Maria Mangicaro – Check for Physical Causes of Psychiatric Symptoms First

Editors note: Much of this post came from a comment previously published on  The comment was by Maria Mangicaro. Because comment copyright ownership is still a matter of debate in the internet era, we’ll be glad to pull this if anyone objects.

Sticker found in Kansas City. What really defines psychiatric symptoms?

Sticker found in Kansas City. What really defines psychiatric symptoms?

I am concerned with the “Chinese menu” approach, or using the DSM just to match people up with psychiatric symptoms:

1. Are certain individuals in our mental health care system. suffering from underlying medical conditions misdiagnosed as schizophrenia or bipolar?  Are they being forced to accept ineffective and potentially lethal treatments? Yes, there are many medical conditions and substances that can induce encephalopic conditions and manifest as psychosis or other psychiatric symptoms.

Medical professionals should follow Best Practice assessment guidelines to rule out underlying medical conditions, and ensure medications are not used long-term for something that never came from psychiatric symptoms.

2. Are there any diagnositic tests for mental disorders?  Yes, these are mental disorder as described by the DSM:

  • 293.82 Psychotic Disorder Due to Medical Condition, with Hallucinations
  • 293.83 Mood Disorder Due to Medical Condition
  • 293.89 Anxiety Disorder Due to Medical Condition

There is a long list of medical conditions that can manifest as a separation from reality that leads people to think of psychiatric symptoms. These include brain tumors and Hashimoto’s encephalopathy. An MRI and blood tests are diagnostic tests that can diagnose these mental disorders.

Bob Whitaker talks about physical causes for psychiatric symptoms:

Please listen to this interview,


Robert Whitaker states quite clearly that youth doing marijuana are at increased risk of ending up with bipolar labels when they show up with what looks like psychiatric symptoms. He also states he believes more than 50% of those labeled with mental illness entered the system starting from the use of illegal drugs. He states he did not realize this when he wrote Anatomy of an Epidemic.

Best Practice assessment of psychotic symptoms is the most ethical standpoint an advocate could take. Why would we want to overlook a medical condition or a substance causing psychosis, especially when that substance could be a psychiatric medication that induced a psychotic episode resulting in a parent killing their own child, like Ryan Ehlis, Dena Schlosser, Otty Sanchez, Julie Schenecker and David Crespi.

Advocates need to get on the same page with this problem of mistaken causes for psychiatric symptoms.

Four emails from Robert Whitaker about the need to check for the true causes of psychiatric symptoms:

1. This mistaken psychiatric symptom problem is huge
Hi Maria,
I was speaking to a group of primary care physicians yesterday, and this very point came up. And that is, in the past, the first thing doctors did when presented with someone with psychiatric symptoms was think of possible physical causes (thyroid, vitamin and mineral deficiencies,), and of course environmental toxins.

And your letter does highlight part of the problem, which is that those against the drug model usually have their own horse they want to ride, which is talk therapy, or some other form of therapy.

But you are right–I think nutrition, environmental toxins, lack of sleep, other medications, etc., should be seen as possible culprits for psychosis (whenever someone presents with such.)

All the best,


2. Integrative Psychiatry/Medicine

HI Maria,

Thank you for this.

I am very much looking forward to Dr. Shannon’s presentation. I also think that your story illustrates that when someone experiences a manic or psychotic episode, the first thing doctors should look for are agents (such as chemical exposure, psychoactive drugs–illicit or licit) that could have triggered such episodes.

I hope that integrative psychiatry becomes the future.


3. Article: After Soteria House Shooting Victim Dies, Questions Remain July 24 2011

Hi Maria,

What happened at Soteria is such a tragedy. What the article didn’t state is that the woman who was killed was one of the home’s real success stories. She had gotten off medications and was doing so well. Her death is so heartbreaking.

Regarding your other point here, well, I think all of psychiatry needs to think about this point, which is that many things can induce psychosis, including other medications, and thus they avoid seeing psychosis as necessarily a sign of mental illness. Physicians a century ago regularly thought that psychosis could result from poisoning, other diseases, etc.

I recently was at an event where one of the psychiatrists said that he believed that 80 percent of those diagnosed with schizophrenia in recent years had been doing illicit drugs before they had their psychotic break.

All the best,


4. Talk by Ex-Patient Dave from the Society of Participatory Medicine Wed, Jul 6, 2011 10:52 am

Hi Maria,

It was nice to meet Dr. Sinaikin there, and all in all, the conference was decent, and actually not too radical.

I’m sorry to hear that The International Society for Ethical Psychology & Psychiatry didn’t show much interest in Dr. Kohl’s presentation.

And I agree with you on this–many, many things can induce psychosis (illicit drugs, lack of sleep, physical illnesses, etc.), and it’s a mistake to lump psychosis into one large cagtegory.

I think the old adage of doctors needing to take a detailed case history (which is a form of participatory medicine) needs to be recalled and reintegrated into practice.

Psychosis is just a symptom of something amiss, and often, not a disease unto itself.

Thanks for this link. I’ll check it out.


3 comments to Maria Mangicaro – Check for Physical Causes of Psychiatric Symptoms First

  • Marcelle Raquel

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  • thank you for posting this information.

    Here is a link to the British Medical Journal’s Best Practice assessement of psychosis guidelines.

    It is unethical to provide those seeking help for, or forced into treatment for, psychotic/manic symptoms anything less than Best Practice standards.

    Advocates from the Treatment Advocacy Center agree on this, we all need to get on the same page.

    Advocates should not be taking sides, they need to find common grounds and fight side-by-side for the greatest good of those we claim to be advocating for.

  • This site and all sites have my blessing to re-post anything I write.

    I focus on the facts and I only speak the truth.

    My message is honest and consistent.

    My only objective is to speed up the process of fixing our broken mental health care system.

    The suffering is real and in many cases it is preventable/treatable.

    The longer it takes to reveal the truth, the longer people suffer and the more money professionals will make off of the suffering of others.

    At this point advocates are just as guilty for turning a blind eye to the fact there are many encephalopic conditions that can cause psychosis and leave individuals “wasting away in a psych ward or a nursing home.”

    There is enough research done already, and there are enough books written. It’s time to start fixing the underlying causes of psychotic symptoms.