Psychosis Workup Flashcards
Key differentials
-mental
-physical
-substances
Mental
-schizophrenia
-schizoaffective
-psychotic depression/mania
Physical
-thyroid
-encephalitis
-tumour/SOL
-epilepsy
Substances
-medication SE
-alcohol
-substance use
History
-what you aim to do
Establish timeline
-triggers
-duration
-pattern of symptoms
Systems review
-abdo, neuro, thyroid
Observations, examination
A-E exam, vital signs
Neuro
Thyroid focused
Abdo
-opiates - pinpoint pupils
-liver signs - alcohol misuse
-arms - IV drugs
MSE
Bloods
-what would you like to dop
FBC, CRP - infective
LFT
TFT
Urine + tox
EEG
Head CT/MRI
CSF LP
How to differential between schizophrenia, drug induced psychosis, psychotic depression, schizoaffective disorder
-schizophrenia
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
How to differential between schizophrenia, drug induced psychosis, psychotic depression, schizoaffective disorder
-drug induced psychosis
Acute
Duration of hours-days
Pattern with cannabis
-Resolves when cannabis stopped
How to differential between schizophrenia, drug induced psychosis, psychotic depression, schizoaffective disorder
-psychotic depression
Gradual onset
Can be concurrent substance use but doesn’t resolve
Last months if untreated
Mood congruent
-nihilistic delusions
How to differential between schizophrenia, drug induced psychosis, psychotic depression, schizoaffective disorder
-schizoaffective
Prodrome
Mood and psychosis at same time
Mood symptoms not as severe as psychotic depression