Mood and Anxiety Disorders as Early Manifestations of Medical Illness: A Systematic Review

[Dolphin]

Free full text: http://www.karger.com/Article/FullText/367913

Psychother Psychosom 2015;84:22-29
(DOI:10.1159/000367913)

Mood and Anxiety Disorders as Early Manifestations of Medical Illness: A Systematic Review

Cosci F · Fava G.A. · Sonino N.

aDepartment of Health Sciences, University of Florence, Florence, bDepartment of Psychology, University of Bologna, Bologna, and cDepartment of Statistical Sciences, University of Padova, Padova, Italy; dDepartment of Psychiatry, State University of New York at Buffalo, Buffalo, N.Y., USA

Abstract

Background:

Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses.

The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis.

Methods:

MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014.

Search terms were ‘prodrome/early symptom', combined using the Boolean ‘AND' operator with ‘anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean ‘AND' operator with ‘medical illness/medical disorder'.

PRISMA guidelines were followed.

Results:

A total of 21 studies met the inclusion criteria and were analyzed.

Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS.

Mania, anxiety and irritability were less frequent.

Conclusions:

Physicians may not pursue medical workup of cases that appear to be psychiatric in nature.

They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

© 2014 S. Karger AG, Basel

 

[Sidereal]

Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS.

That list looks quite incomplete to be honest.

 

[Denise]

Thank you very much for posting this @Dolphin!
Very interesting.

 

[kristysmiles]

I find it interesting that both the psychiatrists in this article are arguing for underlying medical causes of mood and anxiety disorders. (One works at my future medical school of choice!) I don't like the random flux of my moods; anxiety that I can't find an underlying reason to have; and irritability that makes me snap at people without reason. On a brighter note, if I successfully become a neurologist, and my brother a neuro-psychiatrist maybe we can work together to destroy the stigma throughout the medical community that ME/CFS is psychological.

 

[alex3619]

That list looks quite incomplete to be honest.

They will only cite things that have stronger evidence that they are aware of. Depression is most probably an illness response in many cases.

This is one of the issues with the evidence based movement - while it does increase the soundness of the reasoning it does so in a biased way. It puts blinkers on the investigators. While evidence does need to be assessed as to reliability, even anecdotal evidence has value.