Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases
- PMID:23436669
Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases
Abstract
In this Part II psychiatric disorders coexisting with organic diseases are discussed. "Comorbidity phenomenon" defines the not univocal interrelation between medical illnesses and psychiatric disorders, each other negatively influencing morbidity and mortality. Most severe psychiatric disorders, such as schizophrenia, bipolar disorder and depression, show increased prevalence of cardiovascular disease, related to poverty, use of psychotropic medication, and higher rate of preventable risk factors such as smoking, addiction, poor diet and lack of exercise. Moreover, psychiatric and organic disorders can develop together in different conditions of toxic substance and prescription drug use or abuse, especially in the emergency setting population. Different combinations with mutual interaction of psychiatric disorders and substance use disorders are defined by the so called "dual diagnosis". The hypotheses that attempt to explain the psychiatric disorders and substance abuse relationship are examined: (1) common risk factors; (2) psychiatric disorders precipitated by substance use; (3) psychiatric disorders precipitating substance use (self-medication hypothesis); and (4) synergistic interaction. Diagnostic and therapeutic difficulty concerning the problem of dual diagnosis, and legal implications, are also discussed. Substance induced psychiatric and organic symptoms can occur both in the intoxication and withdrawal state. Since ancient history, humans selected indigene psychotropic plants for recreational, medicinal, doping or spiritual purpose. After the isolation of active principles or their chemical synthesis, higher blood concentrations reached predispose to substance use, abuse and dependence. Abuse substances have specific molecular targets and very different acute mechanisms of action, mainly involving dopaminergic and serotoninergic systems, but finally converging on the brain's reward pathways, increasing dopamine in nucleus accumbens. The most common substances producing an addiction status may be assembled in depressants (alcohol, benzodiazepines, opiates), stimulants (cocaine, amphetamines, nicotine, caffeine, modafinil), hallucinogens (mescaline, LSD, ecstasy) and other substances (cannabis, dissociatives, inhalants). Anxiety disorders can occur in intoxication by stimulants, as well as in withdrawal syndrome, both by stimulants and sedatives. Substance induced mood disorders and psychotic symptoms are as much frequent conditions in ED, and the recognition of associated organic symptoms may allow to achieve diagnosis. Finally, psychiatric and organic symptoms may be caused by prescription and doping medications, either as a direct effect or after withdrawal. Adverse drug reactions can be divided in type A, dose dependent and predictable, including psychotropic drugs and hormones; and type B, dose independent and unpredictable, usually including non psychotropic drugs, more commonly included being cardiovascular, antibiotics, anti-inflammatory and antineoplastic medications.
Similar articles
- Psychiatric emergencies (part I): psychiatric disorders causing organic symptoms.Testa A, Giannuzzi R, Sollazzo F, Petrongolo L, Bernardini L, Daini S.Testa A, et al.Eur Rev Med Pharmacol Sci. 2013 Feb;17 Suppl 1:55-64.Eur Rev Med Pharmacol Sci. 2013.PMID:23436668Review.
- [Drawing up guidelines for the attendance of physical health of patients with severe mental illness].Saravane D, Feve B, Frances Y, Corruble E, Lancon C, Chanson P, Maison P, Terra JL, Azorin JM; avec le soutien institutionnel du laboratoire Lilly.Saravane D, et al.Encephale. 2009 Sep;35(4):330-9. doi: 10.1016/j.encep.2008.10.014. Epub 2009 Jul 9.Encephale. 2009.PMID:19748369French.
- Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases.Testa A, Giannuzzi R, Daini S, Bernardini L, Petrongolo L, Gentiloni Silveri N.Testa A, et al.Eur Rev Med Pharmacol Sci. 2013 Feb;17 Suppl 1:86-99.Eur Rev Med Pharmacol Sci. 2013.PMID:23436670Review.
- Behavioral interventions for dual-diagnosis patients.Goldsmith RJ, Garlapati V.Goldsmith RJ, et al.Psychiatr Clin North Am. 2004 Dec;27(4):709-25. doi: 10.1016/j.psc.2004.07.002.Psychiatr Clin North Am. 2004.PMID:15550289Review.
- [Schizophrenia and addiction: An evaluation of the self-medication hypothesis].Potvin S, Stip E, Roy JY.Potvin S, et al.Encephale. 2003 May-Jun;29(3 Pt 1):193-203.Encephale. 2003.PMID:12876543Review.French.
Cited by
- Prevalence of anxiety, depression, and stress among students of Jahangirnagar University in Bangladesh.Hossain MM, Alam MA, Masum MH.Hossain MM, et al.Health Sci Rep. 2022 Mar 14;5(2):e559. doi: 10.1002/hsr2.559. eCollection 2022 Mar.Health Sci Rep. 2022.PMID:35308418Free PMC article.
- Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice.Dell'Osso B, Albert U, Atti AR, Carmassi C, Carrà G, Cosci F, Del Vecchio V, Di Nicola M, Ferrari S, Goracci A, Iasevoli F, Luciano M, Martinotti G, Nanni MG, Nivoli A, Pinna F, Poloni N, Pompili M, Sampogna G, Tarricone I, Tosato S, Volpe U, Fiorillo A.Dell'Osso B, et al.Neuropsychiatr Dis Treat. 2015 Jul 30;11:1885-909. doi: 10.2147/NDT.S83130. eCollection 2015.Neuropsychiatr Dis Treat. 2015.PMID:26257524Free PMC article.Review.
- Enhanced self-administration of the CB1 receptor agonist WIN55,212-2 in olfactory bulbectomized rats: evaluation of possible serotonergic and dopaminergic underlying mechanisms.Amchova P, Kucerova J, Giugliano V, Babinska Z, Zanda MT, Scherma M, Dusek L, Fadda P, Micale V, Sulcova A, Fratta W, Fattore L.Amchova P, et al.Front Pharmacol. 2014 Mar 20;5:44. doi: 10.3389/fphar.2014.00044. eCollection 2014.Front Pharmacol. 2014.PMID:24688470Free PMC article.
- Impact of humanized nursing care on negative emotions and quality of life of patients with mental disorders.Bao L, Shi C, Lai J, Zhan Y.Bao L, et al.Am J Transl Res. 2021 Nov 15;13(11):13123-13128. eCollection 2021.Am J Transl Res. 2021.PMID:34956532Free PMC article.
- A nationwide cohort study on the association between intensive care treatments and mental distress linked psychiatric disorders.Mossberg R, Ahlström B, Lipcsey M.Mossberg R, et al.Sci Rep. 2024 Feb 24;14(1):4519. doi: 10.1038/s41598-024-55102-9.Sci Rep. 2024.PMID:38402361Free PMC article.