Psychiatric Manifestations of Endocrine Disorders

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Review Article
Psychiatric Manifestations of Endocrine Disorders

Full Paper:
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ADRENAL: CUSHING’S SYNDROME AND ADDISON’S DISEASE
Over the past few decades, a number of authors have found a significant amount of psychological disorders associated with Cushing’s syndrome. Sonino and Fava [1] found that major depression is a life-threatening complication, which may affect 50-60% of patients with Cushing’s syndrome.

TYPE 1 AND TYPE 2 DIABETES
Type 1 and type 2 diabetes are endocrine disorders which are also associated with psychiatric symptoms. In a study of 330 type 2 diabetic patients, Derakhshanpour et al., [30] found a significant association with depression and poor self-image which was noted as having a considerable impact on the consequences of diabetes and the quality of life in the patients.

THYROID: HYPERTHYROIDISM AND HYPOTHYROIDISM
When it comes to the subject of hyperthyroidism and hypothyroidism, there have been a number of studies that have found psychological symptoms associated with both hormone imbalances. Stern et al., [47] found in their study of 137 patients with Grave’s disease that the psychiatric symptoms of anxiety and irritability were strongly correlated with the disease. Kathol and Delahunt [48] reported that 60% of their hyperthyroid patients were found to have an anxiety disorder. Furthermore, several other studies have found these symptoms as well as other psychiatric symptoms associated with Grave’s disease which include hypomania, mania, depression, psychosis, insomnia, attention and over activity problems, restlessness, fatigue, and delirium [26,49-58]. As far as treatment, there are discrepancies with some studies that have found that psychiatric symptoms like anxiety generally improve with the treatment of hyperthyroidism [26,48,59]. However, other studies have reported that psychiatric symptoms persisted despite appropriate anti-thyroid treatment [47,60-63].

As alluded to earlier, hypothyroidism has been associated with a number of psychiatric disorders. As early as 1888, the effects of hypothyroidism on the psychological state were recognized by the Clinical Society of London in their study of 109 cases with myxedema. They reported that, “delusions and hallucinations occur in nearly half the cases, mainly when the disease is advanced [64].” In 1949, Asher reiterated this relationship of psychosis and hypothyroidism, and coined the infamous term, “myxedematous madness” [28]. Since then, numerous studies have been working to characterize the psychological symptoms associated with hypothyroidism. In a study of 2,142 individuals diagnosed with thyroid disorders, Ittermann et al., [65] found substantial evidence that untreated hypothyroidism is significantly associated with depression. A number of other studies have found this correlation in hypothyroid patients and have observed additional psychological problems associated with hypothyroidism including attention deficits and cognitive disturbances [26,50,66-68].

LOW TESTOSTERONE
Patients with an androgen deficiency have been found to be associated with psychiatric symptoms. Aydogan et al., [97] is quoted as saying, “Anxiety and depression are the most common and frequently undiagnosed psychological problems associated with male hypogonadism.” In their study of 4,393 Vietnam veterans, Booth et al., [98] had their patients’ free testosterone levels and depressive symptoms tested. From their study, it was found that there was a significant association between low testosterone levels and depression, and in another study of 869 men over the age of 60, Kurita et al., [99] found this correlation as well. Others have also seen this link between depression and androgen deficiency in their studies [100,101]. As far as treatment, Khera [102] proposes that testosterone deficient patients should be given a trial of testosterone replacement therapy for at least 3 months as testosterone replacement therapy alone may improve clinical symptoms of depression. In the meta-analysis of 355 depressed patients with hypogonadism, Zarrouf et al., [101] further supported testosterone treatment when reporting that there was a significant improvement of the Hamilton depression rating scale among patients who were administered testosterone replacement therapy.

 

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