuronfromanother,and
removedeadneurons.

UniversityofCaliforniaatBerkeleyprofessorMarianDiamondhasbeenoneofthepioneersofthe
theorythatanenrichedenvironmentincreasesbrainfunction.Yearsago,Dr.Diamondobtaineda
sliceofEinsteinsbrain.ComparingacorticalregionassociatedwithhighercognitionofEinsteins
brainwithelevencontrolbrains,shefoundEinsteinsbrainhadsignificantlymoreglia.
Ithadlongbeenthoughtthatglialcellswereprotectorsofneurons.However,intheearly1960s,
Diamondandotherresearchersdiscoveredthatthecorticesfromratpupslivinginenriched
environmentscontainedmoreglialcellsperneuronthanthosefromimpoverishedenvironments.
Thissuggeststhatthattheenvironmentintheearlyyearssculptsthebrain.
Astrocytesareatypeofglialcellthatsurroundthesynapsesbetweenneurons.Itappearsthata
dearthofthesecellsplaysapartinmentalillness.Postmortemstudiesonhumanbrainsof
individualswithmajordepressionorbipolardisorderhavedetectedsignificantlylowerthannormal
levelsofglialcells.
Areductioninthenumberofglialcellsintheprefrontalcortexhasbeenobservedinpeoplewhoare
clinicallydepressed.Therearealterationsofglialcellsinschizophrenia.Astrocyticdamageisalso
foundinmultiplesclerosis,temporallobeepilepsy,amyotrophiclateralsclerosis,lupus,human
immunodeficiencyvirus(HIV)dementia,Alzheimersdisease,andtraumaticinjury,allofwhichmay
presentasmentaldisorders.
Thefunctionofastrocytesistosupplyneuronswithenergy,meaningalowastrocytelevelwould
causeloweractivityintheassociatedneurons.Sodiumvalproateisasodiumsaltofvalproicacid
usedinthetreatmentofepilepsy,bipolardisorder,andamoodstabilizer.Valproicacidprotects
dopaminergicneuronsinmidbrainneuronandgliaculturesbystimulatingthereleaseof
neurotrophicfactorsfromastrocytes.
ResearcherSergePrzedborski,thecodirectoroftheCenterforMotorNeuronBiologyandDisease,
hasfoundthatastrocyteswithamutatedformofagene,superoxidedismutase(calledSOD1),kill
neurons,whicheventuallyisseenasamyotrophiclateralsclerosis.

Earlylifeevents
Talktherapyneedstoaddressourbiologicalselvesaswellasourpsychologicalselves.
JohnRatey,MD
ResearchpresentedattheSecondWorldCongressontheFetalOriginsofAdultDiseasessuggests
thatosteoporosismayactuallybegininthewomb.Ifababyisundernourished,shewillbesmallat
birth,willbesmallatthefirstyear,willoftenhavelowbonemassat25,andwillhaveahigh
probabilityofbonetraumaat70andahighprobabilityofhipfracturesat70.Lowbonemassisalso
linkedtoschizophrenia,depression,andothermentalproblems.
Scientistsnowbelievethatmanydisordersincludingmentaldisordershavetheiroriginsinthe
earlystagesoflife.Forexample,lowbirthweightiscorrelatedwithdepressionafterpuberty.Low
birthweightwasnottheonlycausebutincreasedtheriskeffectsofotheradversities,suchaschild
abuse.
Thevolumeofthehumanbrainincreasesmoreduringthefirstyearoflifethanatanyothertime
therefore,earlyphysicalhealthplaysapartinbraindevelopment.ResearcherJWBDouglasfound
thatchildrenwhohadatleastoneadmissiontothehospitalformorethanaweek'sduration,orwho
hadrepeatedhospitaladmissionsbeforetheageoffiveyears,hadsignificantlyincreasedriskof
behaviordisturbanceandpoorreadinginadolescence.Thechildrenweremoretroublesomein
schoolandathome,andmorelikelytobedelinquentinschool.Asadults,theywerepronetoshow
unstablejobpatternsthanthosewhowerenothospitalizedintheirfirstfiveyears.Althoughthistype
ofhistoricaldatawouldbemosthelpfulinmakingadiagnosis,itisrarelysoughtinanintake
interview.
Besidesearlyillness,earlynutritionalsohaslastingconsequences.Duringtheearlyyears,nutrition
isallocatedinwaysthatgivethechildthebestchanceinearlylife,sometimesattheexpenseof

lateryears.
IntheeraoftheBabyBoomers,formulawasconsideredbymanydoctorsassuperiortobreastmilk.
Mostbabyboomerswerebottlefedbabies.Inonestudy,prematurebabiesfedonlystandard
formulamilkhadnoticeablylowerIQsatschoolagethanbreastfedinfants,andtheywere
particularlybadatmathematics.Asmallareaoftheirleftparietallobewaslessactivethanexpected.
Thedevelopmentalphenomenoncalledprogrammingallowsafetustoadapttosuboptimal
conditions,suchasmalnutrition.Insomecases,thiscanhaveaneffectonbraindevelopmentwhich
couldbetheprecursortoamentaldisorderlaterinlife.

Criticalperiods
Therearesensitiveperiodsforgrowthifnotexposedtoenvironmentatthepropertime,brain
developmentisaltered.Forexample,languageisacquiredinthefirstfewyearsoflife.
NeuralPruningisthedeletionofcells.Overonethirdoftheneuronsinthecerebralcortexare
eliminatedinthefirstthreeyears.Atsixmonths,babiescandifferentiatehumanandnonhuman
faces,suchasmonkeyfaces,butbyninemonths,theylosethisabilitytodiscriminatemonkey
faces.Sincethemonkeyfacediscriminationisnotneeded,itisdeleted.Someresearchersbelieve
thatpruningisalsoresponsiblefordementia.Thetheoryisthat,lateinlife,thepruningsystemis
turnedonandcellsbegintobedeleted.

Corticalgrowth
Corticalmigrationandneuronproliferationarecompleteatfiveandtwelvemonthsofage,
respectively,whilemyelinationisonly50percentcompleteateighteenmonthsafterbirth.Seventy
fivepercentofhumanbraingrowthoccursduringthefirsttwoyearstheremaining25percentisnot
completeduntiladulthood.
Brainsizeinthenewbornisproportionatelygreaterthaninadults.Thenewbornbrainweighsone
thirdofanadultbrain,whilethenewbornweighsonlyfourpercentasmuchastheaverageadult.
Thebloodbrainbarrier,whichrestrictsthepenetrationoftoxinstothebrain,isnotfullydevelopedin
humansuntilaboutoneyearofage.Itisnotknownwhenthebarrierbecomesfullyfunctional.
Connectionsinthevisualsystemarenotfullyachieveduntilthreeorfouryearsofage.Brain
developmentdiffersbetweenboysandgirls,withgirlsgenerallyreachingpeakgraymatterthickness
onetotwoyearsearlierthanboys.
Breastfeedingsignificantlydecreasestheriskofcognitiveandbehavioralproblems.Infullterm
infants,increasingthedurationofbreastfeeding(morethaneightmonths)isassociatedwith
consistentandstatisticallysignificantincreasesinIQ(assessedatageseightandnine)reading
comprehension,mathematicalability,andscholasticability(assessedatagestentothirteen).

Headsize
WhileIamnotsuggestingthatyoumeasuretheheadofyouclients,headsizedoescorrelatewith
mentalfunction.Thephraseeggheadcomesfromtheobservationthatpeoplewithlargeheads
tendtohavehighIQs.
Ithaslongbeennoticedthatheadsizeiscorrelatedwithintelligence.Largerheadsizeisrelatedto
highertestsscoresinglobalcognitivefunctioningandspeedofinformationprocessing.These
observationsarenotconfoundedbyeducationallevel,socioeconomicbackground,orheight.
Largeheadsizemayalsoprotectpeopleagainstcognitivedeteriorationduringaging,which
supportsthereservehypothesisofbrainaging.
Peoplewithsmallheadsize(definedaslessthan21.4inchesincircumference),andthepresence
oftheApo4geneare14timesmorelikelytodevelopAlzheimersdisease.However,largehead

sizeisalsocorrelatedwithsocialspectrumdisorders.Thereisalsoacorrelationbetweensmall
headsizeandschizophrenia.

Genderspectrum
Buttheissueofsexualharassmentisnottheendofit.Thereareotherissuespoliticalissues,
genderissuesthatpeopleneedtobeeducatedabout.
AnitaHill
Humanstendtoidentifythemselvesasmaleorfemale.But,infact,genderidentityisacontinuum.
ResearcherSimonBaronCohenstatesinhisbook,PrenatalTestosteroneinMind,thatthedefault
fetalbrainstructureisfemale.Inamalefetus,testosteroneisreleasedattheseventhweek,which
changesthebrainstructuretothatofamale.Howandwhenthisoccursmayplayapartingender
behaviorandidentity.Severalstudiessuggestthatgaymenaremorelikelythaneitherlesbiansor
heterosexualmentohaveolderbrothers,butnotoldersisters.ResearchersGualtieriandHicks
positthatthismayoccurbecauseofamaternalimmunizationeffect.
Amothercarryingherfirstsonhasverylittleexposuretotheproteinsheismakingbecauseofthe
placentalbarrier.However,witheachdeliverytheinevitablemixingoffetalandmaternalblood
occurs,andherimmunesystemisexposedtoproteinsithasneverseenbeforeencodedonher
sonsYchromosome.Herimmunesystemrespondstotheseproteins,andsubsequentsonswillbe
exposed,viaactivetransportacrosstheplacenta,toantibodiesdirectedagainstmalespecific
proteins,whichthenperturbdevelopmentoftheyoungerson.Thisdecreasesbirthweightand
affectstheeventsthatmasculinizethebrain.

Socialskills
ManyyearsagoIbeganworkingwithTom,anengineerinarocketmanufacturingcompany,who
hadcalledmeforwhathesaidwerephaseoflifeproblems.WhenTomarrivedIaskedhim,How
canIhelp?towhichhereplied,Iamfortyyearsold.So,howcanIhelpIagainreplied.Well,
statisticallymostmenmyagearemarriedandhavetwochildren.Ihaveneverbeenmarried,and
thereforeisseemsclearthatIshoulddosonow.Hethenopenedhisbriefcaseandpulledouta
threeringedbinder.IhaveherealistofcharactertraitsthatIwouldliketohaveinmyfemale
partner,andIwanttoreadthemtoyousothatyoucantellmeinwhathabitatImightfindsucha
person.
Clinicalempathyisanessentialrequirementforeffectivepsychotherapy.Itisthewaywebondwith
ourclientsanditisalsothewayweassessthelevelanddepthoftheirsuffering.
Empathyishardwiredinthebrain.Itisoneofthefundamentaltraitsinpairbonding.Therefore,the
brainhasmultiplecircuitsforunderstandingtheemotionalstateofothers.Humanbrainsare
remarkablyalike.Theyallcontaincerebralhemispheres,acorpuscollosum,whitematter,andother
structuresthatmediatebehavior,thought,andmood.Subtlearchitecturalchanges,however,can
haveaprofoundchangeinthesecapacities.
Researchsuggeststhatthedefaultgeneticblueprintofahumanbrainisarighthandedfemale.At
theseventhweekofgestation,themalefetusbeginstosecretetestosterone,andthislateralizesthe
brain.Amongthechangesfromfemaletomalearchitectureisthepruningofthecorpuscollosum.
Savantspeoplewhooftenhaveremarkableabilitieswithmemory,mathandmusicfrequently
haveasignificantlysmallercorpacollosa.
Autismisoneofthemostheritablementaldisorders.Ifoneidenticaltwinhasit,thereisa90percent
probabilitythattheotherwillalsohavethedisorder.Ifonechildinafamilyhasautism,siblingshave
a35timesgreaterthannormalriskofsymptoms.
Itisimportanttoknowifanyoneinyourclientsfamilyhasadiagnosisofanautismspectrum
disorder.Relativesofchildrenwithautismspectrumdisordersareatahigherriskofhavingmild

developmentimpairments,includinglanguagedelaysandimpairmentsinsocialskillsandsocial
gestures,andaremorelikelytoexhibitattentiondeficitdisorders.

SocialSpectrum
Alexithymia

Engineers
Syndrome

Aspergers

Autism

Alexithymiameansnowordsforfeelings.Itisastatepredominantlyseeninmales.People
exhibitingalexithymiahaveadifficulttimespeakingabout,orevenbeingaware,oftheirfeelings.
Interestingly,researchershavefoundthatalexithymiaandengineerssyndromeisoftenseenin
peoplewithhairloss,skindiseases,anxietyanddepression.(Seetheskinandhairsectionsbelow).
Engineerssyndrome(whichisnotamentalillness)isastateofnotonlyhavingtroubleidentifying
onesownfeelings,butalsoadeficitinunderstandingothersfeelings.Feelingsareoftenseenas
bothersomeoruseless.Peoplewiththesetraitsareoftendepictedbyfamilyandfriendsascold,
distant,andnonassertive.
Whilethesetraitsarenotmentaldisorders,theyfrequentlyplayapartthepersonssociallife.
Researchsuggeststhatalexithymiaoftenactsasatriggerformanymedicalandpsychiatric
disorders.Thisalsocontributestomarriageandfamilyproblems.Spousesandfamilywilloften
complainthatthepersoniscold,aloof,andnoncaring.
Thisstateofbeingseemstobehardwiredearlyoninbraindevelopment.Researcherssuggestthat
thisdeficitisinpartcausedbyasmallercorpuscollosum,thepartofthebrainthatconnectstheleft
andrighthemispheres.
Inthedevelopingbrain,therighthemisphereisdominantforthefirstthreeyearsoflife.This
hemispheremodulatesprimitiveemotions,emotionalperception,andnonverbalcommunication.
ResearcherandauthorAlanSchorebelievesthatattachmentmakespossibletheemergenceof
affectregulation,locatedintherightorbitalprefrontalarea,butothersbelievethepredispositionfor
thisishardwired.
VonEconomoneurons(discoveredbyresearcherConstantinvonEconomo)thusfarhaveonlybeen
foundinhumans,thegreatapes,humpbackwhales,finwhales,killerwhales,spermwhales,and
AfricanandAsianelephants.Theseneuronsarefoundinthehumaninsularcortexandtheanterior
cingulatecortexbothareasofthebrainthatmediateintuition,humor,trust,empathy,mood,pain,
andwhatresearcherscalltheoryofmind.Itisthesecircuitsthatallowsustopairbondandreactto
anotherpersonsdistress.
Certaindisorderssuchasantisocialbehavior,frontaldementias,andParkinsonsshowlowlevelsof
theseneurons.Peoplewithdeficitsinthecorpuscollosumtendtohavelowcountsoftheseneurons.
Themirrorneuronsysteminthehumananteriorcingulateisconsideredcrucialforhumanimitation
peoplewhofitthecriteriaforengineerssyndromedonotexhibitneurophysiologicalresponsesto
otherpeoplespainanddiscomfort.Themirrorneuronsofmanychildrenwithautismspectrum
disordersrespondonlytotheirownmovement.
From1987to1998,theCaliforniaStateDepartmentofDevelopmentalServicesreporteda273
percentincreaseinautisticdisorders,whilethestatepopulationgrewonly19percent.Theincrease
didincludecasesofhighfunctioningautismorAsperger's.Manyresearcherstodaybelievethatthis
meteoricincreaseisthatpeoplewhohavemildtendencieslikeengineerssyndromearemorelikely
tomarryeachother.Agenerationago,menwithengineerssyndromewouldseekoutaspousewith
superiorsocialskillsbecausetheyknewtheyhaddeficits,butnowtheyaremarryingwomenwith
thesamedisposition.

Handedness
Sinistralityisnothingmorethananexpressionofinfantilenegativism.

AbrahamBlau1946
Thepercentageoflefthandednessismuchhigherintheabnormalclassofpeople.
CesareLombroso
Mosthumansarerighthanddominant,butthereareagrowingnumberwhoarenotrighthanded.
Beingrightorlefthandedispartiallydeterminedbygenetics.Ifapersoninheritsthegeneforright
handedness,thatpersonwillberighthanded.Butthosewhodonothavethegenemaybeeither
leftorrighthanded.Thereisnospecificgeneforlefthandedness.
Ifidenticaltwinscarrytherighthandgene,bothwillberighthanded.Butiftheylackthegene,one
twinmayberighthanded,whiletheothermaybelefthanded.Onaverage,theprobabilityoftwo
righthandedparentshavingalefthandedchildisabout9percenttwolefthandedparents
probabilityis26percentandonelefthandedandonerighthandedparenthaveaprobabilityof19
percent.Currently,approximately13percentofthepopulationislefthanded.Generally,malesare
threetimesmorelikelytobelefthandedthanfemales.Severalstudiesreportthatgaypeoplehavea
39percentprobabilityofbeinglefthanded,althoughthereisstillcontroversyaboutthesefindings.
Peoplewhocanusebothhandsequallywellareambidextrous.Trueambidexterityisrare.
TheLatinwordforleftissinister,whichisdefinesasthreateningorforeshadowingevilortragic
developments.Forgenerations,lefthanderswhoattendedCatholicschoolswereforcedtobecome
righthanded.
Manylefthandedpeoplehaveapenchantformathematicsandthesciences.Infact,morethan
fourfifthsofyoungstersenrolledintheJohnsHopkinsprogramformathematicallyprecocious
youths(definedaskidswhoscored700onthemathSATwhentheywere12yearsold)were
allergicand/orlefthanded.MembersofMensa,thehighIQclub,alsohaveafarhigherthannormal
incidenceofallergies.
Lefthandednesshasalsolongbeencoupledwithmentaldisorders.Thereisahigherrateof
depressioninlefthandedpeople.A2008studyfoundthatinchildrenwithdevelopmental
coordinationaldisorder,31percentwerelefthanded,and13percentweremixeddominant.Being
lefthandedismorecommoninalexithymiaandisalsocloselyrelatedtoengineerssyndrome,
Aspergers,andautism.Being"alefty"isalsocorrelatedwithsocialanxiety,shyness,and
embarrassment.
Ingeneral,lefthandersarealsoknowntohaveahigherincidenceofallergies,asthma,eczema,and
autoimmunediseases.DoctorLawrenceWoodatMassachusettsGeneralHospitalhasnotedthat
thereisa17percentincidenceoflefthandednessandambidexterityinpatientswithGrave's
Disease,Hashimoto'sdisease,andprimaryhypothyroidism,aswellasinfamilymembers.
Autoimmunediseasesingeneralseemtobeassociatedwithlefthandedness,mixeddominance,
andlearningdisabilities.

TheImmuneSystem
Thebodyisrespondingtowhat'sgoingoninthebrain,nottowhat'sgoingonintheenvironment.
MargaretKemeny,Ph.D.
Thesneezingandrunnynoseyouhavemakesyoumiserable.Youdontfeellikeeating.Theaches
andpainsandlethargymakeyouwanttogotobedandsleepforaweek.Youdon'tfeellikedoing
anything.Gettinguptopaythebillsseemslikeanoverwhelmingtask,andyoucan'tevenfocuson
thebookyoutooktobedwithyou.Allyouwanttodoissleep.
Theaboveisagooddescriptionofthecommoncold,butifyoutakeawaythesneezingandrunny
nose,italsolooksalotlikedepression.

Theimmunesystemisthepartofthebodythatthatfightsinfection.Whenthebodyhasacold,the
immunesystemgoestoworkbyattackingtheviruswithanarrayofspecialcells,proteins,and
organs.
Immunesystemcellsarewhitebloodcellscalledleukocytes.Thesecellsaremanufacturedand
storedinmanysitesinthebody,especiallyinthethymus,spleen,andbonemarrow.Inaddition,
throughoutthebodyaregroupsofcellscalledlymphnodesthathouseleukocytes.Leukocytes
constantlycirculatethroughthebloodvessels,buttheyalsotravelthroughthebodybywayofthe
lymphaticsystem.
Researchershavesuspectedformanyyearsthatinfectionscanleadtomentalillness.Infact,inan
editorialentitledIsInsanityDuetoaMicrobe?publishedinScientificAmericanin1896,theauthors
describedinjectingcerebrospinalfluidtakenfrommentallyillpatientsintorabbitsthatlater
becameill.Syphilis,onceconsideredtobeacommonmentalillness,waseventuallyfoundtobe
causedbyavirus.
Therewasalullinresearchduringtheeraofpsychoanalysis,butin1973,psychiatristand
researcherE.FullerTorreyattheStanleyMedicalResearchInstituteinChevyChasepublisheda
seriesofarticlessuggestingthatmicrobialinfectionscouldcausementalillness.
Inthelastdecades,ithasbecomeclearthatmicrobesandpathogensarethecauseofmanymental
illnesses.Itnowappearsthatschizophrenia,autism,bipolardisorder,andothermentalproblemsare
linkedtovariousinfections,includingfungal,viral,andparasiticinfections.Theseinfectionscan
attackthenervoussystemduringpregnancy,childhood,orlaterlife.Whilesomeinfectionsdirectly
affectthebrain,otherstriggerimmunereactionsthatinterferewithbraindevelopmentorperhaps
evenattackourownbraincellsinanautoimmunemistake.
Morethan200studieshavesuggestedthatschizophreniaoccursbetweenfivetoeightpercentmore
frequentlythanaverageinchildrenborninthewinterorspring.Virusesaremostprevalentinthe
coldwintermonths.In2006,researchersatColumbiaUniversitysuggestedthatonefifthof
schizophreniasarecausedbyprenatalinfections.Ithasalsoknownthatstreptococcuscan,ifleft
untreated,leadtoseriouspsychiatricproblems.
Themappingofthehumangenomehasrevealedconnectionsbetweengenes,microbes,the
immunesystem,andmentalillness.Analterationofgeneticmarkersinaparticularpopulationhas
alsobeenshowntoprovideresistancetospecificdiseases.Forexample,schizophreniahasbeen
showntohaveastronginversecorrelationwithrheumatoidarthritis,suchthatonedisorderprotects
againsttheother.Theburgeoningfieldofresearchlinkingtheimmunesystemandmentalhealthis
calledpsychoneuroimmunology.

Psychoneuroimmunology
Forthelastfiftyyearsthetendencyofmedicinehasbeentoisolatesinglediseasecharacteristicsof
theindividualandlookforsingleagentstotreatthosecharacteristics.
JeffreyBland,Ph.D.
Theimmunesystemandthebrainarealikeintwofundamentalways.Bothhavethecapabilityto
storenewinformationinaformofmemoryandbothareabletorecallthatinformationinresponseto
anappropriatestimulus.Bothsystemshaveanintricatenetworkofsynapticconnectionsandalso
shareanumberofmessengermolecules,suchascytokinesandchemicalmediators
Thereisonlyonetypeofimmunecellinsidethebrainmicroglia.Microgliacellsaresimilarto
immunecellsfoundinthebody,calledmacrophages.Microgliadonotmountmuchofanimmune
responseinthebrain.Infact,insomeinstancestheymadeevenbeharmfultobraincells.The
bodysimmunesystemtalkstothebrain,andinsomecases,damagesit.
JeromePosnerhasfoundthatatumoranywhereinthebodycanleadtodegenerationof
specificbrainregionsbymeansofmolecularmimicry.Antigensfromthetumorcellsinduce
antibodiesthattriggerimmuneresponsesbothinthetumorandinthebrain.Thiscanleadtoan

immuneattackonthebrainresultinginneuraldamage.Forexample,inneruterinecancermay
causedamagetothecerebellum.Theclumsinessthatiscausedbythisdamagemayappearyears
beforethecancerisdiagnosed.
Posnerfoundthatcertaintypesoftumorcellsexpressedthesametargetproteinthatwasthe
antigenunderattackinneurons.Thetermparaneoplasticsyndromeisadisorderorsetofsymptoms
thatistriggeredbycancerinthebody,butisnotduetothelocalpresenceofcancercells.Patients
withparaneoplasticpsychologicaldisordershaveareactiveimmuneresponsetothetumor.Asimilar
autoimmuneattackagainstthebrainisdamagetothemyelinsheath,foundinmultiplesclerosis.
Thesamemoleculethatisinvolvedincelltocellrecognitionintheimmunesystemalsoseemsto
playamajorroleinthebrainsdevelopmentalwiringprocess.Inanimals,thismoleculeiscalledthe
majorhistocompatibilitycomplex,commonlycitedasMHC,aclusterofgeneslocatedon
chromosome6concernedwithantigenproductionandcriticaltothesuccessoftransplantation.The
MHCincludesthehumanleukocyteantigen(HLA)genes.
Whenapathogenisnoticedbytheimmunesystem,moleculestakeafragmentofthepathogen's
peptide,whichisthendisplayedtoacertaintypeofimmunecell,soitcanidentifythepathogenand
attackit.Inthedevelopingbrain,thesamemoleculeappearstobeessentialforonebraincellto
determinewhichotherbraincelltowhichtoconnect.Thissuggeststhesamefamilyofgenesmay
beinvolvedinarecognitionprocessofcellsintheimmunesystemandthenervoussystem.
Cytokines(awordoriginatingfromtheGreekwordscyto,meaningcell,andkinos,meaning
movement)areanumberofsubstancesthataresecretedbycellsoftheimmunesystemthatcarry
signalslocallybetweencellsandhaveaneffectontheothercells.
Theimmunesystemisamessengerthatalertsthebraintoinfectionorinjurybyreleasingproteins
calledproinflammatorycytokines.Thebrainreleasesitsowncytokinesthatsignalthecentral
nervoussystemtohelpthebodyadaptbyreducingenergyoutput.
Increasesincertaincytokines(ofteninterluekin1,interluekin6,andtumornecrosisfactoralpha)
inducefatigue,anorexia,weightloss,sleepdisturbance,lossoflibido,memoryproblems,
anhedonia,andirritability.Thesebehavioralchangesarereferredtoassicknessbehavior.Ithas
beenobservedthatcouplesandfamilymemberswithhighlevelsofcytokinestendtofightmore
often.

Autoimmunedisorders
Findingthecausesoftheimmuneactivationandchronicsecretioninpsychiatricdiseaseswillbe
thekeystounravelingthemysteryofmentalillness.
RonaldS.Smith,MD
Inautoimmunedisorders,theimmunesystemmistakenlyattacksthebody'shealthyorgansand
tissuesasthoughtheywereforeigninvaders.
Inthelastfewdecades,therehasbeenadramaticincreaseofallergicandautoimmunediseases,
suchasasthma,eczema,allergicrhinitis,multiplesclerosis,Type1diabetes,andinflammatory
boweldisease(includingIrritableBowelSyndromeandCrohnsdisease)indevelopedcountries.In
addition,theincreaseofintestinalpermeabilityseeninthesedisordersisalsoseennotonlyin
healthyrelatives,butalsoinspousesofthesepatients,suggestingtheseproblemsmaybe
transferredbypathogens.
Atthesametime,thenumberofpeoplewithmentaldisordershasalsorisendramatically.A
significantnumberofthesemaladiesarethoughttobecausedbyimmunedysregulation.
Epidemiologicstudiessuggestthattheoveruseofantibioticsisconnectedtoareductioninthe
incidenceofinfectiousdiseasesthroughoutthelifespan,whichresultsinacompromisedimmune
system.

Inthelastfewyears,ithasbecomeevidentthattheimmunesystemcanattackanddisorderthe
brain.
Infact,thebulkofrecentresearchofthecauseofmentalillnesshasshiftedfromneurotransmitters
toimmunedysfunctions.Manyofthesedisordersrespondtotherapiesthattargetautoimmune
response.

Rheumatoidarthritis
Rheumatoidarthritisisachronic,progressiveautoimmunedisease.Thediseasecausesandjoint
destruction,disability,andsignificantpain.Itisestimatedtoaffectaboutonepercentofadults
worldwide,increasesinprevalencewithage,andaffectsmorewomenthanmen.
Themagnitudeoftheseverelongtermeconomicconsequencesofthemaladyhasbeen
underestimatedinthepast.Mostpeoplewiththediseaserequirecontinuoustreatmenttoretardor
stopitsprogressionandtocontroldiseaseflareups.Manywillrequiresurgery,suchastotalhipor
kneereplacements.Inadditiontothesedirectcosts,workdisabilityleadstoreducedproductivity
andearlyretirement,andasaresult,substantialindirectcosts.Thediseasecommonlyresultsin
prematuremortality,resultinginameanreductioninlifeexpectancysomewherebetween5to10
years.Thosesufferingwitharthritisoftenexperiencelossofselfesteem,fatigue,mentaldistress,
anddepression.

Lupus
MentalsignsofLupus
Depression
Anxiety
Fatigue
Cognitiveproblems
Irritability
Psychosis
Anorexia

MedicalsymptomsofLupus
Jointswelling
Skinrashes
Weakness
Fever
Nausea
Bruising
Indigestion
Diarrhea
Constipation
Lossofappetite
Weightloss
Headaches
Heartpalpitations
Lowlibido

Lupusisachronicdiseasethatoftenmanifestsasmusclepain,jointpain,andinflammation.The
abnormalimmuneresponsemayalsoinvolveattacksonthekidneysandotherorgans.Ninety
percentofcasesoccurinwomenofchildbearingage.
Themedicaltermforlupusissystemiclupuserythematosus,orSLE.Erythemaisarednessofthe
skincausedbydilatationandcongestionofthecapillaries,whichisoftenasignofinflammationor
infection.
ThewordLupusmeanswolfand,interestingly,Lupusisalsofoundindogs.Someresearchers
believethatLupuspatientshaveinfectedthedogs.
Lupusisanautoimmunedisease,meaningthattheimmunesystemmalfunctionsandattacksthe
bodysowncellsandtissues.TheageofonsetinLupusisgenerallyinthemidtolate20s,but
AfricanAmericanstendtogetamoreseverevariantofthediseasewithanearlieronset.
Thedisorderisbelievedtobegenetic.Certainethnicgroups,includingthoseofAfrican,Asian,
Hispanic/Latino,NativeAmerican,NativeHawaiian,andPacificIslanddescent,haveagreaterrisk
ofdevelopingLupus.Itoftenappearsincertainfamilies.WhenoneoftwoidenticaltwinshasLupus,
thereisanincreasedprobabilitythattheothertwinwillalsodevelopthedisease.AlthoughLupus
candevelopinpeoplewithnofamilyhistoryofthemalady,thereisoftenapresenceofother
autoimmunediseasesinfamilymembers.
TheprevalenceofLupusissignificantlyhigherinfemalesthaninmales.Itisthemostcommon
causeofstrokeinyoungwomen.Whileitispositedsexlinkedgenesmaycontributetothis,other
studiessuggestsexhormones,especiallyestrogenandprolactin,areafactor.Despitetheevidence
ofgeneticvulnerabilitytodate,nogeneorgroupofgeneshasbeenproventocausethedisorder.
Lupusisusuallytriggeredbyenvironmentalevents,exposuretosunlightbeingonewellknown
trigger.Itmaycausemoodandanxietydisorders,particularlymajordepressionandgeneralized
anxietydisorder.
Thediagnosisismadebyavarietyofclinicalexaminationsandbloodtests.Sixtyyearsago,SLE
wasanuncommondisorder,affectinganestimatedthreetofourindividualsper100,000.Today,the
estimatedprevalenceofthisdiseasehasincreasedbyaboutfourtofifteentimes.
Lupusoftenpresentswithseverefatigue,painfuljointswelling,andpersistentskinrashes,butitcan
affectanyorgansysteminthebodyincludingkidneydisease,bloodclotting,andcentralnervous
systemdiseases.
ThesymptomsofLupuscanbeetherealandvague,makingthediagnosisdifficult.Thesymptoms
canvarysomuchthatitmaybemisdiagnosedasmanyotherillnesses.Itoftenpresentswithmental
symptomsandmaybeinitiallydiagnosedasamentaldisorder.Gastrointestinalinflammationfrom
Lupuscancauseeatingproblemsthatmaybemisdiagnosedasanorexia.
Althoughthediseasemostoftenpresentsaspainorprofoundfatigue,itcanalsocausecognitive
andemotionalproblems.Somewillexperienceforgetfulnessandirritability.Itisbelievedthatthe
causeoftheseproblemsisvascularinjuryoftheintracranialbloodvessels.Cognitivedisturbances
andmemorylossarecommonproblemsinLupuspatients,butthediseasecanalsopresentasa
psychosis,majordepressivedisorder,orpersonalitydisorder,oftenofahistrionictype.Infact,itis
believedthatmorethanhalfofpeoplewithLupuswillpresentwithmentalproblems.Formany,the
firstnoticeablephysicalsymptomisabutterflyshapedrashontheface.
Thistypeofpresentationhasfrequentlybeenlabeledasneuropsychiatricsystemiclupus
erythematosus(NPSLE).Evenso,thediagnosisofLupusisoftenmissedinpatientswithmental
disorders.Forexample,in1992,researcherNeilHopkinsontestedthreehundredhospitalized
psychiatricpatientsforautoantibodiesinserumsamplesandfoundthatoneinonehundred
patientshadundiagnosedLupus.Asaresultofthesefindings,Hopkinsonrecommendsthattestsfor
Lupusbedoneineverypatientwithahigherythrocytesedimentationrateinpsychiatricservices.
Druginducedlupus

DruginducedLupus,sometimescalledDILE,isanautoimmunedisordersimilartosystemicLupus,
whichisbroughtaboutbycertaindrugs.Itiscausedbyanautoimmuneresponseproducing
symptomssimilartothoseofclassicLupus.Thusfar,thereareabout40medicationsthatcantrigger
thisproblem.Thehighestnumberofcases,however,arecausedbyhydralazine,brandname
Apresoline,whichisavasodilatorusedtolowerbloodpressureprocainamide,brandname
Pronestylquinidine,brandnameQuinaglutebothofwhichareusedforcardiacarrhythmiasand
isoniazid,brandnameLaniazidorNydrazid,whichisanantituberculosismedication.
DruginducedLupussymptomsincludefever,elevatedbloodpressure,skinlesions,muscleandjoint
pains,andsignificantfatigue.Generally,thesymptomsrecedeafterdiscontinuinguseofthedrugs.
DecreasedlevelsofDHEAhavebeenfoundinpeoplewithautoimmunedisorderslikeLupusand
immunedeficiencysyndrome.ThereissomeevidencethatDHEAcanimprovesymptomsofthese
disorders.Inatwelvemonth,doubleblind,placebocontrolledtrialof381womenwithmildor
moderateLupus,theeffectsofDHEAatadoseof200mgdailyreducedmanysymptomsofthe
disease.

SjgrensSyndrome
PhysicalsymptomsofSjgrens
Dryeyes
Drymouth
Dryskin
Salivaryglandenlargement
Sinusitis
Recurrentotitismedia
Vaginitis
Chroniccough
Frequentdentalcaries
Gingivitis
Pancreaticinsufficiency

MentalsymptomsofSjgrens
Fatigue
Mooddisorders
Psychosis
Panic
Paranoia
Memorydeficits
Cognitiveproblems
Dementia
Somatization
Histrionicpersonality
Sjgren'sSyndromeisachronicautoimmunediseaseinwhichwhitebloodcellsattackthemoisture
producingglands.Itisoneofthemostprevalentautoimmunedisordersitisestimatedthatabout
fourmillionAmericansaresufferingfromSjgrensSyndrome.Nineoutoftenarewomen.
Thehallmarksymptomsaredryeyesanddrymouth,butSjgrensmayalsocausedysfunctionof
thekidneys,gastrointestinalsystem,bloodvessels,lungs,liver,andpancreas.Manypatientswill
havejointpain.

Itproducesahigherriskofdevelopinglymphoma.Ithasasimilartopresentationtomultiple
sclerosisandLupus.Allthreedisordershaveanunpredictablecoursewithwaxingandwaningof
symptoms.
Sjgren'sSyndromeisknowntoaffectthecentralnervoussystemandoftenmanifestsitselfasa
mentaldisorder.Itmostcommonlypresentsasanatypicalmooddisorder,butcanalsocause,
psychosis,dementia,somatization,dissociation,panicattacks,andpersonalitychanges.

Pathogens
"Aberrantgenesdonot,inandofthemselves,causedisease.Byandlarge,theirimpactonan
individualshealthisminimaluntilthepersonisplungedintoaharmfulenvironment."
JerryBishopandMichaelWaldholz

Candida
Mentalsymptomsofcandida
Anxiety
Fatigue
Impairedconcentration
Hyperactivity
Moodswings
Depression
Poormemory
Lowsexdrive
Irritability
Learningdifficulties

Physicalsymptomsofcandida
Rectalitching
Cravingsforsweets
Abdominalgas
Diarrhea
Constipation
Indigestion
Acidreflux
Acne
Eczema
Sinusinflammation
Persistentcough
Muscleweakness
Sorethroat
Antibioticshavesavedmillionsoflives.Theyareoneofthereasonsthatwehaveincreasedour
longevity.However,thereisacorrelationbetweenthetimelineofthediscoveryanduseof
antibioticsandtheriseofautoimmunedisordersthedrugsthataresavinglivesmaybecausing
longtermillnesses.

Yeastoccursinallhumans.Itnormallyresidesintheintestinaltract,mouth,throat,andgenitals.In
mostpeople,thepresenceoftheyeasthasnosymptoms.However,antibioticschangethebacterial
balanceinthegut,causinganopportunisticinfectionofayeastcalledcandidaalbicans.
Candidafungiareespeciallyfoundindenturewearers.Thewarmthandwetnessbetweenthe
dentureandtheroofofthemouthisaperfecthabitatfortheyeast.AKoreanstudyfoundthatin38
peoplewithantibioticassociateddiarrhea,thecommonyeastCandidawaspresentinthestool
culturesofthreeparticipants,whilefourhadevidenceofthebacteriumcostridiumdifficile(C.difficile)
intheirstool.
Womenwithrecurrentvaginalcandidiasisweresignificantlymorelikelytosufferclinicaldepression,
tobelesssatisfiedwithlife,tohavepoorerselfesteem,andtoperceivetheirlivesasmorestressful.
Additionally,womenwithrecurrentvaginalcandidiasisreportedthattheircandidiasisseriously
interfereswiththeirsexualandemotionalrelationships.
Thereisaconnectionbetweenchronicyeastinfections,candida,andmercurypoisoning.Itis
thoughtthatthebodyproducestheyeastasadefenseagainstexcessheavymetals.Theyeastcells
absorbtheirownweightinmercury,whichpreventsthemetalsfromenteringthebloodstream.The
amountofmercurythatcandidacannotingestisexcretedasmethylmercury.

Streptococcus
Insomecasesofobsessivecompulsivedisorder(OCD),infectionwiththebacteriastreptococcus
maybeacontributingcause.ResearcherSusanSwedoreplacedthebloodplasmaof28children
whosufferedfromOCDandhadelevatedlevelsofstreptococcusantibodieswithhealthydonor
plasma.Withinamonth,theincidenceofticsdeclinedbyhalfandtheirotherOCDsymptomswere
reducedby60percent.
Thepathogenhasnowbeenimplicatedinotherdisorders.Anorexianervosahasemergedorhas
worsenedafteracaseofstrepthroat.StreptococcushasalsobeenimplicatedinTourettes
Syndrome,personalitychanges,anxiety,attentiondeficitdisorder,disruptivebehaviors,and
depression.
Dyskinesiasarepurposelessandinvoluntarymovements.Itisnowknownthatstreptococcuscan
triggerSydenham'sChorea,adisorderthatcausesthearmsandlegsofthoseafflictedtojerkina
manneroftenlikenedtodancing.Recently,thespectrumofpoststreptococcalmovementdisorders
hasbeenexpandedbeyondchoreatoincludemotorandvocaltics,dystonia,narcolepsy,and
myoclonus.Theprevalenceofsimilarmovementandemotionaldisordersinfirstdegreefamily
relativessuggeststhatageneticpredispositionisimportantindiseasedevelopment,inadditionto
anenvironmentalevent.

LymeDisease
MentalsymptomsofLymedisease
Cognitiveproblems
Depression
Paranoia
Psychosis
Bipolardisorder
Panicattacks
Anorexia
Obsessivecompulsivedisorder
Attentiondeficithyperactivitydisorder

PhysicalsymptomsinLymedisease

Expandingrash
Flulikesymptoms
Cardiacsymptoms
Visionproblems
Frequentheadaches
Conjunctivitis
Fatigue
Sensitivitytolightandsound
Sleepproblems
Lymediseaseisaninfectiousillnesswhichoftencausespsychologicalsymptoms.Thediseaseis
transmittedtohumansbyaninfectedfemaleIxodestick.Becausethistickissmallerthanthedog
tickandbecausethebiteisnotpainful,thetickisoftenunnoticed.Theinfectionrequiresthatthetick
feedforatleast1224hours.Theticksaremostcommonlycarriedbydeerandbythewhitefooted
mouse,butothercarriershavebeenfoundaswell.
ThefirstrecordedcaseofwhatisnowknownasLymediseasewasrecordedin1883inBreslau,
Germany,byAlfredBuchwald,aphysicianwhodescribedaskindisordernowknownas
acrodermatitischronicaatrophicans(ACA).In1921,DoctorArvidAfzeliuspublishedapaper
describingarashhesuspectedhadbeencausedbythebiteofaninsectcalledtheIxodestick.
In1970,thefirstcaseofLymediseaseintheUnitedStateswasreportedbyRudolphScrimenti,who
diagnosedandtreatedapatientwhohadbeenbittenbyatickwhilehuntinggrouseinWisconsin.In
1976,thefirstU.S.caseofclusteringofthisdiseasewasreportedinLyme,Connecticut,by
researchersattheNavalSubmarineMedicalLaboratory.In1977,AllenSteereandhisassociates
describedthefirstclusteringofadiseasewhichwasmisdiagnosedasjuvenilerheumatoidarthritis.
ThemaladyisnowcalledLymearthritis.
ResearchersWillyBurgdorfer,JorgeBenach,andEdwardBoslerwerestudyingtheoutbreaksof
RockyMountainspottedfeverinthe1980's.Whileexaminingtheticks,Burgdorfernoticedaparasite
inthebodyfluidoftwoticks.Astheresultofhisdiscovery,thebacteriahavebeennamedBorrelia
burgdorferi.HisresearchalsoconfirmedthatthisbacteriawasthecauseofLymedisease.
In1985,LymediseaseresearcherPaulDurayreportedthatLymediseasebacteriainfectsmultiple
systemsinthehumanbody.Inthesameyear,Burgdorferwasabletoconfirmthatinfectedticks
couldbefoundacrosstheentireUnitedStates.Today,Lymediseaseisthemostcommoninsect
borneinfectionintheUnitedStates.Inthelastdecades,ithasbeenrapidlyincreasinginincidence.
Thediseaseoftenpresentswithared,round,expandingrashwithindaysorweeksafterthebite.
Thisisoftenfollowedbyflulikesymptoms.Afteroneortwomonths,theremaybecardiac
symptomssuchaslowheartrateandlowbloodpressure,myopericarditis(inflammationofthewall
oftheheart),leftventricledysfunction,andcardiomegaly(enlargedheart).
Soonafter,visionproblemsandnervoussystemsymptomsbegin.Earlyon,patientsmaybeginto
sufferfrequentheadaches.Conjunctivitismayalsoemerge.Othersymptomsincludeprofound
fatigue,extremesensitivitytosounds(calledauditoryhyperacusis),sleepproblems,andsensitivity
tolight(photophobia).
Psychologicalsymptomsincludeagitation,irritability,emotionallability,paranoia,psychosis,
dementia,bipolardisorder,anxiety,panicattacks,depression,anorexia,andobsessivecompulsive
disorder.
Sometimesalterationsintasteandsmelloccur.Bysixtotenmonthsaftertheinfection,manypeople
willbegintosufferfromarthritisinmultiplejoints.
Neurologicalproblemssuchasmeningitis,encephalitis,ormildtoseveremarkedmentalsymptoms
occur.Aftertwotoeightyears,theinfectionwillcausechronicmentalproblems.Becauseofthis,

patientswithLymediseaseareoftenreferredtomentalhealthprofessionalsbeforeandafter
diagnosis.
Ina1994study,researcherBrainFallonfoundthat40percentofpatientsshowedalterationsin
brainfunction.Depressionisverycommon,andinsomestudies66percentofsufferersshow
depressivesymptoms.Impairmentsalsooccurinshorttermmemory,concentration,learning,and
conceptualability,suggestingproblemsinthefrontallobe.Cognitiveproblemsincludedifficultywith
wordfinding,dyslexiclikeerrorswhenspeakingorwriting,andspatialdisorientation.
Interestingly,theprevalenceofschizophreniaintheUnitedStatesishighestintheurbanized
Northeastern,Northwestern,andGreatLakesStates.Theseareasalsohavethehighestpresence
ofLymedisease.Inotherpartsoftheworld,theincidenceoftickborneencephalitisarealsomost
prevalentincountriesthatalsohavethehighestratesofschizophrenia,includingGermany,Ireland,
Finland,Croatia,andNorway.
Becausethenumberofcasesofthediseaseisrapidlyincreasing,Lymediseaseshouldbeincluded
inthedifferentialdiagnosisofanymentalhealthassessment.Initsmechanismofinfectingthebody,
Lymediseaseissimilartosyphilis,meaningitcancausedamageoverseveraldecades.Forthis
reason,earlydetectionisessential.Intheearlystages,itistreatableillness,butoncethedisease
invadesthecentralnervoussystem,itcanbecomechronic.
Becausediagnostictestsarenotalwaysreliable,cliniciansoftenmustoftenrelyontheobservable
symptomstomakeadiagnosis.Factorsthatsuggestthisdiagnosisincludeknowledgeofatickbite,
orhavingbeeninageographicareaknowntobeinanareainhabitedbyticks,ahistoryofskinrash,
jointpains,arthritis,cardiacproblems,andsymptomsthatbeganafteraflulikeillness.

BornaVirus
Viruseshaveaspecialaffectionfornervecells.
NancyAndreasen,MD.BraveNewBrain
Bornaisa750yearoldtowninSaxony,Germany.Bornadiseasegotitsnamein1885whenthe
townbegantosufferanepidemicofillnessinhorses.Theownersoftheanimalswerebringingthem
toveterinarians,describingthemaslistless,fatigued,andsad.Thehorseswereeventuallyfoundto
haveavirusthathadneverbeenseenbefore.
Oncetheviruswasidentified,researchbegan.In1924,WilhelmZwicksuccessfullytransmitted
Bornadiseasetorabbits.Thismarkedthebeginningofsystematicstudiestodeterminethe
pathogenesisofthedisease.In1909,ErnstJoestandKurtDegenfoundthattheviruscaused
changesinthebrain,especiallywithinganglioncellsofthehippocampus.Sincethen,thevirushas
beendetectedinsheep,birds,cattle,cats,primates,andhumans.Sofar,itisseeninEurope,Asia,
Africa,andNorthAmerica.Interestingly,inGermanysincethemid1960s,theincidenceofBorna
diseasehasdeclinedsignificantly.
Recentfindingshaveimplicatedthebornavirusinhumanneurologicalandpsychiatricconditions
includingschizophrenia,obsessivecompulsivedisorder,panicdisorder,andmooddestabilization.
Thevirusisfoundfrequentlyinpeoplewithrecurrentmajordepressionorbipolardisorder.
Thosewhosufferadepressiontendtohavesevereangstanddeepdespair,whichoftenleadsto
hospitalizations.
Inschizophrenia,itisbelievedthatthevirusmayinsinuateitselfintothefetalbrainatacrucialstage
ofdevelopment,whichsubtlyderangesthebrain'sneuralconnections.Thisdisarrayonlybecomes
apparentasthebrainreachesmaturityinlateadolescencetoearlyadulthood.
Researchersbelievethatonceapersonhasbeeninfectedbythevirus,hemaydevelopBorna
disease,orpossiblyactasacarrierofthevirus.

Amantadine,originallyusedinthetreatmentofinfluenzainfection,hasprovedbeneficialinpeople
withbornavirus.Theantidepressiveeffectiscomparabletoprescriptionantidepressantshowever,
higherdosesofamantadinemaycauseconfusion,hallucinations,andnightmares.
Thereiscontroversyabouthowamantadineworks.Whilesomebelieveitworksbydestroyingthe
virus,otherscontendthatitactuallyworksasanantidepressant.Researcherspointoutthatthedrug
isalsoeffectiveintreatingParkinson'sdisease,traumaticheadinjury,dementia,multiplesclerosis,
andcocainewithdrawal.

HerpesVirus
Althoughanassociationbetweenantibodiestoherpesvirusandcognitivefunctioninghavenotbeen
foundinpeoplewithoutpsychiatricdisorders,infectionwithherpessimplexvirus1isapredictorof
cognitivedysfunctioninindividualswithschizophreniaandbipolardisorder.Thecognitivedeficits
foundinschizophreniaandbipolardisorderaresimilartothosefoundinpeoplewhohaverecovered
fromcentralnervoussysteminfectionswithhumanherpes.Physicaloremotionalabuselowersthe
antibodiesforherpes,increasingoutbreakssignificantly.

HepatitisC
PhysicalsymptomsofHepatitisC
Fatigue
Jointpain
Stomachache
Itchyskin
Darkurine
Jaundice
ThewordHepatitismeansinflammationoftheliver.HepatitisCisaninfectionofthelivercausedby
thehepatitisCvirus.Itisdifficultforthehumanimmunesystemtoeliminatethevirusfromthebody,
meaningthattheinfectionusuallybecomeschronic.Seventyfivepercentofpeoplewhocontractthe
viruswillcarryitforlife.Twentypercentwilleventuallydevelopcirrhosisoftheliver.
HepatitisCwasdiscoveredin1989.Today,approximatelyfourmillionAmericansareinfectedwith
thehepatitisCvirus,anditisestimatedthatapproximately170millionpeopleareinfected
worldwide,whichisequivalenttothreepercentoftheworld'spopulation.Eightypercentofthose
whoareinfectedwillremainasymptomaticforyears.
Researchshowspatientswithchronic,severementalillnesshavefourtoninetimestheprevalence
ofthevirus.Conversely,mostpatientswithHepatitisCinfectionpresenttomedicalclinicswithactive
psychiatricandsubstanceusedisorders.A2005researchpaperbyMarianFiremanatthe
NorthwestHepatitisCResourceCenterfoundthatscreeningHepatitisCpatientsformental
problemsrevealedthat93percenthadacurrentorpasthistoryofatleastonementaldisorder.
Seventythreepercenthadtwodisorders.Themostcommondisordersweredepression(81
percent),posttraumaticstressdisorder(62percent),anysubstanceusedisorder(58percent),and
bipolardisorder(20percent).
ChronicHCVinfectionoftenpresentsasanger,hostility,anxiety,chronicfatigue,lassitude,and
depression.Itcanalsomanifestasamildsubcorticaldementia.Atthepresenttime,treatmentfor
chronicHepatitisCisa2448weekcourseofalphainterferonandribavirin.

Neurocysticercosis
Symptomsofneurocysticercosis
Seizures
Headaches

Headaches
Confusion
Hallucinations
Paranoia
Inattention
Violentandabusivebehavior
Neurocysticercosisisacentralnervoussysteminfectioncausedbyaccidentalingestionofeggsof
Taeniasolium,aporktapewormfoundincontaminationfood.Mostpeopleareinfectedby
consumingraworundercookedpork.Itisoneofthemostcommonparasiticcausesofneurological
diseasesindevelopingcountries.Approximatelytwoandahalfmillionpeopleworldwidecarrythe
adulttapeworm.Manymoreareinfectedwiththeeggs.
AlthoughtheinfectionispredominantlyfoundinLatinAmerica,Africa,andSouthAsia,thehighrate
ofinternationaltravelandimmigrationmakesitahealthissuethroughouttheglobe.Asof2010,itis
estimatedthatabout50millionpeopleworldwideareinfected.Itisestimatedthat200,000peoplein
theUnitedStatesareinfected.IntheU.S.,thediseaseismostprevalentinTexas,NewMexico,and
California.Onestudyreportedneurocysticercosisasthecauseof2percentoftheneurologicand
neurosurgicaladmissionsinsouthernCalifornia.
Althoughneurocysticercosisisnotahighlyprevalentdisorder,itisthemostcommonworminfection
ofthecentralnervoussystem.Itcanpresentasdepression,psychosis,orcognitivedeterioration,
andisalsoknowntocauseseizures.Duringtheearlyphaseoftheinfection,manypeoplewill
presentwithdisorientation,andvisualandauditoryhallucinations,oftenfollowedbyapathy,
euphoria,memoryimpairment,andaslowingofcognition.Theillnessisgenerallydiagnosedasa
mentaldisorder.Itisnotuntilmotorproblemsandseizuresdevelopthatthediagnosisismade.

Toxoplasmosis
Toxoplasmagondii(usuallycalledT.gondii)isoneofthemostinterestingofallparasites.Ithas
actuallyfoundawayofreproducingitselfbychangingthebrainofitshost.
Ratshaveabuiltinfearanddislikeofcaturine.Thisinnatefearpreventsratsfrombeingeatenby
cats.However,ratsinfectedwithT.gondiilosetheirfearofcaturine.Infact,itmakesthemattracted
tothescentofcats,whichmakesthemeasyprey.Thecatsthenbecomeinfectedbyeatinginfected
rats.Catstheninfecthumanswhohandleinfectedcatsortheirfeces.
Thisinfectioncanchangeahumanbrainandactuallyalterapersonspersonalityandbehavior.Men
infectedwiththepathogentendtobecomemorelikelytodisregardrules.Theyaremoresuspicious,
jealous,anddogmatic.Theyalsohaveslowerreactiontimeandsixfoldhigherriskoftraffic
accidents.Curiously,infectedwomenoftenshowmorewarmthandselfconfidence.
Thisisacommonhumaninfection.Mostpeopleareunawarethattheyareinfected.However,an
acuteinfectionwiththisparasitecanproducepsychoticsymptomssimilartothosedisplayedin
peoplesufferingfromschizophreniaandAlzheimer'sdisease.Since1953,therehavebeenseveral
studiesverifyingT.gondiiantibodiesinpeoplewithschizophrenia.Themajorityofthestudiesfound
ahigherpercentageofantibodiestoT.gondiiinaffectedpersons.
Otherstudieshavefoundthatexposuretoinfectedcatsinchildhoodisariskfactorforthe
developmentofschizophrenia.Inpregnantwomen,infectionwithToxoplasmacancauseabortions
andstillbirths.Theviruscanalsocrosstheplacentaandinfectthefetus.Inthesecases,the
infectionmaycausechangesinheadsize,suchashydrocephalyormicrocephalymental
retardationseizuresdeafnesscerebralpalsyanddamagetotheretina.Increasedventricularsize
andcognitiveimpairmentmayalsooccursymptomsthatalsooccurinsomepeoplewith
schizophrenia.
Curiously,severalmedicationsusedtotreatschizophreniaalsoinhibitthereplicationofT.gondiiin
cellculture.WhenhumancellsraisedinpetridisheswereinfectedwithToxoplasma,thegrowthof

theparasitestoppedwhenhaloperidolwasputinthedish.Haloperidol(Haldol)isanantipsychotic
usedtotreatschizophrenia.
Abloodtestcancheckforantibodiestotheparasite.Medicationsforadultsincludepyrimethamine
(Daraprim)pluseithertrisulfapyrimidinesorsulfadiazine.Inpregnancy,spiramycinisusuallygiven.
Spiramin,consideredanexperimentaldrugintheUnitedStates,issometimesisobtainedbyspecial
permissionfromtheFDAspecificallyforToxoplasmosisinthefirsttrimesterofpregnancy.

Toxins
"Wherethepeoplearemanyandtheirhandsareallempty.
Wherethepelletsofpoisonarefloodingtheirwater."
BobDylan,HardRain
TheIndustrialRevolutionbroughttechnologythatchangedtheworldforever.Factoriesand
machineryallowedunprecedentedproductivity,butwithproductioncamesignificantpollution.
Humansneedair,water,andfoodtosurvive,butwehavenowmanagedtocontaminateour
atmosphere,oceans,streams,rivers,andfoodsupply.Thenumberofchemicalsthatcancause
neurotoxicityinlaboratoryanimalsexceeds1,000.Thusfar,researchershavefoundthatatleast
202manmadechemicalshavethecapacitytodamagethehumanbrain.
Behavioraltoxicologyandbehavioralteratologyarethefieldsofresearchthatinvestigatethe
consequencesofexposurestotoxins,includingcognition,learning,memory,andbehavior.
Researchersagreethatcurrentlythemosttroublesomeneurotoxinsinourenvironmentaremetals,
solvents,pesticides,andpharmaceuticals.
Thesepathogens,alongwithhundredsofothermanmademolecules,havepermanentlypermeated
ourbodiesandourminds.Thefirstinternationalsymposiuminbehavioraltoxicologywasin1973.
Sincethattime,researchershaveconcludedthatallpeoplealivetodaycarryintheirbodiesatleast
700contaminants.Thisconglomerateoftoxinshasbeendeemedbodyburden.
Ofconcernarethe32,000hazardouswastesitesintheUnitedStates.Atthetimeofthiswriting,
morethan1,100publicschoolsserving600,000childrenarelocatedwithinhalfamilefrom
contaminatedsitesinCalifornia,Massachusetts,Michigan,NewJersey,andNewYork.
Thereisevidencethatenvironmentaltoxinsplayapartinpoorschoolperformance.Forexample,
environmentalpolycyclicaromatichydrocarbons(PAH)atlevelsrecentlyencounteredinNewYork
Cityairarethoughttoadverselyaffectchildrenscognitivedevelopmentatthreeyearsofage.
Toxins,suchasheavymetals,cancausecytokinereleaseanddestabilizationofthehypothalamus
pituitaryadrenalaxis.Thiscancausechangesinthebrain,manifestedaspsychologicalsymptoms.
Althoughthereisamassiveamountofresearchoftoxinsandmentalhealth,peoplewithmental
problemsrarelyareseldomscreenedfortoxicity.InalltheyearsIpracticedoutpatient
psychotherapy,thethoughtofgettingatoxicologyassessmentnevercrossedmymind.
Theclearestdataonthedeleteriouseffectsofprenatalexposuretotoxinscomesfromthestudyof
twometals,leadandmercury,andfromepidemiologicalinvestigationsoftheeffectsofalcoholintake
duringpregnancy.

Heavymetaltoxicity
"Forresearcherswhooperateattheintersectionofbasicbiologyandtoxicology,followingthedata
wheretheytakeyouasanygoodscientistwouldcarriestheriskthatyouwillbepubliclyattacked
asacrank,chargedwithscientificmisconduct,orremovedfromagovernmentscientificreview
panel."

HerbertL.Needleman

Physicalsymptomsofheavymetaltoxicity
Fibromyalgia
Chronicfatigue
Musculoskeletalpain
Sleepdisturbances
Gastrointestinalproblems
Heavymetalshavelongbeenknowntocauseproblemswiththecentralnervoussystem.The
disseminationofthesesubstancesinourenvironmenthascausedsignificantmentalproblemsin
peopleofallages.Childrenareespeciallyvulnerabletoadverseeffectsofmultiplemetalsexposure.
Treatmentforheavymetalsischelationtherapyinconsultationwithcliniciansexperiencedinlead
toxicitytherapy.Someofthebestknownheavymetaltoxinsfollow.
Mercury
Chronicmercuryexposurehasreachedacriticallevelwhereinorganicmercurydepositionwithin
thehumanbodyisaccumulatingovertime.Itislogicaltoassumethattherisksofassociated
neurodevelopmentalandneurodegenerativediseaseswillriseaswell.
DanR.Laks,MD

Mentalsymptomsofmercury
Insomnia
Moodswings
Irritability
Nervousness
Excessiveshyness
Cognitivedefects
Anxiety
Agitation
Emotionallability
Depression
Hallucinations

Physicalsymptomsofmercurytoxicity
Impairedmotorfunction
Tremors
Slurredspeech
Headaches
InJune1997,KarenWetterhahn,a48yearoldDartmouthCollegecancerresearcher,whose
specialtywasdangerousheavymetals,diedofdimethylmercurypoisoning10monthsaftershe
spilledseveraldropsonherrubbergloves.
Shewasstudyinghowmercurypreventscellsfromrepairingthemselves.Twomonthsafterthespill,
shebeganlosingherbalanceandhavingspeakingandhearingdifficulties.Atthreemonthsafterthe
spill,Wetterhahnexperiencedtwoseriousepisodesofnauseaandvomiting.Soonafterthat,she
washospitalized.Testsshowed80timesthelethaldoseofmercuryinherblood.Soonafter,she

slippedintoacomaand,withinweeks,died.Testsafterherdeathrevealedthatthemercuryhad
passedreadilythroughherrubberlatexgloveswithoutdamagingthem.
Mercuryisanextremelyneurotoxicelement.Methylmercuryconsistsofamethylgroupbondedtoa
mercuryatom.Amethylgroupistheportionofanorganicmoleculederivedfrommethanegas,
createdbyremovalofahydrogenatom.Methanewasoriginallycalled"marshgas"becauseitwas
firstisolatedfromthegasbubblingoutofmarshes.Methaneisproducedbycertainbacteriathatlive
inoxygenfreeenvironmentssuchasestuaries,lakebottomsedimentation,sewage,andmud.This
ishowmercurygetsintothefoodchain.
Formanyyears,methylmercuryhasaccumulatedinourenvironment.Asaresult,eachyear,about
60,000childrenarebornatriskofdevelopmentaldeficits,includingdecreasedschoolperformance,
astheresultofexposuretomethylmercuryinthewomb,usuallycausedbythemothers
consumptionofcontaminatedfish.
GreatLakesfishconsumptionbypregnantwomenisassociatedwithdecreasedbirthweightand
deficitsincognitivefunctionintheirinfantsandchildren.
Mercurycandisrupttheendocrinesystem,causingdysfunctionsofthepituitarygland,thymus,and
adrenalglands.Ithasalsobeenobservedthatmercurycanhavesignificanteffectsonthyroid
function.Disruptionofhormonalfunctionsoccursatverylowlevelsofexposure.Thisabnormality
canoccureventhoughhormonelevelsremainnormalmakingtheusualthyroidtestsinadequatefor
diagnosis.
Inanimalstudies,PCBs(atypeofpesticides)andmethylmercuryactsynergisticallytoreduce
dopamineinthebrain.Adversehealtheffects,whichincludeneurologicalproblems,havebeenwell
documented.
Althoughthemainsourceofmercuryexposureintheenvironmentismethylmercuryfromseafood,
inorganicmercurycomesfromothersources,suchashighfructosecornsyrup(foundinmany
processedfoods)andmercuryvaporfromdentalamalgamfillings.Assessingtheconsumptionof
thesefoodscanleadtotheassessmentofmercurytoxicity.
Fillings
Formanyyears,mercurywasusedindentistryindentalamalgam,afillingmaterialusedinrepairing
toothdecay.Eventoday,themostcommonlyusedamalgamismadeofapproximately4050percent
mercury,25percentsilveranda2535percentmixtureofcopper,zinc,andtin.Amalgamuseis
decliningbecausetheincidenceofdentaldecayisdecreasingandbecausebettersubstitute
materialsarenowavailablefordentalcavities.
Dentalfillingscontainingmercuryhavealwaysbeenacenterofcontroversy.TheFDA,theCenters
forDiseaseControlandPrevention,andothergovernmentagencieshavereviewedthescientific
literaturelookingforlinksbetweendentalamalgamsandhealthproblems.In2001,theCentersfor
DiseaseControlstated,thereislittleevidencethatdentalamalgamimpactsthehealthofthevast
majorityofpeoplewhohavethem.Theyalsoreportthatremovingamalgamfillingshasno
beneficialeffectonhealth.
TheUnitedStatesFoodandDrugAdministration(FDA)considersdentalfillingstobemedical
devices,andhavebeenregulatedsincethe1990s.In2002,theFDApublishedaproposedruleto
classifydentalamalgamasaclassIImedicaldevicewithspecialcontrols.OnApril28,2008,the
FDAreopenedthecommentperiodforthatproposedrule.Afterreviewingallcomments,theFDA
intendstoissueafinalruleclassifyingdentalamalgam.InJanuary2008,NorwayandSweden
completelybannedmercuryfillings.ShortlythereafterinApril2008,Denmarkalsobannedmercury
fillings.
Sincedentalofficesareknowntobeoneofthelargestusersofinorganicmercury,researchershave
assessedmercuryindentistsandpersonnelwhoworkindentaloffices.Mercuryvaporaccumulates

intheirbodiesinmuchhigherlevelsthannonoccupationallyexposed.Infact,mercurylevelsof
dentalpersonnelaverageatleasttwotimesthatofcontrols.
Mercurypoisoningisoftenmisdiagnosedasmentalproblems.Themetalespeciallydamagesthe
liver,theimmunesystem,andthepituitarygland,allofwhichplayapartinmentalfunction.Chronic
mercuryexposureincreasestherisksforautismanddementingillnessessuchasAlzheimer's
disease.Italsopresentsasdepression,chronicanger,andanxiety.Thereareseveralwaystotest
mercuryinthebody,includingbloodandhairtests.
Lead
"Onemoleculeoflead,whenitentersacell,willchangethestateofthatcell."
HerbertNeedleman

Symptomsofleadtoxicity
Fatigue
Irritability
Shorttermmemoryloss
Inabilitytoconcentrate
Headaches
Anemia
Abdominalandjointpain
Violentbehavior
MeasurementsofthebonesofhumansbeforetheIndustrialRevolutionshowthatthenaturallevelof
leadinhumanbloodwas0.016microgramsperdeciliter.CurrentlytheUnitedStatesgovernment's
levelofconcernforleadis10microgramsperdeciliteralevel625timesashighasthenatural
environmentallevel.
Leadisapotentneurotoxin.Exposuretoleadduringpregnancyorduringchildhoodresultsin
deficitsinintelligencequotient(IQ)andinotherbehavioralproblems.
Inschoolresearchstudies,teachersreportanincreasingnumberofproblemssuchassomatic
complaints,anxiety,depressedbehavior,socialproblems,attentionproblems,anddelinquentand
aggressivebehavioringradeschoolchildren.Theincidencesofthesebehaviorscorrelatewiththe
childrensserumleadlevels.Aninterestingfindingwasthatabusedchildrenare27foldmorelikely
tohavehighserumleadlevels.Boneleadlevelsarerelatedtoselfreportsofdelinquentacts.
Familieswholiveinhousesbuiltbefore1978havehigherleadexposures,butthoselivinginhomes
builtbefore1940haveasignificanthigherriskofleadexposure.
Althoughtherearefewstudiesofleadinolderadults,onestudyofolderwomenwithbloodlead
levelsaslowaseightmicrogramsperdecilitershowedsignificantlypoorercognitivefunction.As
peopleage,bonemassdecreases.Asbonesdeteriorate,theamountofleadstoredinbone
becomesasignificantsourceofleadinthebloodstream.Olderworkerswithpreviousoccupational
exposureareatriskforrecirculationofleadinbloodwithadvancingage.
Cadmium

Physicalsymptomsofcadmiumpoisoning
Flulikesymptoms
Respiratorytractdamage
Pulmonaryedema
Lossofbonemineraldensity
Kidneydamage

Kidneydamage
Purecadmiumisasilverywhitemetalwithasubtlebluishhue.Mostofthecadmiuminthe
environmentoccursfromactivitiessuchasmining,smelting,andrefiningmetaloresespecially
zinc,leadandcopper.TheUnitedStatesistheworldsprimaryproducerofcadmium,generatingan
estimated1,100tonsofthemetalperyear.Fertilizersandnickelcadmiumbatteriescontain
significantlevelsofcadmium.
Themetalisreadilyabsorbedbysealife,particularlyshellfish.Becauseofthis,intheUnitedStates,
theEnvironmentalProtectionAgencyhasissuedfishingadvisoriesrelatedtocadmiumforcoastal
watersaroundNewYork,Connecticut,andNewJersey.Thehighestlevelsofcadmiuminfoodare
foundinshellfish,suchasoystersandclams,andintheliverandkidneysofanimals.
Unlikemanytraceelements,thereisnoroleforcadmiuminthehumanbody.Inthebody,cadmium
interfereswithcalciummetabolism,leadingtolossofcalciuminhumantissueandbones.Mostof
themetalwillaccumulateinbones,liver,andkidneys,whereitcancausedamage.Cadmiumis
knowntocausekidneydisease,highblood,pressureandheartdisease.
Onaverage,peopleconsumeabout30microgramsofcadmiumdailythroughanormaldiet,of
whichonetothreemicrogramsareabsorbedintothebody.Cigarettesmokecontainscadmium.
Cadmiuminhaledthroughcigarettesmokeismoreeasilytakenupbythebody,allowingfrom40to
60percentofthecadmiuminhaledinsmokeisabsorbedintothehumanbloodstream.
Motherswhosmokeduringpregnancytendtohavechildrenofsmallerbirthweight,whichisarisk
forneurologicaldisorders,includingdeficitsinsocialbehaviors.Childrenoftenareexposedto
cadmiumbycigarettesmokefromtheirparents.Atschoolage,children'surinarycadmiumlevelsare
linkedwithimmunesuppressiveeffects.Cadmiumhasalsobeenlinkedtobehavioralproblemsand
learningdisabilities.

Pesticides
"Liketheconstantdrippingwaterthatwearsawaythehardeststone,thebirthtodeathcontactwith
dangerouschemicalsmayintheendprovedisastrous.Eachoftheserecurrentexposures,no
matterhowslight,culminatesintheprogressivebuildupofchemicalsinourbodiesandsothe
cumulativepoisoning...theaveragecitizenisseldomawareofthedeadlymaterialswithwhichheis
surroundinghimselfindeed,hemaynotrealizeheisusingthematall."
RachelCarson,SilentSpring(1962)

Mentalsymptomsofpesticidepoisoning
Affectivedisorders
Depression
Anxiety
Inabilitytoconcentrate
Spatialdisorientation
Aggression
ForthreedecadesintheUnitedStates,dichlorodiphenyltrichloroethane(knownasDDT)wasused
tocontrolinsectpestsoncropandforestlands,forhomesandgardens,andforindustrialand
commercialpurposes.Withinafewyears,millionsofbirdsdied.
AsaresultofRachelCarsonscampaign,DDTwasbannedin1973.However,itcontinuestobe
detectedintheorgansandtissuesofpeopleintheU.S.Lateron,undertheStockholmConvention,
DDTwasbannedforagriculturaluseworldwide.WhatisnotwellknownisthatDDTisstillusedin
diseasevectorcontrolthroughouttheworld.India,China,andNorthKoreastillproduceandexport
DDT,andproductionisreportedlyontherise.Currently,IndiaisthelargestconsumerofDDT.The

currentglobaluseofDDTfordiseasevectorcontrolisfourtofivethousandtonsperyear.Foodis
theprimarysourceofDDT.TheadverseeffectsofDDTareparticularlydevastatingtochildren.
CurrentlyintheUnitedStates,therearemorethan900chemicalsregisteredaspesticidethereare
about350pesticidesactivelyusedintheU.S.Peopleareexposedtopesticidesthroughusein
homes,gardens,andonpets,consumingresiduesonfood,drinkingcontaminatedwater,andbeing
exposedduetowinddriftfromnearbyspraying.
Asinsecticidesincreaseinthebody,theyarebrokendownintootherchemicals.Onecommon
chemicalfoundinhumanurinesis3,5,6trichloro2pyridinol,oftencalledTCPY.In2003,theSecond
NationalReportonHumanExposuretoEnvironmentalChemicalsfoundthatmorethan90percent
ofmenhavedetectablelevelsTCPYintheirurine.Inadultmen,TCPYisassociatedwithreduced
testosterone.Lowtestosteronehasasignificantimpactonmood,behavior,andcognition.(Formore
onthis,seethechapterontestosterone.)
Higherlevelsof1naphthol(aproductknownasSevin)inmensurineareassociatedwith
decreasedspermconcentration.Prenatalexposuretopesticidecanalsoresultinlowspermcountin
achild.Studiessuggestthatifapregnantwomanisexposedtoapesticideatthewrongtime,her
children,grandchildren,andtherestofherdescendantscouldinheritthedamageanddiseases
causedbythetoxin.TheoverthecounterantiulcerdrugTagamet(cimetidine)hasbeenshownto
inhibitthebreakdownofsemeninbothlaboratoryanimalsandhumans.
Otherconsequencesofpesticideexposureincludedepressionandsuicide.Suicideratesarehighin
farmingpopulations.Animalandhumanstudieshavelinkedorganophosphateexposureto
acetylcholineandserotonindisturbancesinthecentralnervoussystem,neurotransmittersthatare
implicatedindepressionandsuicideinhumans.
Polychlorinatedbiphenyls(usuallycalledPCBs)areclassifiedaspersistentorganiccontaminants
thataccumulatetotoxiclevelsinthefoodchainandposeamajorthreattohumanhealth.
Organophosphatepesticidescauseserotonindisturbancesinthecentralnervoussystem,whichare
implicatedinsuicide.PesticideexposureandatleastonedefectivecopyofthegeneCYP2D629B+
predictan83percentprobabilityofParkinsonsdiseasewithdementia.Peoplewhoworkonfarms
haveahighincidenceofParkinsons.Inaddition,suicideratesarehighinfarmingcommunities.
Aninterestingstudyof29,074thefemalespousesofprivatepesticideapplicatorsindicatedthat,
althoughthewomendidnotapplypesticides,theywereoftenexposedtothembecausetheylived
onthefarmandsometimeshelpedpreparethepesticide.Thispopulationhadahighlevelofmajor
depression,oftenrequiringmedication.
Thelongtermimplicationsareevenmoreserious.ResearcherMichaelSkinnerhasfoundthatwhen
pregnantratswereexposedtoapesticideatacertaintime,fourgenerationsoftheirdescendants
inheritedthedamageanddiseasescausedbythetoxin,evenifitdidnotinvolveageneticmutation.
Althoughthiswasananimalstudy,Skinnerbelievesthatthiscanalsooccurinhumans.Thisis
consideredasanepigeneticreasonthatamentalillnesscouldbefoundinmultiplefamilymembers.

Carpets
Symptomsassociatedwithperfluorooctanoicacid(PFOA)exposure
Infertility
Highcholesterol
Thyroiddisease
Birthdefects
Increasedcancerrates
Changesinlipidlevels

Manysyntheticcarpetscontainarsenic,benzeneandothervolatilesolvents.Therearesignificant
positiveassociationsbetweenatopiceczemaandwalltowallcarpets,butoutgassingoftoxinsin
carpetscanalsocausedepression,moodswings,agitation,dysphoria,andconfusion.
Thechemicalperfluorooctanicacid(PFOA)isusedtomakefluoropolymers,substancesthatmake
flameresistantcarpets(alsousedforwaterrepellentclothingandfoodwrappers).Scotchgard,
whichisusedtoprotectcarpets,fabric,andupholstery,andTeflon,aremadefromPFOA.
TheEnvironmentalProtectionAgencyhaspressuredcompaniestodiscontinuetheuseofPFOA,
becauseofevidenceoflowbirthweightandreproductivehealthproblems.Thesubstancealso
causesliverdamage,thyroiddisorders,immunedisorders,andcancer,allofwhichcanpresent
initiallyasmentaldisorders.

Mold
Thepriestistogoinandinspectthehouse.Heistoexaminethemoldonthewalls,andifithas
greenishorreddishdepressionsthatappeartobedeeperthanthesurfaceofthewall,thepriest
shallgooutthedoorwayofthehouseandcloseitupforsevendays.
Leviticus14

Mentalsymptomsofmold
Memoryproblems
Visuospatiallearning
Verballearning
Irritability
Depression
Anxiety
Dysphoria
Fatigue
Dementia
Moldsporesarepresentinallindoorenvironments.Inmostcases,thesemoldsdonotcauseillness,
butexposuretomoldsandtheirassociatedmycotoxinsinwaterdamagedbuildingscancausea
multitudeofhealthproblems,includingdisordersinthecentralnervoussystemandimmunesystem,
bothofwhichcausementaldisorders.
StachybotrysandAspergillusversicolorarecommonmoldsthatdestabilizebrainfunction.The
symptomsofstachybotrysoftenmimicAlzheimer'sdisease.Severalstudiesreportthatpeoplewith
moldexposurehaveasymptomarrayverysimilartothosewhosuffermildtraumaticbraininjury.
Moldexposureisfrequentlymisdiagnosedasfibromyalgia,chronicfatiguesyndrome,orLyme
disease.Itoftenpresentsasanxiety,depression,ordysphoria.

Medications
Medicationsassociatedwithpsychologicalproblems
Antihypertensives
Reserpine
Methyldopa
Betablockers
Oralcontraceptives

Steroids
Histamine2blockers
Cancerchemotherapyagents
Vincaalkaloids
Procarbazine
Lasparaginase
Amphotericin
Interferon
ThereisatroublingphenomenonafootintheUnitedStates.Mostpsychotropicdrugsarenow
prescribedbyphysiciansandnursepractitioners,notpsychiatrists.Evenworse,aNewEngland
ResearchInstitutestudyofantidepressantfoundthat43percentofpeoplewhohavebeen
prescribedantidepressantshadnopsychiatricdiagnosis,noassessment,noranymentalhealth
carebeyondtheprescriptionofthedrug.Thesemedicationsareusuallyprescribedbyfamily
physicians,oftengivenusuallyattherequestofthepatientwhohadseenthedrugonatelevision
advertisement.
UnknowntothepersonrequestingthedrugisthetroublingfindingpublishedintheJournalofthe
AmericanMedicalAssociationthattheriskofsuicidalbehaviorisincreasedinthefirstmonthafter
startingantidepressants,especiallyduringthefirstonetoninedays.Thereisoftennofollowupby
theprescriber.
Evenmoredisturbingisthefindingina2006studythatthreequartersofpeopleprescribed
antidepressantdrugsreceivethemedicationsforreasonsnotapprovedbytheFDA.Themajorityof
thesedrugsareprescribedforwomen.Thereisevidencethatpregnantwomenshouldnotbetaking
thesedrugs.BabiesexposedtoEffexorandotherSNRIsandSSRIslateinthethirdtrimesterof
pregnancyhavedevelopedcomplicationsrequiringprolongedhospitalization,respiratorysupport,
andtubefeeding.Thesecomplicationscanariseimmediatelyupondelivery.
Whenapatientisusingpsychotropics,itisimportanttoaskhowlongthedrughasbeenusedand
howeffectiveithasbeen.Askforpermissiontospeaktotheprescribingpractitioner.Askforany
workupsorlabtestsusedtomakethediagnosis.

Medicationinducedmentalillness
Althoughitiswellknownthatmentalproblemscanbecausedbymedications,thereislittleresearch
exploringthesephenomena.Clinicalstudiesareseldomdonebecauseadversemedication
reactionsaresporadic,idiosyncratic,andunpredictable.Unfortunately,theseproblemsareusually
noticedonlyafteradrughasbeenapproved,whenanecdotaladversereportsbegintoaccumulate.
Drugsarechemicalsthatchangebiochemicalsystemsinthebody.Therefore,anydrugthathasan
effectonthebodyalsohasthepotentialtodemonstrateadverseeffects.Aconservativeestimateis
thatatleast60percentofallprescriptiondrugscausepsychiatricproblems.Arecentsurveystates
thatpsychiatricsideeffectsareactuallylistedonover65percentofpharmaceuticals.These
medicationsmaycausementalproblemsdirectlyormayactivatelatentmentaldisorders.
Inmostcases,medicalprofessionalswhoprescribemedicationsdonotalerttheirpatientsabout
potentialsideeffects.Infact,arecentstudyshowedthatover65percentofpatientswerenottoldby
theirdoctorsaboutanyadversereactionsofadrug,and67percentofpatientswerenottold
anythingaboutpotentialsideeffects.
Althoughitisimpossibletoaddressallproblematicmedications,herearesomeexamplesof
medicationsknowntocauseemotional,cognitive,andbehavioraldifficulties:
MedicationsforParkinson'sdiseaseandrestlesslegsyndromearedopamineagonists,meaning
thattheyincreasethelevelofdopamineinthecentralnervoussystem.Thesemedicationsare
advertisedvehementlyandarebecomingmorepopular.Althoughthemajorityofconsumersofthe

medicationsdoseeanabatementofsymptoms,aboutoneinfivepatientsusingthesemedications
willexhibitproblems,includingpathologicgambling,excessiveshopping,andhypersexuality.
Requip,apopulardopamineagonist,hasbeenfoundtocausepeopletofallasleep,without
warning,duringdailyactivities.Thissometimesoccursaslateasoneyearafterthepersonhasbeen
takingthedrug.
AlargepercentageofpatientstakingtheprostatecancermedicationLeuprolideAcetatereport
shorttermmemoryloss,depression,emotionallability,insomnia,dizziness,andanxiety.
Researchershavenowconfirmedthattherearetoxicinteractionsbetweenpharmaceuticalsand
chemicalstowhichwecommonlyexposedonaregularbasis.Longtermchronicexposureto
organicsolvents,whicharefoundinmaterialssuchaspaints,printinginksanddrycleaningagents,
hasbeenlinkedtolongtermcognitiveimpairment,fatigue,clumsiness,anddepression.Inaddition
topesticides,55contaminantshavebeendetectedinpopularproductssoldasalawnandgarden
fertilizers.Thecombinationwithmedicationsandenvironmentaltoxinscanbedisastrous.Hereare
someexamples:

Cimetidine
Sideeffectsofcimetidine
Confusion
Agitation
Psychosis
Depression
Anxiety
Hallucinations
Disorientation
Inthesummerof1985,ThomasLatimer,ahealthy30yearoldwasmowinghislawn.Afteraboutan
hour,hebegantoexperiencedizzinessandnausea,followedbyasevereheadache.Eachday,he
becameworse.Forthenextsixyears,Mr.Latimerwasunabletoexerciseandbegantohave
seizures.Inthenextfewyears,hevisited20differentdoctors.Hissymptomswereconsistentwith
organophosphatepoisoning,mostlikelyfromtheinsecticidethathadbeenappliedtohislawn.
However,hissymptomsweresosevere,andtheamountofpesticidehewasexposedtowassolow,
thedoctorslookedlookforasynergisticfactor.
Afterextensivetestingandresearch,atoxicologist,threeneurologistsandtwoneuro
ophthalmologistsallconcludedindependentlythatthepopularulcerdrugTagamet(cimetidine)an
overthecounterantacidhadmadehimmorevulnerabletothepesticide.Hisdoctor,AlfredoA
Sudan,aprofessorofneurologyandophthalmologyattheUniversityofSouthernCalifornia,stated
thatTagametcanmakeaperson100to1,000timesmoresensitivetoorganophosphatepoisoning.
Tagametcanalsocausetroublewithconcentration,irritability,severeheadaches,agitation,
restlessness,disorientation,andhallucinations.Tagametimpairsacidsecretioninthestomach,
whichblockstheabsorptionofioniciron(theironfoundinvegetables).Areviewoftheliterature
showsthatcentralnervoussystemsideeffectscanoccurwithin24hoursoftreatmentwiththedrug.
Theyareoftenunrecognizedormisdiagnosedbyclinicians,andarereversedwithin12to48hours
afterthediscontinuationofthemedication.

Statins
Sideeffectsofstatins
Memoryloss
Transientglobalamnesia

Impulsivity
Aggression
Assault
Everycellinyourbodycontainscholesterol.Itmakeseachcellwaterproof.Italsoparticipatesinthe
formationofnewmemories,andallowstheuptakeofserotonin.
StatinsareoneofthemostprescribedmedicationsintheU.S.Themostcommonsideeffectofthe
drugismusclepainandweakness,butothersideeffectsnotlistedinthepackageinsertare
transientglobalamnesia(thesuddenandtemporarylossofmemory),cognitiveimpairment,memory
problems,lowsexdrive,dizziness,depression,andsuicidalideation.Therehavealsobeencasesof
severeirritability,homicidalimpulses,threatstoothers,roadrage,anddamagetoproperty.A1997
Norwegianstudyreportedthatpsychiatricdisordersrepresent15percentofadversereactionsto
statins.

Protonpumpinhibitors
SideeffectsofProtonPumpInhibitors
Depression
Agitation
Aggression
Hallucinations
Confusion
Insomnia
Nervousness
Tremors
Apathy
Protonpumpinhibitorscameonthemarketin1988,asomeprazole(Prilosec).Sincethattime
dozensofsimilardrugshavehitthemarket.Thedrugsworkbyblockingstomachacidproduction.
Todate,theyarethemostpotentinhibitorsofgastricacidsecretionavailable.
Gastricacidisakeydefenseagainstgastrointestinalinfections.Unfortunately,loweringstomach
acidincreasestheriskofanincreasinglycommoninfectiousformofdiarrheacausedbya
proliferationofClostridiumdifficilebacteria,alsoknownasCdiff.Infact,a2008studydoneinthe
UKshowedthat64percentofallpatientswhodevelopedC.diffinfectionswereonprotonpump
inhibitors.
Peopletakingthesedrugsalsohavehigherincidenceofhelicobacterpylori.InfectionsintheGI
systemarewellknowntobeconnectedtomentalproblems,suchasdepressionandanxiety.These
medicationsalsointerferewiththeabsorptionofvitaminB12andvitaminD.ThelackofB12is
knowntopresentasmentaldisorders.Insomepeople,theuseofthesedrugscancauseanxiety,
aggression,confusion,anddepression.

Polypharmacy
Amedicationcanbesaidtocausementalsymptomsonlywhenthesymptomsoccurwhenthedrug
isdeliveredandwhensymptomsabatewhenitiswithdrawn.However,theproblembecomes
difficulttoassesswhenthepersonistakingmorethanonemedication.
Inaddition,manypeopletakingprescriptiondrugsarealsotakingoverthecountermedications,
herbs,vitamins,andsupplements,whichcaninteractwithmedications.
Polypharmacyhasbecomeaseriousproblem.Forthisreason,itismandatorytogetacompletelist
ofyourclientsprescriptionandoverthecountermedications,aswellasherbs,vitamins,and

neutraceuticals.
Unfortunately,wenolongerhavetobeusingpharmaceuticalsinordertohaveproblemswiththem.
Anewsourceofpharmaceutical,hormone,andorganicchemicalingestionisourwatersupply.
ThousandsofsubstanceshavenowbeendetectedinstreamsacrosstheentireUnitedStates,many
whichcanalterbrainfunction.AlthoughadversedrugeffectsaremonitoredbytheFDA,most
pharmaceuticalsarenotregulatedbytheEnvironmentalProtectionAgency.

TheEndocrineSystem
Thehumanendocrinesystemconsistsoftwobasictypesofglands:endocrineandexocrine.
Exocrineglandsarealsocalledductglands,whichincludemammaryglands,sweatglands,salivary
glands,andthestomach,liver,andpancreas.Theproductsoftheseglandsdonotenterthe
bloodstream.Endocrineglandssecretesubstancescalledhormonesintothebloodstreamthat
regulatemetabolisminothertissues,includingthecentralnervoussystem.
Theendocrinesystemismediatedbytworegionsofthebraincalledthehypothalamusandthe
pituitarygland.Thehypothalamusisactuallyagroupofsmallnervecellsnearthebottomofthe
brain.Thehypothalamuscontrolsmanybodyfunctionssuchastemperature,respiration,andsleep
architecture.Italsocontrolsthepituitarygland,whichthensendsmessagestothethyroidandthe
adrenalglands.Thiscircuitiscalledthehypothalamicpituitaryaxis(HPA).
Thereisuniversalagreementthat50to75percentofpatientswithmajordepressionexhibit
hyperactivityoftheHPAaxis.Ithasalsobeenfoundthatpeoplewithgeneralizedanxietydisorder
havedeficitsintheregulatorymechanismsoftheHPAassociatedwithanabnormalresponseto
stress.
Thequestionis,then,whatcausestheHPAaxisdestabilization?Wedoknowthatagingand
depressionchangetheHPAsysteminsimilardirections.Thisisonereasonthatolderadultsare
morepronetodepression.IthasalsobeenfoundthatantidepressantsaffecttheHPAsystemby
reducingitsactivity.
Itmay,inpart,bethatantidepressantsalsoseemtohaveanantiinflammatoryaffect.Althoughthere
aremanywaystoalterthisaxis,oneofthemorecommoncausesofHPAaxisdestabilizationis
inadequateintakeofomega3fattyacids.

Pinealgland
Themostplausibleexplanationfortheassociationbetweengeomagneticactivityanddepression
andsuicideisthatgeomagneticstormscandesynchronizecircadianrhythmsandmelatonin
production,
Kelly,Posner,PhD.ColumbiaUniversityintheUS.
Thepinealglandisatinypineconeshapedorgan(hencethewordpineal)locatedatthebackofthe
brain,justabovethebrainstem.Themajorfunctionofthisglandappearstobethestabilizationof
thecircadianrhythm.Thisisthefundamentalcircuitoftheinternalbalanceknownaswellbeing.
Melatonin,thehormonesecretionfromthepinealgland,isenhancedindarknessanddecreasedby
lightexposure.Asmelatoninissecretedeachnight,ithelpsusfallasleep.Generallyspeaking,
melatoninandserotoninarenotactiveinthebodyatthesametime.Melatoninisactiveatnight
serotoninisactiveinthedaytime.Dysregulationofthisrhythmcancausemooddisorders.
Inadditiontosleep,melatoninhasmanyotherfunctions.Itcontrolsthetimingandreleaseoffemale
reproductivehormones,affectingmenstrualcycles,menarche,andmenopause.Melatonininhibits
thereleaseofcortisolviathereleaseofoxytocin.Thisisinterestinginthatstudiesshowthat
oxytocinplaysaroleinorgasm,socialrecognition,pairbonding,anxiety,trust,love,andmaternal
pairbondingbehaviors.

Aswellasbeingacentralnervoussystemhormone,melatoninisalsofoundintheskinand
digestivetract.Forthisreason,melatoninisfoundtoplayapartinpepticulcers.Stressanddietary
habitscanleadtodeficienciesofbothserotoninandmelatonin.Pinealreceptorcellsareconnected
tothehypothalamus,aspartoftheHPAaxis.
Childrenhavethehighestlevelsofnocturnalmelatonin,butwithage,nocturnalmelatoninlevelsget
lowerandlower,whichismanifestedbythetendencyforagingadultstogotobedearlierandwake
upearlier.Itisalsocommonforolderadultstosufferfromdisruptedsleeppatterns.
Forthesereasons,oneofthecommonusesofmelatoninsupplementsisfortreatmentofinsomnia.
YaledermatologistAaronB.Lernerwastheleaderofateamofresearcherswhodiscovered
melatoninin1958.Thehormonebecameavailableoverthecounterin1994.Whenthisproductwas
initiallyreleasedtothepublic,everyonebelievedthatitwouldbethemosteffectivetreatmentfor
insomniabecauseitwasknownasthe"sleephormone."Unfortunately,itdidnotworkwellasa
supplementtoimprovesleep.Recently,researchersfoundthecause:thedosagehadbeen
incorrect.Whenpeopleoverage50withagerelatedinsomniareceived0.1milligram,0.3milligram,
or3.0milligramdosesofmelatoninhalfanhourbeforebedtime,asignificantincreaseinsleep
efficiencyoccurredwiththe0.3mgdose.Theconclusionwasthatthelowerdosehadbeentoolow
andthehigherdosehadcausedafeedbackloopinthepineal.
Althoughrare,anomaliessuchaspinealtumorsandpinealcystsdooccur.Symptomsinclude
fatigue,irritability,headaches,andnausea.Whilefatigueandirritabilitycanlooklikeamood
disorder,headachesornauseaareredflagsfororganicproblems.UniversityofCaliforniaSan
DiegoresearchersNamirDamlujiandJamesFergusonalsohavedescribedawomanwithapineal
tumorthatpresentedwithanorexia.

Pituitarygland
MentalsymptomsofHypopituitary
Inactivity
Depression
Apathy
Tiredness
Lossofappetite
Dependencybehavior

MedicalSymptomsofPituitaryDisorders
Headache
Peripheralvisionloss
Nausea
Fatigue
Weakness
Coldintolerance
Constipation
Lowbloodpressure
Bodyhairloss
Sexualdysfunction
Unintendedweightlossorgain
Thepituitaryhasbeencalledthemasterglandofthebodybecauseofitscentralroleingoverning
homeostasis,maintainingthereproductivecycle,anddirectingtheactivityofotherglands.Housed
inthesphenoidboneatthebaseoftheskull,ithasimportantanatomicconnectionswiththe

hypothalamus,visualpathways,cavernoussinus(alargecollectionofveinscreatingacavity
borderedbythetemporalboneoftheskullandthesphenoidbone,whichispartoftheeyesocket)
carotidartery,andcranialnerves.
Thetinyglandoriginatesfromtwodiscretepartsofthedevelopingembryo:Rathke'spouch,a
depressionintheroofofthedevelopingmouth,andthestomodeum,theprecursorofthemouthand
anteriorlobeofthepituitarygland.Thepituitarystalkformstheposteriorlobe.Theanterior,
intermediate,andposteriorlobesofthepituitaryglandfunctionasthreeseparateendocrineorgans,
eachcharacterizedbydistinctcellpopulations,secretoryproducts,andregulatorymechanisms.
Theanteriorlobesecretesthyroidstimulatinghormone,corticotropin,luteinizinghormone,follicle
stimulatinghormone,growthhormone,andprolactin.Itisregulatedbythehypothalamusviathe
portalvascularsystem.Theanteriorlobecomprisesapproximately80percentoftheentiregland.
Theposteriorlobereleasesoxytocinandvasopressinfromaxonterminalsthatoriginateincell
bodieslocatedinthehypothalamus.Interestingly,theglandsintermediatelobeisrudimentaryin
humanbeings,butproducesseveralhormoneswhosephysiologicsignificancehasyettobe
established.
Hypopituitarismcanbecausedbyatumor,aninfection,alesion,oraheadinjury.Thepituitary
sendsmessagestotheadrenalglands,thethyroid,andothertargetorgans.Forthisreason,
damagetothepituitaryoftenlookslikeathyroidoradrenalglandproblem.Hypopituitarismisoften
diagnosedasdepression,apersonalitydisorder,oranorexia.
ResearchfromDukeUniversityMedicalCenterandtheU.S.FoodandDrugAdministration(FDA)
suggestsalinkbetweenpituitarytumorsandantipsychoticmedicationdrugsusedtotreat
schizophrenia,psychosis,paranoia,andmanicdepressivedisorders.Theconnectionhasbeen
suspectedforover20years,butthisisthefirststudythatlinksthemostwidelyusedantipsychotic
medication,risperidone(tradenameRisperdal),topituitarytumorsinhumans.Whatisstrikingis
thatthedrugwaslinkedto70percentofpituitarytumorsreportedtotheFDA'sAdverseEvents
ReportingSystemdatabase.
ThefindingswerepublishedintheJune2,2006issueofPharmacotherapybycoauthorsAna
Szarfman,JosephTonningandJonathanLevine,allaffiliatedwiththeFDA.Theresearchers
cautionedthatthestudy,althoughsuggestive,doesnotprovethatthemedicationsactuallycause
pituitarytumors.

Thyroid
ThereareaboutelevenmillionpeopleintheUnitedStatesandCanadawhohaveanoveractiveor
underactivethyroid,twomillionofwhomdonotrealizethattheyaresick.
LawrenceC.Wood,MD,FACPPresident,ThyroidFoundationofAmerica

Drugsthatmayproducehypothyroidism
Amiodarone(Cordarone)
Colchicine(Colsalide)
Fluoxetine(Prozac)
Interferonalfa(AlferonN,IntronA,RoferonA)
Lithium(Eskalith,Lithobid)
Methimazole(Tapazole)
Potassiumiodide,KI(Pima,SSKI)
Propylthiouracil
Putyourhandonyourneck(asifyouwerepretendingtochokeyourself),andyouwillfeelyour
Adamsapple,whichisblanketedbyyourthyroidgland.Thisbutterflyshapedgland,wrapped

againstthewindpipe,isthelargestpureendocrineglandinthehumanbodyitmeasures
approximatelytwoinchesacross.
Itisalsothefirstglandtoappearinthefetus.Ababy'sthyroidwillbegintofunctionatabout10to12
weeksofpregnancy.Thyroidhormonesplayanimportantroleinthedevelopmentoffetalnervous
systems.Theyarelikelyderivedfromboththebaby'sthyroidgland,aswellasthemother'sthyroid
hormoneswhichcrosstheplacenta.
Itisknownthatiodinefromamother'sdietalsocrossestheplacentaandisusedbythefetalthyroid
glandtomakethyroidhormone.Fetaliodinedeficiencycancausenewbornhypothyroidismor
mentalretardation(cretinism)andisamajorworldhealthprobleminunderdevelopedcountries.
However,intheUnitedStates,thereisanabundanceofiodineinthedietanddisorderscausedbya
lackofiodinerarelyoccur.
TheHumanThyroidglandproducesT4(Thyroxine),T3(Triiodothyronine),smalllevelsofT2,T1,
andanotherimportanthormonecalledcalcitonin.Calcitoninregulatescalcium,andhelpsstopthe
leechingofcalciumfrombones.Thesehormonesarereleasedintotheblood.Curiously,westilldo
notknowwhatT1andT2actuallydo,althoughsomeresearchsuggeststhatT2mayplayarolein
conversionofT4toT3.T2alsoincreasesthemetabolismoftheliver,heart,andmuscletissue.It
alsoreducesbrownfat.Becauseofthis,T2isbecomingapopulartoolforweightlossand
bodybuilding,despitealackofaccreditationbytheFDA.
Theleveloftheglandsactivityisgovernedbythyroidstimulatinghormone(TSH).Thesecretionof
TSHisregulatedbycirculatinglevelsofthyroidhormonesviaanegativefeedbackloopand
hypothalamicthyrotropinreleasinghormone(TRH).
Inpostmenopausalwomen,theincidenceofthyroiddiseaseisabout2.4percent,butsubclinical
thyroiddiseaseisabout23.2percent.Inthosewithsubclinicaldisease,hypothyroidis73.8percent
whilehyperthyroidis26.2percent.Synthroid,usedtotreathypothyroidism,isnowoneofthetopfive
prescribeddrugsintheU.S.
In1974,diagnosingaccordingtosymptomswasputasideinfavorofgettingadiagnosisfromlab
results.Atthattime,themainstreammedicalindustrydecidedthatTSHtestingwouldbethegold
standardfordiagnosinghypoandhyperthyroidism.
ThishasbecomeaprobleminthatTSHlevelsarenotareliableindicatorofthyroidfunction.Asa
consequenceofrelyingonlabsandnotsymptoms,manypeopletodaysufferforyearswith
symptomsofthyroidproblems.
Seasonalchangesinlightandtemperaturemayaffectthemetabolismofbrainthyroidhormones.T3
mayitselfbeaneurotransmitterandmayhaveanantidepressanteffect.Itenhancestheeffectsof
norepinephrine,serotonin,andaminobutyricacid.
Malfunctionofthethyroidglandcancausesignificantproblemsinthecentralnervoussystem.
Althoughovertthyroiddiseaseisrareamongdepressedpatients,depressionoftencoexistswith
subclinicalthyroiditis,suggestingthatdepressionmayaltertheimmunesystem,orcouldbean
autoimmunedisorderitself.
Stimulationofthyroidhormonesoftenoriginatesinanareaofthebraincalledthehypothalamus,
locatedinthebrainjustabovethepituitarygland.Whenthehypothalamussecretesthyrotropin
releasinghormone,ittriggersthepituitaryglandtoreleasethyroidstimulatinghormone(TSH).
Inhealthypeople,almostallthyroxineisconvertedtotriiodothyronineinthetissues.Thismeansthat
theprimarythyroidhormonefinallydeliveredtoandactingontissuesisT3.Innormalhealth,
maintenanceofrestingmetabolismandexcitabilityofmembranesrequirebetween3550
microgramsofT3aday.
Manyenvironmentaltoxinsderegulatehormones,butthethyroidisespeciallysusceptible.Thisisof
greatconcernbecausethethyroidisinstrumentalinorchestratingfetalbraindevelopment,including
theprocessesofneuralmigrationandmyelination.

Thyroidproblemsareoftenmissed,evenafteracompletephysical.Inmyworkshopsandseminars,
Ihavelistenedtoseveralhundredpeoplemostlywomendescribehowtheysufferedfromthyroid
problemsforyears.Thesufferersbeginbygoingtoadoctorcomplainingofsleepproblems,
lassitude,lethargy,malaise,andachesandpains.Theymayalsohavecognitiveandmemory
problems.Hearingthesewoes,thedoctorwillconductaphysicalandmayrequestathyroidpanel.
Thepanelcomesbacknormal.Thisgetsthemadiagnosisofdepression,andeitheran
antidepressant,orareferraltoamentalhealthprofessional.Neitherpsychotherapynor
psychotropicshelptheproblems.Theproblemislabeledtreatmentresistantdepression.Afterthis,a
journeyofdoctorshoppingbegins.
Aftermanydoctors,manytherapies,andnumerousthyroidpanels,apractitionerfinalsays,Mrs.
Stevens,yourthyroidpanellooksgood,butyoulookawful.Letstrysomethyroidanywayandsee
whathappens.Whathappensisalmostcompleteremissionofallsymptoms.(Interestingly,the
clinicianthatprescribesthistreatmentisoftennotanMD,butanOD,ND,orNursePractitioner.)
Thyroidpanelscanbeveryuseful,buttheyrelyonnorms.Everypersonisdifferentwhatisnormal
formemaynotbeadequateforyou.
Around1974,TSHwasdeclaredthebesttesttodiagnosehypothyroidismandhyperthyroidism,and
todeterminetheamountofmedicationneeded.Thiswasapparentlydonewithoutanyclinicaltesting
toseeifTSHlabtestresultsactuallycorrelatedwithsymptoms.Duringthistime,diagnosingby
symptomswasconsideredlessusefulthanlabvalues.
Researchrevealsthatpeoplewiththyroiddisordershavesignificantlyhigherratesofpanicdisorder,
phobias,irritability,obsessivecompulsivedisorder,majordepressivedisorder,bipolardisorderand
cyclothymia.
ResearcherandclinicianLeslieM.C.Goldenbergsaysthatthyroidproblemsareroutinelymissedin
olderwomenbecauseofbonethinning.Bonemodelingcausestheheadtobecomepositioned
forward,bringingthelowerpartoftheneckforwardanddown,causingthestructuresintheneck
includingthethyroid,todescendorcrawlintothechest,oftenbehindthebreastbone.Thismeans
thatitisoftendifficultorimpossibleforphysicianstoexaminephysicallythethyroidofmostolder
women.
AccordingtoGoldberg,hypothyroidismpresentssignsinoldpeoplewhichalmostneverappearin
youngpatients.Theseareabnormalitiesinthecerebellumatthebackofthebrainwhichleadtoan
ataxicordrunkengait,achesandpainsthatarenotinoraroundthejoints,andcarpaltunnel
syndrome,acompressionofanimportantnerveinthewrist,whichresultsintinglingsensations.
Hyperthyroidism

MentalSymptomsofHyperthyroidism
Markedanxietyandtension
Emotionallability
Irritabilityandimpatience
Distractibleoveractivity
Exaggeratedsensitivitytonoise
Fluctuatingdepression

PhysicalSymptomsofHyperthyroidism
Increasedbodytemperature
Rapidheartbeat
Heartpalpitations
Thinninghair
Intolerancetoheat

Breathlessness
Increasedbowelmovements
Diarrhea
Lightorabsentmentrualperiods
Muscleweakness
Warm,moistskin
Puffyeyes
Thethyroidglandsecreteshormonesthatcontrolmetabolismthespeedatwhichthebody
convertsfoodintoenergy.Overactivityofthethyroidglandiscalledhyperthyroidism.
HyperthyroidismisthestateofhavinglowlevelsofTSH,highT4,andhighT3.About300,000new
casesofhyperthyroidismoccurintheUnitedStateseachyear.
Asignificantnumberofpatientswillbeinitiallyseenbymentalhealthprofessionals.Amajorityof
hyperthyroidpatientswillshowmildmentalsymptoms,butsomewillexhibitpsychosis,hypomanic
orbipolarsymptoms,dementia,confusion,depression,apathy,problemsfallingasleep,problems
withconcentration,hyperactivity,andanxiety.
Researchersestimatethat60to75percentofpeoplewithhyperthyroidismwillexperienceanxiety.
Infact,thesymptomarrayisoftenindistinguishablefromanxietydisorders,presentingwith
restlessness,irritability,attentiondeficitdisorder,poorconcentration,andhistrionicaffect.Other
symptomsincludeflightofideas,pressuredspeech,irritability,shorttemper,andtangentialspeech.
Theredflagforhyperthyroidismisweightloss.
Autoimmunethyroiddisease
Thetermautoimmunethyroiddiseaseencompassesalloftheautoimmunethyroidconditions,
includingHashimoto'sthyroiditis,Grave'sDisease,mostcasesofsilentthyroiditis,andpostpartum
thyroiditis.
Hashimoto'sThyroiditis

MentalSymptomsofHashimoto'sthyroiditis
Anxiety
Labilityofmood
Withdrawalfromnormalduties
Fatigue
Drowsiness
Forgetfulness
Difficultywithlearning
Agitation
Disorientation
Persecutorydelusions

PhysicalsymptomsofHashimoto'sthyroiditis
Dry,brittlehairandnails
Dry,itchyskin
Puffyface
Constipation

Hashimoto'sThyroiditisisthemostcommoncauseofhypothyroidismintheUnitedStates.Itis
namedafterthefirstdoctorwhodescribedthisconditionDr.HakaruHashimotoin1912.
Hashimoto's,alsocalledautoimmunethyroiditis,isaconditioncausedbyinflammationofthethyroid
gland.Itisanautoimmunedisease,whichattacksthethyroidglandasifitwasforeigntissue.The
causeisunknown,butthediseasetendstooccurinfamilies,andisoftenassociatedwithother
autoimmuneconditionssuchasType1diabetesandceliacdisease.Currently,itaffects
approximately14millionAmericansandisaboutseventimesmorecommoninwomenthaninmen.
Itmostoftenpresentsinadulthood.ThereisahigherprevalenceofchronicHashimoto'sThyroiditis
inchildrenandadolescentswithvitiligo.Forthisreason,researcherssuggestthatallchildrenwith
vitiligobeassessedforthyroiddisease.
BlooddrawnfrompatientswithHashimoto'sThyroiditiswillshowanincreasednumberofantibodies
totheenzymethyroidperoxidase,anenzymefoundinthethyroidgland.
Theantibodies'interactionwiththeenzymecausesinflammationinthethyroidgland.Eventuallythe
thyroidglandisdestroyedandthepatientisrenderedhypothyroid.
Likemanythyroidmaladies,Hashimoto'scanpresentasamentaldisorder,withboutsofexcessive
sleepiness,chronicfatigue,anddepression.
GravesDisease

MentalsignsofGraves'Disease
Anxiety
Difficultyconcentrating
Fatigue
Insomnia
Nervousness
Restlessness

PhysicalsymptomsofGraves'Disease
Brittlehair
Frequentbowelmovements
Increasedappetite
Increasedsweating
Menstrualirregularitiesinwomen
Muscleweakness
Rapidheartbeat
Weightloss
Itwas1835,whentheIrishdoctorRobertJamesGravesfirstdescribedacaseofgoiterwithbulging
eyes,nowcalledGravesDisease.Gravesisnowknowntobeanautoimmunedisorder.Itisthe
mostcommoncauseofhyperthyroidism.Morethan90percentofpatientswithGravesDisease
haveamalfunctionintheimmunesystemwhichreleasesabnormalantibodiesthatmimicTSH.
Mentalsymptomsincludedepressionandanxietydisordersand,sometimes,cognitivedysfunction.
Interestingly,asignificantnumberofpeoplehaveanalteredmentalstateevenaftersuccessful
treatmentofthehyperthyroidism.Anxiety,hypomania,andirritabilityarecommonsymptomspriorto
thediagnosisand,therefore,thepersonwillbediagnosedwithamentaldisorderbeforethe
discoveryofGravespathology.PsychiatristPaulSteinbergin1994publishedacaseofaman
diagnosedwithparanoiddisorderthateventuallywasassociatedwithGravesDisease.Another

studyrevealedthatnineofthirteensubjectswithGraveshadmajordepression,eightofthethirteen
hadgeneralizedanxietydisorder,andthreewerehypomanic.
Evenwithtreatment,theconditionispronetorelapseorworseninthepostpartumperiod.Whenthis
occurs,antithyroiddrugsarestartedortheirdoseincreased.Radioactiveiodinecanbegivenifthe
motherisnotbreastfeeding.
A1993articleintheJournaloftheAmericanMedicalAssociation,suggestedthatsmokersaretwice
aslikelyasnonsmokerstodevelopGravesDisease.Smokingorsecondhandsmokealsoworsens
eyeproblemsinpeoplewithGravesDisease.
Autoimmunesubclinicalthyroiditis
Depressionoftencoexistswithautoimmunesubclinicalthyroiditis,suggestingthatdepressionmay
causealterationsintheimmunesystem.Someclinicianspositthatdepressionitselfcouldbean
autoimmunedisorder.Theoutcomeoftreatmentandthecourseofdepressionmayberelatedto
thyroidstatusaswell.Addingthyroidhormones,usuallyT3toantidepressanttherapyisawell
documentedtreatmentoptionforrefractorydepressedpatients.
Hyperthyroidismisseventimesmorefrequentinwomen.Italsorunsinfamilies.Anxietydisorders
anddepressionalsopresentsmorecommonlyandwomen.Ithasalsobeenfoundthat
hyperthyroidismismorefrequentamongAfricanAmericanwomenthanisCaucasianwomen.
Subclinicalhyperthyroidism

MentalSymptomsofSubclinicalHyperthyroid
Fear
Anxiety
Hostility
Depression
Cognitiveproblems
Amildformofhyperthyroidismverycommoninthegeneralpopulation,particularlyinwomen,is
calledsubclinicalhyperthyroidism.Oneofthemorecommoncausesofthisdisorderisrepeatedviral
infections.Othermedicalproblemsfrequentlyoccurinpeoplewithsubclinicalhyperthyroidism,
includingcardiacabnormalitiesandboneloss.
Aninterestingfindinginhyperthyroidismisaconnectionwithcarpaltunnelsyndrome.Researchers
havefoundthattreatingthethyroidproblemoftenremovedtheneedforcarpaltunnelsurgery.
Thedisorderoftenpresentsasalumpinthethroatorafeelingofbeingstrangled.Thisisoften
missedormisdiagnosedashysteria.
Subclinicalhyperthyroidismisusuallyreferredtoasastatewhereinthepatientdoesnotshowthe
symptomsofhyperthyroidism.Itoccursinmorethan10percentofwomenolderthan60years.The
onlyabnormalityisanincreasedlevelofTSHintheirblood.Thismeansthatthepituitaryglandis
overworkingtopreservethecirculationlevelofthyroidhormones.Amiodaroneandlithiumare
medicationsthatarethelesscommoncausesofhyperthyroidism.Lithiumcarbonate,widelyusedin
thetreatmentofbipolarpatients,iswellknowntoinducethismalady.
Subclinicalhyperthyroidismisdefinedasanormalserumfreethyroxine(T4)andfree
triiodothyronine(T3)levelswithathyroidstimulatinghormone(TSH)levelsuppressedbelowthe
normalrange,butusuallyundetectable.Itisanincreasinglyrecognizeddisorder.Theproblemwith
diagnosisisthemeasurementofonlytotalT4andT3levelsisofteninsufficient.T4andT3levels
areoftenwithinthenormalrangehowever,freeT4andT3areincreased.Mostelderlypatientswith
subclinicalhyperthyroidismhaveamultinodulargoiter,butotherconditionssuchasGravesDisease
orHashimotosdiseasemayalsoresultintheproblem.

Thisstatemaydevelopmentintomajordepressivedisorder.Evenwhenhyperthyroidhadbeen
treated,researchersMartinBommerandassociateshavefoundthatmanypatientswithsubclinical
orremittedhyperthyroidismshowedmoreabnormalitiesthanthecontrolsinalldimensions
investigated.Fortythreepercentofthesepatients(comparedtotenpercentofcontrols)complained
ofseriouslyreducedwellbeing,feelingsoffear,anxiety,hostility,andcognitiveproblems.
Treatmentisoftenalowdoseofthedrugmethimazole(Tapazole)5mgperday,whichmayresultin
normalTSHlevels.Unfortunatelythismedicationcanalsocauseupsetstomach,nausea,lossof
tastesensation,headache,drowsinessordizziness.
Apathetichyperthyroidism
Thesequiet,disinterestedpatients,wholookoldfortheiragebutdonotlookextremelyill,may
quietlyandpeacefullysinkintoapathy,fromthatintocoma,anddieanabsolutelyrelaxeddeath.
FH.Lahey,1931

Mentalsignsofapathetichyperthyroidism
Apathy
Inactivity
Avolition
Depression

Medicalsignsofapathetichyperthyroidism
Weakness
Povertyofspeech
Exhaustion
Weightloss
Tachycardia
Althoughhyperthyroidismusuallypresentsasanxietyandrestlessness,somewillexhibitsevere
signsofdepression,extremeapathy,andsocialwithdrawalaconditioncalledapathetic
hyperthyroidism.Thispresentationoccursmoreinelderadults,butmaybeseeninchildren,
adolescents,andyoungeradults.
Becauseofthesymptomarray,itisoftendiagnosedasamooddisorder.Childrenandadolescents
withthedisordermaybecomewithdrawn,appeardisinterested,andhavepoorschoolperformance.
Theymayexhibitexcessivesleepandweightloss.Mostpeoplewiththisconditionwilldisplayno
symptomsofthyroidproblems.Insomecasesthepersonwillhavenormalthyroidhormonelevels.
Hypothyroidism
Asignificantnumberofpeoplewithhyperthyroidismwilleventuallysufferfromhypothyroidism,which
mayoccurfromfivetotwentyyearsafterthefirstsymptomsappear.
Hypothyroidismlowersmetabolicrate.Italsolowersbodytemperature.Peoplewithhypothyroidism
exhibitpsychomotorretardation,lethargy,fatigueandlassitude.Thyroxine(T4)stimulatesmetabolic
activityinthebody.Iodineisneededforproperthyroidfunctionpeoplewhodonothaveenough
dietaryiodinemaydevelopagoiter,whichisaswellingofthethyroidgland.Thisresultsinunder
activityofthethyroid,aconditioncalledhypothyroidism.Thisdisorderoftenpresentinpsychological
symptoms.PresentationofhypothyroidismisthestateofhavinghighlevelsTSH,lowT4,andlow
T3.
Despitetheknowneffectsofthyroidondepression,reviewsoftheliteraturefindlittleconclusivedata
abouthowthyroidfunctioncontributestodepression.Whileitisclearthatnotallpeoplesuffering

fromdepressionhaveovertthyroiddysfunction,itisalsoclearthatasubgroupofdepressedpatients
manifestsubtlethyroidabnormalitieswhichdonotfitthecriteriaforthyroidproblems.Inmany
cases,thepresenceofasubtlethyroiddysfunctionisignored.Thiswilloftentimesbelabeled
treatmentresistantdepression.
Smokersaremorelikelytohavethyroidenlargement.Mildthyroidenlargementinsmokerscouldbe
asignofthyroiddisturbance.Tobaccocontainscyanide,whichinthebodyisconvertedto
thiocyanate,whichactsasanantithyroidagent,directlyinhibitingiodideuptakeandhormone
synthesis.Researchersbelievethattherearemanyothercomponentsofsmokethatmayhave
antithyroidactiondecreasingthebindingoftriiodothyroninetoitsreceptorsoritspostreceptor
actionsintheliver,muscle,orotherorgans,orboth.
Centralhypothyroidism

SymptomsofCentralHypothyroidism
Fatigue
Apathy
Weightgain
Dryskin
Constipation
Intoleranceforcold
Centralhypothyroidismisthedeclineinthyroidhormonebecauseofinadequatestimulationofa
normalthyroidglandbythyroidstimulatinghormone.Itissometimescausedbypituitarydiseaseor
dysfunctionofthehypothalamus.Causesincludehypothalamicandpituitarytumors,Sheehan's
Syndrome(damageoccurstothepituitaryglandcausedbyseverebloodlossduringorafter
childbirth),sarcoidosis(aninflammatorydisorder),histiocytosis(anabnormalincreaseinthenumber
ofimmunecellscalledhistiocytes),andlymphocytichypophysitis(arareinflammatorycondition
affectingthepituitarygland).
CentralHypothyroidismiscommoninpatientswhohavebeenirradiatedforpituitarytumors,sinus
tumors,andbraintumors.Thelongertheintervalsinceirradiation,themorelikelyapatientdevelops
hypothyroidism.
ManypeoplewiththisdisordershownormallevelsofTSH.ResearcherspositthattheTSHis
modifiedandnotfunctioningcorrectlytherefore,aTSHtestswillnotshowabnormalities.
Subclinicalhypothyroidism

SymptomsofSubclinicalHypothyroidism
Treatmentresistantdepression
Panicdisorders
Alterationsincognition
SubclinicalhypothyroidismisdefinedasaserumTSHconcentrationabovethestatisticallydefined
upperlimitofthereferencerangewhenserumfreeT4(FT4)concentrationiswithinitsreference
range.
Inpatientswithsubclinicalhypothyroidism,labtestsshownormallevelsofserumfreeT4andT3,
butelevatedserumTSH.Theincidenceofthedisorderisfromfivetotenpercentofthepopulation,
mainlyinwomen.Itmostoftenoccursinwomenolderthan45yearsofage.Theincidenceinthat
populationis1520percent.
Betweeneighttofourteenpercentofpatientswithsubclinicalhypothyroidismwillhavesymptomsof
depression,buttheymayhavemildornoclassicsymptomsofthyroidhormonedeficiency.

Pregnancyproducesanincreaseddemandonthethyroidgland.Towardtheendofthefirsttrimester
ofpregnancy,bloodlevelsofTSHoftenaresuppressed.Thethyroidstimulatingactivityofhuman
chorionicgonadotropin(hCG)willcausesomewomentoexhibitatransienthyperthyroidism.In
normalindividuals,thiswillnotcauseasignificantloadtothethyroidgland,butinfemaleswith
subclinicalhypothyroidism,theextrademandsofpregnancymaycauseaclinicalthyroiddisease.
Lifetimefrequencyofdepressionissignificantlyhigherinpeoplewhomeetthecriteriaforsubclinical
hypothyroidism.
Missingthyroidproblems
"TheprevalenceofundiagnosedthyroiddiseaseintheUnitedStatesisshockinglyhigh.
HosseinGharib,MD

Medicalsymptomsofthyroidproblems
Slowedcognition
Cloudedsensorium
Chronicfatigue
Anhedonia
Apathy
Paranoidideation
Delusions
Althoughthyroiddisordersoftenpresentaspsychologicalproblems,symptomsusuallyinclude
observablemedicalproblemssuchasdiarrhea,protrudingpuffyeyes,andweightloss.
Anypersonwithamooddisordershouldbeaskedwhethertheyhavehadapersonalorfamily
historyofthyroidproblems,aswellasanyprevioustreatmentforthyroidproblems.
Thyroiddisordersareusuallydiagnosedwithbloodtestscalledthyroidpanels.Thisiscurrentlythe
mosteffectivediagnostictool.Beawarehowever,thatsomepeoplewiththyroidproblemswill
presentwithnormallabvalues.Inthesecases,patientsmayhaveahistoryofdoctorshopping,as
thediagnosisismissed.Forexample,T4levelsarehighinapproximately90percentofhyperthyroid
patientsandlowinapproximately85percentofhypothyroidpatients.Thisalsomeansthat10
percentto15percentofpeoplewiththyroidproblemswillbemisdiagnosed.
In2003,theTSHdiagnosticlevelssetbytheAmericanAssociationofClinicalEndocrinologistswere
changedfrom0.46.0to0.33.0.ThenewimprovedrangeincreasedthenumberofAmericans
diagnosedwiththyroidillnessfrom13milliontoapproximately27million.Unfortunately,over13
millionAmericanswiththyroiddiseasewillremainundiagnosed.
Somelabsandsomepractitionersmaynotbeawareoftherevisedguidelines.Thesevaluesare
averages.Valuesmayvarysomewhatfromlabtolab.Besuretoaskwhatthenormalrangesarefor
eachlabthatisused.
LaboratoryValuesforThyroidDisorders

LaboratoryValuesforThyroidDisorders
TestName
TSHTest
ThyroidStimulating
Hormone

NormalRange
0.4to6.0

0.3to3.0(asof2003)

Interpretation
TSHunder0.3indicates
possiblehyperthyroidism
TSHOver3.0is
consideredindicativeof

hypothyroidism

Serumthyrotropin
TotalT4test

4.5to12.5

Serumthyroxine

T4levellessthan4.5is
anindicationofan
underactivethyroidwhen
TSHisalsoelevated
T4over12.5indicates
hyperthyroidism

FreeT4test

0.7to2.0

FreeThyroxineFT4
T3test

80to220

Serumtriiodothyronine

LowT4withlowTSH
suggestsapituitary
problem
T4lowerthan0.7is
indicativeofpossible
hypothyroidism
Lessthan80canindicate
hypothyroidism

Thesearegeneralvaluesoraverages.Labvaluesmayvarysomewhatfromlabtolab.
Unfortunately,theresultsreflectedinthetableabovecandonomorethanindicatethepossibilityof
athyroidproblem.Sinceasignificantproportionofpeoplewhosufferfromthyroidproblemsmay
havenormallabresults,thismeanstheresultsareunreliableandoftenproduceawrongdiagnosis.
InmyseminarsthroughouttheU.S.,Ihaveheardnumerousstoriesaboutpeopledoctorshopping
withsymptomsofdepression,sleepdisturbances,cognitiveproblems,andchronicfatigue.Once
thyroidpanelsshownormalvalues,thethyroidisoftendiscardedasadiagnosis.Thepersonthen
visitsnumerousdoctorsandtherapistsfortreatmentofdepression.Afterrepeatedtreatmentfailures,
theyarelabeled"treatmentresistant."
Treatment
Doctorsmusttreatthepatient,NOTthebloodtest.
LeonardWartofsky,MD
Truehyperandhypothyroidismdisordersarenotmentalillnesses,andthereforeshouldnotbe
treatedwithpsychotherapyorpsychotropics.Infact,psychotropicsmaycauseadversereactionsin
thesedisorders.Researchstatesthathyperthyroidismshouldalsonotbetreatedwithtricyclic
antidepressants.Lithiumandantipsychoticsarealsocontraindicated.
Iamnotbyanymeanssuggestedthatyougivemedicaladvicetoclientorpatients.Thyroid
disordersaremedicaldisordersthatcanbetreatedwithmedications,surgeries,ordietary
alterations,whichareclearlyoutsideofpsychotherapistsscopeofpractice.Nevertheless,you
shouldbeawareofclinicaltreatments.
ThegoalofmedicaltreatmentistorestorenormallevelsofTSH.MedicationsareavailableforT3
andT4.ButthethyroidhormonesT2andT1areonlyindesiccatedthyroid,whichisnaturalthyroid
hormonederivedfrompigthyroids.Verylittleisknownaboutthesehormones.
SomecliniciansrecommendtheuseofArmourthyroid,becauseitisabioidenticalhormone
replacementandcontainsT1,T2,T3,T4,andTSH.Armouristhemostwellknownofthenatural
desiccatedporcinethyroidmedsandoldestonthemarket,havingbeenintroducedinthe20th
century.OtherbrandsincludeErfasThyroidfromCanada,andNaturethroidandWesthroid,which
arebothproducedbyRLCLabs.AnotherdesiccatedthyroidcalledThyroidSisimportedfrom
Thailand.Australiausescompoundeddesiccatedthyroidpowder.Allcomefrompigthyroidsandall
usethyroiddesiccatedpowder,whichmeetsthestringentguidelinesoftheU.S.Pharmacopeia.

ArmourappearstobegrandfatheredinbytheFDA,sinceitwasaroundbefore1938whentheFDA
wascreated.
AlthoughmostthyroidpatientsdowellwithT4medicationalone,oronT4andT3together,a
numberofpatientswhodonotrespondtothesedrugsandswitchtodesiccatedthyroidwillfindthat
theirhealthimproves.SomecliniciansbelievethisisanindicationthatT1andT2mayalsohave
somefunction.

Parathyroid
Althoughyoucanfeelyourthyroidbyplacingyourhandonyourthroat,youcannotfeelthefour
smallnodulesbehindit,calledtheparathyroidglands.
Theprefixparatechnicallymeansbeside,near,oralongside,buttheglandsareactuallylocated
behindthethyroid.Eventhoughthewordsthyroidandparathyroidsoundsimilar,theglands
themselvesarenotrelatedtooneanotherandhavecompletelyseparatefunctions.
Ahealthyparathyroidglandisusuallyaboutthesizeofagrainofrice.Itismadeupofabout80,000
verysmallparathyroidcells.Throughouttheday,thesecellsmeasurethecalciumintheblood.
Parathyroidglandssecreteasubstancecalledparathyroidhormone.Itisthemasterregulatorof
calciumandphosphorusconcentrationinourextracellularfluids.Whenthecalciumislow,they
makeparathyroidhormone(calledPTH).Whenthecalciumishigh,theystopmakinghormone.
Parathyroidhormone'smajortargetcellsinthebonesandkidneys,butmalfunctioninthisglandcan
haveprofoundeffectsinthecentralnervoussystem.About25percentofpeoplewithidiopathic
hypoparathyroidismwillhavementalproblems.
Hypoparathyroidism

Mentalsymptomsofhypoparathyroidism
Cognitivedysfunction
Mildpersonalitychanges
Depression
Psychosis
LowEnergy
Socialisolation
Emotionallability
Irritability
Fatigue
Anxiety
Hypoparathyroidismisaconditioninwhichtheparathyroidglandsdonotproduceenough
parathyroidhormone,whicheventuallyleadstoadecreaseincalciumintheblood,acondition
calledhypocalcemia.Hypocalcemiaoccursrarelyinadults,butisfoundmorefrequentlyinchildren
andtheelderly.Itismorecommoninfemalesthatitisinmales.
Thetwomostcommoncausesofparathyroidmalfunctionarethyroidglandsurgeriesthat
inadvertentlydamagedtheparathyroids,oravitaminDdeficiency,whichisoftencausedby
nutritionaldeficiencyorakidneymalfunction.Thisstatecancauseseizures,oftenwithconvulsions,
frequentheadaches,thinninghair,muscleweaknessandmusclecramps,andnumbnessortingling
inthefaceofhands.
Thesephysicalsymptomsdonotlooklikementalillness,buttheyusuallydonotoccurinthe
beginningstagesoftheproblem.Instead,thisdisorderisemergesasdepressionoranxiety.When

misdiagnosed,thediseaseprogressesuntilphysicalsymptomseventuallyoccur.
Hyperparathyroidism

Mentalsymptomsofhyperparathyroidism
Decreasedabilitytocompletetasks
Irritability
Shorttemperedness
Decreasedsexdrive
Inabilitytoconcentrate
Memoryproblems

Physicalsymptomsofhyperparathyroidism
Headache
Backpain
Chestpain
Weakness
LowEnergy
Sleepdisorders
Tiredallday
Hyperparathyroidismoccurswhenoneofthefourparathyroidglandsgrowsintoabenigntumor.
Thiscausestheglandtoconstantlymakelargeamountsofparathyroidhormone,withoutpaying
attentiontohowhighthebloodcalciumis.
Thisdisorderoccursintwoforms:primaryandsecondary.Primaryhyperparathyroidismiscausedby
parathyroidglanddisease.Thisismostcommonlyduetoabenignparathyroidtumor(calledan
adenoma)inoneofthefourparathyroidglands,whichoversecretesthehormone.Womenarefour
timeslikelytohavehyperparathyroidismthanmen.
Inmostcasesofhyperparathyroidismdisease,oneoftheparathyroidglandshasgrownintoatumor
usuallynotmorethanthesizeofanolive.
Butthissmalltumorcancausesignificantmentalsymptomsincludingdelirium,suddenonset
dementia,depression,anxiety,psychosis,visualhallucinations,paranoiddelusionsandapathy.
Parathyroidtumorsareoftenremovedsurgically.Aftersurgicalremovalofaparathyroidtumor,low
levelsofmagnesiummayoccur(themedicaltermforthisproblemishypomagnesemia).
Primaryhyperparathyroidismisacommondisorderinpeopleover65yearsofage.Inthisage
group,theprevalenceisthreepercentforwomenandonepercentformen.Parathyroidglands
stabilizecalcium.Thephysicalsignsofthisdisorderarechronicelevationsofbloodcalcium
concentration(calledhypercalcemia),kidneystones,andthedecalcificationofbones.Beaware,
however,thatevenmildelevationofcalciummaycausesignificantsymptomsinsomepeople.This
subtleelevationissometimesignoredbyphysiciansand,therefore,thedisorderwillgo
undiagnosed.Expertsinthescienceofparathyroidproblemsarequicktopointoutthatthelevelof
thecalciumdoesnotcorrelatewiththeamountorseverityofsymptomsapatientmayexperience.
Becauseofthesymptoms,thisdisorderisoftendiagnosedasdepression.Becauseofthesmall
increaseincalcium,mostdoctorswillnotdiagnoseitashyperparathyroidism.Itisnotuncommonfor
apersontosufferforseveralyearsbeforereceivinganaccuratediagnosis.
Althoughmostcasesarecausedbyonlyoneparathyroidgland,aboutthreetofivepercentofall
patientswithprimaryhyperparathyroidismwillhaveanenlargementofallfourparathyroidglands,a
termcalledparathyroidhyperplasia.

Secondaryhyperparathyroidismiscausedbyconditionsoutsideoftheparathyroidglands,which
alsoleadstoexcessivesecretionofparathyroidhormone.Acommoncauseofthisdisorderis
kidneydisease.Whenthekidneysareunabletoreabsorbcalcium,calciumlevelsinthebloodwill
fall,whichthensignaltheparathyroidtosecretemoreparathyroidhormonetoincreaseblood
calcium.Theconditionmayalsobecausedbyinadequatenutrition,especiallyfromdietsthatare
deficientincalciumorvitaminD.Itcanalsobetriggeredbydietsthatcontainhighamountsof
phosphorussuchashighprotein,lowcarbohydratediets.Lithium,frequentlyusedforbipolar
disorders,cancausehypercalcaemiaandsometimeswillcauseirreversiblehyperparathyroidism.
Theprominentphysicalsignofsecondaryhyperparathyroidismisdecalcificationofbone,leadingto
multiplefractures.

Adrenalglands
Physicalsymptomsofadrenaldysfunction
Loweredimmunesystem
Inabilitytosleeprestfully
Bloodsugarimbalances
Poormetabolism
Exhaustion
Putyourhandsonthelowerbackribcagenearyourspine.Here,yourhandsareveryclosetoyour
adrenalglands.Theysitontopofyourkidneys,aretriangularshaped,and,whenhealthy,measure
aboutonehalfinchinheightandthreeinchesinlength.
Eachglandconsistsofthemedulla,thecenterofthegland,andthecortexwhichsurroundsthe
medulla.
Everyoneisfamiliarwiththetermadrenalinrush,thatfeelingofeuphoriaandenergy.Adrenalinis
secretedbythemedulla.Itactsasahormoneandaneurotransmitter.Inthemedicalworld,
adrenalinisalsocalledepinephrine.
Theadrenalcortexsecretesotherimportanthormonesincludingcortisol,aldosterone,andthesex
hormoneandrogen.Cortisolhelpsthebodycopewithstress,stabilizesbloodsugarlevels,
modulatestheimmunesystemandhelpscontrolbloodpressure.Aldosteronehelpsmaintainthe
correctlevelofsaltinthebody,whichalsoinfluencesbloodvolumeandbloodpressure.Androgenis
amalesexhormonethatisresponsibleformalesexualcharacteristics.Allofthesehormonesare
synthesizedfromcholesterol.Particularenzymesarethenneededtohelpconvertcholesterolinto
theadrenalhormones.
Overexcretionofcortisolfromtheadrenalglandsisoftenaccompaniedbydepression.Infact,
cortisoliselevatedin50to60percentofdepressedpatients.Adrenalvolumecansometimesbe70
percentlargerindepressedpeople.Adrenalglandenlargementmaybeameasureofcumulative
lifetimedepression.
Chronicstresscancausetheadrenalglandstomalfunction.Themostcommonclinicalsymptomof
thisconditionischronicfatiguetherefore,adrenalmalfunctionshouldalwaysberuledoutwhen
evaluatingapersonforchronicfatiguesyndrome.
Othersignsofweakadrenalfunctionareovereatingandweightgain,alsoconditionsrifeinour
society.
Whenadrenalsbecomecompletelynonfunctional,weightlosswilloftenoccur.Lossofsaltfromthe
kidneyswilloccuralongwithabnormallylowbloodpressure.Thisconditionismostcommonlyseen
infemales.

Adrenoleukodystrophy

AdrenoleukodystrophyisaninheritedXlinkeddisorderthatdamagestheadrenalcortex,testes,and
thebrain.Itmayoccuratanyage.Adultonsetdiseaseoftenpresentswithmentalproblems.While
themajorityofpatientshavesignsandsymptomstypicalofmania,psychosisandcognitive
impairmentmayalsooccur.Thisdisorderisunderrecognizedasacauseofpsychiatricillness.

Corticosteroids
Thebrainisamajortargetorganforcorticosteroids.
JosephKBelanoffemail
Cognitivedeficitsandelevatedcortisolarehallmarksofdepression.
KimHinkelmannemail

Mentalsymptomsofcorticosteroids
Memorydeficits
Psychosis
Hypomania
Depression
Dementia
Cortisolregulatesmanysystemsinthebody,includingmaintainingsaltandwaterbalance,and
regulatingcarbohydrate,fat,andproteinmetabolism.Whenapersonbecomesstressed,the
pituitaryglandbeginstoreleaseadrenocorticotropichormone(knownasACTH),whichstimulates
theadrenalglandstoproducecortisol.Thehighercortisollevelshelpthebodycopewithstress.
Eventsthattriggerthissystemincludeinfections,physicaltrauma,andemotionalproblems.Healthy
adrenalglandsusuallyproduceabout20milligramsofcortisolperday,butwhenstressoccursitcan
producefivetimesasmuch.
Corticosteroidsaredrugscloselyrelatedtocortisol,ahormonethatisnaturallyproducedbythe
outerlayeroftheadrenalgland,calledtheadrenalcortex.

DHEA
PhysicalsymptomsoflowDHEA
Jointpain
Loweredlibido
Dryskin
Poormemory
Difficultylosingweight
Depression
Dehydroepandrosterone(DHEA)anditsrelatedcompoundcalledDHEAsulfate(DHEAS)arethe
mostabundantsteroidhormonesinthehumanbody.AdultbloodlevelsofDHEASare100500
timeshigherthantestosteroneand1,00010,000timeshigherthanestradiol.Bloodlevelsofthese
hormonespeakaroundages2530,andthenbeginasignificantdecline.Byage80,apersons
DHEAlevelisabout10percentofwhatitwasinhis30s.
Abouthalfofthebody'sDHEAisproducedintheadrenalcortexwiththerestcomingfromgonads,
fattissue,andthebrain.WomenaremorepronetolowerDHEAlevels.
Thepathwayofsteroidmanufactureinthehumanbodyis:

CholesterolpregnenoloneDHEAtestosteroneestrogen

CholesterolpregnenoloneDHEAtestosteroneestrogen
Adrenalinsufficiencycancauselowtestosteroneinmenandwomen.Italsocausesadeficiencyof
DHEA.Inadoubleblindstudyofadrenalinsufficiencyinwomen,82percentofthosetaking50mg
DHEAperdayreportedanimprovedsenseofwellbeing,definedasbettersleep,moreenergy,and
betterabilitytohandlestress.Inaddition,thesubjectstakingthesupplementforfourmonths
showedsignificantlyreducedanxietyanddepression,andincreasesinenergy.Increasedsexuality
wasassociatedwithandrogeniceffects.A30to50mgdailydoseimprovedmood,senseofwell
being,andsexualappetiteinwomenwithadrenalinsufficiency.Itsimportanttonotethatthe
improvementswereseenafterfourmonths,butnotafteronemonth.
DHEAisextractedfrombarbascoroot,alsocalledthewildMexicanyam.Itissoldwithout
prescriptionintheUnitedStates.Canada,however,hasdeclaredDHEAtobeananabolicsteroid
anditcannotbeobtainedwithoutaprescriptioninthatcountry.
DespiteitspopularityintheU.S.asanutritionalsupplement,fewclinicalstudieshavebeendoneon
theefficacyofDHEAreplacementtherapyinhumans.Thismaybe,inpart,becauseDHEAcannot
bepatentedand,therefore,cannotbemarketedasapharmaceutical,sothereisnomonetary
incentivetoverifyitsusefulness.AccordingtoDr.MarcWeksleratCornellUniversityMedical
College,peoplewithafamilyorpersonalhistoryoftumorsresponsivetohormones,suchasbreast
cancerorprostatecancer,shouldnotuseDHEA.

Cushing'sSyndrome
MentalsymptomsofCushing'sSyndrome
Problemswithconcentration
Irritability
Lowsexdrive
Sleepproblems
Problemsconcentrating
Memorydeficits
Cushing'sSyndromeisoveractivityintheadrenalglands.Itisastateofchronicexcessofcortisol.
Cushing'sSyndromeisusuallycausedbyadrenaldisease(whichmayresultinadrenaltumors),but
canalsobecausedbyincreasedlevelsofACTHsecretedbythepituitarygland,ordysfunctionin
thehypothalamus.
Problemsmayalsoemergefromtheuseofcorticosteroids.Inthesecases,amajorityofpeoplewill
showsporadicboutsofeuphoria,increasedappetite,hypersexuality,andincreasedactivitylevel.
Althoughthesymptomsmaylooklikeamanicepisode,mostpeoplewithCushing'sSyndromedo
notfitthecriteriaforbipolardisorder.Inrarecases,however,thepersonmayhaveboutsofmanic
psychosis.
MostpeoplewithCushing'sSyndromeinitiallypresentwithpsychologicalproblems.Over50percent
ofpeoplewiththissyndromewillhaveseriouspsychiatricproblemsincludingsuicidalideation,
severedepression,orpsychosis.Insomecases,thepersonwillexhibitsignificantagitation,
emotionallability,andboutsofacuteanxiety.
AlthoughthemajorityofpeoplesufferingfromCushing'sSyndromewillexhibitsymptomsof
depression,about15percentofpeoplewiththisdisordermaydevelopapsychosisordelusional
disorder.Theageofonsetofthisdiseaseistypicallysomewherebetween20and60yearsold.
Asthediseaseemerges,physicalsymptomsarise,includinghypertension,amenorrhea(the
absenceofmenstrualperiodsinawomanofreproductiveage),weightgain,musclewasting,and
obesityintheface,oftencalledmoonface.Surgeryorradiationisneededformostpatientswith
Cushing'sdiseaseduetoadrenaltumors.

Addison'sDisease
MentalsymptomsofAddison'sDisease
Povertyofthought
Apathy
Avolition
Fatigue
Depressedmood

MedicalsymptomsofAddison'sDisease
Muscleweakness
Lowbloodpressure
Darkeningoftheskinonpartsofthebody
AddisonsDiseaseisahormonaldisorderaffectingaboutonein100,000people.Itcanoccurinall
agegroups.Itafflictsmenandwomenequally.Thisdiseasecanalsocomeaboutasaresultofthe
gradualdecreaseofproductionofthesteroidhormoneswithaging.Thediseaseoccurswhenthe
adrenalglandsdonotproduceenoughofthehormonecortisol,andinsomecases,thehormone
aldosterone.Forthisreason,thediseaseissometimescalledchronicadrenalinsufficiency,or
hypocortisolism.AcommoncauseofAddison'sDiseaseisanautoimmuneresponsetotheadrenal
gland.
SimilarsymptomsmakethedifferentialAddison'sDiseasedifficultattimes:classicsymptomsof
Addisonsincludevomiting,weightloss,hypotension,depressedmood,reduceddrive,and
increasedirritability.Allofthesesymptomsmayalsooccurinanorexianervosa.Italsocanpresent
withchronicfatigue.Becausethesteadydecreaseinallthecirculatingcorticosteroidsisaslowand
insidiousprocess,thisdisorderisofteninitiallydiagnosedasapsychiatricproblem.
ThediagnosisofAddison'sDiseaseismadebylaboratorytests.Iflevelsofcortisolareinsufficient,
Xrayexamsoftheadrenalandpituitaryglandsarealsoused.

Pheochromocytoma
Physicalsymptomsofpheochromocytoma
Intermittenthypertension
Chestandabdominalpain
Headache
Perspiration
Palpitations
In1996,Iworkedwithawomanwhowasseverelyanxious,depressed,andsuicidal.Severalyears
before,herfatherhadcommittedsuicidebyshootinghimself.Shehadtwosistersthatshedescribed
asalcoholic.Allofthemsufferedfrompheochromocytoma.
Apheochromocytomaisatumorthatoccursintheadrenalmedullapercentofthetime.Inrare
casesitmaybefoundinthemiddleear,carotidbody(asmallclusterofchemoreceptorsand
supportingcellslocatedneartheforkofthecarotidartery),ortheurinarybladder.
Pheochromocytomasareoftencalled"thegreatmimicbecauseofthevastarrayofsymptoms.Most
ofthesetumorsemergebetween30and60yearsofage,buttheycanoccuratanytimeinthe
lifespan.Aboutoneintenoccurinchildren.
Seventypercentofpeoplewithapheochromocytomawillneverbediagnosedwhilealivethe
disorderwillbenoticedinautopsy.Althoughitoftenpresentsashighbloodpressure,manypatients

willsufferfromrestlessnessandanxiety.Thesymptomsalsomimicandwillbediagnosedas
panicattacks.

Testosterone
Mentalsymptomsoflowtestosteroneinmen
Difficultyconcentrating
Reducedmentalagility
Depression
Agitation
Anger
Irritability
Nervousness
Bytheageof40,testosteronelevelsinmenandwomenbegintodecreasebyaboutonepercenta
year.Thisprogressivedeclineintestosteroneincreasestheriskofobesity,heartattack,
osteoporosis,andmuscleloss.Lowlevelsoftestosteronecanalsocausedecreasesinsexdrive
andbonemineraldensity.
ItisestimatedthatfourmillionAmericanssufferfromlowtestosterone,yetaboutfivepercentof
thesearebeingtreated.Thislowtreatmentleveliscausedsimplybecausetestosteroneisseldom
assessedinaroutinephysical.

Physicalsymptomsoflowtestosteroneinmen
Decreasedleanbodymass
Decreasedbodyhair
Increasedfacialwrinkling
Erectiledysfunction
Fatigue

Mentalsymptomsoflowtestosteroneinwomen
Difficultyconcentrating
Reducedmentalagility
Depression
Apathy
Inmen,testosteroneisproducedmainlyintheLeydigcells,foundinthetestes,butsmalleramounts
aremanufacturedintheadrenalglands.Thenormalleveloftestosteroneinthebloodstreamformen
isbetween350and1230nanogramsperdeciliter.(Ananogramisonebillionthofagram.Agramis
about1/30ofanounce.Adecilitermeasuresfluidvolumethatis1/10ofaliter.Aliterisalittlebigger
thanaquart.)Lowtestosteronelevelsinmenmaypresentasdepressionbutitcanalsocause
problemswithcognition,andincreaseviolentbehavior.
Inwomen,testosteroneisproducedintheovariesandadrenalglands.Theovariescontinueto
producetestosteroneevenaftermenopause.Healthyyoungwomenproduceapproximately300
microgramsoftestosteroneperday,abouthalfofwhichisderivedfromtheovaries,andhalffrom
theadrenalglands.Forthisreason,womenwhohavetheirovariesremovedoftenexperiencea
significantdropintestosterone.
Inwomenaftermenopause,testosteronelevelsdrop.Inaddition,estrogenreplacementtherapy
oftenreducestestosteronelevels,whichmaymanifestaslackofenergyandlibido.

Testosteronedeficiencyinwomenmaybecausedbyprematureovarianfailure,removalofthe
ovaries,estrogenpreparations,removalofoneorbothadrenalglands,adrenaldisease,pituitary
disease,HIV,Turner'ssyndrome,andhighdosecorticosteroids.Simpleagingandnatural
menopausemayalsocontributetotestosteronedeficiencyinsomewomen.
Testosteronelevelsaffectcouples'behavior.Researchshowsthatwhenwiveswithhigh
testosteronechoseaproblemtodiscuss,bothpartiesaremorenegativethanwhenthehusband
chosethetopic.Husbandsaremorepositiveaboutproblemsolvingandprovidingemotionalsupport
whenbothpartieshavesimilartestosteronelevels.StudiesfromresearcherPeterGrayshowthat
testosteronebeginstodeclineshortlyaftermarriage,butsurgesupwardwhencouplesdivorce.

Estrogen
Estrogenscanbeproducedinthebrainfromsteroidprecursors.Asanantioxidant,theyhavebeen
foundtohaveneuroprotectivefunction.Estrogenlowersthelevelofmonoamineoxidase(MAO).
LowMAOmeanshigherlevelsofserotonin.Therefore,lowestrogenmaycauseirritabilityand
depression.Inthesecases,estrogentherapyisusuallyeffective.
Recentlyithasbeendiscoveredthatwomenwhotakeestrogenplusprogestinhave10to30
percenthigherriskofhearingloss.ThiscombinationalsoincreasestheriskofAlzheimer's.Estrogen
alonedecreasestheriskofmultiplesclerosis.Inarecentstudyofwomenonchemotherapywho
eitherstoppedestrogenreplacementtherapyorstartedtamoxifen,38percentdevelopedmajor
depressivedisorder,themajoritywithinsixmonths,and95percentexhibiteddysphoriaand/or
insomnia.

Estradiol
Duringthereproductiveyears,mostestradiolinwomenisproducedbygranulosacellsofthe
ovaries.Smalleramountsofestradiolareproducedintheadrenalcortexinwomenandinthetestes
inmen.
Inbothsexes,testosteroneisconvertedtoestradiol.Fatcellsconvertprecursorstoestradiolandwill
continuetodosoevenaftermenopause.Estradiolisalsoproducedinthebrainandinarterialwalls.
AnAustralianstudyin2008showedthatwomensschizophreniasymptomsweresignificantly
alleviatedbyaddingestradiolskinpatchestoconventionalantipsychotictherapy.

Centralnervoussystempathologies
TourettesSyndrome
PhysicalsymptomsofTourette'sSyndrome
Suddenmotortics(bodymovements)
Suddenvocaltics(soundsorwords)
Aberrantbehaviors
Premonitoryurges
TourettesSyndromeisacommon,hereditaryneurologicaldisorderoftenpresentingwithticsanda
compulsiveuseofobscenewords.However,itissometimesmanifestedbyaberrantsexual
behaviors,includinghypersexuality,exhibitionism,transvestitism,transsexualism,sadism,
masochism,pedophilia,fetishism,aversiontobeingtouched,andaversiontosex.
WhatmentalhealthcliniciansoftenmissisthatTourettesSyndromemaypresentasattentiondeficit
hyperactivitydisorder,obsessivecompulsivebehaviors,conductdisorder,oppositionaldefiant
disorder,rages,mania,depression,anxiety,panicattacks,sleepdisorders,andphobias.

Thepresentationofthesebehaviorsoftenresultsinareferraltoapsychotherapist.Althoughthese
behaviorsareprimarilyneurological,theymaybemisinterpretedasparentingproblemsorfamily
dynamicdifficulties.Thedisorderwasoriginallythoughttobegenetic,butmostresearchersnow
believeitistheresultofavarietyofgeneticandenvironmentalfactors,notofanysinglespecific
gene.
ThereisathreetofourtimeshigherfrequencyofTourettesSyndromeinmalesthanfemales.In
patientswithatypicalonset,theremaybeafamilyhistoryofticsorobsessivecompulsivedisorder.
About50percentofTourettespatientsmeetthecriteriaforattentiondeficithyperactivitydisorder.It
isoftenthepresentingproblem.Aboutonethirdmeetthecriteriaforobsessivecompulsivedisorder
oranxietydisorders.Inadolescence,selfconsciousness,socialdiscomfort,anddepressedmood
frequentlyoccur.
Ticsoccurin10to20percentofschoolagechildren,whereastheprevalenceofTourettes
Syndromeisonlyaboutoneintwothousand.However,thisnumbermaybelow,sincethediagnosis
isbasedonclinicalpopulations,notpeopleinthegeneralpopulationwithminimaltics.Aboutone
thirdofchildrenwithTourettesSyndromehavelearningdisabilitiesresultingintheneedtorepeata
grade.Inthisstudyofchildreninspecialeducation,26percenthadsomeformofticdisorderas
comparedtosixpercentinregularclassroomstudents.
ResearcherSimonBaronCohenbelievesthatamajorityofmildcasesofthesyndromearenever
diagnosed.Forexample,ticsmaymanifestthemselvesasdifficultieswithhandwriting,whichis
usuallynotdiagnosedasadisorder.Asaresult,somechildrenwiththisdisordermayhavedifficulty
finishingtheirhomeworkbecausetheyfeelcompelledtodoitoverandoveruntilitisperfect.
Althoughthismayappeartobeobsessivecompulsivedisorder,itmayinsteadbeTourettes
Syndrome.

MultipleSclerosis
Mentalsymptomsofmultiplesclerosis
Cognitiveproblems
Memoryloss
Cognitivedysfunction
Euphoria
Mania
Suicidalideation
Depression
Dysgraphia
Dyslexia

Physicalsymptomofmultiplesclerosis
Chronicfatigue
Visualfieldproblems
Cognitivedifficulties
Dysphasia
Tinglinginhandsandfeet
Hypersexuality
Multiplesclerosis(MS)isaninflammatory,autoimmune,demyelinatingdiseaseofthecentral
nervoussystemthatcausesdamagetothebrainandspinalcord.MStendstoappearincolder
climates,andrarelyoccursintropicalareasoftheworld.Interestingly,nocasesofmultiplesclerosis
havebeenreportedbetweenthelatitudesof40degreesnorthand40degreessouth.Therefore,the
diseaseisfoundmainlyinthenorthernUnitedStatesandinthenorthernportionofothercountries

aroundtheworld.TogiveyouafeelforwherethatlineexistsintheU.S.,the40thparallelmarkeris
inWhiteCloud,Kansas,andBoulderColorado'sBaselineRoadrunsonthe40thparallel.
Curiously,whenpeoplewhoarebornabovethe40thparallelmovetoatropicalclimatewiththeir
children,thechildren'sriskofmultiplesclerosisisverylow,andconversely,whenchildrenmove
fromalowrisktoahighriskenvironmentbeforetheyare15yearsofagetheyassumeahigherrisk
ofthedisease.
EvenmoreintriguingisthatsporadicoutburstsofMSthathaveoccurredthroughouthistory.The
largestoutburstoccurredintheFaroeIslands(agroupofislandslocatedbetweenIcelandand
Norwayatthe62ndparallel)aftertheoccupationbytheBritishtroopsinWorldWarII.
MultipleSclerosisisthemostcommondemyelinatingdiseaseofthecentralnervoussystem,
especiallyinyoungadults.TheageofonsetofMSisusuallybetween20and30years.Seventy
percentofsuffererswillshowsymptomssomewherebetweenage20to40.Althoughthemalady
rarelyoccurspriorto10orafter60years,therehavebeenrecordedcasesasearlyasagetwoand
inpeopleover67.Femalesareaffectedmorefrequentlythanmales.
Therealsoappearstobeageneticsusceptibilityforthedisorder.Itisfoundprimarilythepeopleof
GermanandScandinaviadescent,butisalmostnonexistentinAfricans,AfricanAmericans,Asians,
andAsianAmericans,andisveryrareinSouthAmerica.Forthisreason,ahistoryoffamilygenetic
origin,andgeographiclocationsthepersonhaslivedinisdiagnosticallyusefulthesecases.
OtherevidenceofgeneticlinkageisthefindingthattheincidenceofMSinfirstdegreerelativesis20
timeshigherthaningeneralpopulation,Identicaltwinshaveaconcordancerateof30percent,while
fraternaltwinshaveconcordancerateoflessthanfivepercent.
MSdamagesthemyelinsheath,afattylayerthatinsulatesneuronsinthebrainandspinalcord.It
actsasinsulationthewayplasticinsulatesanextensioncord.Whendamagetothisinsulation
occurs,pathwaysinthebrainshortcircuit,causingphysicalandmentalsymptoms.Thecauseof
multiplesclerosisisunknown,butmanyresearchersbelieveitisanautoimmunedisorderprovoked
bytoxins.
Althoughthediseasemaymanifestitselfinmanyways,itusuallycausesdamageinthecerebellum,
thespinalcord,andtheopticnerves.However,MScanmanifestasaneuropsychiatricdisturbance
evenintheabsenceofphysicaldisabilities.AgoodproportionofpeoplesufferfromwithMultiple
Sclerosiswillpresentapsychologicalproblemsfirst,whichwillgetthemapsychiatricdiagnoses.
HereisacasestudyfromresearcherDianeTreadwellDeeringandassociates:
"A14yearoldHispanicboywithasixmonthhistoryofapsychoticdisordernecessitating
severalhospitalizationswhowasincidentallyfoundtohavemultiplesclerosiswithno
physicalfindings.Neuropsychologicalassessmentrevealedimpairmentsinwordfinding,
bilateralfinemotorskills,andattention.Imagingandlaboratorystudieshavesupported
thediagnosisofmultiplesclerosis.Steroidandimmunomodulatingtherapyhasnot
significantlyaffectedpsychiatricsymptoms.Hehadpoorresponsetopsychotropic
medicationsaswell."
MSoftenpresentswithunusualsymptoms,suchas,dysphasia,dysgraphia,anddyslexia.Others
willsufferchronicfatigue,pain,depression,suicidalideation,andcognitivedysfunction.Insome
casesintheearlystageofMS,peoplewillexperienceboutsofeuphoria,whichissometimes
misdiagnosedasbipolardisorder.Anothersymptomofthedisorderishypersexuality,whichmaybe
diagnosedashistrionicpersonalitydisorder.
Lookforanyunexplainedneurologicalfindings.Forexample,subtlemotorproblems,suchas
clumsinessortinglinginthehandsandfeetoftenoccurwithMultipleSclerosis.Aneurological
workup,includinganMRI,isneededforadiagnosis.AbloodtestforMScalledgMScanalso
predictclinicalsyndromessuggestiveofMS.

AnonblindedbiochemicaldietaryexperimentonMSpatientsshowedthatallabnormalitiescouldbe
normalizedbydailyintakeofselenium,vitaminE,andvitaminC.Dr.PaoloZambonibelievesthat90
percentofpeoplewithMShaveamalformationorblockageintheveinsthatdrainbloodfromthe
brain.Hisresearchsuggeststhatasimplevascularsurgerywillcausesignificantimprovement.

Migraine
"Therelationbetweenmigraineandmajordepressionsuggestsacommonneurobiology."
GretchenTietjen,MD

Mentalsymptomsofmigraines
Auditoryhallucinations
Visualhallucinations
Depression
Anxiety

Physicalsymptomsofmigraines
Sleepproblems
Wateringeyes
Stomachpain
Backpain
Jointpain
Numbnessinthehandandotherparts
ofthebody
Everyyearthereisaworldwidemigraineartcompetition.Theartworkisarepresentationofthe
migrainers'visualhallucinations.
Migrainesymptomsoftenincludevisualandauditoryhallucinations,abnormalitiesintasteandsmell,
nausea,anddizziness.BritishnovelistHilaryMantelinherbiographyGivingUptheGhost,
describeshermigraineexperience:
Sometimestheauratakesmoretryingforms.Iwillgodeaf.ThewordsItrytowriteend
upasotherwords.Iwillsufferstrangedreams,fromwhichIwakewithhallucinationsof
taste....Atunewilllodgeinmyheadlikeaticandbringthewordstrippinginwithit.
Itsafamiliarcomplaint,tohavetuneyoucantgetoutofyourhead.Butformostpeople
thetunesarentthepreludetoadayofheartyvomiting.
Amigraineheadacheisavascularheadachethatusuallyoccursinonesideofthebrainandis
progressivelysevere.Afullblownmigraineisoftenathrobbingheadachethatimpactstheoccipital
lobeand/orfrontotemporalbrainregionsareasthatareimplicatedinmooddisorders.
Migrainesaffectabout15percentofthepopulation.Theyaresignificantlymorecommoninwomen
thaninmen.Theheadachesarefrequentlyaccompaniedbynausea,vomiting,photophobia(an
abnormalsensitivitytoorintoleranceoflight),phonophobia(aheightenedresponsetosound),and
focalneurologicaldeficits,sometimespresentingwithnumbnessorparalysis.
InternationalHeadacheSocietydividesmigrainesintotwodistinctcategories:withauraorwithout
aura.Migraineswithoutauraarethemostcommon,andaffectabout80percentwiththecondition,
whilemigrainewithauraoccursintheremaining20percent.
Migraineheadachessignificantlyincreasetheriskofdepressionandfatigue.Ina2007study,
womenwithfrequentmigraineswerefourtimesmorelikelytoreportsymptomsofmajordepression
thanthosewithinfrequent,episodicheadaches.

Insomepeopleintermittentnumbnessofahandoronesideofthebodymayoccur.Becauseifthe
presentation,acompleteworkupshouldbedonetoruleoutotherneurologicalsuchastransient
ischemicattacks(TIA),strokes,tumors,orseizuredisorders.
AboutonefifthofmigrainesufferershaveamedicalconditioncalledpatentforamenovaleorPFO,
whichisasmallholeintheheart.Incertainpatients,usuallysufferingwithmigrainewithaura,
surgicalclosureofthePFOreducesthefrequencyofmigrainebyabout50percent.
Basilarmigraine,anischemiceventonthebasilarartery,oftenpresentswithvertigo,doublevision,
andothervisualdisturbanceswithnoheadache.Migraineswiththesesymptomsreferredtoas
vertebrobasilarmigraines.
Manyresearchersnowbelievethatmanymigrainesarespawnedbecauseofdeficitsof
mitochondrialmetabolism.Theyfindthat400mgofriboflavin(vitaminB2)and/oralphalipoicacid
amelioratestheheadaches.Botoxhasalsobeenshowntodecreasemigraines.

HeadInjury
"Noheadinjuryistootrivialtoignore."
Hippocrates
Traumaticbraininjury(TBI)istheinjuryordamagebyablowtohead.ATBIcanbeaclosedhead
injuryinwhichtheskullandbrainremainintact,orapenetratinginjury,whereanexternalobject
penetratestheskullandbrain.Researchersstatethateveryfifteenseconds,someoneintheUnited
Statessuffersatraumaticbraininjury.
OnSeptember13,1848,twentyfouryearoldrailroadworker,PhineasGage,hadanironrod,
knownasatampingiron,rammedthroughhisheadbyanexplosion.Thebarenteredthetopofhis
head,passedthroughthefrontallobe,andexitedthroughhistheleftcheek.Astonishingly,hedid
notloseconsciousness.However,aftertheaccidenthisdemeanorwasdrasticallychanged.Hewas
unabletowork,andexhibitedbizarrebehavior.ThebarandGagesskullareondisplayatHarvard
University.
Itseemsclearthatheadinjurywouldchangebrainfunction.However,mildheadtraumaisoften
overlookedasacauseofmentaldisorders.Infact,thesignificanceofheadinjuryandmentalhealth
isfraughtwithcontroversy.Asignificantproportionofheadinjurypatientsarethoughttobe
malingering.
In2002,researchersattheUniversityofPennsylvaniaMedicalCenterassessedthetotalbrain
atrophyin14patientswithmildormoderatetraumaticheadinjurythreemonthsafterinjury,andin
sevenpatientsattwotimepointsmorethanthreemonthsapart.Wholebrainatrophywasfound
amongmildormoderatetraumaticbraininjurysufferers.Theatrophybecameevidentatanaverage
ofelevenmonthsafterthetrauma.Injuriesthatcausedlossofconsciousnessproducedevenmore
atrophy.
InanotherstudyattheUniversityofWashingtoninSeattle,peoplewithmoderatetosevereandmild
braininjurieswereassociatedwithanincreasedriskofpsychiatricillness.Theauthorsstatedthat
althoughmoderatetosevereinjuriescarriedhigherinitialrisk,mildinjurieswereoftenassociated
withpersistentpsychiatricillness.RaviKantattheMedicalCollegeofPennsylvaniahasreported
fourindividualswhodevelopedOCDsymptomsafteraclosedheadinjury.
Manypeopleforgetthattheyhavehadamildheadinjury.Askingaboutgettinghitonthehead
shouldbeanintegralpartofamentalhealthassessment.
Postconcussionsyndrome

Symptomsofpostconcussionsyndrome
Fatigue

Sleepdisturbance
Headache
Dizziness
Irritability
Affectivedisturbance
Personalitychange
Apathy
Problemswithsocialfunction
Aconcussionisamildtraumaticbraininjurythatusuallyoccursafterablowtothehead.A
concussioncanoccurwithorwithoutlossofconsciousness.Inmanycases,thepersonmay
experiencesabrieflapseofmemoryorafeelingofbeingdazed.
Mostpeoplewhoexperienceamildtomoderatebraininjurywillexperiencesymptomsof
postconcussionsyndrome.Thesymptomsusuallyappearwithinthefirstseventotendays,and
graduallydecreasewithinthreemonths.However,about15percentofthosewhosufferfroma
concussionwillhavesymptomslastingmorethanayear.
Physicalsymptomsofconcussionincludenausea,vertigo,insomnia,ringingintheears,blurred
vision,changesinappetite,anddecreasedsexdrive.Insomecases,theremaybedifficulty
speakingorcommunicating.Sensoryproblems,suchashearing,smell,andtasteissues,mayalso
occur.
Therehasbeenalongstandingdebateastowhetherpostconcussionsyndromeisapsychological
orneurologicalproblem.Recently,however,postmortemstudiesofconcussionvictimsshow
diffuse,microscopicaxonalinjury,andbrainscansshowlesionsintenpercentofindividualswith
concussions.
Theriskofdevelopingpostconcussionsyndromeincreaseswithage.Concussionsymptomsare
reportedmoreofteninwomen,butsomeresearchersbelievethatthisisbecausewomenaremore
likelytoseekmedicalhelpthanmen.
ResearchersM.W.CollinsandG.L.Iversonpublishedastudyofhighschoolandcollegeathletes
whohadsufferedconcussions.Atotalof78athletessustainingsportsrelatedconcussionwere
selectedfromalargersampleof139concussedathletes.Thesesubjectsexhibitedonfield
presenceofdisorientation,posttraumaticamnesia,retrogradeamnesia,andlossofconsciousness.
Acomputerizedneuropsychologicaltestbatterywasadministeredpreseasonand,onaverage,two
dayspostinjury.Goodpostinjurypresentationwasdefinedasnomeasurablechange,relativeto
baseline,intermsofbothmemoryandsymptomcompositescores.Poorpresentationwasdefined
asa10pointincreaseinsymptomreportingand10pointdecreaseinmemoryfunctioning.
Theathletesdemonstratingpoorpresentationattwodaysaftertheinjuryweremorethantentimes
likelytohaveexperiencedretrogradeamnesiafollowingtheinjurywhencomparedwithathletes
exhibitinggoodpresentation.Similarly,athleteswithpoorpresentationwereoverfourtimesmore
likelytohaveexhibitedposttraumaticamnesiaandatleastfiveminutesofmentalstatuschange.
Theauthorsfoundthatitwasthepresenceofamnesia,notthelossofconsciousness,thatpredicted
cognitivedeficitsfollowingaconcussion.
Whiplash
Soonafterhiscaraccidentin1932,classicalcomposerMauriceRavelbecameunablecompose.
Althoughmanyresearcherscontributethistodementia,othersbelieveitwastheresultofwhiplash.
Whiplashisthemostcommontypeofinjuryfollowinganautomobileaccident.Itisoneofthemost
commoncausesoflitigationafteraninjury.Thevalidityofmentalhealthproblemscausedby
whiplashiscontroversial.Themostcommoncomplaintisdepression.

Strokes
Astrokeisalifethreateningeventinwhichthebrain'soxygensupplyiscutoff,oftencausingbrain
damage.Therearetwobasictypesofstroke:ahemorrhagicstroke,whenabloodvesselburstsand
causesabnormalbloodtoflowintothebrain,andanischemicstroke,whenablockageofbloodflow
tobraintissuecausesittostarveanddie.Eachyear,morethanhalfamillionstrokesoccurinthe
UnitedStates.
Althoughtheword"stroke"usuallyconjuresimagesofparalysis,aphasiaandapraxia,strokesmay
alsocausecognitive,emotional,andbehavioralproblems,includingbizarrementalsyndromes.
Havingastrokecanbeatraumaticexperiencethatwilloftencauseprolongedmentalproblems.In
1998,theRoyalEdinburghHospitalintheUKfoundthatsixmonthsafterstroke,26.percentofthe
patientsmettheDSM5criteriaforananxietyordepressivedisorderdepressionbeingthemost
commondiagnosis.A2015researchfound220,336strokepatientswithatotalfollowuptimeof
860,713personyears.Duringfollowup,therewere1,217suicideattempts,ofwhich260werefatal.
Transientischemicattacksarestrokesthatlastonlyafewminutes.Forthisreason,theygenerally
donotcausepermanentdamage,buttheyareacriticalwarning.About10percentofstrokesare
precededbyTIAs.ResearchersintheongoingNorthernManhattanStrokeStudyhaveshownan
associationbetweenperiodontaldisease,achroniclowgradeinfectionoftheboneunderlyingthe
teethandathickeningofcarotidarteryplaque,andamajorriskofstroke.
Asilentstrokeisaneventthatisnotseenasastroke.Thereisnoparalysisorothermotor
problems.Strokesofthisnaturearesometimesmisdiagnosedasamentalillness.
Basilararterystroke
Thebasilararteryisthelargearterycomingupthroughthespinalcordintothebottomofthebrain.
Symptomsofabasilararterystrokeareavolition,apathy,anddizziness.Acommonbutunusual
symptomispathologiclaughingorcrying.
Insularstroke
Theinsula,astructurefoundbetweenthetemporallobeandthefrontallobe,isrelatedtoolfactory,
gustatory,visceral,andlimbicfunction.Theposteriorinsulaisrelatedtoauditorysensation,bodily
sensations,andskeletomotorfunction.Italsoplaysanimportantroleintheexperienceofpainand
mediatesemotions,includingdisgust,anger,fear,empathy,happiness,andsadness.Astrokeinthis
partofthebraincanpresentwiththeattenuationorlossoftheseabilities,andoftenpresentsasa
mentaldisorder.Interestingly,smokerswhohaveastrokeintheinsulastopsmokingimmediately.

Braintumors
Symptomsofbraintumors
Unusualsymptomarray
Olfactoryhallucinations
Noprevioushistoryofthe
presentingproblem
"Treatmentresistance"
Braintumorsarerelativelyrare,comprisingabout1.5percentofallmalignanttumors.Nevertheless,
theyareincreasingrapidly.In1997,eighteenthousandnewbraintumorswerediagnoseda50
percentincreasefrom1987.Dataoftumorincidencein2008showthatoneinfivethousandpeople
over60willdevelopbraintumors.

ResearchersfromtheNationalInstituteonAginginBethesdaMarylandhavefoundasignificant
increaseinbraintumorsinpeopleovertheageof75.Theincidenceofthetumorshasdoubledfrom
1968to1985(whichwasthelastyearforwhichstatisticswereavailable).Forthoseover80,the
rateofincreasewas300percent,whichisanincreaseof23percentperyear.
Whilethecausesofbraintumorsareusuallyunknown,researchersbelievethatmanyarecausedby
toxins.Forexample,highlevelsofbraintumorsoccurinpeopleworkinginoilrefining,rubber
manufacturing,anddrugmanufacturingindustries.Tumorscanalsobetriggeredbyviralinfections
andexposuretoradiation.Onetypeofradiationthathasbeensuggestedascausingtumorsisthe
cellphone.Bothcellphonesandahouseholdcordlessphonesuseaformofmicrowaveradiationto
sendandreceivesignals.
Tumorsthatoriginateinthebrainarecalledprimarytumors.Butcancersfromotherpartsofthe
bodysometimesspreadintothebrainthroughaprocesscalledmetastasis.Thesetumorsarecalled
secondarytumors.Althoughcancerfromanywhereinthebodycanspreadtothebrain,secondary
tumorsoccurmostoftenwithbreastorlungcancers.Ifatumorbeginsinthebreastandspreadsto
thebrain,thecellsofthebraintumorwillresembleabnormalbreastcells,notabnormalbraincells.
Ofconcernformentalhealthpractitionersisthefindingthatprimarybraintumorsoccur20times
morefrequentlyinpsychiatricpatientsthaninthenormalpopulation.Therateofprimarybrain
tumorsinhospitalizedpsychiatricpatientsisoneinonethousand.
Oneinonethousandpeoplecomplainingofheadachehasabraintumor,and60percentofpeople
withbraintumorshaveheadaches.Yet50percentofpeoplewithbraintumorswillbemisdiagnosed
withapsychiatricproblem.Thisisunfortunate,becausethetumorwillcontinuetogrowunabated
whilethepersongoesfrompsychotherapisttopsychotherapist.
Frontallobetumors

Mentalsymptomsoffrontallobetumors
Mooddisturbances
Moodswings
Difficultythinking
Confusionanddisorientation
Disinhibition
Sociallyinappropriatebehavior
Hypoorhypersexuality
Thefrontallobesofthehumanbrainaretheharbingersofjudgment,foresight,motivation,social
skills,andpersonality.Theyarealsoresponsibleforthought,attention,planning,reasoning,
movement,senseofsmell,andsexualurges.
Apersonwithfrontallobetumorcanexhibitmoodswings,decreasedacademicperformance,
unpredictablecrying,unusualsexualbehaviors,violentbehavior,andsuicidalideation.Tumorsin
therightfrontallobecanpresentasexcessiveelationandeuphoria,anoncriticalperceptionof
reality,lackofconcentration,diminutionperception,andatendencytoconfabulate.Theymayalso
exhibitanosognosia,aconditioninwhichapersonwhosuffersdisabilitywillbeunawareofthe
existenceofhisdeficits.
Parietallobetumors

Symptomsoftumorsoftheparietallobe
Difficultieswithhandwriting
Difficultywithmath

Problemswithmovement
Lossofthesenseoftouch
Theparietallobesareresponsibleforintellect,reasoning,sensationoftouch,responsetointernal
stimuli,portionsoflanguageandreadingfunctions,andsomevisualfunctions.
Becausetheparietallobeinterpretsvariousbodilysensations,theremaybeanalteredawareness
ofpain,touch,temperature,pressure,shapes,sizes,andpartsofthebody.Itmaybehardtotellleft
fromrightormakecomparisons.
Occipitallobetumors
Theoccipitallobeisprimarilyresponsibleforvisiontherefore,tumorsarelikelytocausevisual
hallucinations.Lossofsegmentsofvisualfieldmayalsooccur.
Temporallobetumors

Mentalsymptomsoftemporallobetumors
Depersonalization
Emotionalchanges
Behavioraldisturbances
Psychosis
Panicattacks
Thetemporallobeisresponsibleformemory,behavior,hearing,emotions,andparticipationinvisual
pathways.Tumorsinthisareaareoftenmanifestedasanxiety,panicattacks,andpsychosis.
Limbicandhypothalamictumors
Tumorsinthehypothalamusmaycauseemotionalchanges,changesintheperceptionofhotand
cold,rage,mania,emotionallability,alteredsexualbehavior,anddelusionsinvolvingcomplicated
plots.
Cerebellartumors
Thecerebellumisacauliflowerlikeorganatthebackofthebrain.Itisresponsibleformonitoring
sequentialactivity,includingbalanceandcoordination,andcomplexmotorskills,includingwalking
andtalking.Cerebellartumorsmaypresentasbalanceandgaitdisturbances.
Thethirdpartofthebrain,thebrainstem,connectsthebraintothespinalcord.Itcontrolssomeof
themostimportantandnecessarybodyfunctions,suchasbreathingandmaintainingbody
temperatureandbloodpressure.Italsocontrolshungerandthirst.

Seizuredisorders
Symptomsofseizuredisorders
Convulsions
Suddenchangesinbehavior
Changesinsensoryperception
Thoughtdisturbances
Changesinmood
Unusualinterpretationsofthe

environment
Changesinmood,behaviors,andemotionsasaconsequenceofseizureshavebeenrecognizedfor
centuries.Ancienttexts,includingtheBible,describeunusualthoughts,feelings,andbehaviors
causebyseizures.
Aseizureisanepisodeofabnormalelectricalactivityinthebrain.Althoughseizuresarenotpartof
normalbrainfunction,manypeopleactuallyexperienceepilepticlikeepisodesfrequentlyasudden
joltjustpriortofallingasleepiscalledahypnagogicjerk.Otherresearchersbelievethatthe
experienceofdjvumaybecausedbyatransientseizure.Repetitiveseizuresarecharacteristicof
aconditioncalledepilepsy.
Seizurescanbecausedbylesionsinthebrain,headinjuries,braintumors,toxins(suchaslead
poisoning),abnormalitiesinbrainstructure,infections,andfevers,butinhalfofthepeoplewith
seizures,nocausecanbefound.Thetypesofsymptomsseizurescreatearedependentonwhere
electricalactivitytakesplaceinthebrain.Otherfactors,suchastheperson'sageorgeneralstateof
health,mayalsobeafactorinhowseizuresmanifestthemselves.
Insomecases,uncontrolledseizurescan,overtime,causebraindamagethatresultsinimpairment
ofmentalandphysicalabilities.Itiswellknownthatseizuredisordersaremoreprevalentinpeople
withneurologicaldisorders,immunesystemproblems,andmentaldisorders.
Seizuresareoftenclassifiedasprimaryorsecondary.Aprimaryseizureisusuallygeneticor
structural.
Thesecondaryseizures,however,maybecausedbyprenatalevents,orenvironmentaltoxinsand
brainpathologies,includingbraintumors,vasculardiseaseis,anoxia,heavymetalpoisoning,
hypoglycemia,andhighfevers.Seizurescanalsobecausedbyhypoparathyroidism.
Seizuresarediagnosedbyobservation,neurologicalexaminations,electroencephalogram(EEG),
andbrainimagingtechniques.
Asof2008,theCenterforDiseaseControlestimatesthatabout2.3millionAmericanshaveseizure
disorders.Theprevalencerateisapproximatelyoneinonehundredeighteen.Becausethe
symptomsmaymanifestasperceptualchanges,somepeoplearenotawarethattheyarehaving
seizures.
Questionstoask:
Didyouhaveanycomplicationsatbirth?
Haveyoueverhadanyheadinjuries?
Didyoueverhaveaseizurewithahighfeverwhenyouwereachild?
Doesanyoneinyourfamilyhaveseizures?
Temporallobe

Mentalsymptomsoftemporallobeseizures
Emotionality
Mania
Depression
Guilt
Humorlessness
Aggression
Angerandhostility
Hypergraphia(excessivewriting)
Alteredsexualinterest

Religiosity
Philosophicalinterests
Senseofpersonaldestiny
Hypermoralism
Paranoia
Obsessionalism
Circumstantiality
Viscosity(incessanttalking)
Theprevalenceoftemporallobeseizuresisestimatedtobethreeinonethousand.Morethanone
thirdofpeoplewiththeseseizureswillexperiencesignsofmentalproblemsasaresultofthese
events.
Apredominantnumberofpeoplewhohaveseizureactivityinthetemporalareawillexhibitanarray
ofsymptomscalledGeschwindSyndrome(alsoknownasWaxmanGeschwindSyndromeor
GastautGeschwindSyndrome).
Thissyndromeusuallypresentswithcircumstantialities,excessivetalking,chroniccompulsive
writing(hypergraphia),intensifiedmentallifewithdeepenedcognitiveandemotionalresponsesto
certainevents,hyperreligiosity,hypermorality,andhyposexuality.Asignificantnumberare
completelyasexual.Manywillinterprettheirsymptomsasreligiouscallings.Viscosity(incessant
talking)isalsocorrelatedwithseizuredurationandlefthandedness.
GeschwindSyndromeisusuallyassociatedwithleftsidetemporallobeseizures.Geschwind
Syndromehasalwayscausedcontroversy.Somebelievethatitrepresentsaspecificpsychiatric
disorder,whileothersassumetemporallobeepilepsyisaneurologicalcondition,notapsychiatric
condition.GeschwindSyndromecanbeseenbothintheinterictal(betweenseizures)andtheictal
(duringseizures)states.SomehavecometocallitVanGogh'sMalady.Mostpeoplewiththis
syndromedonotseekmentalhelp.Theyconsiderthesephenomenanormal.
Auditoryseizuresarecausedbyaseizureinthesuperiortemporalgyrus.Thisproceduremay
manifestitselfbyringingintheearsorbuzzingorhissingsounds.Thesesymptomshavesometimes
beenmisdiagnosedasanxietyorhysteria.Sensoryseizuresaredisconcertingtotheperson
experiencingthem.Becausetheydonotunderstandwhat'shappeningtothem,theymay
misinterprettheirsymptomsasapsychologicaldisorder.
Aseizureinthesuperiortemporalgyrusmayalsocauseboutsofvertigo,aphenomenoncalleda
vertiginoussensoryseizure.Thismaybeexperiencedasdizzinessornauseaandissometimes
misdiagnosedasasomatizationdisorder.
Frontallobe
Frontallobeseizuresoftenoccurduringsleep.Signsofthiscanbebicyclepedalingmotionsand
pelvicthrusting.Somepeoplescreamprofanities.Uncontrollablelaughingorcryingmayoccur.The
personmayalsoawakenwiththefeelingofchokingalongwithabnormalmotoractivity.
Theseseizurescanbecausedbytumors,vascularmalformationsinthebrain,orheadtrauma.A
raregeneticdisordercalledautosomaldominantnocturnalfrontallobeepilepsyisalsoknownto
causetheseevents.Havingaparentwiththisformofseizuremeansa50percentchanceof
inheritingthegene.
Excessivedaytimesleepinessmaybeasignofnocturnalfrontallobeseizures,andmaybe
misdiagnosedasobstructivesleepapnea.
Parietallobe

Somaticsensoryseizuresoccurinthepostcentralgyrusoftheparietallobe.Althoughmanyof
theseseizuresresultinconvulsions,somedonot.Asignificantnumberofpeoplewillbeunaware
thattheyhaveaseizuredisorder,butwillpresentwithanxietyordepression.Rightparietallobe
seizurescancausepanicattacks.
Occipitallobe
Visualsensoryseizuresoccurintheoccipitallobe.Theyareusuallycharacterizedbyunformed
visualhallucinations.Often,theseareflashingcolorsandprovideproblemswithvision.Thesetypes
ofseizuresmaybemisdiagnosedasaneyedisorder,amigraineheadache,orinsomecases
hysteria.
Cingulate
Theanteriorcingulatecortexisvitaltocognitivefunctionssuchasconflict,selfregulation,decision
making,andemotions.Patientswithanteriorcingulatecortexseizuresoftendisplayaberrantsocial
behavior,psychopathicorsociopathicbehaviors,tics,andobsessivecompulsivebehavior.
Panicdisorders
Panicdisorderresearchsuggeststhatpanicattacksarefamilial.Panicattacksinthesefamilies
showthatwomenhavetwicethefrequentlyasmen.Panicisnotassociatedwithanincreased
familialriskofotherpsychiatricconditions.Althoughmostpanicattacksappeartobeprimarymental
disturbances,someevidencesuggestsabiologicalbasisforpanicdisorder,possiblyassociatedwith
temporallobedysfunction,includingseizures.
Inthesecases,afullnightvideopolysomnographicmonitoringisneededtodifferentiatebetween
thetwoconditions,andtoverify,inthecaseofthecoexistenceofthetwodisorders,whichisthe
oneresponsibleforsleepdisruption.Researchdemonstratedthatobstructivesleepapneacan
causenocturnalpanicattacks.Asleepassessmentcanaccuratelydiagnosenocturnalpanic
disorders.

MedicalIllnessesLinkedtoMentalProblems
Hypoglycemia
Invariably,thehypoglycemicattackischaracterizedbysomepsychiatricphenomenaandindeed
thementalsymptomsmaydominatetheclinicalpicture.
EdwinJ.KeplerMD

Mentalsymptomsofhypoglycemia
Anxiety
Mania
Apathy
Nervousness
Confusion
Impairedjudgment
Dysphoria
Depression
Irritability

Belligerence
Emotionallability

Physicalsymptomsofhypoglycemia
Automaticbehavior
Slurredspeech
Incoordination
Paralysis
Hemiparesis
Paresthesias
Headache
Seizures
Fatigue
Tachycardia
Sweating
Pallor
Clamminess
Dilatedpupils
Nauseaandvomiting
Hypoglycemiaisadropinbloodglucose.Althoughmanypeoplewiththisproblemmayfeeldizzy,
weak,andshaky,othersmanifestmentalproblemssuchashysteria,depression,anxiety,panic
attacks,andpsychosis.Itisalsomisdiagnosedasaseizuredisorder,braintumor,narcolepsy,
multiplesclerosis,aswellascardiacarrhythmia.
Itcanalsolooklikestrokeoratransientischemicattack.Theremaybelossoflimbmovementwhich
canbemisdiagnosedasaconversiondisorder.
Therearethreemajorcausesofhypoglycemiainjectionsofinsulin,organicpathologies,and
unknowncauses.Organichypoglycemiascanbeendocrinerelated,includingproblemsinthe
pituitary,adrenal,orthyroidinsufficiency.Changesinthepancreasmayalsooccur.Autoimmune
disorders,suchasLupus,SjgrenSyndrome,HashimotoThyroiditis,AddisonsDisease,
rheumatoidarthritis,Type1diabetes,polymyositis(muscleinflammation),scleroderma(a
connectivetissuedisorder),vitiligo(lossofskinpigment),andperniciousanemia(lowB12levels)
alsoplayapartinbloodsugarstabilization.Itistheunknowncausesgroupthatismostfrequently
diagnosedasmentalillness.
Reactivehypoglycemiaisthetermforrecurrentepisodesofhypoglycemiaoccurringtwotofour
hoursaftereatingahighcarbohydratemeal.Thediagnosisforthisstateisaconcentrationofblood
sugar40mg/100mlorless.Hypoglycemiamayalsooccurfollowinganinjectionofinsulin.
Symptomsincludenervousness,hunger,weakness,vertigo,andfaintness.Childrenwithlowblood
sugarespeciallychildrenwithType1diabeteshavediminishedlevelsofcognitivefunction.Many
ofthesechildrenwillbediagnosedasattentiondeficitdisordered.
Between1979and1983,theNewYorkCityschoolsystemremovedthesugar,additives,and
preservativesfromitsschoollunchprogram.Thischangealoneproduceda15percentincreasein
performanceonstandardizedtests.SchoolperformanceintheNewYorkCitySchoolSystemmoved
frombelownationalaveragetoabovenationalaverage.Thisstudywaswellcontrolled,andinvolved
800,000children.Otherreasonsfortheoutcomewerecarefullyruledout.
Hypoglycemiaisrelatedtohostile,aggressivebehavior.Thistypeofresponseisseeninhabitually
violentandimpulsivecriminals.Aninterestingstudyin1984suggestedthatreactivehypoglycemia
wasconnectedwithfiresettingbehavior.Thestudyalsorevealedthatthehypoglycemiacarsonists

fitthecriteriaforintermittentexplosivedisorder,antisocialpersonality,andborderlinepersonality
disorder.
Sugar,whiteflour,alcohol,caffeine,andtobaccocancontributetolowbloodsugar.Medicationscan
alsoinducehypoglycemiaincludinginsulinBactrim(anantibiotic)betablockerssuchas
PropranololHaldolMAOinhibitorsQuinidineQuinineandSulfonylureas,adrugthatstimulates
betacellstoproducemoreinsulin.

Olfaction
"Whennothingelsesubsistsfromthepast,afterthepeoplearedead,afterthethingsarebroken
andscattered,thesmellandtasteofthingsremainpoisedalongtime,likesoulsbearingresiliently,
ontinyandalmostimpalpabledropsoftheiressence,theimmenseedificeofmemory."
MarcelProustTheRemembranceofThingsPast

Mentaldisorderswitholfactorydeficits
Schizophrenia
MultipleSclerosis
Alzheimer'sdisease
Lewybodydementia
Parkinson'sdisease
Depression
Smellisoftenourfirstresponsetotheoutsideworld.Itcanalertustodangers,suchassmokeor
spoiledfood.Itwhetsourappetite.Ithelpsusfallinlove.
Theclinicaltermforsmellisolfaction.Olfactionisrelatedtosocialaffiliationinmammals.Thesense
ofsmellisalsolinkedtothesectionsofthebrainthatprocessemotionandlearning.Theolfactory
bulbinthebrainisthecentralareaofolfaction.Alongwiththeamygdalaandhippocampus,itmakes
upthelimbicsystem,whichmediatesourbehaviors,mood,andmemory.
Olfactorydevelopmentcoincideswithdevelopmentoftheforebrain.Thisisofinterestbecause
certainbraindisordersincludeproblemswitholfaction.Forexample,smallnasalvolumeandsmell
identificationdeficitsarefoundinschizophrenia.
Olfactionconsistsofseveralfacets,including,detection,identification,andhedonicresponses.
(Basically,thismeansthatyousmellit,yourecognizeit,andyoulikeitoryoudontlikeit.)
Almostallofuslosesomeolfactorysensesasweagethegreatestdeclineoccurringbetween60
and100.Olfactoryabnormalitieshavelongbeendocumentedinpsychiatricdisorders.Researchers
believethatthisis,inpart,becauseolfactionispartofourcognitiveandemotionalcircuitry.
Moreover,differenttypesofolfactorydeficitsarefoundindifferentpathologies.Forexample,people
withschizophrenicdisordersoftenhavenormalodorsensitivity,butexhibitsignificantdeficitsinodor
identification,recognition,anddiscrimination.Thosesufferingfromdepressionwilloftenexhibit
deficitsinthehedonicaspectsofolfaction,evenif,insomecases,alterationsinsensitivityor
identificationarealsofound.Inotherwords,theylosethepleasureofolfaction.Olfactory
hallucinationsindepressionareoftenthoseoffoulodors.Interestingly,twothirdsofthesepeople
believetheodortoemitfromtheirownbodies.A2008studybyJ.F.Dileoshowedthatinsoldiersin
PTSDolfactoryidentificationdeficitsasapredictorofaggressionandimpulsivity.
Currently,thereisnomethodorsingleinstrumentthatisuniversallyrecognizedasbeingthebest
tooltodetectmalingeringinPTSDclaimants,GurielJ,FremouwW.Assessingmalingered
posttraumaticstressdisorder:acriticalreview.

Changesinodorperceptionindementiaandinsomeneurodegenerativediseaseseemto
encompassallaspectsofthesensorialexperience(detectionthreshold,identification,and
recognition).About90percentofpeoplewithParkinson'sdiseasehaveolfactorydeficits,andthere
isevidencefordopaminergicdysfunctionunderlyingthesedeficits.Thisisinterestinginthatchildren
withADHDtendtohavelowerlevelsofdopamineandalsohaveolfactorydeficits.Ritalin,a
dopamineagonist,notonlyhelpssomepeoplewithADHD,butalsoimprovestheirolfactorysenses.
Thereareseveralodorassessmenttestsonthemarket.ThemostwellknowntestistheUniversity
ofPennsylvaniaSmellIdentificationTest.Thisisascratchandsnifftestwhichdifferentiatestypesof
odordeficits.

Liverdisease
Thedetectionofliverdiseaseoftenrequiresahighindexofsuspicion.
CatherineC.Crone,MD

Physicalsymptomsofliverdisease
Hairloss
Itching
Poorappetite
Weakness
Fatigue

Mentalsymptomsofliverdisease
Mooddisorders
Memorydeficits
Impairedconsciousness
Changesinlogicalthinking
Personalitychanges
Impairedjudgment
Confusion
Disorientation
Sluggishspeech
Liverdiseaseisacommoncauseofillnessandmortality.Itcanbecausedbyinfections,
malignancies,geneticdisorders,ortoxins.Theclinicalpresentationsarehighlyvariableandare
oftenmanifestedbypsychiatricsymptoms.
Theliverisresponsibleformanyphysiologicalprocesses,includingthesynthesisofproteins,
metabolizingnutrients,toxins,anddrugs.Forthesereasons,anydiseasecausingliverimpairment
willhaverepercussionsthroughoutthebody,includingimpairmentofbrainfunction.
CommonliverdisordersincludehepatitisC,alcoholiccirrhosis,Wilsonsdisease,porphyria,andliver
encephalopathy.
HepatitisCvirusiscurrentlythemostcommoncauseofliverdiseaseintheUnitedStatesandisthe
mostcommonindicationforlivertransplants.Itscurrentlyestimatedthat170millionpeople
worldwideandfourmillionintheUnitedStatesareinfected.
ThemostcommoncauseoftransmissionofHepatitisCintheUnitedStatesisintravenousdruguse.
Itcanalsobetransmittedbytattooing.

Variousstudieshavefoundfrom10to20percentofadultswithseverementalillnessesareinfected
withHepatitisC.ItsestimatedthatonethirdofAmericanswhoareincarceratedarehaveahepatitis
Cinfection.
Hepaticencephalopathy
Hepaticencephalopathyisaneuropsychiatricsyndromewhichoftendevelopsinacuteorchronic
liverdisease.
Itimpairsbrainfunctionduetotoxinsthatarenormallyremovedbytheliver.Hepatic
encephalopathyoftenpresentswithdisturbancesinconsciousness,mood,behavior,andcognition.
Thesymptomseverityofthedisordervariesfromminorcognitiveimpairmentstosignificant
confusion,agitation,anddisorientation.
Aftermanyyearsofreferringmilderliverproblemsaslatent,subclinical,orStage0hepatic
encephalopathy,themedicalcommunityhasagreedtousethetermminimalhepatic
encephalopathy.
Minimalhepaticencephalopathyisfoundincirrhoticpatientswithnormalclinicalandneurological
exams,buttheywillshowimpairmentsonneuropsychologicaltesting.
Cognitivedisturbancesaresubtle,buttypicallyinvolvepsychomotorspeedandvisualattentionand
perception.Theseproblemswillmanifestthemselvesaspersonalitychanges,impairmentsinwork
performance,reducedqualityoflife,sleepproblems,andproblemswithdriving.
Oneoftheearliestmanifestationsisasleepcyclechangethepersonwillbegintosleepduringthe
dayandstayawakeatnight.
Manystudiessuggestthatminimalhepaticencephalopathycausespoordrivingperformance.
Peoplewiththedisorderhaveagreaterselfreportedfrequencyofmotorvehicleaccidentsand
trafficviolationstherefore,acrucialaspectofthediagnosisisdrivinghistory.Unfortunately,askinga
personabouttheirdrivingrecordisseldomdoneinamentalhealthintake.
Severalmedicationsareknowntocausethisdisorder,especiallybenzodiazepines(suchasAtivan
andValium),narcotics,anddiuretics,andalcohol.Psychometrictestsbatteriesareoftenusedto
helpdetectthisdisorder.ThePSEtest(portosystemicencephalopathytest)consistsofa
combinationofestablishedtests,includingTrailmakingAandB,andDigitSymbol.Lactuloseand
probioticsareofteneffectivetherapiesforthisdisorder.

LungDisease
Lungdiseasessuchaschronicobstructivepulmonarydisease(COPD)asthma,restrictivelung
disease,andcysticfibrosis,cancausescognitiveimpairment,depression,andanxiety.Itseems
logicalthatdifficultybreathingwouldcauseanxietyhowever,researchshowsthatthelevelof
anxietyinlungdiseaseisnotcorrelatedwiththediseaseseverity.
Overtime,hypoxiafromlungdiseasecanleadtofrontallobedeficits.Beawarethatpeoplewith
pulmonarydiseaseandbreathingproblemsareoftenusingmedicationswhichcausemental
symptoms,includingcorticosteroids,theophylline,2ReceptorAgonists(Alupen,Advair).Anxiety
andsleepproblemsareknownproblems.Anticholinergics(Atrovent,Spiriva)maycausefatigue,
headache,dizziness,depression,insomnia,andabnormaldreams.

HeartDisease
Theinteractionofheartandmindisanendlessloop.Stressfulexperiencesandemotionalevents
affecttheheartdirectlythroughtheautonomicnervoussystemandindirectlythroughendocrine
pathways.Conversely,abnormalitiesintheactivityoftheheartcancauseconsciousawarenessand
cancausedemotionalchanges.

Thereisasignificantrelationshipbetweendiseasesofthepsycheandcardiovascularsystem,the
associationbeingparticularlystronginthosewithdepression,phobias,andanxiety.Manyyears
aftercardiacarrest,somepeoplewillexhibitmildcerebralimpairment.Thismaypresentas
personalitychanges,dysinhibition,apathy,ordisturbancesofjudgment.
Patientswithchronicnonrheumaticatrialfibrillationshowedsignificantlypoorerperformancesin
tasksexploringattentionandverbalmemoryfunctions,whiletheparoxysmalgroupwassignificantly
impairedinalongtermmemorytask.
Becauseamajorityofheartpatientsexhibitcognitivedeficitsandmoodproblems,manyclinicians
todaysuggestthatallcardiacpatentsbescreenedformentalproblems.Manypeoplesufferfrom
posttraumaticstressdisorderfollowingmyocardialinfarction.

SkinDisease
Therearefewexperiencesthatgiveusthemagicalfeelingofhumantouchanessentialingredient
inlove,pairbonding,andhealing.Ahug,anembrace,orakiss,aretactileeventsthathave
profoundemotionalevents.Infact,weusethewordfeelingnotonlyfortactilesensation,butfor
emotionsthemselves.Tactilestimulationhelpstheimmunesystem,lowersbloodpressure,and
improvesmood.
Humanskinandthecentralnervoussystemarebothcreatedfromthesametissuetheectoderm.
Weexpressourawarenessofthisconnectionwithphrasessuchas,Thatreallytouchedme,It
makesmyskincrawl,Thatgavemegoosebumps,andHessothinskinned.
Thisinterplayofskinandbrainhasspawnedmyriadclinicalstudies.Itisclearthatskinproblems
coexistandcontributetomentalproblems.Onecommonfindingintheliteratureisthe
connectionofskindiseaseswithahighprevalenceofdepression.Patientsseeningeneralmedical
practiceforotheralimentshaveaprevalenceofdepressionofabout22percent,butamongpeople
withskindisorderstheincidenceisabout30percent.Thesuiciderateinpeoplewithskindisorders
isalsosignificantlyhigh.
Skindisordershavealsobeenlinkedtoalexithymia.Otherpsychiatricsyndromesfrequentlyfoundin
skindisordersincludeobsessivecompulsivedisorder,socialphobia,posttraumaticstressdisorder,
bodyimagepathologies,delusionaldisorder,sleepdisorders,andpersonalitydisorders.
Althoughitmayseemlogicalthatskindiseasescouldimpairapersonsselfimagewhichcould
resultinconsiderablepsychologicalsuffering,thepercentageofmooddisorderswithskinproblems
isfoundtobeequaltoorhigherthanpeoplesufferingfrommoreincapacitating,moredisfiguring,
moreserious,andmorepainfulmedicalconditions.
Researchersconjecturethatbothmooddisordersandskindisordersareimmunemediated,
inflammatorystates,bothwithchronicprogressandsimilarcomorbidity.
AgeneticallytriggeredskindiseaseknownaskeratosisfollicularisorDarierdiseaseislinkedto
bipolardisorderandisalsoassociatedwithmentalretardation,schizophrenia,mooddisorders,and
suicide.Itcommonlyoccursfromagesixtotwentyyearsofage,buthasbeenseenasearlyasage
fourandaslateasseventy.Thisdiseaseisseenmoreoftenamongmenandwherethedisease
courseismoresevere.
Itoftenpresentswithbumpsontheskinandlongitudinalstripesonthefingernails.
Aconfoundingvariableinsuicideinskinproblemsisthatsuicidalthoughtscanalsobetriggeredby
medicationssuchasinterferons,whichareusedtotreatskindisease.Beawarethatlithium,a
frontlinetreatmentforbipolardisorderisknowntocauseavarietyofskinproblems,including
psoriasis.

Hair

Changesinhairareoftenawarningsignsofphysicalandmentalhealth.Haircellsaresomeofthe
mostrapidgrowingcellsthebodyand,therefore,whenthebodybecomesill,itisnotuncommon
thathaircellsshutdownresultinginchangesinhairstructureorhairloss.Thesechangescanbe
triggeredbyhormonalchanges,malnutrition,medication,andmanymedicaldisorders,especially
thyroiddisease.
Peoplewithredhairaremorelikelytohaveareceptorgenethatcanaffectsensitivityto
anaestheticsandresponsetopain.
Hairlosscanalsobeasignofalackofcertainnutrients,suchaszincandbiotin.Somepeople
develophairlossafterbariatricsurgerythatmakeschangesintheirdigestivesystemanddecreases
theirzincabsorption.
Peopleoftenexperiencehairlossbecauseofhyperthyroidismorhypothyroidism.Thesedisorders
arefrequentlymisdiagnosedasaffectivedisorders,mainlydepressionandanxiety.
Peoplesufferingfromheartburnandacidrefluxfrequentlytakeantacids(includingNexiumand
Prilosec)whichinterferewithBvitaminabsorption,includingB12andbiotin.LowlevelsofB12and
biotinoftencausehairloss,butcanalsoleadtoskinrashes,heartproblems,anxiety,depression,
lethargy,andattimes,hallucinations.

Sleep
"We'veallbeentoldyououghttosleepeighthours,butthereisneveranyevidence"
DanielKripke

Mentalsymptomsofpoorsleep
Fatigue
Daytimesleepiness
Memoryproblems
Depression
Increasedbodymassindex
Increasedappetite
Diabetes
Heartproblems
Attentiondeficits
Usingalcoholtosleep
Usingdrugstosleep
Sleepproblemsandbiologicalrhythmsdisordershavelongbeentiedtomentalhealthproblems.
Disruptioninnormalsleepisassociatedwithincreasedirritabilityandaggression.Forthisreason,
anassessmentofthequalityandquantityofsleepisessentialforanaccuratementaldiagnosis.It
wouldalsobeprudenttogetasleephistoryofthefamily.
Theamountofsleepapersonneedsdifferssignificantlyfrompersontoperson.Thebeliefthat
everyoneshouldsleepeighthourscancausepeopletoassumetheyhaveinsomnia.Thisoftengets
themaprescriptionforsleepingpills,whichtheydontneed.
Theamountofsleepanindividualneedsis,inpart,genetic.Recentlyitwasdiscoveredthatabout
threepercentofhumanshaveagenecalledDEC2.Peoplewhopossessthisgenehaveanormal
sleepcycleof6.0hourspernight.
Therehavebeensignificantchangesinselfreportedsleepdurationoverthepasthalfcentury.A
sleepsurveyin1960,whichpolledoveramillionpeople,foundthatthemodalsleepdurationwas

8.0to8.9hoursanight.Butsurveysdonein2000,2001,and2002foundtheaveragedurationof
sleepforAmericanshadfallento6.97.0hours.In2009,itwasobservedthatmanypeopleslept
only5.06.0hourspernightonaregularbasis.Chronicsleepdeprivationislinkedtoinjuriesand
motorvehicleaccidents,problemswithshorttermmemory,impairmentinattention,depressed
mood,andinabilitytocontrolappetite.
Circadianrhythmdisturbances

Problemsofshiftworkers
Accidents
Workrelatederrors
Highersickleave
Irritability
Mooddisorders
Relationshipproblems
Familyproblems
Statistically,peoplewhosleepbetweensixtosevenhoursanightlivethelongest.Conversely,shift
workers,whoseldomgetadequatesleep,haveaperpetualsleepdebtwhichputsthemathighrisk
foranumberofpathologies,includingcardiovasculardisease,digestivedisorders,andpsychiatric
problems.Shiftworkers(peoplewhoworkatnight,orchangeshiftsfrequently)donotadjusttotheir
sleeppatterns,andtheriskoftheirproblemsincreasesovertime.Theyalsohaveasignificantly
higherrateofrelationshipandfamilyproblems.
Lithiumseemstoimprovethesymptomsofbipolardisorder,inpart,bynormalizingthecircadian
clock.ThemineralreducestheactivityofReverbalpha,areceptorinthebrainthatturnsoff
circadianclockgenes.(Itisalsoknownthatinregionsoftheworldwheretherearelowlevelsof
lithiuminthewatersupply,therearehigherincidentsofincidencesuicide,homicide,andviolent
behaviors.)
Sleepapnea

Physicalsymptomsofsleepapnea
Excessivedaytimesleepiness
Morningoreveningheadaches
Heartburnatnight
Swellingoflegs
Loudsnoring
Chokingorgaspingduringsleep
Breastfeedingaltersababysmouth,shapingitproperlytoallowadequateairflow.Breastfeeding
requireslessforcefulsuckingthanbottlefeedingandamorepropertongueplacement(forward
positioninthemouth).Thiscontributestoalowerroofarchandbetterbreathing.Thenewborns
palate,beingsoftandmalleable,issculptedbysuckingandswallowing.Thisprimaryrepetitive
motionofinfancyshapesbreathingpatternsthroughadulthood.
Bottlefeeding,ontheotherhand,oftencausesincorrectpositioningofthetongue.Becausebottle
nipplesaremuchfirmerthanahumanbreast,thetonguepositionleadstoadifferenttonguethrust
andanincorrectformationofthepalate.Inadulthood,thisincreasestheriskofsleepdisordered
breathingproblems.BrianPalmer,adentistandresearcherinLeawood,Kansas,believesthat
bottlefedinfantsdisplayasignificantlydifferentsuckingpatternandtonguepositionthanbreastfed
babies.Bottlefedbabiesdonothavesameexperience,andmayhaveairintakeproblems.They
alsohaveahigherincidenceofobstructivesleepapnealaterinlife.

Takeadeepbreathandholditaslongasyoupossiblycan.Inlessthanaminute,youwillhavean
overwhelmingpanickyfeelingthatwillcauseyoutotakeadeepbreath.Youhavejustexperienced
apnea.
Anyabnormalbreathingwhilesleepingiscalledsleepapnea.Abouttwoandahalfmillionpeoplein
theUnitedStatessufferfromsleepapnea,butthemajorityofthemareunawareoftheproblem.
Therearethreebasictypesofapnea,obstructive,central,andcomplex.Obstructivesleepapneais
thephysicalcollapseoftheairway.Thisisoftencausedbyexcessweight.Althoughobesityisa
commoncauseofobstructiveapnea,othermedicalconditionsincludeareductioninmuscletoneof
thesoftpalate,ashortthickneck,theuvula(thesmall,conical,fleshytissuehangingfromthecenter
ofthesoftpalate),andthepharynx.Theupperairwaycanalsobenarrowedbyenlargedtonsils,
adenoids,deviatednasalseptums,nasalpolyps,orcongenitalairwayabnormalities.
Obstructivesleepapneaandhypothyroidismhavemanysignsandsymptomsincommon.Asleep
studyattheUniversityofCalgaryshowedthatfourpercentofpeoplewithobstructiveapneahad
undiagnosedhypothyroidism.Thistypeofhypothyroidsleepdisorderedbreathingcanoftenbe
treatedwiththyroxine.
Centralapneaisthephenomenonofthecessationofbreathing.Peoplewithcentralapneaoften
havedamageorabnormalitiesinbrainregionsthatregulatebreathingandspeech.Asaresult,
almost40percentofpeoplewithcentralapneaalsostutteredaschildren.Childrenwithcentral
apneaareoftenmisdiagnosedwithattentiondeficitdisorder,becausetheirpoorsleepqualitymakes
themdrowsyduringtheday.Sincestutteringisatreatableproblem,peoplemaynotbeawarethat
theystillhaveapnea.
Complexsleepapneaisthepresenceofcentralapneaplusobstructiveapnea.About15percentof
allsleepapneapatientshavecomplexapnea.
Thereisastrongassociationbetweenepisodichypoxiaandsleepfragmentationwithmemory
deficits,attention,globalintelligence,hyperactivebehaviors,andmooddisturbances.
Childrenwithapneaareoftenmisdiagnosedwithattentiondeficithyperactivitydisorder(ADHD).
Becausetheysleeppoorly,theycannotfocusintheclassroom.Ina2003studybysleepresearcher
LouiseOBrien,44childrenwithsymptomsofADHDspentanightinasleeplab.Obstructivesleep
apneawasfoundinfivepercentofthosewithsignificantADHDsymptoms,andtwentysixpercentof
thosewithmildsymptoms,butonlyfivepercentofhadnosymptoms.Ahighprevalenceofsnoring
wasidentifiedamongagroupofchildrendesignatedasshowingmildsymptomsofADHD.Rapid
eyemovementdisturbancesaremorelikelytooccurinchildrenwithsignificantsymptoms,andthey
seemtoimposesignificanteffectsondaytimebehavior.
Anotherstudyfocusedonsnoring,sleepdisorderedbreathing,andproblembehaviorsinfiveyear
oldchildren.Theparentsreportedthatchildrenwhosnoredandthosethatexhibiteddaytime
sleepinessalsopresentedwithhyperactivity,inattention,andaggressiveness.Thestudyrevealed
thatsleepdisorderedbreathingsymptomsarecommoninfiveyearoldchildrenresultingin
behaviorsthatsuggestedattentiondeficit/hyperactivitydisorder.
ThesechildrenmaybegivenastimulantsuchasRitalin.Althoughthestimulantmaymakeachild
morealert,itwillnotcuretheprobleminfact,thedrugsmayactuallyinterferewithsleep.
Sometimesremovingthetonsilshelps,byvirtueofimprovingairflowthroughthethroat.
WhileADHDismorelikelytobediagnosedinchildrenwithapnea,adultswithapneaaremoreoften
misdiagnosedwithdepression.Oneinfivepeoplewithdepressionislikelytohaveapnea.Adults
withsleepapneaarethreetimesmorelikelytoalsohavediabetes.
Obesityhypoventilationsyndromeisunderrecognized,misdiagnosed,andundertreated.Because
obesityhasbecomeanationalepidemic,itisimportantthatallhealthcareprofessionalslearnto
recognizethesedisorders.

Somesymptomsofapneasuchasawakeningwithfeelingofchoking,abnormalmotoractivity
duringsleep,andtheexcessivedaytimesleepinessarecommonlyfoundinobstructiveapnea,but
arealsofoundinnocturnalfrontallobeepilepsy.Forthisreason,asleepstudyshouldbedoneto
identifytheoriginofthesesymptoms.
Inaddition,bothmenandwomenwithapneaalsohaveahighincidenceofsexualdysfunction.Men
whosufferfromobstructivesleepapneaproducelowerlevelsoftestosterone.
Manyofthesesymptomsofapneawillimprovereducedthroughcontinuouspositiveairwaypressure
(CPAP)treatment.Othertreatmentsincludesurgerytoremovesofttissueinthemouthandincrease
airflow.

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