The DSM 5 diagnostic criteria always require that general medical conditions or drug-induced symptoms are ruled out before a clinician diagnosis a patient with having a primary psychiatric disorder. There are in fact many psychiatric symptoms triggered not only by recreational drugs, but also by prescription medications that are widely used in primary care and specialized care. Medical conditions associated with depression include endocrinopathies, neurologic disorders, vitamin deficiencies and cardiovascular disease. Medical disorders associated with anxiety include hyperthyroidism, COPD, asthma, diabetes, chronic pain, irritable bowel, pheochromocytoma, Lyme disease, head trauma, vascular dementia, Parkinson’s disease, Lupus, rheumatoid arthritis, loss of estrogen and electrolyte imbalance. Symptoms of mania can be associated with infections, epilepsy, stroke, brain tumors, influenza and hemodialysis. Psychotic symptoms can result from CNS diseases, toxins, autoimmune diseases, chromosomal abnormalities, infectious diseases, nutritional deficits, endocrine disorders and metabolic diseases. On the other hand, prescription drugs can also generate psychopathology symptoms. Steroids are associated with psychosis, mania, depression and anxiety. Similar symptoms can be associated with ACE inhibitors, anticholinergic drugs, anticonvulsants, barbiturates, benzodiazepines, beta-adrenergic drugs, calcium channel blockers, dopamine agonists for Parkinson’s, certain antibiotics, antihistamines, NSAIDS, opioids, procaine derivatives, salicylates, SSRIs and sulfonamides. In summary, psychiatrists must screen for medical conditions and recreational/prescription medications in every patient they evaluate to rule out an iatrogenic disorder (drug-induced secondary psychiatric illness) rather than a primary psychiatric disorder. Discontinuation of the offending agent may be the treatment of choice if iatrogenesis is established. Learning Objectives:
1) Review the medical conditions that are associated with mood, anxiety and psychotic disorders.
2) Recognize the risk of triggering various psychotic symptoms with many prescription drugs.
3) List the prescription medications associated with depression, anxiety, mania or psychosis.