ABSTRACT
In Chapter 12 a patient who presented with paranoid symptoms eventually was diagnosed with Graves’ disease. This patient suffered concurrently from a delusional disorder and hyperthyroidism in a clear state of consciousness. This case underscores the need to maintain a high index of suspicion of possible medical conditions in patients identified as “psychiatric,” especially in the presence of unexplained symptoms, and when there is a difficulty in communicating with the patient, for example, because of language differences. The importance of carrying out a careful physical examination on admission to a psychiatric unit is emphasized. Another indication for further medical investigation in a patient with psychiatric symptoms is the absence of a psychological explanation for a worsening of the psychiatric symptoms. A psychoanalytic approach to exploring possible psychological explanations is very useful in such cases. Additional thoughts are offered regarding the likelihood that trauma played a significant role in the genesis of the patient’s psychiatric symptoms, which was not recognized at the time. I also describe psychoanalytic approaches to patients with psychotic symptoms.
