Behavioral disorders encompass a wide range of conditions in which the common factor is disordered functioning of thinking, behavior, and/or interpersonal relationships. In the absence of screening, only approximately 50% of persons with depression and other mental health conditions are ever diagnosed. Recent reports indicate that less than 5% of adults in primary care settings are ever formally screened for depression. Because electronic health records are starting to include standardized screening tools, including questions targeting depression, this percentage may improve. The prevalence of these disorders is staggering: each year, 1 in 5 adults will experience a mental health condition, and 75% of these conditions develop by the age of 24. The goal of the WHO’s Mental Health Gap Action Program is to raise awareness of the challenges related to mental health disorders and to facilitate solutions for the growing need for services, particularly in resource-poor regions.
Behavioral Disorders Associated With Medical Conditions
Behavioral disorders are sometimes associated with other conditions, which can present a challenge to clinicians in understanding their cause and determining the best course of treatment. Sometimes the disorder is caused by the medical condition itself, and sometimes the etiology is multifactorial. Potential causes include adverse effects from medication or stressors related to dealing with the medical condition such as the associated financial burden, limited access to appropriate care, or the lack of an adequate support network.
Because almost any disease can result in behavioral changes in an individual, it is imperative for clinicians to look for indicators of underlying causal factors. For example, mental disorders that develop in patients later in life are more likely to be related to an underlying medical condition that would explain the delayed onset. In addition, more acute changes may be the result of a physiological change, such as a neurovascular event, an infection, an environmental exposure, an electrolyte imbalance, or a hormonal change. Finally, behavioral abnormalities associated with disorders of the motor system, such as gait and balance problems, speech irregularities, or unusual tics, suggest a possible underlying neuropathology, warranting further investigation. Neurologic disease states that can cause behavioral changes include head trauma and post-concussion syndrome, stroke, multiple sclerosis, and brain tumors, especially tumors involving the frontal lobe.
Chronic disease states, such as disabling rheumatoid arthritis, chronic pulmonary illness, or cardiovascular disease, are associated with higher rates of depression in adults. Other illnesses associated with behavioral changes in patients include untreated thyroid disorders, Lyme disease, hemochromatosis, and Wilson disease. Some diseases may present with only minor mood changes, whereas others present with major depression, hallucinations, and delusions. As noted, behavioral changes may be induced by medications, for example, carbonic anhydrase inhibitors, steroids, and chemotherapeutic agents, among others.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.