psychosis

see also:

• anti-psychotic medications
• Mental state - delirium vs dementia vs psychosis
• medical clearance of the acutely disturbed patient prior to transfer to a mental health facility
• bipolar disorder
• psychiatry and mental health

• clouding of consciousness
• focal neurologic abnormality
• inflammatory process - eg. febrile illness
• systemic disease
• atypical age of onset (> 35 years of age)
• lack of prior episodes of psychosis
• lack of expected family history
• focal symptoms (eg. unilateral hallucinations)
• non-auditory hallucinations
• catatonia
• co-existing deficit syndromes - delirium, dementia, aphasia, amnesia, etc
• atypical clinical course
• atypical response to treatment

• schizophrenia
• bipolar disorder

• see table below

• psychotic symptoms are common in the elderly due to underlying medical conditions and/or susceptibility to certain effects of medications
• most of these causes generally cause delirium as well but can sometimes present as an acute psychosis

• brain tumour, infection, cerebrovascular events
• intracranial infection - meningitis, etc
• intracranial haemorrhage
• SLE
• non-convulsive seizures

• hyponatraemia, hypernatraemia, etc
• thyrotoxicosis
• sepsis
• etc

• anti-muscarinic anticholinergic agents - particularly in the young and the elderly
  • H2 antihistamines
• dopamine agonists
• 1st generation H1 antihistamines such as cimetidine (rare with 2nd generation)

• ACE inhibitors
• beta adrenergic blockers
• calcium channel blockers
• cephalosporins - esp. in renal impairment
• flouroquinolone antibiotics
• indomethacin
• procaine derivatives
• sulphonamides

• tricylics - especially if bipolar disorder
• monoamine oxidase inhibitors (MAOIs)
• SSRI/SNRI antidepressants

• anti-muscarinic anticholinergic agents
  • Antihistamine overdose
• corticosteroids
• Anticonvulsant overdose
• opiates and opioids
• salicylate poisoning

• benzodiazepines
• ethanol intoxication/poisoning
• corticosteroids

• amphetamines and related substances
• anabolic steroids
• alcohol
• psychedelic drugs
  • LSD
  • phencyclidine
  • etc.