First, dramatic, unlikely or even impossible physical complaints may of course be symptomatic of primary psychiatric illness. somatic preoccupations are common in both schizophrenia and major depression, and may range from a chronic sense of unwellness to the fixed conviction of a dread disease (acquired immunodeficiency syndrome, cancer), to bizarre ideas of infestation, or to deliberate implantation of foreign bodies or devices. The true anorexia of depression, as well as the odd and rigid eating patterns seen in schizophrenia, obsessive compulsive disorder and eating disorders, may lead to weight loss and delayed transit times suggestive of primary medical illness. indeed, some such patients may deliberately injure themselves in direct response to hallucinated commands or delusional convictions. Drawing out patients' beliefs about their illnesses may reveal these processes, but formal psychiatric consultation, including personal and family history, mental state examination, and corroborative interviews, are necessary to establish the diagnosis and institute treatment.
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