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1
Tree Root Damage to Buildings: Causes, Diagnosis and Remedy. Willowmead Publishing Ltd, 1998.
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2
Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 61-Year-Old Male with Severe Shoulder and Cervical Pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0007.
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Severe shoulder pain in the absence of a clear orthopedic cause may be due to acute brachial plexitis. Numbness and tingling in association with weakness and muscle atrophy that cannot be accounted for by a single nerve or nerve root distribution suggests the diagnosis. Additional clues suggesting brachial plexitis include intensity of shoulder pain and antecedent events such as illness, vaccination, injury, unusual physical activity or surgery. The approach to diagnosis of plexitis/plexopathy and appropriate evaluation for etiology are discussed. Management of this condition is conservative, relating to pain control and judicious use of mobilization and strengthening with physical therapy. Prognosis is generally good with recovery of strength occurring in weeks to months.
3
Conradie, Ernst M. Redeeming Sin? The Rowman & Littlefield Publishing Group,Inc., 2017. https://doi.org/10.5040/9781978725577.
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Can Christian sin-talk be retrieved within the public sphere? In this contribution to ecotheology, Ernst M. Conradie argues that, amid ecological destruction, discourse on sin can contribute to a multidisciplinary depth diagnosis of what has gone wrong in the world. He confronts some major obstacles related to the plausibility of sin-talk in conversation with evolutionary biology, the cognitive sciences, and animal ethology. He defends an Augustinian insistence that social evil, rather than natural evil, is our primary predicament. If the root cause of social evil is sin, then a Christian confession of sin may yet yield good news for the whole earth.
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Fletcher, Nicholas. Tremor, ataxia, and cerebellar disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0898.
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Tremors are characterized by rhythmic oscillations of one or more body parts. Although typically seen in the upper limbs, almost any area may be involved, including the trunk, head, facial muscles, and legs. Sometimes, tremor is not visible at all but may be heard or palpated, for example, in vocal or orthostatic tremor, respectively. In neurological practice, the diagnosis and treatment of tremor is an everyday problem. A common scenario is the distinction between essential tremor and Parkinson’s disease. In this chapter, the wide range of tremors are discussed, with their aetiolology, pathophysiology, diagnosis and management described.Ataxia is a term used to describe a wide range of neurological disorders affecting muscle coordination, speech and balance that reflect dysfunction of a part of the central nervous system involved in motor function. Many of ataxias have a cerebellar pathology as root cause, although it must be remembered that ataxia, clumsiness, disordered ocular motility, dysarthria, and even kinetic or intention tremor are not always caused by cerebellar disease. This chapter describes the wide range of cerebellar disorders and ataxias, as are non-cerebellar ataxias such as Friedreich’s ataxia.
5
Stogicza, Agnes, Virtaj Singh, and Andrea Trescot. Neurogenic Thoracic Outlet Syndrome. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0008.
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Neurogenic thoracic outlet syndrome (nTOS) is caused by compression of the brachial plexus as it travels from the exiting nerve roots to the axilla. Its presentation, with varying degrees and distributions of arm and hand pain, paresthesias, and numbness, is often either not recognized or is confused with other conditions. Delay in diagnosis causes ongoing suffering for patients, with a concomitant increased use of healthcare services. Imaging and electrodiagnostic studies are often unremarkable, and therefore the diagnosis is based on a detailed medical history, a thorough physical exam, and diagnostic injections. Treatment options are available and can lead to significantly improved quality of life for the patient. Increased awareness of nTOS will likely contribute to its proper diagnosis and treatment.
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Mill, Fredrick. Cystic Fibrosis: A Comprehensive Guide on the Disorders, Diagnosis, Root Causes, Medications and Treatment of Cystic Fibrosis. Independently Published, 2022.
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7
Croskerry, Pat. The Cognitive Autopsy. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190088743.001.0001.
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Behind heart disease and cancer, medical error is now listed as one of the leading causes of death. Of the medical errors that lead to injury and death, diagnostic failure is regarded as the most significant. Generally, the majority of diagnostic failures are attributed to the clinicians directly involved with the patient, and to a lesser extent, the system in which they work. In turn, the majority of errors made by clinicians is due to decision making failures manifested by various departures from rationality. Of all the medical environments in which patients are seen and diagnosed, the emergency department is the most challenging. It has been described as a ‘wicked’ environment where illness and disease may range from minor ailments and complaints to severe, life-threatening disorders. The Cognitive Autopsy is a novel strategy towards understanding medical error and diagnostic failure in 42 clinical cases with which the author was directly involved or became aware of at the time. Essentially, it describes a cognitive approach towards root cause analysis of medical adverse events or near misses. Whereas root cause analysis typically focuses on the observable and measurable aspects of adverse events, the cognitive autopsy attempts to identify covert cognitive processes that may have contributed to outcomes. In this clinical setting, no cognitive process is directly observable but must be inferred from the behaviour of the individual clinician. The book illustrates unequivocally that chief among these cognitive processes are cognitive biases and other flaws in decision making, rather than knowledge deficits.
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D, Sheetal DeCaria M. Break the Chronic Pain Cycle: A 90-Day Program to Diagnose and Eliminate the Root Cause of Pain. Megrina Publishing, 2020.
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9
Fairbank, Jeremy. Management of nerve root pain (syn: sciatica, radicularpain). Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.003007.
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♦ Radicular pain can be diagnosed clinically and confirmed by imaging♦ Pain caused by disc herniation can be very severe, but often resolves without intervention♦ Surgery is often successful if non-operative treatment fails.
10
Tree Root Damage to Buildings: Causes, Diagnosis and Remedy / Patterns of Soil Drying in Proximity to Trees on Clay Soils. Willowmead Publishing Ltd, 1998.
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11
Vydyanathan, Amaresh, Allan L. Brook, Boleslav Kosharskyy, and Samer N. Narouze. Thoracic Nerve Root and Facet Injections: Computed Tomography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0014.
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Thoracic back pain patients present with associated radiculopathy, degenerative disc disease, spondylosis, stenosis, scoliosis, rib fractures, tumors, or after undergoing thoracic surgery. Thoracic transforaminal or selective nerve root blocks (SNRBs) may be both therapeutic and diagnostic. Therapeutic injections may include either local anesthetics for pain relief or corticosteroids for anti-inflammatory effects. The two types of pain amenable to therapeutic SNRBs include pain caused by irritation or direct pressure on a spinal nerve and pain originating from anatomic structures that are innervated by the sinuvertebral nerve. Although these blocks are traditionally performed under fluoroscopic guidance, computed tomography (CT) and CT fluoroscopy have been increasingly used to direct needle placement and have been advocated by experts due to superior visualization of the needle tip and the ability to clearly define spinal anatomy and adjacent soft-tissues.
12
Mills, Kerry R. Disorders of single nerves, roots, and plexuses. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0021.
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The role of electromyography (EMG) and nerve conduction studies in disorders of single nerve, root, and plexus lesions are discussed. The motor and sensory anatomy underpinning diagnosis is described and a scheme presented showing the key muscles to be examined using EMG to differentiate nerve, plexus, and root lesions. The main causes of mononeuritis multiplex, of either axonal degeneration or demyelinative pathology, are covered, including diabetic neuropathy, vasculitic neuropathy, multifocal motor neuropathy with block, and the Lewis–Sumner syndrome. The confirmatory role of EMG and nerve conduction studies in the investigation of cervical and lumbar radiculopathies is highlighted as is the use of transcranial magnetic stimulation to differentiate cervical radiculopathy with myelopathy from amyotrophic lateral sclerosis. The neurophysiological hallmarks of traumatic cervical plexus lesions, including obstetric causes, inherited and acquired brachial neuritis, hereditary liability to pressure palsies, the cervical rib syndrome, and radiation plexopathy are also covered.
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Wheaton, Michael, Dustin Nowacek, and Zachary London. Radiculopathy and Plexopathy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0125.
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Disorders of the nerve roots and neural plexi present with pain, numbness, or weakness in the neck, back, or extremities. Although the history and physical examination provide essential diagnostic information, imaging and electrodiagnostic studies may further aid in localizing and characterizing the underlying lesion. Causes of radiculopathy include intervertebral disc herniation, spondylosis, spinal synovial cysts, infection, metastatic disease, hematoma, or infiltrative disease. The brachial and lumbosacral plexi are susceptible to trauma, structural anomalies, neoplastic infiltration, and inflammatory processes. Management of these disorders is directed at treating the underlying cause, alleviating pain, and focused physical rehabilitation.
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Wecksell, Matthew, and Kenneth Fomberstein. Traumatic Brain Injury and C-Spine Management. Edited by David E. Traul and Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0020.
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Traumatic brain injury encompasses two different types of pathology: that caused at the time of the initial physical insult, called primary injury, and then further, secondary injury caused by either host cellular responses such as oxidative injury and inflammation or by physiological insults such as ischemia, hypoxia, hypo- or hypercapnia, intracranial hypertension, and hypo- or hyperglycemia. While primary injury falls to the realm of public health (e.g., encouraging helmet use for sports, discouraging impaired driving, etc.), many secondary injuries are avoidable with proper medical management. As the stem case for this chapter, an older patient experiences a fall and is incoherent on presentation to the emergency room. This case concerns her initial management, stabilization, diagnosis, and airway management. With progression of her traumatic brain injury, the authors discuss intracranial pressure management, surgical management, and resuscitation as well as likely postoperative sequelae.
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Katirji, Bashar. Case 11. Edited by Bashar Katirji. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190603434.003.0015.
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Cervical radiculopathy and neck pain are among the most common neurological presentations seen in clinical practice. Cervical radiculopathy results in radicular pain, sensory manifestations, motor weakness and reflex changes, that are dependent on the specific compressed cervical root. The accurate diagnosis of cervical radiculopathy depends on a detailed neurological examination supplemented by electrodiagnostic studies and imaging of the cervical spine. This case highlights the anatomy, pathophysiology, and findings of the various cervical radiculopathies and distinguishes them from brachial plexopathies and other upper limb mononeuropathies. The benefits, pitfalls, and challenges of electrodiagnostic studies, including nerve conduction studies and needle electromyography, are also discussed.
16
Psych ER: Psychiatric Patients Come to the Emergency Room. The Analytic Press, 2003.
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17
Hinshaw, Stephen P., and Richard M. Scheffler. ADHD in the twenty-first century. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198739258.003.0002.
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ADHD is a worldwide phenomenon of considerable importance, having generated major controversy throughout its history. In this chapter we emphasize the confluence of biological vulnerabilities and contextual influences essential for its manifestations. We also provide information on the sharp rises in both diagnosed prevalence and rates of medication treatment in recent years, providing a case example from the US pertaining to the influences of educational policies as one trigger of such increases. We conclude with commentary on the need for integrative and integrated perspectives on both the origins of ADHD and evidence-based treatments. Even though ADHD has important heritable and biological roots, its symptoms and impairments are amplified or diminished in homes and schools, and multimodal treatments are optimal for enhancing competence. Moreover, societal context and policy clearly shape diagnostic trends. We emphasize the need for integrative perspectives on ADHD, as reductionistic viewpoints polarize essential dialogue.
18
Gary, Peterson. Ways on How to Manage Chronic Pain: Breaking the Chronic Pain System/cycle, to Diagnose and Eliminate the Root Cause of Pain, Effective Strategies to Increase Comfort, Reduce Stress, Pain Management. Independently Published, 2021.
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19
Bates, David. Spinal cord disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0650.
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Non-traumatic spinal cord disease may be caused by compression due to tumour, infection or haematoma, inflammation, infection or post-infection, metabolic disturbances, infarction, and degeneration. The diagnosis is often made easier by the clinical assessment: the patient’s age, the speed of onset of the disease, severity of the deficits, the pattern of motor and sensory involvement, and presence of pain and sphincter symptoms are all important in making an assessment of the site and likely nature of the spinal disease.Investigations are obligatory to confirm a diagnosis and to direct therapy. MRI is the most useful investigation. It has largely replaced myelography which should now only be considered in patients with indwelling cardiac pacing wires. Additional investigations including examination of the cerebrospinal fluid, evoked potentials, and specific blood tests may be required and the value of plain X-rays, CT scan, and, in some instances, angiography should not be overlooked.The remainder of this chapter will consider specific disorders, identifying pathology, clinical presentation, investigation, and management. Acute and chronic conditions are considered separately and those affecting the cauda equina, spinal root, and sphincters are considered in Chapter 29.
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Lonser, Russell, and Brad Elder, eds. Surgical Neuro-Oncology. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190696696.001.0001.
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Surgical Neuro-Oncology, part of the Neurosurgery by Example series, has the overarching goal of spanning the spectrum of clinical practice and complexity within adult surgical neuro-oncology using representative cases. The presentation and discussion reflects the logic, thought process, and technical details behind surgical candidacy, planning, surgical procedure (including bail-out options, and complication avoidance/management), aftercare, evidence and outcome, and lessons learned. Authors with expert knowledge and technical skills address a wide range of complex clinical cases, which are presented as they are encountered the neurosurgical clinic, hospital emergency department, and operating room. While addressing the overall diagnosis, treatment, and outcome, the authors provide insight into how they handle each case. The books transmits experience gained from leaders to colleagues and provides a great background for maintenance of certification preparation, with each chapter providing lists that highlights elements of accurate diagnosis, successful treatment, and effective complication management. Cases included cover the spectrum of clinical diversity and complexity within surgical neuro-oncology.
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Astarci, Parla, Laurent de Kerchove, and Gébrine el Khoury. Aortic emergencies. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0061.
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Acute aortic dissections account for the leading and most feared of aortic emergencies. Acute dissections are associated with a dreadful mortality rate; therefore, an accurate diagnosis and immediate treatment are mandatory. The key point of a lifesaving management strategy is the distinction between acute type A dissection, uncomplicated type B dissection, and complicated type B dissection, and those including contained ruptured aorta (severe pleural effusion) and/or malperfusion syndrome (by end-organ ischaemia: paraplegia, intestinal ischaemia, renal insufficiency, limb ischaemia). Type A generally requires urgent surgery; uncomplicated type B dissections are treated conservatively, while complicated type B dissections are currently managed by means of minimally invasive endovascular techniques, eventually associated with a tight surgical time (e.g. in the case of limb ischaemia). Surgical repair of type A dissection consists of the replacement of the ascending aorta. The repair is extended proximally towards the aortic root and valve, and distally towards the aortic arch, in function of the lesions found and the clinical presentation of the patient (haemodynamic status, age, comorbidities). The emergence of endovascular techniques and the contribution of thoracic endovascular aortic repair, with thoracic stent-grafts deployed from the proximal descending aorta to reopen the true lumen and to seal the entry tear in type B dissections, have revolutionized the surgical treatment algorithm in this pathology, and thus the patient’s immediate and medium-term survival. In the same group of acute aortic syndromes, traumatic aortic isthmic ruptures are also life-threatening conditions and account for one of the main causes of death at the time of traumatic accidents. As in the case of complicated type B dissections, the introduction of aortic stent-grafts has changed the outcome of these patients.
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Anitescu, Magdalena, and Chirag Shah. The Vasovagal Reflex and Neuraxial Techniques. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0042.
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Syncope, or the transient loss of consciousness, is one of the leading causes of emergency department visits. Syncope can be neurally mediated, orthostatic, cardiac, or cerebrovascular. Neurally mediated vasovagal syncope is the most frequent form. Diagnostic modalities are tilt- table testing and implantable loop recorders. Therapeutic options usually begin with supportive measures, such as a fluid bolus or changing patient positioning, but complex cases may require vasoactive agents or placement of a pacemaker. In many situations patients who present to the operating room for various surgeries may suffer from asymptomatic neurally mediated syncope. Regional anesthetic techniques and interventional pain procedures can complicate syncope by superimposing sympathectomy.
23
Shaibani, Aziz. Pseudoneurologic Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0022.
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The term functional has almost replaced psychogenic in the neuromuscular literature for two reasons. It implies a disturbance of function, not structural damage; therefore, it defies laboratory testing such as MRIS, electromyography (EMG), and nerve conduction study (NCS). It is convenient to draw a parallel to the patients between migraine and brain tumors, as both cause headache, but brain MRI is negative in the former without minimizing the suffering of the patient. It is a “software” and not a “hardware” problem. It avoids irritating the patient by misunderstanding the word psychogenic which to many means “madness.”The cause of this functional impairment may fall into one of the following categories:• Conversion reaction: conversion of psychological stress to physical symptoms. This may include paralysis, hemisensory or distal sensory loss, or conversion spasms. It affects younger age groups.• Somatization: chronic multiple physical and cognitive symptoms due to chronic stress. It affects older age groups.• Factions disorder: induced real physical symptoms due to the need to be cared for, such as injecting oneself with insulin to produce hypoglycemia.• Hypochondriasis: overconcern about body functions such as suspicion of ALS due to the presence of rare fasciclutations that are normal during stress and after ingestion of a large amount of coffee. Medical students in particular are targets for this disorder.The following points are to be made on this topic. FNMD should be diagnosed by neuromuscular specialists who are trained to recognize actual syndrome whether typical or atypical. Presentations that fall out of the recognition pattern of a neuromuscular specialist, after the investigations are negative, they should be considered as FNMDs. Sometimes serial examinations are useful to confirm this suspicion. Psychatrists or psychologists are to be consulted to formulate a plan to discover the underlying stress and to treat any associated psychiatric disorder or psychological aberration. Most patients think that they are stressed due to the illness and they fail to connect the neuromuscular manifestations and the underlying stress. They offer shop around due to lack of satisfaction, especially those with somatization disorders. Some patients learn how to imitate certain conditions well, and they can deceive health care professionals. EMG and NCS are invaluable in revealing FNMD. A normal needle EMG of a weak muscles mostly indicates a central etiology (organic or functional). Normal sensory responses of a severely numb limb mean that a lesion is preganglionic (like roots avulsion, CISP, etc.) or the cause is central (a doral column lesion or functional). Management of FNMD is difficult, and many patients end up being chronic cases that wander into clinics and hospitals seeking solutions and exhausting the health care system with unnecessary expenses.It is time for these disorders to be studied in detail and be classified and have criteria set for their diagnosis so that they will not remain diagnosed only by exclusion. This chapter will describe some examples of these disorders. A video clip can tell the story better than many pages of writing. Improvement of digital cameras and electronic media has improved the diagnosis of these conditions, and it is advisable that patients record some of their symptoms when they happen. It is not uncommon for some Neuromuscular disorders (NMDs), such as myasthenia gravis (MG), small fiber neuropathy, and CISP, to be diagnosed as functional due to the lack of solid physical findings during the time of the examination. Therefore, a neuromuscular evaluation is important before these disorders are labeled as such. Some patients have genuine NMDs, but the majority of their symptoms are related to what Joseph Marsden called “sickness behavior.” A patient with carpal tunnel syndrome (CTS) may unconsciously develop numbness of the entire side of the body because he thinks that he may have a stroke.
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Lövey, Imre, Eszter Erdélyi, and Manohar Nadkarni. How Healthy Is Your Organization? Praeger, 2007. http://dx.doi.org/10.5040/9798400666636.
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In today's stressful work environment, organizations can be crippled not only by product failures or dramatic market shifts but by internal demons. Typical symptoms of corporate dis-ease include distrust, lack of communication, territoriality, and other negative qualities that fester below the surface and ultimately sap the organization's vitality. But according to these experts in organizational dynamics, it doesn't have to be that way. In truly strong organizations, employees experience joy in performing their tasks and give their utmost to add value and help achieve organizational goals. This provocative book, featuring over fifty case studies, shows how organizations can uncover problems in the corporate culture, root them out, and prosper. As the authors argue, sustainable profitability, over the long term, is a function of achieving a balance among financial objectives, customer demands, and employee needs. Through numerous examples, case studies, and diagnostic exercises, the authors show managers and employees, as well as students and researchers of organizational behavior, how to identify the sources of organizational disease and focus on promoting a positive, inclusive culture. The end result? Profitability, better employee retention, and a company that's fun to work for.
25
Smith, Rebecca. Smallpox. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0063.
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Symptoms of the smallpox virus include fever and a progressive papular rash that becomes vesicular and then pustular. A systemic inflammatory response syndrome (SIRS) leads to septic shock and death in 30% of cases. The definitive diagnosis can be confirmed via blood samples, lesion contents, or scrapings from crusts analyzed using electron microscopy, viral antigen immunohistochemistry, or polymerase chain reaction. The suspicion of a single smallpox case should lead to immediate notification of local public health authorities and the hospital epidemiologist. Because the disease does not exist in nature, smallpox should be considered the result of a bioterrorist attack until proven otherwise. An epidemiologic investigation is essential for determining the perimeter of the initial release so that tracking and quarantine of those exposed can be completed. Patients are extremely contagious and must be placed on contact, droplet, and airborne precautions in a negative pressure room.
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Pitt, Matthew. Investigation of channelopathies. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754596.003.0008.
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The chapter begins with a general description of the clinical findings in conditions where hyperexcitability occurs. These are divided into the dystrophic conditions, such as myotonia dystrophy, and the non-dystrophic conditions, which include myotonia congenita, paramyotonia congenita, and potassium-aggravated myotonia. Conditions where hypoexcitability occurs such as periodic paralysis are next discussed. The associated disorders of sodium, calcium, chloride, and potassium channels are described. Next, the protocols for the neurophysiological tests that are used in myotonia, and the short exercise test either at room temperature or after cooling are introduced. The different patterns seen in these tests are outlined and the algorithms allowing precise targeting of genetic testing explained. The inter-discharge interval calculation that can be used in delineating the causes of myotonia is discussed. Other conditions where prominent spontaneous activity occurs such as Schwartz–Jampel syndrome and Pompe’s disease are described. The chapter concludes with details of the long exercise test used in diagnosis of periodic paralysis.
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Garcia, Erik J., and Warren J. Ferguson. General medical disorders with psychiatric implications. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0038.
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Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.
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Garcia, Erik J., and Warren J. Ferguson. General medical disorders with psychiatric implications. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199360574.003.0038_update_001.
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Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.