“Masquerading Symptoms: Uncovering Physical Illnesses that Present as Psychological Problems”

By Paul Efthim PhD
March 1st, 2015

“Masquerading Symptoms: Uncovering Physical Illnesses that Present as Psychological Problems”

By Barbara Schildkrout

John Wiley & Sons

Hoboken, N.J., 2014


Reference work comprehensive and readable

Reviewed by Paul Efthim, Ph.D.

Consider the diseases commonly encountered in clinical psychology practice: sleep disorders, dementia, hypo- or hyperthyroidism, Lyme disease, neurological disorders. Quite frequently, the first signs of these and other illnesses may emerge as behavioral or mental status changes.

For the majority of mental health professionals who are not medically trained, how do we recognize hidden medical problems that may be lurking underneath psychological symptoms?

To address this tricky problem, Boston psychiatrist Barbara Schildkrout recently published “Masquerading Symptoms,” an innovative reference book that explains how people with undiagnosed medical conditions may end up seeking help from mental health clinicians. Schildkrout teaches at Harvard Medical School and Beth Israel Deaconess Medical Center with a special interest in behavioral neurology and neuropsychiatry.

The author’s introductory comments are well worth quoting at length: “As therapists, we are in a unique position. We often have more time with a patient than other clinicians….  Yet often as therapists we feel that we do not know enough about medical diseases that might be contributing to or generating the mental symptoms for which patients have sought our help…. Even when we feel we are providing optimal care, some of our patients actually get worse. It is at times like these that we often ask ourselves whether there might be an underlying medical condition that we are missing. This book provides the information that is needed to approach that question.”

Schildkrout sets up this guidebook so clinicians can take information gleaned from clinical interviews and look up relevant signs and symptoms that may be associated with specific medical conditions. The first section is organized according to the elements of the traditional mental status exam, such as mood, affect, thought content, behavior, judgment, insight and vegetative symptoms.

For example, in the section on mood-related phenomena we learn about a range of medical diseases that may present with hypomania: hepatic encephalopathy, porphyria, syphilis, carbon monoxide poisoning, vascular dementia and Wilson’s disease, among others. More than a cross-index, this first section offers useful tips on differential diagnosis.

In the larger second section of this reference book, the author lays out descriptions of 71 medical diseases, presented in an easy-to-use format that summarizes important features of each disease that may be observed in a therapist’s consulting room. Other subsections detail clinical course and prognosis, risk factors, questions to ask, and suggestions for special referral.

Brief case vignettes bring each disease to life and illustrate how diagnosis can be quite confusing at times. Some diseases are familiar to most readers, while others are quite rare. Mercifully free of technical and medical jargon, the writing does not insult one’s intelligence either.

At 580 pages, “Masquerading Symptoms” is hefty, yet not too big to flip open and quickly find what one is looking for. It’s an impressive feat for a solo writer to put together a comprehensive reference book on such a big topic. Schildkrout also deserves praise for its readability; although not designed to be read front to back, the book has a way of drawing you in to the intriguing detective work of diagnosis at the interface of mind and body. It is highly recommended for clinicians interested in behavioral and medical psychology and practitioners in medical and health settings.

Paul Efthim, Ph.D. is a licensed psychologist in private practice in Brookline, Mass. He holds a faculty appointment at the Boston Institute for Psychotherapy and is a candidate at the Massachusetts Institute for Psychoanalysis.

Learn more about the book: Masquerading Symptoms: Uncovering Physical Illnesses That Present as Psychological Problems

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