Organic Psychosis: Diagnosis and Thyroid Influence

Q: Organic Psychosis: Diagnosis and Thyroid Influence

Hello： 1. <br>Organic mental disorders refer to psychiatric conditions that may be caused by tangible (organic) factors, such as brain injuries, physiological issues, electrolyte imbalances, or drug-induced effects. <br>Since the causes can be identified or inferred, they are col

Inquiry on Organic Mental Disorders

Hello, doctor.
Thank you for taking the time to answer my questions despite your busy schedule.
I would like to inquire about the diagnosis of organic psychosis.
My family member exhibited symptoms of delusional disorder a year and a half ago, and at that time, there was also a noted low TSH level, while T3 and T4 were normal.
The endocrinologist diagnosed it as subclinical hyperthyroidism, but due to the delusional symptoms, a psychiatrist was also consulted.
However, the psychiatrist felt that the hyperthyroidism was not severe enough to cause delusions and diagnosed F22, F29, and F20.0.
After continuing medication for six months, the medication was stopped, and the psychiatrist later indicated that follow-up visits were unnecessary unless symptoms returned.
Currently, it has been a year without symptoms after stopping the medication, but due to the ongoing subclinical hyperthyroidism issue, there have been continuous follow-ups with the endocrinologist and medication for hyperthyroidism.
The endocrinologist believes that the delusions are more likely caused by the low TSH levels, primarily based on the observation that the delusional symptoms disappeared relatively quickly after medication was started.
Now that the TSH levels have stabilized, there have been no further delusional symptoms for an extended period.
Due to personal reasons, I am not very keen on having the psychiatrist label it as schizophrenia or delusional disorder, so I would like to ask if a diagnosis made by a psychiatrist is usually not changed? Is there a possibility to discuss with the psychiatrist whether it could be organic psychosis caused by hyperthyroidism and potentially change the diagnosis? Additionally, I have consulted other doctors, most of whom believe that the hyperthyroidism is not severe enough to cause delusions, but there are also some doctors and case reports indicating that a minority of patients with subclinical hyperthyroidism seem to exhibit clinical phenomena of delusions.
It feels like there is no definitive answer, so I am unsure how to define organic psychosis.

A-Kuan, 30~39 year old female. Ask Date: 2024/01/19

Dr. Qiu Junda reply Psychiatry

Hello: 1.
Organic mental disorders refer to psychiatric conditions that may be caused by tangible (organic) factors, such as brain injuries, physiological issues, electrolyte imbalances, or drug-induced effects.
Since the causes can be identified or inferred, they are collectively referred to as organic.
2.
The principle of diagnostic order for mental illnesses prioritizes organic mental disorders over functional psychoses such as schizophrenia or delusional disorder.
At that time, the physician may have considered the evidence for organic causes (such as hyperthyroidism) to be weak, which led to the F2x diagnosis.
If you are concerned about the diagnosis, you may still seek an opportunity to discuss it with the physician.

Reply Date: 2024/01/19

More Info

Understanding organic psychosis, particularly in the context of thyroid dysfunction, is a complex and nuanced topic. Your inquiry touches on several important aspects of psychiatric diagnosis, the influence of endocrine disorders, and the interplay between physical and mental health.

Organic psychosis refers to a category of mental disorders that are secondary to identifiable physical conditions, such as neurological diseases, infections, or metabolic imbalances. In your family member's case, the presence of low TSH (Thyroid Stimulating Hormone) levels alongside psychotic symptoms raises the question of whether the thyroid dysfunction could be contributing to the psychiatric manifestations.

Thyroid hormones play a crucial role in regulating metabolism, mood, and cognitive function. Both hyperthyroidism (excess thyroid hormone) and hypothyroidism (insufficient thyroid hormone) can lead to psychiatric symptoms. In cases of hyperthyroidism, symptoms can include anxiety, irritability, and in some instances, psychosis. The relationship between thyroid function and mental health is well-documented, and it is not uncommon for individuals with thyroid disorders to experience mood disturbances or psychotic symptoms.

In your situation, it appears that the initial psychiatric evaluation led to a diagnosis of F22 (delusional disorder), F29 (unspecified psychosis), and F20.0 (paranoid schizophrenia). These diagnoses suggest a primary psychotic disorder rather than one secondary to a medical condition. However, the subsequent stabilization of thyroid function and the resolution of psychotic symptoms after treatment raise important questions about the initial diagnosis.

It is essential to understand that psychiatric diagnoses can evolve over time, especially as new information becomes available or as a patient's condition changes. While a diagnosis may not be easily altered, it is certainly possible to revisit and discuss the diagnosis with the treating psychiatrist. If there is compelling evidence that the psychotic symptoms were indeed secondary to thyroid dysfunction, this could warrant a re-evaluation of the diagnosis.

In clinical practice, it is crucial for healthcare providers to consider the whole patient, including their medical history, current symptoms, and any underlying conditions that may contribute to their mental health. If your family member's psychotic symptoms resolved with the stabilization of thyroid levels, this could suggest that the initial diagnosis may have been influenced by the thyroid condition.

It is advisable for your family member to have an open discussion with their psychiatrist regarding the potential link between their thyroid condition and the psychotic symptoms. Providing the psychiatrist with comprehensive information about the thyroid treatment and the timeline of symptom resolution can facilitate a more informed discussion. Additionally, involving an endocrinologist in the conversation may help clarify the relationship between thyroid function and mental health.

In summary, organic psychosis can be influenced by various medical conditions, including thyroid disorders. The diagnosis of psychosis should be continually assessed in light of the patient's overall health status. Open communication with healthcare providers is key to ensuring that all aspects of a patient's health are considered in their treatment plan. If there are lingering concerns about the diagnosis, seeking a second opinion or further evaluation may also be beneficial.

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