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psychosis

psychosis

introduction

features that suggest an organic cause (ie. not a primary psychiatric cause)

  • 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

aetiology

primary psychiatric

secondary to drugs

  • see table below

secondary to medical conditions

  • 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

neurologic conditions

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

metabolic conditions

drugs which can cause psychotic symptoms (not just delirium)

adverse effects of normal doses of prescribed medications

  • 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)

uncommonly

hypomania or mania

adverse effects of toxic doses of prescribed medications

withdrawal reactions

recreational drugs

psychosis.txt · Last modified: 2011/10/04 21:09 (external edit)