Psychosis

Question 1

Key history in psychosis

Answer 1

Positive symptoms (delusions, hallucinations, disorganized thoughts, catatonia)
Negative symptoms (blunted affect, social withdrawal, amotivation, decreased speech and thought)
Cognitive symptoms (disorganized speech, thought patterns, paranoia)
Age at first symptoms or hospitalization
Prior psychiatric medications
Alcohol and substance use

Question 2

Key physical exam in psychosis

Answer 2

Vital signs, MMSE, general appearance (poor grooming, poorly fitting or odd clothing)

Question 3

19 yo M with paranoid delusions
+ social withdrawal since high school
+ poor grooming

Answer 3

Schizophrenia
Schizoid or schizotypal personality disorder
Schizophreniform disorder

MMSE, urine toxicology, TSH, CBC, electrolytes

Question 4

28 yo F seeing bugs crawling on her over last two days after ingesting unknown substance
+ auditory hallucinations
+ no prior episodes

Answer 4

Substance-induced psychosis
Brief psychotic disorder
Schizophreniform disorder

Urine toxicology, MMSE, TSH, CBC, electrolytes, BUN/Cr, AST/ALT

Question 5

48 yo F with one-week history of auditory hallucinations stating she should commit suicide
+ two-week history of weight loss, early morning awakening, decreased motivation, guilt

Answer 5

Schizoaffective disorder
Mood disorder with psychotic features
Schizophrenia

MMSE, Beck Depression Inventory, TSH, CBC, electrolytes