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The behavioral effects of endocrinopathies suggest many different psychiatric illnesses, and the neuropsychiatric effects can be among the first manifestations of endocrine disease. This chapter lists out the endocrine diseases that include: hypothyroidism, hyperthyroidism, hyperparathyroidism, hypoparathyroidism, adrenal disorders, hypocortisolism, diabetes mellitus and hyperprolactinemia. Hypothyroidism is treated by thyroid replacement. Acute Hashimoto's encephalopathy can be treated with glucocorticoids. Antidepressants can be combined with thyroid hormone for depression that does not respond to thyroid replacement alone. In most cases, psychiatric symptoms are resolved when hyperparathyroidism is treated and serum calcium levels return to normal. Primary hyperparathyroidism is treated by surgical resection of the adenoma or parathyroidectomy. Suitable replacement antipsychotics can be found for patients at higher risk with schizophrenia and bipolar disorder with propensity to weight gain and metabolic syndrome. Cognitive behavioral therapy is also effective for depression and improves hemoglobin A1c levels.
The treatment of the most common of mental disorders by the means most patients prefer, psychotherapy, is likely to be one of the most frequently referenced chapters in this book. Here we see a common message writ clear; psychological treatments are in the same league as drug treatments for depression and tend to be better in the long term in maintaining a stable mood. Not all psychological therapies are similar in efficacy, but both cognitive therapy and interpersonal therapy can be championed as contenders for preferred treatment for all forms of mild to moderate depression. While drug treatment may have the edge in more severe depression, when combined with psychological treatments they do even better. The only negative issues are the paucity of skilled therapists and the delay in reaching improvement, the latter being generally greater with psychological therapy. But we are still at the relative dawn of good evidence in this subject and in particular the specific place of the different psychological treatments has yet to be determined.
There is perhaps more high-quality evidence for the efficacy of psychotherapy in the treatment of depression than in any other mental disorder. A large number of randomized controlled trials (RCTs) have demonstrated that psychological treatments work, and research is beginning to shed light on possible active mechanisms of treatment.
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