Psychosis

Question 1

Diagnostic criteria for Schizophrenia:

Answer 1

DSM V:

AT LEAST 2
Present AT LEAST 1 MONTH
MUST INCLUDE 1,2 or 3:

• Delusions
• Hallucinations
• Disorganised speech
• Grossly abnormal motor behaviour (incl. catatonia)
• Negative symptoms

Question 2

‘Negative’ symptoms in schizophrenia:

Answer 2

Blunted affect
Reduced activity (avolition)
Reduced speech (alogia)
Reduced pleasure (ahedonia)
Social withdrawal

Question 3

Psychosis differentials:

Answer 3

PSYCHIATRIC
Schizophrenia
Depression with psychosis (incl. PND)
Mania with psychosis

ORGANIC
Biochemical: thyroid, hyper/oNa, hyperCa, hypoglycaemia, hypoxia, deficiencies (B12, thiamine)

Infective: encephalitis, sepsis delirium

CNS: dementia, stroke, brain tumour, subdural, encephalitis, neurosyphilis, AIDS, Huntingtons, Wilson’s, Epilepsy

Substances: hallucinogens, amphetamines, withdrawal, alcohol, ketamine, LSD, MMDA, ecstasy, THC

Meds: steroids, anticholinergic, dopamine agonists

Poisoning: CO, lead

Porphyria

Question 4

Signs of delirium, rather than psychosis:

Answer 4

Disorientation (time and place)
Fluctuating
Plucking
Poor attention
ALOC

Question 5

‘Medical clearance’ in psychosis:

Answer 5

History:
Age of onset (>40 first presentation suspicious)
PMHx and meds (eg. Epilepsy, steroids)
Substances
Head injury

Examine:
Vitals (eg. Hypoxia, fever)
Head injury
Focal neurology
Toxidrome- intoxication or poisoning

Investigate.
CONSIDER:
- BSL, electrolytes, CMP, CTB,
- B12/ folate, LFTs, BAL
Etc.