Medical Issues Masqurading as Mental Illness Part II

I'm so honored to have Jordyn Redwood back today! If you missed her post Monday, click here. Once again, we're crossblogging on each other's blog. My post today focuses on types of serial killers.

It's all yours, Jordyn.

______________________________________________

Acute Intermittent Porphyria

I’m continuing my two-part series on medical conditions that can initially present as psychiatric ones. Last post I talked about Cerebral Salt Wasting Syndrome which can happen in patients who have suffered head injury.

Today, something new. Something I hadn’t even heard of until now.

I work with physicians on a daily basis in my job as a pediatric ER nurse. Now, all of them are smart but a couple are UBER-smart and if your kid is the zebra in the forest you would definitely want one of these two ladies to be on.

I posed Jeannie’s request to one of these women and the first thing to slip off her tongue was Acute Intermittent Porphyria. And then when she said it was a genetic condition—my ears were all sorts of perked up more because I am a medical nerd at heart and love learning new things.

Just what is Acute Intermittent Porphyria or AIP?

AIP is a group of rare diseases that are passed down from families where the important part of hemoglobin (which is attached to your red blood cells) is not made properly as the result of a deficiency of certain enzymes. Heme is also found in certain muscles.

AIP is an autosomal dominant disease. The leading problem is neurologic damage that can first show as psychiatric manifestations like anxiety, agitation, hallucinations, hysteria, delirium and depression and these patients are commonly misdiagnosed as having a psychiatric illness. There are 1-5 cases per 100,000 people but can be as high as 60-100 cases per 100,000 people in northern Sweden. It affects women more than men. Hmm—I wonder if this lends to the initial psychiatric diagnosis. Most patients become sick between the ages of 18-40.

The normal sequence during an acute attack is abdominal pain, followed by psychiatric symptoms and then peripheral neuropathies. Patients can be symptom free between attacks.

One important step in the diagnosis is to check the patient’s urine for porphobilinogen and I can tell you that this is not a common urine test at all.

Treatment is to decrease heme synthesis and reduce the precursors of porphyrin. This is accomplished by giving the patient high doses of glucose (sugar) for mild attacks and hematin for severe attacks. Narcotics can be used effectively for pain control.

What do you think? Have you ever heard of this particular genetic disease?

If interested in learning more—please follow the links that I used as a reference for this piece.

http://en.wikipedia.org/wiki/Acute_intermittent_porphyria

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002188/

http://emedicine.medscape.com/article/205220-overview

Thanks so much Jeannie for hosting me! It’s been a pleasure to be here with your readers.

And if you’re a writer looking for medical help—I run a medical blog for authors (what Jeannie does only on the medical side.) You can find it at www.redwoodsmedicaledge.com.

Jordyn Redwood is a pediatric ER nurse by day, suspense novelist by night. She hosts Redwood’s Medical Edge, a blog devoted to helping contemporary and historical authors write medically accurate fiction. Her first two novels, Proof and Poison, garnered starred reviews from Library Journal and have been endorsed by the likes of Dr. Richard Mabry, Lynette Eason, and Mike Dellosso to name a few. You can connect with Jordyn via her website at www.jordynredwood.net. 

______________________________________________

Thanks, Jordyn, for taking the time to inform us of these amazing disorders that we could wrangle into our fiction.

Let's Analyze

After reading about Cerebral SaltWasting Syndrome and Acute Intermittent Porphyria, what are your thoughts about leading readers along a merry chase? You get them thinking that a character has a serious psychological problem, only to resolve it with a medical problem that's easily treated?

Medical Issues Masquerading as Mental Illness - Part 1

Life surprises me, especially with regards to how people connect. My guest blogger this week, Jordyn Redwood, and I discovered each other through our blogs. She runs a blog devoted to helping authors write medically accurate fiction.

Sound familiar? It's what I try to do with this blog, except I focus on psychological consistency and feasibility. Jordyn and I are crossblogging this week on each other's blog, with my post today focusing on common characteristics of psychopaths, and her post featuring medical issues that sometimes present as psychological ones.

Writers, this stuff is invaluable, so I hope you continue reading. Without further ado, here's Jordyn!

____________________________________________________

Cerebral Salt Wasting Syndrome

I’m honored to be here at The Character Therapist. I’ll be interested to hear some of Jeannie’s thoughts on the character issues going on in my latest medical thriller Poison. I think there will be plenty for her to diagnose! Is there truly such a thing as repressed memories? Can hypnosis influence someone to do something they don’t want to do? Is brainwashing possible?

Hmm . . .

I’m taking the opposite side of Jeannie’s couch and talking about medical conditions that can initially present like psychiatric ones. Those that some physicians could even diagnose as mental disorders. This is one reason why it is preferred that a patient see a licensed physician first—particularly with what may be initially thought of as a psychiatric complaint to rule out a medical cause.

During my years as a PICU nurse (Pediatric Intensive Care Unit) I took care of a young girl who had been involved in a car accident and suffered a head injury. Over the course of a couple of days she became increasingly agitated and paranoid. We do try to calm children by giving them distraction activities (games, watching TV, etc) to keep their minds off what is happening medically. It was around Christmastime and I put on the older, Claymation version of Rudolph and the Yeti.

Well, as this young patient of mine watched this movie it caused her to completely come unhinged and she also began to have hallucinations of bugs and other things crawling over her. In light of her head injury, the physician first thought of a medical cause but if a patient were to present with the paranoia and hallucinations and the medical team didn’t know about previous head injury (like a patient who perhaps was knocked over the head with a beer bottle several days before, was knocked out, but seemingly okay after that and never sought treatment) we might first assume a psychiatric issue.

What this patient had was a condition known as Cerebral SaltWasting Syndrome. Cerebral salt wasting syndrome usually develops in the first week following brain injury. A good friend of mine’s husband actually developed this syndrome after he’d fallen out of a top bunk onto a cement floor incurring several serious head and neck injuries. Other brain events that can lead to this condition include brain tumor, brain surgery, stroke and a brain bleed. It can also occur in the absence of brain disease. 

The exact mechanism is not clear but what happens biologically is the kidneys begin leaking excessive amounts of salt (or sodium). The body is very sensitive to increases and decreases in sodium. Normal levels are 135-145 mmol/L.

The patient can have hallucinations, confusion, lethargy, agitation, headache, altered consciousness, seizures and subsequent coma. Severity of symptoms is directly related to the level and loss of sodium. The lower the number the more symptomatic the patient is.

Treatment: These patients need to be admitted in the hospital. Sodium levels cannot be corrected too quickly or more problems can ensue for the patient. They must be monitored under direct medical care. Usually, hypertonic (IV solutions with a lot of sodium) fluids are given to the patient to restore sodium and balance fluid. Once the patient is stable—they may need to take salt supplements.

Good news is the syndrome usually spontaneously resolved in 2-4 weeks.

____________________________________________________

 
Thanks so much for this info, Jordyn. Don't forget to come back on Wednesday for Part Two in this series!

Jordyn Redwood is a pediatric ER nurse by day, suspense novelist by night. She hosts Redwood’s Medical Edge, a blog devoted to helping contemporary and historical authors write medically accurate fiction. Her first two novels, Proof and Poison, garnered starred reviews from Library Journal and have been endorsed by the likes of Dr. Richard Mabry, Lynette Eason, and Mike Dellosso to name a few. You can connect with Jordyn via her website at www.jordynredwood.net.