Psychosis Workup

Question 1

Key differentials
-mental
-physical
-substances

Answer 1

Mental
-schizophrenia
-schizoaffective
-psychotic depression/mania

Physical
-thyroid
-encephalitis
-tumour/SOL
-epilepsy

Substances
-medication SE
-alcohol
-substance use

Question 2

History
-what you aim to do

Answer 2

Establish timeline
-triggers
-duration
-pattern of symptoms

Systems review
-abdo, neuro, thyroid

Question 3

Observations, examination

Answer 3

A-E exam, vital signs
Neuro
Thyroid focused
Abdo
-opiates - pinpoint pupils
-liver signs - alcohol misuse
-arms - IV drugs
MSE

Question 4

Bloods
-what would you like to dop

Answer 4

FBC, CRP - infective
LFT
TFT
Urine + tox
EEG
Head CT/MRI
CSF LP

Question 5

How to differential between schizophrenia, drug induced psychosis, psychotic depression, schizoaffective disorder
-schizophrenia

Answer 5

Prodrome
- increased social isolation
-low mood, increased anxiety
-difficulty focusing
-change in thinking or behaviour

Psychosis => low mood

Can be substance related but doesn’t resolve when stopped

Other symptoms of schizophrenia

Can last years if untreated

Question 6

How to differential between schizophrenia, drug induced psychosis, psychotic depression, schizoaffective disorder
-drug induced psychosis

Answer 6

Acute

Duration of hours-days

Pattern with cannabis
-Resolves when cannabis stopped

Question 7

How to differential between schizophrenia, drug induced psychosis, psychotic depression, schizoaffective disorder
-psychotic depression

Answer 7

Gradual onset

Can be concurrent substance use but doesn’t resolve

Last months if untreated

Mood congruent
-nihilistic delusions

Question 8

How to differential between schizophrenia, drug induced psychosis, psychotic depression, schizoaffective disorder
-schizoaffective

Answer 8

Prodrome

Mood and psychosis at same time

Mood symptoms not as severe as psychotic depression