The following is a list of medical disorders that are commonly associated with psychiatric symptoms. The list has been selected to emphasize those disorders that are most often considered in the psychiatric differential diagnosis.
Connective Tissue Diseases |
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Disorder: | giant cell arteritis
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| Alternate name: | temporal arteritis
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| Prevalence range: | infrequent
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| Age at oneset: | 50+ yr
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| Sex ratio: | females 2:1
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| Signs or symptoms: | headache, joint, and muscle pain, low-grade fever, vision loss, jaw claudication, polymyalgia rheumatica
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| Psychiatric features: | depression, confusion, psychosis
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| Diagnostic tests: | ESR, temporal artery biopsy
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| Comments: | rapid diagnosis and treatment may prevent blindness.
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Disorder: | system lupus erythematosus
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| Alternate name: |
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| Prevalence range: | infrequent
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| Age at oneset: | 20 - 40 yr
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| Sex ratio: | females 10:1
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| Signs or symptoms: | arthritis, malar rash, lymphadenopathy, oral ulcers, fever, weight lsos, renal disease, fatigue
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| Psychiatric features: | depression, psychosis, mania
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| Diagnostic tests: | ESR, ANA, serum complement levels
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| Comments: | treatment with corticosteroids may complicate psychiatric features.
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| Endocrine and Metabolic Diseases |
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Disorder: | hyperadrenalism
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| Alternate name: | Cushing's syndrome
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| Prevalence range: | common; multiple causes
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| Age at oneset: | any age; rare in children
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| Sex ratio: | females 3:1
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| Signs or symptoms: | central obesity, moon facies, purple striae, weakness, acne, hypertension, diabetes mellitus, osteoporosis
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| Psychiatric features: | depression, mood lability, psychosis
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| Diagnostic tests: | serum and urine cortisol, dexamethason suppression test, imaging studies
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| Comments: | clinical picture varies with etiology, most common cause is iatrogenic
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Disorder: | adrenal cortical insufficiency
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| Alternate name: | Addison's disease
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| Prevalence range: | rare
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | hyperpigmentation, orthostatic hypotension, anorexia, dizziness, generalized weakness
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| Psychiatric features: | apathy, depression
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| Diagnostic tests: | serum and urine cortisol, serum aldosterone and renin, serum and urine sodium, serum potassium, metabolic acidosis, CT of abdomen
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| Comments: | insidious onset may resemble depression, psychasthenia; multiple etiologies
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Disorder: | hyperparathroidism
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| Alternate name: |
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| Prevalence range: | common
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| Age at oneset: | 50 - 60 yr
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| Sex ratio: | females > males
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| Signs or symptoms: | hypercalcemia, weight loss, constipation, dyspepsia, renal stones, proximal muscle weakness, bone pain
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| Psychiatric features: | depression, anxiety, confusion, irritability, psychosis
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| Diagnostic tests: | serum calcium and phosphorus, serum parathyroid hormone, bone radiographs
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| Comments: | most individuals are asymptomatic with high serum calcium detected by laboratory screening
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Disorder: | hypoarathroidism
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| Alternate name: |
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| Prevalence range: |
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | hypocalcemia, dry skin, malabsorption diarrhea, congestive heart failure, extrapyramidal symptoms, tetany, numbness, tingling
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| Psychiatric features: | irritability, paranoia, depression, psychosis
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| Diagnostic tests: | serum calcium and phosphorus, serum parathroid hormone, general chemistry group
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| Comments: | iatrogenic form (postsurgical) is most common
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Disorder: | hypercalcemia
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| Alternate name: |
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| Prevalence range: | multiple causes
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| Age at oneset: |
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| Sex ratio: |
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| Signs or symptoms: | QT interval shortening, weakness, fatigue, constipation, anorexia, nausea, dyspepsia, polyuria, renal stones, renal failure, soft tissue calcification
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| Psychiatric features: | depression, confusion
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| Diagnostic tests: | serum calcium and parathyroid hormone
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| Comments: |
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Disorder: | hyperthyroidism
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| Alternate name: | common
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| Prevalence range: | Graves: 30 - 40 yr
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| Age at oneset: | multinodular goiter: 50 + yr
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| Sex ratio: | females 10:1
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| Signs or symptoms: | tremor, weight loss, palpitations, warm and moist skin, hair loss, weakness, malaise, insomnia
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| Psychiatric features: | anxiety, depression, irritability, gradiosity, psychosis
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| Diagnostic tests: | thyroid hormones (T3RU, T4, TSH, TRH), thyroid stimulation test, thyroid imaging studies
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| Comments: | rapid onset resembles anxiety; slow onset associated with depression
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Disorder: | hypothyroidism
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| Alternate name: | myxedema
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| Prevalence range: | infrequent
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| Age at oneset: | adolescents and adults
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| Sex ratio: | females 8-10:1
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| Signs or symptoms: | dry skin, coarse hair, cold intolerance, slow or hoarse speech, weight gain, anorexia
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| Psychiatric features: | impaired cognition, somnolence, paranoia, withdrawal, anxiety, depression
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| Diagnostic tests: | thyroid hormones (T3RU, T4, TSH, TRH), thyroid stimulation test, thyroid imaging studies
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| Comments: | slow onset may be mistaken for depression or may resemble sleep apnea
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Disorder: | hypoglycemia
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| Alternate name: |
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| Prevalence range: | multiple causes
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | headache, diaphoresis, palpitations, tremor, weaknes, diplopia
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| Psychiatric features: | anxiety, irritability, confusion, obtundation
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| Diagnostic tests: | plasma glucose, plasma insulin antibodies and C peptide, supervised fast, imaging studies
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| Comments: | symptoms occur in fasting or postprandial states, depending on etiology
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Disorder: | SIADH
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| Alternate name: |
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| Prevalence range: | multiple causes
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | headache, anorexia, weakness, polyuria
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| Psychiatric features: | irritability, obtundation, deliriu, lethargy, coma
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| Diagnostic tests: | serum and urine sodium serum and urine osmolality
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| Comments: | multiple causes, including psychotropic medications
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Disorder: | hypernatremia
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| Alternate name: |
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| Prevalence range: | multiple causes
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | respiratory paralysis, neuromuscular irritability, serizures
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| Psychiatric features: | somnolence, confusion, coma
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| Diagnostic tests: | serum and urine sodium, serum and urine osmolality
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| Comments: | multiple etiologies, based on inadequate water intake, excess water loss, or combination
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Gastrointestinal diseases |
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Disorder: | hepatolenticular degeneration
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| Alternate name: | Wilson's disease
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| Prevalence range: | rare (30/million)
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| Age at oneset: | 5 - 20 yr
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| Sex ratio: | both sexes
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| Signs or symptoms: | abdominal pain, tremor, dystonia, ataxia, hepatic disease, hemolytic anemia, Kayser-Fleischer rings, delayed puberty
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| Psychiatric features: | personality changes, schizophreniform illness, dementia
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| Diagnostic tests: | serum copper and ceruloplasmin, urinary copper, slit-lamp examination
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| Comments: | autosomal recessive
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Disorder: | hepatic encephalopathy
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| Alternate name: |
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| Prevalence range: | multiple causes
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | ataxia and incoordination, asterixis, seizures, fetor hepaticus, lateralizing signs, posturing (late signs)
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| Psychiatric features: | early: change in affect or sleep pattern.
late: episodic agitation, confusion, obtundation
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| Diagnostic tests: | liver function tests, serum ammonia
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| Comments: | multiple etiologies, management of alcohol abuse and avoidance of hepatotoxic medications
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Hematologic Syndromes |
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Disorder: | anemia
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| Alternate name: |
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| Prevalence range: | multiple causes. Common
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | dyspnea on exertion, dizziness, lightheadedness, headache, palpitations, syncope, decreased libido, sleep disturbance, pallor, tachycardia, lassitude
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| Psychiatric features: | decreased concentration, mood disturbance, worsening of dementia
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| Diagnostic tests: | complete blood cell count, peripheral blood smear, serum iron and total iron-binding capacity, serum B12 and folate, other hematologic studies
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| Comments: |
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Disorder: | Acute intermittent porphyria
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| Alternate name: |
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| Prevalence range: | rare (5/100,000)
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| Age at oneset: | 15 - 30 yr
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| Sex ratio: | females > males
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| Signs or symptoms: | abdominal pain, nausea, vomiting, peripheral neuropathy, sensory loss, constipation, tachycardia, hypertension, weakness, seizures
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| Psychiatric features: | anxiety, insomnia, depression, hallucinations, paranoia, delirium
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| Diagnostic tests: | urine porphyrins, Watson-Schwartz test
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| Comments: | autosomal dominant; SIADH may occur; attacks provoked by anesthetics, sedatives, hynotics, other medications, crash diets
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Disorder: | AIDS dementia complex
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| Alternate name: |
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| Prevalence range: | incidence unknown; majority of AIDS patients
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| Age at oneset: |
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| Sex ratio: |
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| Signs or symptoms: | cognitive, motor, behavioural dysfunction tria; hyperreflexia, frontal release signs, ataxia, incoordination, malaise
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| Psychiatric features: | early: decreased attention, concentration.
late: dementia, personality changes, apathy, agitated organic psychosis
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| Diagnostic tests: | HIV serology and Western blot; rule out other CSF abnormality; imaging studies
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| Comments: | appears to related to HIV itself (not opportunistic infections); worsens wtih deteriorating immune function
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Disorder: | AIDS
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| Alternate name: |
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| Prevalence range: |
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| Age at oneset: | high-risk groups of any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | fever, weight loss, lymphadenopathy
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| Psychiatric features: | anxiety, depression, psychosis
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| Diagnostic tests: | HIV serology and Western blot
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| Comments: |
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Disorder: | tuberculous meningitis
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| Alternate name: |
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| Prevalence range: | 5% of US TB patients
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| Age at oneset: | children, elderly
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| Sex ratio: | both sexes
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| Signs or symptoms: | low-grade fever, weight loss, headache, SIADH, lethargy, meningeal signs
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| Psychiatric features: | confusion, obtundation, coma
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| Diagnostic tests: | CSF for cells, protein, glucose, acid-fast bacteria; CSF cultures, tuberculin skin test
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| Comments: | acute or insidious onset
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Disorder: | neurosyphilis
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| Alternate name: | general paresis
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| Prevalence range: | infrequent
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| Age at oneset: | adults
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| Sex ratio: | males 4:1
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| Signs or symptoms: | ataxia, slapping gait, lightning pains, urinary disturbance, Argyll Robertson pupil, meningitis
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| Psychiatric features: | subacute encephalopathy, dementia, delusions and psychosis (rare)
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| Diagnostic tests: | CSF serology
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| Comments: | early-onset dementia; rapid progression if untreated; may coexist with AIDS
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Disorder: | crytococcal meningitis
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| Alternate name: |
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| Prevalence range: | 5% - 10% of HIV patients
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | headches, nausea, vomiting, seizures, ataxia, ocular changes; may occur with or without pneumonia
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| Psychiatric features: | personality change, obtundation, confusion, coma, lethargy, dementia
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| Diagnostic tests: | MRI or CT of head for cryptococci, CSF and serum cryptococcal antigen
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| Comments: | pigeons are biologic vector; two thirds of patients are immunocompromised; insidious onset
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Disorder: | creutzfeldt-Jakob disease
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| Alternate name: |
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| Prevalence range: | 2% - %5 of HIV patients (otherwise rare)
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| Age at oneset: |
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| Sex ratio: | both sexes
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| Signs or symptoms: | progressive focal neurologic deficits, progressive cortical dysfunction, visual disturbances myoclonic jerks
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| Psychiatric features: | rapidly progressive dementia
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| Diagnostic tests: | neuroimaging, EEG shows periodic bursts of slow waves, brain biopsy
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| Comments: | requires virus exposure and T-cell-related immunosuppression
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Neoplasias |
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Disorder: | pancreatic carcinoma
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| Alternate name: |
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| Prevalence range: | infrequent
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| Age at oneset: | 60 - 80 yr
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| Sex ratio: | males 1.5:1
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| Signs or symptoms: | abdominal pain radiating to the back, weight loss, jaundice, anorexia, nausea, vomiting
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| Psychiatric features: | depression
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| Diagnostic tests: | abdominal imaging, ERCP
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| Comments: | insidious onset with few nonspecific findings and symptoms initially
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Disorder: | pheochromocytoma
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| Alternate name: |
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| Prevalence range: | rare (0.1% of hypertension patients)
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | hypertension, paroxysmal headahce, sweating, palpitations, tachycardia
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| Psychiatric features: | anxiety, panic
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| Diagnostic tests: | plasma epinephrine and norepinephrine; urinay catecholamines, vanillylmandelic acid or metanephrines; abdominal imaging studies
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| Comments: | may have positive family history (ie. multiple endocrine adenomatosis syndrome)
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Neurologic Symptoms |
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Disorder: | intracranial tumours
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| Alternate name: |
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| Prevalence range: | rare
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | headache, vomiting, focal neurologic signs, seizures, papilledema; may be asymptomatic
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| Psychiatric features: | personality change, dementia, depression, anxiety, obtundation
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| Diagnostic tests: | CT or MRI of head, increased intracranial pressure
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| Comments: | clinical picture varies with location and size of lesion
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Disorder: | subdural hematoma
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| Alternate name: |
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| Prevalence range: | common (especially in elderly and alcoholics)
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| Age at oneset: |
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| Sex ratio: | males > females
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| Signs or symptoms: | dull headache, mild focal weakness
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| Psychiatric features: | irritability, confusion, hypersomnolence, dementia
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| Diagnostic tests: | CT or MRI of head
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| Comments: | a treatable cause of dementia, precipitating trauma may be minor or unrecalled
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Disorder: | normal-pressure hydrocephalus
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| Alternate name: | communicating hydrocephalus
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| Prevalence range: | 7% of dementia patients
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| Age at oneset: | 45 + yr
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| Sex ratio: | both sexes
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| Signs or symptoms: | triad of gait apraxia, shuffling walk, urinary incontinence, dementia
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| Psychiatric features: | apathy, psychomotor retardation, dementia
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| Diagnostic tests: | CT or MRI of head
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| Comments: | a treatable cause of dementia
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Disorder: | seizure disorder
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| Alternate name: | epilepsy
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| Prevalence range: | common (0.5% of population)
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | episodes may include staring, automatisms, tonic-clonic jerking, sensory aura
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| Psychiatric features: | memory deficits, postictal confusion, personality changes interictaly, dream states, time distortion, fear and rage, depression, elation, illusions, hallucinations
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| Diagnostic tests: | EEG
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| Comments: | differentitate from dissociative states, hysteria, conversion symptoms, impulse control disorder, panic attacks, psychosis, tics, narcolepsy
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Disorder: | postconcussion syndrome
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| Alternate name: |
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| Prevalence range: | unknown incidence
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | headache, dizziness, insomnia
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| Psychiatric features: | depression; deficits in recent memory concentration, and abstract thinking; irritability
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| Diagnostic tests: | neuropsychologic testing, neuroimaging studies
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| Comments: | symptoms may follow relatively minor head trauma (especially in elderly patients)
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Disorder: | alzheimer type (senile) dementia
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| Alternate name: |
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| Prevalence range: | common
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| Age at oneset: | 60 + yr
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| Sex ratio: | female > male
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| Signs or symptoms: | none until late stage
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| Psychiatric features: | dementia, depression, delusions (especially at night), apathy, anxiety, personality changes, decreased judgement
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| Diagnostic tests: | psychologic testing; diagnosis of exclusion: rule out treatable causes of dementia
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| Comments: | insidious onset, incidence increases with age
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Disorder: | multi-infarct dementia
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| Alternate name: |
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| Prevalence range: | common
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| Age at oneset: | 60 + yr
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| Sex ratio: | male > female
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| Signs or symptoms: | focal neurologic deficits; hypertension and diabetes are associated diseases
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| Psychiatric features: | affective lability, personality change
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| Diagnostic tests: | neuroimaging studies
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| Comments: | stepwise progression of impairments
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Disorder: | peripheral neuropathy
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| Alternate name: |
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| Prevalence range: | common
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| Age at oneset: | 45 + yr
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| Sex ratio: | both sexes
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| Signs or symptoms: | numbness, pain, dysesthesias, associated clinical entities (i.e. alcoholism, diabetes). Late: distal skin changes or muscle wasting
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| Psychiatric features: | vague somatic complaints
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| Diagnostic tests: | EMG, muscle biopsy
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| Comments: | may be confused with hypochondriasis or other somatoform disorder; multiple causes
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Disorder: | multiple slerosis
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| Alternate name: |
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| Prevalence range: | infrequent
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| Age at oneset: | 15 - 50 yr
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| Sex ratio: | females 3:2
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| Signs or symptoms: | waxing and waning focal neurologic deficits; paresthesias, clumsiness, optic neuritis, chronic fatigue
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| Psychiatric features: | affective disturbance, memory loss
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| Diagnostic tests: | MRI (characteristic patchy white matter lesions), CSF for gamma globulins and oligoclonal beands (not specific for multiple sclerosis)
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| Comments: | episodic or chronic course with long latent periods; may be mistake for somatization
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Disorder: | myasthenia gravis
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| Alternate name: |
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| Prevalence range: | rare
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| Age at oneset: | females peak: 30 - 40 yr. Males peak 60 - 70 yr.
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| Sex ratio: | females 3:2
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| Signs or symptoms: | diplopia, ptosis, dysphagia, weakness after exertion
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| Psychiatric features: | anxiety from respiratory muscle weakness and hypoxia; dependency
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| Diagnostic tests: | anticholinesterase challenge tests, acetylcholine receptor antibodies, EMG
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| Comments: | symptoms worsened by exertion, temperature exrtremes, infections, menses, and excitement
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Disorder: | Parkinson's disease
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| Alternate name: |
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| Prevalence range: | common (1% of persons older than age 60 yr)
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| Age at oneset: | 55 + yr
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| Sex ratio: | males 3:2
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| Signs or symptoms: | resting tremor, pill-rolling tremor, bradykinesia, rigidity, loss of postural relfexes
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| Psychiatric features: | depression, anxiety, dementia, psychosis, sleep disturbance, dependency
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| Diagnostic tests: | no specific tests
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| Comments: | insidious onset, masked facies may mimic depression; drug used for treatment may cause psychosis
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Disorder: | Huntington's chorea
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| Alternate name: |
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| Prevalence range: | rare (4-8/100,000)
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| Age at oneset: | 40 - 50 yr
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| Sex ratio: | both sexes
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| Signs or symptoms: | chorea
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| Psychiatric features: | personality change, mania, depression, dementia, psychosis
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| Diagnostic tests: | molecular genetic studies, neuroimaging (late stage)
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| Comments: | autosomal dominant
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Nutritional Syndromes |
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Disorder: | pernicious anemia
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| Alternate name: |
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| Prevalence range: | 1% of US population
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| Age at oneset: | 20 + yr
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| Sex ratio: | both sexes
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| Signs or symptoms: | ataxia, peripheral neuropathy, sore tongue, weight loss, gastrointestinal symptoms
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| Psychiatric features: | anxiety, depression, mania, psychosis, acute confusion
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| Diagnostic tests: | serum B12 and folate, peripheral blood smear, red cell indices, serum methylmalonic acid and homocysteine, Schilling
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| Comments: | mental status changes may precede anemia; more likely in persons of northern European descent
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Disorder: | Wernicke's encephalopathy
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| Alternate name: | thiamine deficiency
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| Prevalence range: |
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| Age at oneset: | adults
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| Sex ratio: | both sexes
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| Signs or symptoms: | triad of ophthalmoplegia, ataxia, and global confusion
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| Psychiatric features: | amnesia, apathy, delirium, coma
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| Diagnostic tests: | no specific tests
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| Comments: | most common in chronic alcoholics
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Disorder: | Korsakoff's syndrome
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| Alternate name: | thiamine deficiency
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| Prevalence range: |
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| Age at oneset: | adults
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| Sex ratio: | both sexes
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| Signs or symptoms: | active or prior Wenicke's encephalopathy
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| Psychiatric features: | anterograde amnesia, confabulation, disorientation with clear sensorium
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| Diagnostic tests: | no specific tests
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| Comments: | 20% recover completely; give thiamine to treat coexisting encephalopathy and to prevent progression of amnesia
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Respiratory Diseases |
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Disorder: | acute hypoxia
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| Alternate name: | respiratory acidosis
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| Prevalence range: |
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | headache, tachycardia, hypotension; when severe: bradycardia, cyanosis
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| Psychiatric features: | restlessness, confusion, impaired judgement; may resemble sedative intoxication; may progress to coma
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| Diagnostic tests: | arterial blood gases, electrolytes, pulmonary function tests, chest radiograph, tests for specific causes
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| Comments: | multiple causes
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Disorder: | chronic hypoxia
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| Alternate name: |
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| Prevalence range: |
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | possibly see signs of congestive heart failure
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| Psychiatric features: | apprehension, confusion, drowsiness, coma
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| Diagnostic tests: | as for acute hypoxia
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| Comments: | multiple causes
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Renal Diseases |
|---|
Disorder: | acute renal failure
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| Alternate name: |
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| Prevalence range: | common
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | decreased urine output, anorexia, nausea, vomiting, hyperreflexia, asterixis, seizures
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| Psychiatric features: | irritability, lethargy, confusion, coma
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| Diagnostic tests: | urinalysis, urine volume, urine and serum osmolality, electrolytes, renal imaging studies, biopsy
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| Comments: | multiple causes
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Disorder: | chronic renal failure
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| Alternate name: |
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| Prevalence range: | common
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | peripheral neuropathy, signs of multisystem disease and failure
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| Psychiatric features: | fatigue, agitation, irritability, depression, dependency
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| Diagnostic tests: | blood chemistry group, urinalysis, renal imaging studies, biopsy
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| Comments: | diabetes mellitus and hypertension are the most common causes
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Toxicity Syndromes |
|---|
Disorder: | arsenic poisoning
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| Alternate name: |
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| Prevalence range: |
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | abdominal pain, diarrhea, nausea, vomiting, headahce, weakness, symmetric polyneuropathy; with chronic exposure; hyperpigmentation, alopecia, hepatic disease, Mees' lines
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| Psychiatric features: | delirium, psychosis
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| Diagnostic tests: | urine heavy metal screen
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| Comments: | most commonly in miners, painters, other workers with chemical exposures
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Disorder: | lead poisoning
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| Alternate name: |
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| Prevalence range: |
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | abdominal pain, nausea, vomiting, headache, dizziness, syncope, ataxia, localizing neurologic signs, seizures, blindness
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| Psychiatric features: | irritabilty, restlessness, delirium, dementia, coma
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| Diagnostic tests: | serum and urine lead, peripheral blood smear for basophilic stippling, bone lead for cumulative exposure levels
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| Comments: | inner-city children at tisk; paint and industrial exposures (auto and plumbing industry)
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Disorder: | mercury poisoning
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| Alternate name: |
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| Prevalence range: |
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| Age at oneset: | any age
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| Sex ratio: | both sexes
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| Signs or symptoms: | mild exposure: mild tremor, metallic taste, gastrointestinal complaints, dermatitis. Severe exposure: persiten involuntary tremors, swollen gums iwht blue teeth line, erythroderma, neurosensory and motor impairments
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| Psychiatric features: | fatigue, anxiety, irritability, depression, loss of libido
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| Diagnostic tests: | blood and urine mercury levels
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| Comments: |
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