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Introduction
Medical conditions can sometimes lead to mental health problems such as panic attacks, social anxiety disorder, and depressive mood. The awareness of these conditions is important as it can offer to psychologists but also to physicians a better understanding of them and their expressions. In turn, a better understanding can lead to an accurate diagnosis and a more effective and comprehensive intervention. Some of the negative outcomes of this unawareness are reported in the studies of Johnson and Ananth and Sox and co-workers.

Johnson and Ananth physical exams on psychiatric patients revealed that 12% of them were admitted to psychiatric hospital for problems that seem to be caused by a physical illness. High percentages of these illnesses have been missed by physicians before and after the admission work up. Moreover, Sox, Koran, Sox, Marton, Dugger, and Smith found that from 509 psychiatric patients, 39% had an important medical disorder and that the staff of the hospital was aware only of the 47% of them. They also reported that 63 of the patients had some other undiagnosed diseases and also that 14% of them had a medical condition that was making their mental status worse.

Hyperthyroidism/Hypothyroidism
Thyroid problems are divided into four different categories; the overt primary hypothyroidism, the subclinical hypothyroidism, the overt hyperthyroidism and the subclinical hyperthyroidism. Each subtype is characterized by different variations in triiodothyronine (T3), thyroxine (T4) and serum thyrotropin (TSH) levels. The above elements are thyroid hormones.

It is observed that thyroid problems have prevalence with mental health disorders and symptoms. For example, the prevalence of depressive symptomatology in thyroid patients has been reported as 31-69%, while the prevalence of anxiety symptomatology as 31-61%. It is important to notice that in most cases of hyper/hypothyroidism the psychiatric symptoms remit after thyroid treatment.

Some of the symptoms of hyperthyroidism that could be confused with psychiatric symptoms are; anxiety, insomnia, emotional instability, dysphoria and cognitive dysfunction, while in hypothyroidism, memory impairments, depressive mood, floating anxiety, and somatic complaints are some of the most common symptoms. Generally, hypothyroidism is correlated more with mood disorders while hyperthyroidism with anxiety disorders.

It appears that an underlying dysfunctional interaction between thyroid hormones, serotonergic and adrenergic systems, play an important role in this complex clinical symptomatology.

Pheochromocytomas
Pheochromocytomas are neuroendocrine tumors. Their clinical presentation varies but their most common symptoms are headaches, palpitations, sweating, hypertension, severe anxiety, tremulousness, nausea, pain in the chest, weight loss and visual disturbances.

Research findings suggest that the prevalence of panic disorder, agoraphobia, and multiple phobias, is significantly higher in patients with pheochromocytomas. Additionally, these patients are characterized by significantly higher levels of psychological distress, impaired quality of life and distorted image about their physical and mental health.

The above clinical presentation of pheochromocytomas is caused by the excess circulation of catecholamines and hypertension that are part of the medical condition. Furthermore, the catecholamines dysregulation can lead pheochromocytomas patients to potentially lethal cardiovascular complications.

Diabetes mellitus/Hypoglycemia
Diabetes is a disorder where the body cannot control the amount of sugar in the blood because of lack of insulin. Furthermore, hypoglycemia is associated with insulin treatment in type 1 and type 2 diabetes and is characterized by physical and psychological symptoms such as nausea, shaking, sweating, drowsiness, motor dysfunctions, confusion and negative mood.

Anxiety and mood disorders have a higher prevalence in patients with diabetes. Specifically, in Grigsby, Anderson, Freeland, Clouse and Lustman's research, generalized anxiety disorder was present in 14% of the patients with diabetes. Furthermore, in the same study, anxiety disorder not otherwise specified was found in 27% of diabetes patients. Generally, diabetes is associated with an increased likelihood of having higher anxiety levels.

Moreover, depression is also significantly higher in patients with type 2 diabetes than in people with type 1 diabetes and people without diabetes at all. The above comorbidity (diabetes-depression) can lead to worse glycemic control and noncompliance with the treatment. Additionally, diabetic patients with depression report greater persistence of depressive symptomatology, worse quality of life more somatic symptoms, higher health care expenses and greater risk of mortality. Finally, diabetic patients may present fear of hypoglycemia (FOH) which has a negative impact on diabetes management. However, psychotherapy can reduce the levels of negative emotions and contribute to the better control of this health condition.

Mitral valve prolapse
In mitral valve prolapse, which is also known as Barlow’s syndrome, click-murmur syndrome, and floppy valve syndrome, “the two valve flaps of the mitral valve do not close smoothly or evenly”. The main symptoms of this condition are palpitations, tachycardia, chest pain, nervousness, and fatigue and a catecholamine dysregulation as well as a general autonomic uprising are observed.

Dager, Cowley, and Dunner reported that according to different studies, the prevalence of panic attacks in mitral valve prolapse patients highly varies from 0% up to 59%. This great prevalence could have three different explanations. First of all, mitral valve prolapse could present similar symptoms with panic attack symptoms, something that leads to confusion about the differentiation of these two conditions. Secondly, panic attacks may cause hemodynamic changes that lead to mitral valve parts buckling. Finally, an underlying abnormality such as a biochemical abnormality might contribute to the presentation of mitral valve prolapse and panic attacks that could be two separate manifestations.

Asthma
Asthma is a chronic condition which is related to minor distortions in lungs during air passing through them. Some of the main symptoms are wheezing and breathlessness that can lead to sleeplessness and fatigue.

Smoller, Pollack, Otto, Rosenbaum, and Kradin by reviewing the findings of some researchers, reported that 6 to 30% of asthmatic patients meet the criteria for panic disorder. For example, Carr, Lehrer, Rausch, and Hochron found that 9.7% of asthmatic patients also present panic attacks. Moreover, Shavitt and coworkers found that among 107 asthmatic patients, 6.5% met criteria for panic disorder and 13.1% for agoraphobia. However, none of these patients had received a diagnosis or an intervention for these mental health conditions. Because of the symptoms similarities between panic attacks and asthma, panic in asthma patients is often under-recognized.

Finally, patients with asthma often develop an avoidance of daily activities and the high levels of their anxiety can contribute to hospitalization more often.

Epilepsy
Epilepsy is a dysfunctional brain condition and it is expressed through uncontrolled seizures. The prevalence of anxiety disorders in epileptic patients varies between 14.8% and 25%. It is observed that temporal lobe structures play an important role in the anxiety manifestations in epilepsy and that temporal lobe epilepsy is frequently associated with fear of upcoming seizures.

Temporal lobe seizures can present a variation of symptomatology such as fear, affective symptoms, changes in skin color, heart rates, and blood pressure. Because of the similarities between panic disorder and temporal lobe epilepsy, both conditions can be misdiagnosed.

Changes in neurotransmitters (norepinephrine, dopamine, and serotonin) and in neuroendocrine substances (GABA, adrenocorticotrophic hormone, neuropeptide Y) could be part of the underlying mechanism of anxiety in epilepsy.

Brain tumors
A significant correlation between lower brain tumor grades and neuropsychiatric disorders has been reported. Findings suggest that 30% of patients with neoplasms suffer from anxiety and 16% from depression or anxiety.

Primary brain tumors in the right hemisphere seem to be associated with anxiety symptomatology and their removal leads to anxiety remission. This right laterality reveals the biological and neuropsychological base of this anxiety.

One explanation of the above lateralization effect could be that the two hemispheres have different concentrations of neurotransmitters and therefore, each of them is involved in different functions. Because of that, changes in different hemispheres cause different hemispheric-specific syndromes. Another explanation could be that the right hemisphere is more involved in negative emotions processing and when it is damaged, the left hemisphere is over activated.

Parkinson's disease
Patients with Parkinson's disease often present social anxiety disorder probably because of their hypodopaminergic function which is common not only in Parkinson's disease but also in social anxiety disorder.

However, Parkinson's disease has been associated with a variety of neuropsychiatric disorders such as panic attacks, depression, and anxiety in general. The serotonergic dysfunction in Parkinson’s disease may be a risk factor for anxiety and depression manifestations.

Vitamin B12 deficiency
Vitamin B12 deficiency, in other words, cobalamin deficiency, can be one of the most common causes of macrocytic anemia and is involved in many neuropsychiatric conditions. However, Lindenbaum and coworkers found an association between cobalamin deficiency and neuropsychiatric disorders without the presence of anemia or macrocytosis. Specifically, the result of their experiment showed that 40% of patients with neuropsychiatric disorders due to B12 avitaminosis did not have anemia or macrocytosis.

Some of the main symptoms of this condition are; paresthesia, dementia, ataxia, sensory loss and psychiatric disorders such as depression.

It has been supported that, for many years psychiatric cases with B12 avitaminosis basis have been misdiagnosed by physicians.

Conclusion
In conclusion, a holistic attitude from professionals and a comprehensive knowledge of the above medical conditions can lead to a better understanding of patients’ feelings and also to a more effective therapeutic intervention. Psychologists should be more careful with patients that are over 40 without a previous psychiatric history. Additionally, a comorbid chronic disease, a head injury, a change in headaches, memory impairments, disorientation, impaired consciousness, visual disturbances, speech deficits and  abnormalities in blood pressure, pulse, and temperature, should also keep professionals alert. Finally, significant changes in weight (thyroid dysfunction signs), frequent urination and increased thirst (diabetes signs) and persistence of psychological symptoms after psychiatric medication should be also carefully taken into consideration.