Somatic origins of psychiatric illnesses

This article will be dedicated to the evaluation and especially to the fact that it is necessary to think about the organic origins of a psychiatric or psychological pathology when you have a patient who presents to you. 

It is the idea that behind a patient who is depressed, who is anxious, who has a mood instability can hide a somatic disorder, an organic disorder. That is to say, a medical or surgical pathology to be treated. 



During the general examination, it is important that you begin by paying attention to the general state of the patient. Observe the way he presents himself. Is your patient thin? Is he sweating? Is he complaining of severe fatigue? If there is severe fatigue, consider ordering a blood test or ask the patient to be seen by a general practitioner. There may be an organic problem behind the fatigue! 


Hormonal disorders

During the evaluation, whether you are a doctor, psychologist, psychotherapist or other, it is very important that you ask the patient the right questions. Start by asking if they have a history of hormonal disorders. Does he have hypothyroidism, hyperthyroidism, hypoparathyroidism or hyperparathyroidism? Hormonal disruption of these hormones, can cause anxiety due to excitement and in the case of hyperthyroidism. Conversely, hypothyroidism can cause slowing down, sadness, weight gain, etc. In these cases, the treatment is not at all psychiatric or psychological.


Hormonal disorder in your female patients

As you can see, it is very important that you ask your patients if there is a hormonal disorder somewhere. The same goes for your female patients. Don’t hesitate to ask them if they are well regulated, if their periods are not too painful, if they face a significant mood change at the time of the period, etc. Make sure there is no problem related to this. The same goes for your menopausal patients. Make sure that the anxiety in these patients did not start during pre-menopause and that the anxiety is, in fact, related to a hormonal imbalance. In this case, hormone replacement therapy can solve the anxiety problem in these postmenopausal patients. 


Neurological pathologies 

Other pathologies should not be ignored, notably neurological pathologies. A patient with neurological disorders may have a psychiatric picture. It is important to ask your patient if he does not have hydrocephalus, Niemann-Pick disease, a previous history of head trauma, cerebral hematomas (especially epidural hematomas and particularly chronic subdural hematomas). In these cases, psychiatric treatment is not necessarily the solution.


Sleep apnea disorders

This is another possible cause. If your patient is overweight, or if his or her partner complains that he or she snores a lot or stops breathing during sleep, consider asking your patient if he or she has sleep apnea. Indeed, sleep apnea disorders, due to the hypoxia that is caused during the night and the resulting sleep disturbance, will cause mood disorders, anxiety or stress. Here again, a psychiatric or psychotherapeutic treatment is not the solution.


It is important to keep in mind that behind a psychological problem may be a somatic disorder that requires neurosurgical treatment. All the questions we have just mentioned are therefore strongly recommended to be asked during the session. If you see that the patient is not in good health (sweating, thinness, fatigue, etc.) these questions are even more essential, as well as a blood test.


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