User:7mike5000/Depression (differential diagnoses)

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Neuroimaging can be helpful in finding a medical reason for a person's depression.[1]

Depression - is one of the most common of mental health[2][3] and every year the number of new cases in the whole world gets learger..[4][5]In the United States alone depression 17.6 million Americans have depression each year that means 1 out of every 6 people has depression.

Depressed people have more of a chance of getting other disorders and diseases like, Type 2 diabetes, heart disease and they have a higher risk of dying by suicide. Soon depression is expected to be the second leading cause of disability worldwide and the number 1 cause in rich nations, like the United States and Canada.

There are other mental and medical problems that may copy some or all of the symptoms of depression, or a person can have depression and another mental or medical problem which can make it worse.[6][7][8] A medical or mental problem that has the same kind of symptoms as another disorder, and may be the the real problem is called a differential diagnosis.[9]

Many people are told what mental problem they have (diagnosis) by therapists or others with little or no medical training.[10]they say a person has a mental illness like depression without trying to find out what may be casuing it. [11][12][13][14][15][16] Many mental health care workers do not know about the medical illnesses that can cause symptoms of a mental problem.[17]

When a person does not get the right diagnosis of what is causing their depression it can make them much more sick.[18][19]At least 10% of all symptoms of a mental problem may actually be because of a medical problem,[20] and as many as 50% of people diagnosed with a mental illness have a medical problem that the doctors don't know about, which is causing the symptoms or which are making them worse [21][22]

Autoimmune disorders[change | change source]

  • Celiac disease; is when the body is can not handle gluten which is found in foods like, wheat, rye and barley. It can cause mental problems even without causing physical ones.[23]
  • Lupus: Systemic lupus erythematosus (SLE), is a disease that lasts a long time (chronic) that can affect any part of the body.[24]and it can cause or worsen depression.[25]

Bacterial-viral-parasitic infection[change | change source]

MRI brain scan: Neurocysticercosis
  • Lyme disease; is an infection caused by a bacteria. People become infected when they are bitten by a deer tick. Lyme disease can mimic (act like) many other different medical and mental illnesses.[26][27] Lyme disease can be very difficult to diagnose.[28]but it can be treated with antibiotics. If it is not treated in time it can cause severe damage to the brain.[29]
  • Syphilis; is a sexually transmitted disease (STD) if it is not treated in time it can get worse and become neurosyphilis which can harm the brain. Sometimes the only symptoms of syphilis are symptoms that look like they are caused by a mental illness.[30]
  • Neurocysticercosis (NCC): is an infection of the brain or spinal cord caused by the larval stage of the pork tapeworm, Taenia solium. NCC is the most common parasitic worm infestation of the central nervous system worldwide. Humans get cysticercosis when they eat eggs of the pork tapeworm. This can happen when they come into contact with contaminated fecal matter and do not wash their hands well enough, or if they eat food that was contaminated eat undercooked pork.[31] "While cysticercosis is common in Latin America, alot of cases are starting to appear in the United States."[32] "The rate of depression in those with neurocysticercosis is higher than in the general population."[33]
  • Toxoplasmosis; is an infection caused by Toxoplasma gondii a small one-celled animal called a protozoan which is a parasite. Humans can be infected by eating with contaminated hands, or a fetus can become infected while inside the mother's womb if the mother is infected. The main way that humans are infected is contact with the feces of the host species, the domesticated cat, which can happen when cleaning the litter box.[34] Toxoplasma gondii infects about 30% of the world's human population, but most people do not have any major symptoms. Just being exposed to Toxoplasma gondii (seropositivity) without getting the disease Toxoplasmosis can change a person's behavior and can cause depression in some people.[35][36]and causes an increased rate of suicide.[37]
  • West Nile virus (WNV); which can cause encephalitis can also cause depression. People can get WNV by being bitten with an infected mosquito.[38][39]In the United States, WNV infection causes many cases of neurological disease.[40]

Blood disorders[change | change source]

  • Anemia: is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood which can be caused by a person not getting enough Vitamin B12.[41]Anemia can cause depression.[42]

Chronic fatigue syndrome[change | change source]

Millions of people are believed to have Chronic Fatigue Syndrome (CFS), but only 50% have gone to a doctor to treat the symptoms of CFS. People who have CFS symptoms also often have an undiagnosed medical or mental disorder such as diabetes, thyroid disease or substance abuse. Early diagnosis and treatment can help cure the symptoms.[43] CFS is often misdiagnosed as depression.[44][45]

Dietary disorders[change | change source]

  • "Fructose malabsorption is when the body cannot digest fructose, a type of sugar. This cause a depressed mood. "Fructose malabsorption should be considered in patients with symptoms of major depression...."[46]

Endocrine system disorders[change | change source]

Problems in the endocrine system can cause many symptoms mental illness; problems in the pituitary, adrenal and thyroid glands have been shown in patients with primary depression.[47]


Adrenal gland[change | change source]

Thyroid and parathyroid glands[change | change source]

Location of the thyroid and parathyroid glands in front of the layrnx.

Pituitary tumors[change | change source]

Tumors of the pituitary gland are common, as many as 25% of people have them.[51] Most tumors are considered to be harmless (benign) however even in benign cases, pituitary tumors can affect thinking, behavior and emotions changes.[52][53] Pituitary microadenomas are smaller than 10 mm in diameter and are generally considered benign, yet the presence of a microadenoma has been positively identified as a risk factor for suicide.[54][55]

"... patients with pituitary disease were misdiagnosed (not given the right diagnosis) and treated for depression and they showed little response to the treatment for depression". This is because in this case the depression was not a "mental illness", it was a symptom of a problem in the pituitary gland. [56]

Pancreas[change | change source]

  • Hypoglycemia: is when the body makes too much insulin and this causes the amount of glucose in the blood to less than the body needs. This may cause a depressed mood.[57]

Neurological[change | change source]

In addition to pituitary tumors, tumors in various locations in the central nervous system may cause depressive symptoms and be misdiagnosed as depression.[58][59]

Post concussion syndrome[change | change source]

Post-concussion syndrome (PCS), is a set of symptoms that a person may experience for weeks, months, or occasionally years after a concussion with a prevalence rate of 38–80% in mild traumatic brain injuries, it may also occur in moderate and severe cases of traumatic brain injury.[60] A diagnosis may be made when symptoms resulting from concussion, depending on criteria, last for more than three to six months after the injury, in which case it is termed persistent postconcussive syndrome (PPCS).[61][62][63][64][65] In a study of the prevalence of post concussion syndrome symptoms in patients with depression utilizing the British Columbia Postconcussion Symptom Inventory: "Approximately 9 out of 10 patients with depression met liberal self-report criteria for a postconcussion syndrome and more than 5 out of 10 met conservative criteria for the diagnosis." These self reported rates were significantly higher than those obtained in a scheduled clinical interview. Normal controls have exhibited symptoms of PCS as well as those seeking psychological services. There is considerable debate over the diagnosis of PCS in part because of the medico-legal and thus monetary ramifications of receiving the diagnosis.[66]

Pseudobulbar affect[change | change source]

Diagnostic differences between PBA and depression

Pseudobulbar affect (PBA) is an affective disinhibition syndrome that is largely unrecognized in clinical settings and thus often untreated due to ignorance of the clinical manifestations of the disorder; it may be misdiagnosed as depression.[67] It often occurs secondary to various neurodegenerative diseases such as amyotrophic lateral sclerosis, and also can result from head trauma. PBA is characterized by involuntary and inappropriate outbursts of laughter and/or crying. PBA has a high prevalence rate with estimates of 1.5 - 2 million cases in the United States alone.[68]

Neurotoxicity[change | change source]

Various compounds have been shown to have neurotoxic effects many of which have been implicated as having a causal relationship in the development of depression.

Cigarette smoking[change | change source]

There has been research which suggests a correlation between cigarette smoking and depression. The results of one recent study suggest that smoking cigarettes may have a direct causal effect on the development of depression.[69] There have been various studies done showing a positive link between smoking, suicidal ideation and suicide attempts.[70][71]

In a study conducted among nurses, those smoking between 1-24 cigarettes per day had twice the suicide risk; 25 cigarettes or more, 4 times the suicide risk, than those who had never smoked.[72][73] In a study of 300,000 male U.S. Army soldiers, a definitive link between suicide and smoking was observed with those smoking over a pack a day having twice the suicide rate of non-smokers.[74]

Link Between Smoking Depression and Suicide

"Current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt."[75]

"It would seem unwise, nevertheless, to rule out the possibility that smoking might be among the antecedent factors associated with the development of depression."[76]

"Abstinence from cigarettes for prolonged periods may be associated with a decrease in depressive symptomatology."[77]

"The stress induction model of smoking suggests, however, that smoking causes stress and concomitant negative affect."[78]

Medication[change | change source]

Various medications have been suspected of a having a causal relation in the development of depression; this has been classified as "organic mood syndrome". Some classes of medication such as those used to treat hypertension, have been recognized for decades as having a definitive relationship with the development of depression.[79]

Monitoring of those taking medications which have shown a relationship with depression is often indicated, as well as the necessity of factoring in the use of such medications in the diagnostic process.[80]

  • Topical Tretinoin (Retin-A); derived from Vitamin A and used for various medical conditions such as in topical solutions used to treat acne vulgaris. Although applied externally to the skin, it may enter the bloodstream and cross the blood brain barrier where it may have neurotoxic effects.[81]
  • Interferons; proteins produced by the human body, three types have been identified alpha, beta and gamma. Synthetic versions are utilized in various medications used to treat different medical conditions such as the use of interferon-alpha in cancer treatment and hepatitis C treatment. All three classes of interferons may cause depression and suicidal ideation.[82]

Chronic Exposure to Organophosphates[change | change source]

The neurophsychiatric effects of chronic organophosphate exposure include mood disorders, suicidal thinking and behaviour, cognitive impairment and chronic fatigue.[83]

Neuropsychiatric[change | change source]

Bipolar disorder[change | change source]

  • Bipolar disorder is frequently misdiagnosed as major depression, and is thus treated with antidepressants alone which is not only not efficacious it is often contraindicated as it may exacerbate hypomania, mania, or cycling between moods.[84][85] There is ongoing debate about whether this should be classified as a separate disorder because individuals diagnosed with major depression often experience some hypomanic symptoms, indicating a continuum between the two.[86]

Nutritional deficiencies[change | change source]

Nutrition plays a key role in every facet of maintaining proper physical and psychological wellbeing. Insufficient or inadeqaute nutrition can have a profound effect on mental health. The emerging field of Nutritional Neuroscience explores the various connections between diet, neurological functioning and mental health.

  • Vitamin B6:pyridoxal phosphate (PLP) the active form of B6 is a cofactor in the dopamine serotonin pathway, a deficiency in Vitamin B6 may cause depressive symptoms.[87]
  • Folate (vitamin B9) - [[Vitamin B12|Vitamin BTemplate:Ssub]] cobalamin : Low blood plasma and particularly red cell folate and diminished levels of Vitamin BTemplate:Ssub have been found in patients with depressive disorders. "[W]e suggest that oral doses of both folic acid (800 µg/(mcg) daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression."[88][89]

Sleep disorders[change | change source]

  • Insomnia: Not being able fall asleep is often a symptom of depression, it can also be the trigger for getting a depressive disorder.[93][94] It can be transient, acute or chronic. It can be a primary disorder or a co-morbid one.
  • Restless legs syndrome:(RLS), also known as Wittmaack-Ekbom's syndrome, is characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso, and even phantom limbs.[95] Restless Leg syndrome has been associated with Major depressive disorder. "Adjusted odds ratio for diagnosis of major depressive disorder... suggested a strong association between restless legs syndrome and major depressive disorder and/or panic disorder."[96]
  • Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea, lasts long enough for one or more breaths to be missed; such episodes occur repeatedly throughout the sleep cycle. Undiagnosed sleep apnea may cause or contribute to the severity of depression.[97]
  • Circadian rhythm sleep disorders, of which too few clinicians are aware, often go untreated or are treated inappropriately, as when misdiagnosed as either primary insomnia or as a psychiatric condition.[98]

See also[change | change source]

References[change | change source]

  1. ↑ Neuroimaging: a new training issue in psychiatry? -- Bhriain et al. 2005 - [1]
  2. ↑ Sharp LK, Lipsky MS (September 2002). "Screening for depression across the lifespan: a review of measures for use in primary care settings". American family physician. 66 (6): 1001–8. PMID 12358212.
  3. ↑ Torzsa P, Szeifert L, Dunai K, Kalabay L, Novák M (September 2009). "A depresszió diagnosztikája és kezelése a családorvosi gyakorlatban". Orvosi Hetilap. 150 (36): 1684–93. doi:10.1556/OH.2009.28675. PMID 19709983.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ↑ College Students Exhibiting More Severe Mental Illness, Study Finds
  5. ↑ Lambert KG (2006). "Rising rates of depression in today's society: Consideration of the roles of effort-based rewards and enhanced resilience in day-to-day functioning". Neuroscience & Biobehavioral Reviews. 30 (4): 497–510. doi:10.1016/j.neubiorev.2005.09.002. PMID 16253328.
  6. ↑ Adults Admitted to a Mood-Disorder Clinic Are Often Misdiagnosed by Marlene Busko [2]
  7. ↑ Jones DR, Macias C, Barreira PJ, Fisher WH, Hargreaves WA, Harding CM (November 2004). "Prevalence, Severity, and Co-occurrence of Chronic Physical Health Problems of Persons with Serious Mental Illness". Psychiatric Services. 55 (11): 1250–7. doi:10.1176/appi.ps.55.11.1250. PMC 2759895. PMID 15534013.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ↑ Felker B, Yazel JJ, Short D (December 1996). "Mortality and medical comorbidity among psychiatric patients: a review". Psychiatric services (Washington, D.C.). 47 (12): 1356–63. PMID 9117475.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ↑ Merriam-Webster's Medical Dictionary, Merriam-Webster, Inc.
  10. ↑ Preventing Misdiagnosis of Women: A Guide to Physical Disorders That Have Psychiatric Symptoms (Women's Mental Health and Development) by Dr. Elizabeth Adele Klonoff and Dr. Hope Landrine p. xxi Publisher: Sage Publications, Inc; 1 edition (1997) Language: English ISBN 0761900470
  11. ↑ Singh H, Thomas EJ, Wilson L; et al. (July 2010). "Errors of Diagnosis in Pediatric Practice: A Multisite Survey". Pediatrics. 126 (1): 70–9. doi:10.1542/peds.2009-3218. PMC 2921702. PMID 20566604. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  12. ↑ Margolis RL (1994). "Nonpsychiatrist house staff frequently misdiagnose psychiatric disorders in general hospital inpatients". Psychosomatics. 35 (5): 485–91. doi:10.1016/S0033-3182(94)71743-6. PMID 7972664.
  13. ↑ Clinical errors and medical negligence Femi Oyebode; Advances in Psychiatric Treatment (2006) 12: 221-227 [3] The Royal College of Psychiatrists
  14. ↑ Scheinbaum BW (1979). "Psychiatric diagnostic error". Schizophrenia bulletin. 5 (4): 560–3. PMID 515705.
  15. ↑ Hall RC, Popkin MK, Devaul RA, Faillace LA, Stickney SK (November 1978). "Physical illness presenting as psychiatric disease". Archives of General Psychiatry. 35 (11): 1315–20. doi:10.1001/archpsyc.1978.01770350041003. PMID 568461.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ↑ Small GW (December 2009). "Differential Diagnoses and Assessment of Depression in Elderly Patients". The Journal of Clinical Psychiatry. 70 (12): e47. doi:10.4088/JCP.8001tx20c. PMID 20141704.
  17. ↑ Grace GD, Christensen RC (2007). "Recognizing psychologically masked illnesses: the need for collaborative relationships in mental health care". Primary care companion to the Journal of clinical psychiatry. 9 (6): 433–6. PMC 2139921. PMID 18185822.
  18. ↑ Witztum E, Margolin J, Bar-On R, Levy A (1995). "Stigma, labelling and psychiatric misdiagnosis: origins and outcomes". Medicine and law. 14 (7–8): 659–69. PMID 8668014.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ↑ Margolin J, Witztum E, Levy A (June 1995). "Consequences of misdiagnosis and labeling in psychiatry". Harefuah. 128 (12): 763–7, 823. PMID 7557684.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ↑ When Psychological Problems Mask Medical Disorders: A Guide for Psychotherapists. Morrison J: New York, Guilford, 1997 ISBN 1-57230-539-8
  21. ↑ Previously undetected metabolic syndromes and infectious diseases among psychiatric inpatients. Psychiatric Services Rothbard AB,et al: 60:534–537,2009 [4]
  22. ↑ Hall RC, Gardner ER, Stickney SK, LeCann AF, Popkin MK (September 1980). "Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population". Archives of General Psychiatry. 37 (9): 989–95. doi:10.1001/archpsyc.1980.01780220027002. PMID 7416911.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. ↑ Bushara KO (April 2005). "Neurologic presentation of celiac disease". Gastroenterology. 128 (4 Suppl 1): S92–7. doi:10.1053/j.gastro.2005.02.018. PMID 15825133.
  24. ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  25. ↑ Lupus Disease Activity May Cause, Worsen Depression — Psychiatric Newsby J Arehart-Trechel - 2006 [5]
  26. ↑ Fallon BA, Nields JA (November 1994). "Lyme disease: a neuropsychiatric illness". The American Journal of Psychiatry. 151 (11): 1571–83. PMID 7943444.
  27. ↑ Hájek T, Pasková B, Janovská D; et al. (February 2002). "Higher prevalence of antibodies to Borrelia burgdorferi in psychiatric patients than in healthy subjects". The American Journal of Psychiatry. 159 (2): 297–301. PMID 11823274. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  28. ↑ Fallon BA, Kochevar JM, Gaito A, Nields JA (September 1998). "The underdiagnosis of neuropsychiatric Lyme disease in children and adults". The Psychiatric clinics of North America. 21 (3): 693–703, viii. PMID 9774805.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. ↑ Fallon BA, Nields JA, Parsons B, Liebowitz MR, Klein DF (July 1993). "Psychiatric manifestations of Lyme borreliosis". The Journal of clinical psychiatry. 54 (7): 263–8. PMID 8335653.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. ↑ Friedrich F, Geusau A, Greisenegger S, Ossege M, Aigner M (2009). "Manifest psychosis in neurosyphilis". General Hospital Psychiatry. 31 (4): 379–81. doi:10.1016/j.genhosppsych.2008.09.010. PMID 19555800.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  31. ↑ García HH, Evans CA, Nash TE; et al. (October 2002). "Current consensus guidelines for treatment of neurocysticercosis". Clin. Microbiol. Rev. 15 (4): 747–56. doi:10.1128/CMR.15.4.747-756.2002. PMC 126865. PMID 12364377. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  32. ↑ Sorvillo FJ, DeGiorgio C, Waterman SH (February 2007). "Deaths from cysticercosis, United States". Emerging Infectious Diseases. 13 (2): 230–5. PMC 2725874. PMID 17479884.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  33. ↑ Almeida SM, Gurjão SA (February 2010). "Frequency of depression among patients with neurocysticercosis". Arquivos de neuro-psiquiatria. 68 (1): 76–80. PMID 20339658.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  34. ↑ Carruthers VB, Suzuki Y (May 2007). "Effects of Toxoplasma gondii Infection on the Brain". Schizophrenia Bulletin. 33 (3): 745–51. doi:10.1093/schbul/sbm008. PMC 2526127. PMID 17322557.
  35. ↑ Henriquez SA, Brett R, Alexander J, Pratt J, Roberts CW (2009). "Neuropsychiatric Disease and Toxoplasma gondii Infection". Neuroimmunomodulation. 16 (2): 122–33. doi:10.1159/000180267. PMID 19212132.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  36. ↑ Nilamadhab Karl, Baikunthanath Misra (February 2004). [http: "Toxoplasma gondii serpositivity and depression: a case report"]. BMC Psychiatry. 4 (1): 1. doi:10.1186/1471-244X-4-1. PMC 356918. PMID 15018628. {{cite journal}}: Check |url= value (help)CS1 maint: unflagged free DOI (link)
  37. ↑ Yagmur, F; Yazar, S; Temel, HO; Cavusoglu, M (2010). "May Toxoplasma gondii increase suicide attempt-preliminary results in Turkish subjects?". Forensic Science International. 199 (1–3): 15–7. doi:10.1016/j.forsciint.2010.02.020. PMID 20219300.
  38. ↑ Depression after infection with West Nile virus Murray KO, Resnick M, Miller V. Depression after infection with West Nile virus. Emerg Infect Dis [serial on the Internet]. 2007 Mar [Retrieved July 9, 2010]. Available from [6]
  39. ↑ Berg PJ, Smallfield S, Svien L (April 2010). "An investigation of depression and fatigue post West Nile virus infection". South Dakota medicine : the journal of the South Dakota State Medical Association. 63 (4): 127–9, 131–3. PMID 20397375.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  40. ↑ Carson PJ, Konewko P, Wold KS; et al. (September 2006). "Long‐Term Clinical and Neuropsychological Outcomes of West Nile Virus Infection". Clinical Infectious Diseases. 43 (6): 723–30. doi:10.1086/506939. PMID 16912946. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  41. ↑ MedicineNet.com Definition of Anemia
  42. ↑ Onder G, Penninx BW, Cesari M; et al. (September 2005). "Anemia is associated with depression in older adults: results from the InCHIANTI study". The journals of gerontology. Series A, Biological sciences and medical sciences. 60 (9): 1168–72. PMID 16183958. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  43. ↑ CDC - Chronic Fatigue Syndrome Jul 1, 2010 ... CDC Centers for Disease Control and Prevention Chronic Fatigue Syndrome.[7]
  44. ↑ Griffith JP, Zarrouf FA (2008). "A Systematic Review of Chronic Fatigue Syndrome: Don't Assume It's Depression". Primary care companion to the Journal of clinical psychiatry. 10 (2): 120–8. PMC 2292451. PMID 18458765.
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  46. ↑ Ledochowski M, Sperner-Unterweger B, Widner B, Fuchs D (June 1998). "Fructose malabsorption is associated with early signs of mental depression". European Journal of Medical Research. 3 (6): 295–8. PMID 9620891.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  49. ↑ McLachlan SM, Nagayama Y, Pichurin PN; et al. (December 2007). "The Link between Graves' Disease and Hashimoto's Thyroiditis: A Role for Regulatory T Cells". Endocrinology. 148 (12): 5724–33. doi:10.1210/en.2007-1024. PMID 17823263. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
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  51. ↑ Pituitary Macroadenomas eMedicine
  52. ↑ Meyers CA (1998). "Neurobehavioral functioning of adults with pituitary disease". Psychotherapy and psychosomatics. 67 (3): 168–72. PMID 9667064.
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  54. ↑ Alicja Furgal-Borzycha; et al. (October 2007). "Increased Incidence of Pituitary Microadenomas in Suicide Victims". Neuropsychobiology. 54: 163–166. doi:10.1159/000106475. PMID 17657169. {{cite journal}}: Cite has empty unknown parameter: |urlview= (help); Explicit use of et al. in: |author= (help)
  55. ↑ Forensic Neuropathology p. 137 By Jan E. Leestma
  56. ↑ Weitzner MA, Kanfer S, Booth-Jones M (2005). "Apathy and Pituitary Disease: It Has Nothing to Do With Depression". Journal of Neuropsychiatry. 17 (2): 159–66. doi:10.1176/appi.neuropsych.17.2.159. PMID 15939968.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  58. ↑ Cite error: The named reference newsweek.com was used but no text was provided for refs named (see the help page).
  59. ↑ Lahmeyer HW (June 1982). "Frontal lobe meningioma and depression". The Journal of clinical psychiatry. 43 (6): 254–5. PMID 7085582.
  60. ↑ Rao V, Lyketsos C (2000). "Neuropsychiatric sequelae of traumatic brain injury". Psychosomatics. 41 (2): 95–103. doi:10.1176/appi.psy.41.2.95. PMID 10749946.
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  62. ↑ Legome E. 2006. Postconcussive syndrome. eMedicine.com. Accessed January 1, 2007.
  63. ↑ Schnadower D, Vazquez H, Lee J, Dayan P, Roskind CG (2007). "Controversies in the evaluation and management of minor blunt head trauma in children". Current Opinion in Pediatrics. 19 (3): 258–264. doi:10.1097/MOP.0b013e3281084e85. PMID 17505183.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  65. ↑ Evans RW (2004). "Post-traumatic headaches". Neurological Clinics. 22 (1): 237–249. doi:10.1016/S0733-8619(03)00097-5. PMID 15062537.
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  74. ↑ Miller M, Hemenway D, Bell NS, Yore MM, Amoroso PJ (June 2000). "Cigarette smoking and suicide: a prospective study of 300,000 male active-duty Army soldiers". American Journal of Epidemiology. 151 (11): 1060–3. PMID 10873129.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  91. ↑ Kiecolt-Glaser JK.; et al. (April 2007). "Depressive symptoms, omega-6:omega-3 fatty acids, and inflammation in older adults". Psychosom Med. 69 (3): 217–204. doi:10.1097/PSY.0b013e3180313a45. PMC 2856352. PMID 17401057. {{cite journal}}: Explicit use of et al. in: |author= (help)
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  98. ↑ Dagan Y (2002). "Circadian rhythm sleep disorders (CRSD)" (PDF: full text). Sleep Med Rev. 6 (1): 45–54. doi:10.1053/smrv.2001.0190. PMID 12531141. Retrieved 2007-11-08. Early onset of CRSD, the ease of diagnosis, the high frequency of misdiagnosis and erroneous treatment, the potentially harmful psychological and adjustment consequences, and the availability of promising treatments, all indicate the importance of greater awareness of these disorders.

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