Authors' Note: A psychiatric workup for mental disorders starts with the separation of causality into two streams. In the first, brain function, thoughts and behavior may be altered by subtle or unusual manifestations of disease in body systems outside the brain — these are sometimes termed exogenous. In the second stream, manifestations are attributable to disorder of the brain itself (usually of unknown cause) in patterns reflective of neurosis, schizophrenia and depressive illness. In somewhat archaic, but still utilized descriptions, psychiatrists may refer to this distinction as indicating organic versus non-organic mental disorders.
rarefactive: (a non-standard use) — the condition of becoming less frequent; under-functioning
By far the most common cause of thyroid hormone deficiency or hypothyroidism (historically known as myxedema for a type of puffy swelling and rash in the legs) is progressive destruction of normal hormone-producing tissue by the process of colloid degeneration. Owing to the metabolic role of thyroid hormone, most body functions then slow, resulting, for example, in reduced heart rate and weight gain. For the brain, somnolence and depression may be accompanied in extreme cases by disordered mentation known as 'myxedema madness'.
Under normal circumstances, the anterior pituitary gland, stimulated by the brain's hypophysis, plays a key role as the 'master gland' in regulating hormone production. When the thyroid gland is flagging, the master gland increases its production of TSH (thyroid stimulating hormone), a messenger that is excreted into the bloodstream, targeted to normalize the peripheral gland's production. Fortunately, the robust sensing mechanism in the hypophysis and pituitary, not impaired by the metabolic slowdown elsewhere, produces high levels of blood TSH so reliably that a simple test can be used as the best test for detection of the hypothyroid state.
Authors' Note: stroma: connective tissue that supports normal body structures and, on occasion, abnormal growths
Meningioma is a relatively common, slowly growing benign tumor within the cranium. Pressure on adjacent portions of normal brain induce neurological symptoms. When the tumor is located in the frontal cortex, neuropsychiatric manifestations may include bizarre thoughts, frequently paranoid, and unrepressed behavior. Fortunately, the tumors when suspected are readily diagnosed on neuro-imaging studies, and surgical therapy is usually curative.
Brain tumours account for only a small portion of patients suffering such neuropsychiatric symptoms; however, medical practitioners frequently hope that such a correctable cause may be discovered.
Authors' Note: Although military recruits and physically abused spouses also number among the victims of this disease of insidious onset, (characteristically diagnosed with certainty only at post-mortem examination), it is the scourge of those who earlier in life indulged in contact sports, particularly those with a risk of repetitive minor brain trauma.
Everything that you wanted to know about chronic traumatic encephalopathy can be found in the author's note appended to MikeAq's verse on the subject.
Authors' Note: A course of high-dose synthetic corticosteroids, e.g. dexamethasone, may be used to help bring under control a severe exacerbation of a chronic illness, e.g. asthma, inflammatory diseases, or an initial presentation, e.g. anaphylaxis, septic shock or brain swelling. Owing to the common side-effect of drug-induced euphoria/mania and other psychiatric issues, doctors attempt to taper the high doses as soon as possible.
Authors' Note: A chronic subdural hematoma is a space-occupying intracranial lesion resulting from the body's failure to resorb blood that collected between the dural membrane and the brain parenchyma, usually caused by traumatic head injury. Whereas an initial expanding clot presents as a neurosurgical emergency, smaller clots, with a tendency to absorb fluid and expand gradually, may be later suggested only by chronic neuropsychiatric symptoms. In jargon used in actual medical settings and in televised fictional series, the term for the lesion responsible may be shortened to subdural.
In elderly patients, such as Hazel, and in those on blood-thinning drugs, the trauma required to incite events such as those in this tale may be minor or even subliminal.
Authors' Note: Recent reports point out the devastating effects of an early onset of Alzheimer's dementia. Fortunately, this variant, manifesting at an earlier than usual age, is relatively uncommon, but isn't it time that we discovered the cause and treatment for this tragic disorder?
Hyperthyroid states make you feel crazy;
Every organ, geared up, can't act lazy.
Your brain, hyped, may act manic,
Or repeatedly panic;
Your perception and judgment are hazy.
But, one part of your noggin that's copin',
Is the gland where cells make thyrotropin.
TSH levels fall,
For your Doc that's a call:
"It's an endocrine illness, I'm hopin' --
Psychiatric behaviour provokin'. "
Dr G.H. and Giorgio Coniglio, 2022
TSH: thyroid stimulating hormone, also known as thyrotropin, initialism for a substance produced by the anterior pituitary gland in a feedback loop that regulates production of thyroid hormones by the thyroid gland
The operation of the feedback loop in relation to states of thyroid deficiency is discussed here.
Authors' Note: You can find the above multiverse limerick-style poems ("brief sagas"), along further notes and relevant illustrations on our blog "Daily Illustrated Nonsense". The thematically related shorter poems can be found there as well, or you could look for them here in their topic-based collections, e.g. "General Paresis of the Insane" can be found here in the collection "STD-Poetry". (for those whose lay- or professional experience is limited, STD is the medical initialism for Sexually-Transmitted-Diseases)
Collections of intriguing verses on other medical/dental topics that can now be found on various posts include:
and in 'brief sagas' including:
DIRECTION FOR WEB-TRAVELLERS:
To resume daily titillations on our blog 'Daily Illustrated Nonsense', click HERE. Once you arrive, you can select your time frame of interest from the calendar-based listings in the righthand margin, and check the daily offerings for any month in the years 2020 to the present. (As of September 2022, there are 1000 entries available on the Daily blog, and most of these are also presented here on 'Edifying Nonsense' in topic-based collections.)
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