Mad as hell ! Medical causes of Anger

I really enjoy conversing with sassy & fun elderly patients who have lived long enough to be mad at everyone & everything but cope with it with a dash of humor. An elderly patient of mine was very displeased at low-salt lunch she was served after she had ordered food off of a shiny hospital cafe menu and blurted “The trailer was great, but the movie sucks!” 🤣

This post is about how I remember & recall causes of irritability and anger where the family is very concerned with the new personality changes. We rule out potentially treatable, medical or organic causes of anger. Here’s a mnemonic to help recall – Is your angry patient SCREAMING 😡?

S – Steroids (can also cause frank psychosis and emotional states), Sundowning (New Dementia coming on ? )
C – Calcium elevation
R – Recent tragic events (deaths, breakups, new diagnoses, job-loss, etc)
E – Epilepsy (non-convulsive or post-ictal confusion/anger) AND Encephalitis (Have seen in 3 cases of CJ-Disease I have seen thus far presenting with angry personality changes, a couple cases of herpes encephalitis presenting with anger & sleepiness and of course there is “Brain on Fire” encephalitis)
A – Ammonia elevation
M – Medications (including antiseizure, psychiatric and sleeping meds, excess thyroid & statins too)
I – Intoxications & Withdrawals (Don’t forget withdrawal from Nicotine & some prescription meds)
N – Neoplasms of brain (especially Frontal Lobe)
G – Glucose instability with highs and lows. (uncontrolled, too tightly controlled or brittle diabetics)