When Psychological Problems Mask Medical Disorders: A Guide for Psychotherapists

In recent decades, two trends have become apparent in the field of psychiatry. The first is the increasing awareness of the impact of the entire soma on the mental state, both in primary psychiatric illness and in psychiatric disorder secondary to a medical condition. The second is the expanded role of clinicians whose training does not include medicine. Although any reasonable psychotherapy training should include somatopsychic models for presenting problems, clinicians trained primarily in psychodynamic or behavioral theory may be at disadvantage when evaluating newly presenting patients or patients who have medical issues.

Dr. Morrison has provided a three-part source book that introduces psychotherapists to medical disorders likely to be seen in general psychotherapy practice. His book provides a foundation in the assessment of mental state and in a number of commonly encountered medical conditions and is a reference for specific conditions and presentations.

Part 1 is a thorough review of the mental status assessment as practiced in psychiatry. Interspersed through this section are examples of medical illnesses that may present as mental state change or abnormality. Also included are brief anecdotes that give the reader a sense of the clinical presentation of such illnesses.

In this section Dr. Morrison points out the importance of differentiating personality disorder from personality change, the latter often reflecting acute, progressive medical events necessitating immediate referral.

Part 2 consists of a review of 60 medical disorders that may present with psychiatric symptoms. The author has selected these disorders for their frequency of presentation in mental illness treatment settings. He points out that the listed disorders often occur without significant psychiatric symptoms and that most psychiatric symptoms reflect primary psychiatric disorder. Dr. Morrison also underscores that the identification of significant medical disorder in psychiatric patients may prevent serious consequences of untreated illness.

Each of the 60 disorders is presented in a chart listing occurrence, age of onset, gender ratio, specialty to which the case may be referred for evaluation, cause, physical symptoms, and mental symptoms. This chart is followed by brief descriptions of the anatomy, physiology, and pathology involved. After that comes a description of physical symptoms, mental symptoms, evaluation procedures, and clinical outlook.

Part 3 consists of symptom summaries organized by organ systems as well as by emotional, behavioral, cognitive, and personality symptoms. The symptom tables, used in concert with the summary charts in part 2, provide a quick reference for the therapist making a medical referral.

When Psychological Problems Mask Medical Disorders is at once a primer on the collaboration of psychotherapist and physician and a useful reference book for this purpose. Although it is intended for psychotherapists with limited medical training, it may also be useful to primary care physicians and other medical clinicians who may be the first contact for patients who present with psychiatric symptoms.

Dr. Seymour is assistant professor of psychiatry and is on the staff of the adult consultation-liaison service at the University of Massachusetts Medical Center in Worcester.