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Monday, March 4, 2013

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