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Diagnosis of medical versus psychiatric anxiety or depression

Posted by Margaret Donohue on April 10, 2017 at 11:35 PM

Medical causes of depression and anxiety account for about 58-79 % of all diagnosed cases of depression and anxiety.  So it's helpful to differentiate them.  

  • Psychological cases respond generally well to evidence based treatments for depression and anxiety.  So if a person has been through an evidence based treatment, and followed the protocol, and was adherent, they should have some degree of improvement in about 4 to 6 weeks. 
  • In addition there should be something that triggered the depression or anxiety to start.  So if that's missing, it's more likely to have a medical cause.  
  • The most common causes of missed diagnosed medical conditions are infection, endocrine, medication side effects, neurological conditions, vitamin or mineral deficiencies, allergic reactions, and malignancy. 
  • There should also be thoughts related to emotions in psychological conditions but there may not be thoughts related to mood issues in medical conditions.

One thing I try with people is to see if they respond to what I call the straw test.  See if the person can access the anxious or depressed feeling.  Have them then place a straw lengthwise between their teeth forcing their mouths into a wide smile.  See if they can still access the feeling of depression or anxiety.  If they can it's more likely medical than psychiatric.  Psychiatric conditions will respond to changing behaviors or thoughts.  This was first found in 1988 in a study by Strack, et.al.  where he had people hold a pencil between their teeth or between their lips.  Between the teech creates a forced smile and between the lips a forced frown.  He said it was a facial feedback hypothesis.  Neurolinguistic programming would hypothesize that it's a physical anchor.  It's a simple trick that can help with differential diagnosis.

Categories: Diagnosis

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