Positive Space
Anxiety disorders affect 17-19 million adults every year and are the most commonly diagnosed category of mental disorders. Statistics for depressive disorders are similar — about 15 million Americans will be diagnosed sometime in their adulthood. What if we could identify a medical origin to psychiatric illnesses? What if anxiety or depression could be treated in much the same way a bacterial infection or benign tumor would be? How might this change the landscape of psychiatric diagnosis and treatment?
I raised this issue in a prior post about PANS/PANDAS: “This is relatively unchartered territory: the notion that the mind/body connection could be this obvious, that a subset of children suffering from severe psychiatric symptoms don’t need psychotropic medication and involuntary hospitalization — they need an urgent and accurate diagnosis, antibiotics, and a return to normal functioning.” In the case of PANS/PANDAS, it appears Big Pharma may be willfully impeding clients’ access to medical treatments for psychiatric symptoms because, well, Big Pharma would lose a lot of dinero on that concession.
We already know that certain medical conditions (ex: tumors, hormonal imbalances, streptococcal virus, Lyme disease, Vitamin B12 deficiencies, hyperparathyroidism, hyper- or hypothyroidism, Wilson’s disease, and traumatic brain injuries) can cause symptoms that mirror those of mental health disorders (ex: panic disorder, generalized anxiety, obsessive-compulsive disorder, intermittent explosive disorder, major depression, psychotic or delusional disorders). What if we could more finely tune our ability to identify the likely medical origins for psychiatric symptoms — and, in turn, our ability to treat psychiatric suffering? What if the onset of psychiatric symptoms could be a harbinger of the future onset of a medical disorder? What if this meant we could provide earlier treatment for diseases like Parkinson’s or cancer because we were more adept at using information about mental health symptoms as clues for burgeoning physical conditions like Parkinson’s and cancer?
There is a good argument to be made that the medical and psychiatric fields should not be so stringently divided from one another — that a cohesive medical/psychiatric model should exist in which primary care physicians, neuropsychologists, and mental health workers are constantly overlapping and sharing data on cases. Mental health providers should be routinely inquiring about the results of standard blood work and raking the details of medical reports for clues: Vitamin B or D deficiencies, elevated calcium levels, sleep difficulties, an excessive history of strep or other viruses. Primary care physicians should be routinely inquiring about mental health symptoms, especially markers that might indicate underlying psychiatric problems: how is your sleep? do you have thoughts you would never share with another person and which trouble you greatly?
Many primary care providers currently ask about domestic abuse, suicidal ideation, and your run-of-the-mill depression and anxiety. But, few inquire about more obscure psychiatric symptoms such as the shame, disgust, and guilt experienced by those suffering privately with OCD or more unusual psychotic symptoms such as olfactory hallucinations. Some may argue: “But, this isn’t their job! They’re supposed to treat things like skin infections and strep.” Oh really? And, what now that we’ve linked strep to the onset of severe OCD and eating disordered symptoms in children? There is increasing evidence that sleep and mental health are closely intertwined, with some studies even suggesting that sleep problems precede depressive symptoms, perhaps even causing depression, rather than sleep difficulties being a symptom of depression. If we treat the sleep might we treat the depression? Primary care physicians should routinely inquire about sleep problems as there are over 70 types of sleep disorders and a high comorbidity between sleep problems and mental health disorders such as anxiety, depression, ADHD, and psychotic disorders.
Because a medical diagnosis can be an indicator of a mental health condition and vice versa, it is imperative that we better train providers to assess in overlapping domains. For example, multiple sclerosis and Parkinson’s disease often show up as psychiatric disorders before they are properly diagnosed as medical conditions, as evidenced by a study at UMASS Medical School in which a full 3/4 of patients examined had a delayed diagnosis of a neurodegenerative disorder because it was initially misdiagnosed as a psychiatric disorder. Similarly, we have some preliminary ability to see indicators of psychiatric problems before their onset via medical tests alone: an elevated thyroid hormone has actually been shown to precede anxiety problems — and the onset of hyperthyroidism. One study in 2011 conducted by Columbia University and the New York State Psychiatric Institute found that mothers who contracted the influenza virus during pregnancy had a threefold risk of bearing a child who later developed schizophrenia. We must concretize these links and understand them better.
A 2007 New Zealand study found a link between gastroenteritis, IBS, and high anxiety. Similarly, several studies have found links between inflammation of the airways (asthma, COPD, etc) and panic attacks or severe anxiety. Perhaps we are treating the same problems using SSRIs (for the psychiatric symptoms) and inhalers (for the inflamed airways) when a different or unified approach might make more sense.
On the flip side, there is good evidence that mental health disorders may contribute to medical conditions. One study determined that persons with the most severe phobic anxiety were 59% more at risk of suffering a cardiac event such as a heart attack and 31% more likely to die from a cardiac event than persons without a severe phobia. Two independent studies found nearly identical results: of men and women who had heart disease, those with a co-occurring anxiety disorder were twice as likely to suffer a heart attack as those without a comorbid anxiety disorder.
The brain and the body are not divided. They exist within the same structure, under the same skin. To divorce one from the other does an enormous disservice to the actual living human being in which the structures of the mind and body reside. It is incumbent upon the medical community as a whole — and, for now, individual practitioners — to ensure they are conducting holistic assessments which attempt to account for the myriad ways the mind and body overlap in terms of symptomology and etiology. I hope that, one day, science catches up and we are able to connect all the dots between physical and mental illnesses. When that day comes, we might look back on some treatments such as exposure therapy or tonsillectomies as we now do lobotomies — with a sense of shock and regret. We must do better.
