Differential diagnoses of depression

Neuroimaging can be a valuable tool in the diagnostic work-up of various psychiatric disorders including depression.[1]

Depression, one of the most commonly diagnosed psychiatric disorders,[2][3] is being diagnosed in increasing numbers in various segments of the population worldwide.[4][5] Depression in the United States alone affects 17.6 million Americans each year or 1 in 6 people. Depressed patients are at increased risk of type 2 diabetes, cardiovascular disease and suicide. Within the next twenty years depression is expected to become the second leading cause of disability worldwide and the leading cause in high-income nations, including the United States. In approximately 75% of suicides, the individuals had seen a physician within the prior year before their death, 45–66% within the prior month. About a third of those who died by suicide had contact with mental health services in the prior year, a fifth within the preceding month.[6][7][8][9][10]

There are many psychiatric and medical conditions that may mimic some or all of the symptoms of depression or may occur comorbid to it.[11][12][13] A disorder either psychiatric or medical that shares symptoms and characteristics of another disorder, and may be the true cause of the presenting symptoms is known as a differential diagnosis.[14]

Many psychiatric disorders such as depression are diagnosed by allied health professionals with little or no medical training,[15] and are made on the basis of presenting symptoms without proper consideration of the underlying cause, adequate screening of differential diagnoses is often not conducted.[16][17][18][19][20][21] According to one study, "non-medical mental health care providers may be at increased risk of not recognizing masked medical illnesses in their patients."[22]

Misdiagnosis or missed diagnoses may lead to lack of treatment or ineffective and potentially harmful treatment which may worsen the underlying causative disorder.[23][24] A conservative estimate is that 10% of all psychological symptoms may be for medical reasons,[25] with the results of one study suggesting that about half of individuals with a serious mental illness "have general medical conditions that are largely undiagnosed and untreated and may cause or exacerbate psychiatric symptoms".[26][27]

In a case of misdiagnosed depression recounted in Newsweek, a writer received treatment for depression for years; during the last 10 years of her depression the symptoms worsened, resulting in multiple suicide attempts and psychiatric hospitalizations. When an MRI finally was performed, it showed the presence of a tumor. However, she was told by a neurologist that it was benign. After a worsening of symptoms, and upon the second opinion of another neurologist, the tumor was removed. After the surgery, she no longer had depressive symptoms.[28]

  1. ^ Neuroimaging: a new training issue in psychiatry? -- Bhriain et al. 2005 - [1] Archived 2010-04-27 at the Wayback Machine
  2. ^ Sharp LK, Lipsky MS (September 2002). "Screening for depression across the lifespan: a review of measures for use in primary care settings". American Family Physician. 66 (6): 1001–8. PMID 12358212.
  3. ^ Torzsa P, Szeifert L, Dunai K, Kalabay L, Novák M (September 2009). "A depresszió diagnosztikája és kezelése a családorvosi gyakorlatban". Orvosi Hetilap. 150 (36): 1684–93. doi:10.1556/OH.2009.28675. PMID 19709983.
  4. ^ College Students Exhibiting More Severe Mental Illness, Study Finds
  5. ^ Lambert KG (2006). "Rising rates of depression in today's society: Consideration of the roles of effort-based rewards and enhanced resilience in day-to-day functioning". Neuroscience & Biobehavioral Reviews. 30 (4): 497–510. doi:10.1016/j.neubiorev.2005.09.002. PMID 16253328. S2CID 12525915.
  6. ^ Depression and Suicide Andrew B. Medscape
  7. ^ González HM; Vega WA; Williams DR; Tarraf W; West BT; Neighbors HW (January 2010). "Depression Care in the United States: Too Little for Too Few". Archives of General Psychiatry. 67 (1): 37–46. doi:10.1001/archgenpsychiatry.2009.168. PMC 2887749. PMID 20048221.
  8. ^ Luoma JB, Martin CE, Pearson JL (June 2002). "Contact with mental health and primary care providers before suicide: a review of the evidence". The American Journal of Psychiatry. 159 (6): 909–16. doi:10.1176/appi.ajp.159.6.909. PMC 5072576. PMID 12042175.
  9. ^ Lee HC, Lin HC, Liu TC, Lin SY (June 2008). "Contact of mental and nonmental health care providers prior to suicide in Taiwan: a population-based study". Canadian Journal of Psychiatry. 53 (6): 377–83. doi:10.1177/070674370805300607. PMID 18616858.
  10. ^ Pirkis J, Burgess P (December 1998). "Suicide and recency of health care contacts. A systematic review". The British Journal of Psychiatry. 173 (6): 462–74. doi:10.1192/bjp.173.6.462. PMID 9926074. S2CID 43144463.
  11. ^ Adults Admitted to a Mood-Disorder Clinic Are Often Misdiagnosed by Marlene Busko [2]
  12. ^ Jones DR, Macias C, Barreira PJ, Fisher WH, Hargreaves WA, Harding CM (November 2004). "Prevalence, Severity, and Co-occurrence of Chronic Physical Health Problems of Persons with Serious Mental Illness". Psychiatric Services. 55 (11): 1250–7. doi:10.1176/appi.ps.55.11.1250. PMC 2759895. PMID 15534013.
  13. ^ Felker B, Yazel JJ, Short D (December 1996). "Mortality and medical comorbidity among psychiatric patients: a review". Psychiatric Services. 47 (12): 1356–63. doi:10.1176/ps.47.12.1356. PMID 9117475.
  14. ^ Merriam-Webster's Medical Dictionary, Merriam-Webster, Inc.
  15. ^ Preventing Misdiagnosis of Women: A Guide to Physical Disorders That Have Psychiatric Symptoms (Women's Mental Health and Development) by Dr. Elizabeth Adele Klonoff and Dr. Hope Landrine p. xxi Publisher: Sage Publications, Inc; 1 edition (1997) Language: English ISBN 0761900470
  16. ^ Singh H, Thomas EJ, Wilson L, et al. (July 2010). "Errors of Diagnosis in Pediatric Practice: A Multisite Survey". Pediatrics. 126 (1): 70–9. doi:10.1542/peds.2009-3218. PMC 2921702. PMID 20566604.
  17. ^ Margolis RL (1994). "Nonpsychiatrist house staff frequently misdiagnose psychiatric disorders in general hospital inpatients". Psychosomatics. 35 (5): 485–91. doi:10.1016/S0033-3182(94)71743-6. PMID 7972664.
  18. ^ Clinical errors and medical negligence Femi Oyebode; Advances in Psychiatric Treatment (2006) 12: 221-227 [3] The Royal College of Psychiatrists
  19. ^ Scheinbaum BW (1979). "Psychiatric diagnostic error". Schizophrenia Bulletin. 5 (4): 560–3. doi:10.1093/schbul/5.4.560. PMID 515705.
  20. ^ Hall RC, Popkin MK, Devaul RA, Faillace LA, Stickney SK (November 1978). "Physical illness presenting as psychiatric disease". Archives of General Psychiatry. 35 (11): 1315–20. doi:10.1001/archpsyc.1978.01770350041003. PMID 568461.
  21. ^ Small GW (December 2009). "Differential Diagnoses and Assessment of Depression in Elderly Patients". The Journal of Clinical Psychiatry. 70 (12): e47. doi:10.4088/JCP.8001tx20c. PMID 20141704.
  22. ^ Grace GD, Christensen RC (2007). "Recognizing psychologically masked illnesses: the need for collaborative relationships in mental health care". Primary Care Companion to the Journal of Clinical Psychiatry. 9 (6): 433–6. doi:10.4088/pcc.v09n0605. PMC 2139921. PMID 18185822.
  23. ^ Witztum E, Margolin J, Bar-On R, Levy A (1995). "Stigma, labelling and psychiatric misdiagnosis: origins and outcomes". Medicine and Law. 14 (7–8): 659–69. PMID 8668014.
  24. ^ Margolin J, Witztum E, Levy A (June 1995). "Consequences of misdiagnosis and labeling in psychiatry". Harefuah. 128 (12): 763–7, 823. PMID 7557684.
  25. ^ When Psychological Problems Mask Medical Disorders: A Guide for Psychotherapists. Morrison J: New York, Guilford, 1997 ISBN 1-57230-539-8
  26. ^ Previously undetected metabolic syndromes and infectious diseases among psychiatric inpatients. Psychiatric Services Rothbard AB,et al: 60:534–537,2009 [4]
  27. ^ Hall RC, Gardner ER, Stickney SK, LeCann AF, Popkin MK (September 1980). "Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population". Archives of General Psychiatry. 37 (9): 989–95. doi:10.1001/archpsyc.1980.01780220027002. PMID 7416911.
  28. ^ Is It Depression--or a Tumor? - Newsweek Nov 21, 2007