Psychosis, Medical Vs. Psychiatric
Basics
Basics
Basics
Description
Description
Mental derangement involving hallucinations, delusions, or grossly disorganized behavior resulting in loss of contact with reality- Complex and poorly understood pathophysiology
- An excess in dopaminergic signaling may be a contributing factor
- Psychosis ranges from a relatively mild derangement to catatonia
- CNS impairment leading to a psychotic presentation may be due to:
- Neurologic disorders
- Metabolic conditions
- Toxins or drug effects
- Infections
- Higher risk for underlying psychiatric disorder:
- Hallucinations and illusions incorporated into delusional system
- Late adolescence/early adulthood
- Normal orientation
- Higher risk for underlying medical disorder:
- Middle- to late-life presentation
- Acute onset
- History of substance abuse
- No pre-existing psychiatric history
- Absence of a family history of major mental illness
- Presence of pre-existing medical disorders
- Lower socioeconomic level
- Recent memory loss
- Disorientation or distractibility
- Abnormal vital signs
- Visual hallucinations:
- Delirium
- Dementia
- Migraines
- Dopamine agonist therapy (i.e., carbidopa)
- Posterior cerebral infarcts
- Narcolepsy
Etiology
Etiology
- Neurologic:
- Head trauma
- Space-occupying lesions
- Cerebrovascular accident
- Seizure disorders
- Hydrocephalus
- Neuropsychiatric disorders (Parkinson, Huntington, Alzheimer, Pick, Wilson disease)
- Infectious:
- Focal infections in the elderly (UTI, pneumonia)
- HIV
- Neurosyphilis
- Encephalitis
- Lyme disease: Neuroborreliosis
- Parasites:
- Cerebral malaria
- Neurocysticercosis
- Schistosomiasis
- Toxoplasmosis
- Trypanosomiasis
- Metabolic:
- Electrolyte imbalance
- Hypoglycemia
- Hypoxia
- Porphyria
- Withdrawal syndromes
- Endocrine:
- Thyroid disorders
- Parathyroid disorders
- Diabetes mellitus
- Pituitary abnormalities
- Adrenal abnormalities
- End-organ failure:
- Cardiac/respiratory
- Renal
- Hepatic
- Nutritional deficiencies:
- Pernicious anemia
- Wernicke–Korsakoff syndrome
- Pellagra
- Pyridoxine deficiency
- Autoimmune disorders:
- Systemic lupus erythematosus
- Sarcoidosis
- Myasthenia gravis
- Paraneoplastic syndromes
- Demyelinating disease:
- Multiple sclerosis
- Leukodystrophies
- Postoperative states:
- Intoxicants:
- Alcohol
- Benzodiazepines
- Barbiturates
- Stimulants (cocaine, amphetamines)
- Hallucinogens
- Opiates
- Anticholinergic compounds
- Inhalants
- Cannabis/synthetic cannabinoids
- Toxins:
- Bromide
- Carbon monoxide
- Heavy metals
- Organophosphates
- Medication side effects:
- Corticosteroids
- Anticholinergics
- Sedative-hypnotics
- Psychiatric:
- Antidepressants
- Antipsychotics
- Lithium carbonate
- Antiparkinsonian drugs
- Anticonvulsants
- Antibiotics (quinolones, isoniazid)
- Antihypertensive agents
- Cardiac (digitalis, lidocaine, propranolol, procainamide)
- Interferon
- Muscle relaxants
- Over-the-counter medications:
- Pseudoephedrine
- Antihistamines
- Psychiatric:
- Schizophrenia
- Schizoaffective disorder
- Delusional disorder
- Bipolar disorder with psychotic features
- Major depression with psychotic features
- Stress reactions including posttraumatic stress disorder
- Narcolepsy (hallucinations at edge of sleep/wake cycle)
- Postpartum psychosis
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