Psychosis, Acute

Basics

Description

A set of symptoms that can arise from various causes characterized by illogical, bizarre, or delusional beliefs, abnormal perceptions, and disorganization of emotions, thought, and behavior

Etiology

Psychiatric

  • Schizophrenia: >6 mo with 2 of the following:
    • Hallucinations
    • Delusions
    • Negative symptoms
    • Disorganized thought
    • Disorganized behavior
  • Brief psychotic disorder <1 mo
  • Schizophreniform disorder if symptoms 1–6 mo
  • Schizoaffective disorder: Prominent mood symptoms concurrent with psychotic decompensations
  • Delusional disorder: Presence of rigid delusion without other symptoms of psychosis
  • Mania with psychotic features
  • Depression with psychotic features

Medical, Nonpsychiatric

  • Neurologic disease:
    • Dementia (Alzheimer’s, Lewy body, frontotemporal dementia)
    • Seizures
    • Space-occupying lesions (neoplasm, abscess, cysts) → Depending on location, can produce psychosis-like symptoms if they affect frontal/temporal lobes.
    • Demyelinating diseases (multiple sclerosis)
    • Neuropsychiatric disorders (Parkinson, Huntington, Wilson disease) → can produce psychotic symptoms, often related to disease progression or treatment.
    • Prion disease (Creutzfeldt–Jakob disease) → Early stages may include hallucinations and paranoia before cognitive decline.
  • Infectious disease:
    • Meningitis/encephalitis (bacterial, viral, or fungal)
    • HIV
    • Tertiary syphilis
    • Tertiary Lyme disease
  • Metabolic:
    • Intoxication (psychostimulants, hallucinogens, ketamine, phencyclidine, cannabinoids, MDMA, dextromethorphan)
    • Adverse medication effect (cyclosporine, cycloserine, corticosteroids, fluoroquinolones, amantadine, levodopa, pramipexole, levetiracetam)
    • Heavy metal poisoning (arsenic, mercury)
    • Porphyria
  • Endocrine:
    • Thyroid disease
    • Cushing syndrome
    • Adrenal insufficiency
  • Autoimmune disease:
    • Lupus cerebritis
    • Autoimmune encephalitis
    • Paraneoplastic syndrome
  • Toxins:
    • Heavy metals
    • Carbon monoxide

There's more to see -- the rest of this topic is available only to subscribers.