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3. Psychosis > Sub/Med Induced Psychotic Disorder + Due to AMC > Flashcards

Sub/Med Induced Psychotic Disorder + Due to AMC Flashcards

1
Q

criterion A for substance/medication induced psychotic disorder

A

presence of ONE OR BOTH of the following symptoms:

  1. delusions
  2. hallucinations
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2
Q

criterion B for substance/medication induced psychotic disorder

A

there is evidence from the history, physical examination, or lab findings of BOTH:

  1. symptoms in criterion A developed during or soon after substance intoxication or withdrawal or after exposure to medication

AND

  1. the involved substance/med is capable of producing the symptoms in criterion A
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3
Q

criterion C for substance/medication induced psychotic disorder

A

the disturbance is not better explained by a psychotic disorder that is not sub/med induced

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4
Q

what evidence may suggest that psychotic symptoms are better explained by a psychotic disorder rather than a substance or medication (i.e for criterion C of substance/medication induced psychotic disorder)

A

the symptoms PRECEDED the onset of the sub/med use

the symptoms persist for a substantial period of time i.e ABOUT ONE MONTH AFTER the cessation of acute withdrawal or severe intoxication

there is other evidence of an independent non sub/med induced psychotic disorder i.e hx recurring nonsub/med induced episodes

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5
Q

criterion D substance/medication induced psychotic disorder

A

the disturbance does not occur exclusively during the course of a delirium

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6
Q

criterion E substance/medication induced psychotic disorder

A

the disturbance causes clinically significant distress or impairment in social, occupational or other areas of functioning

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7
Q

under what circumstances should you diagnose substance/medication induced psychotic disorder rather than simply substance intoxication or withdrawal?

A

only when the symptoms in criterion A (delusions/hallucinations) PREDOMINATE in the clinical picture and when they are sufficiently severe to warrant clinical attention

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8
Q

what specifiers are there for substance/medication induced psychotic disorder

A
  1. with onset during intoxication–> if criteria are met for intox with the substance and the symptoms develop during intoxication
  2. with onset during withdrawal
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9
Q

are hallucinations accompanied by insight included in criterion A of substance/medication induced psychotic disorder

A

no–> if the person realizes they are hallucinations, then you would code this as intoxication or withdrawal with perceptual disturbances, not psychosis

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10
Q

which substances might we expect may cause hallucinations with insight either in the withdrawal or intoxication phases

A

alcohol withdrawal

cannabis intoxication

sedative, hypnotic or anxiolytic withdrawal

stimulant intoxication

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11
Q

which drugs of abuse can cause psychosis in the intoxication phase

A

cannabis

alcohol

hallucinogens

inhalants

sedative, hypnotics, anxiolytics

stimulants

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12
Q

which drugs of abuse can cause psychosis in the withdrawal phase

A

alcohol

sedative, hypnotic or anxiolytic drugs

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13
Q

list medication classes reported to cause psychotic symptoms

A

anesthetics and analgesics

anticholinergic agents

anticonvulsants

antihistamines

antihypertensives and cardiovascular drugs

antimicrobial medications

antiparkinsonian medication

chemotherapeutic agents (i.e cyclosporine, procarbazide)

corticosteroids

GI medications

muscle relaxants

NSAIDs

phenylephrine

pseudoephedrine

antidepressants

disulfiram

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14
Q

list toxins known to cause psychotic symptoms

A

anticholinesterase

organophosphate insecticides

sarin and other nerve gasses

carbon monoxide

carbon dioxide

volatile substances such as fuel or paint

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15
Q

what is the prevalence of substance/medication induced psychotic disorder in the general population

A

unknown

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16
Q

what is the prevalence of substance/medication induced psychotic disorder in those presenting with first episode of psychosis

A

7-25% (depending on setting)

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17
Q

in what situation is psychosis due to alcohol use most likely

A

only after prolonged, heavy ingestion in individuals who have moderate to severe AUD and hallucinations are generally auditory

*unlikely otherwise (but can have during withdrawal)

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18
Q

how might substance/medication induced psychotic disorder due to stimulant use present

A

persecutory delusions may develop rapidly after use

hallucination of bugs or vermin crawling in or under the skin can lead to scratching and extensive skin excoriations

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19
Q

what is formication

A

hallucination of bugs or vermin crawling in or under the skin

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20
Q

how might cannabis induced psychotic disorder present

A

may develop shortly after high-dose cannabis duse

usually involves:
persecutory delusions
marked anxiety
emotional lability
depersonalization

*usually remits within a day but can persist for several days

21
Q

list three agents that have been reported to trigger temporary psychotic states that have persisted for weeks or longer despite removal of the agent and treatment with neuroleptics

A

cocaine

phencyclidine

amphetamines

22
Q

what is the course of substance/medication induced psychotic disorder

A

typically severely disabling in acute phase–> most often observed in ER

typically self limiting however and usually resolves upon removal of the offending agent

23
Q

what opioid may cause psychosis

A

meperidine

24
Q

how do you characterize “flashback” hallucinations due to hallucinogen use in the past

A

“hallucinogen persisting perception disorder”

25
Q

criterion A for psychotic disorder due to another medical condition

A

prominent hallucinations or delusions

26
Q

criterion B for psychotic disorder due to another medical condition

A

there is evidence from the history, physical exam or lab findings that the disturbance is the direct pathophysiological consequence of another medical condition

27
Q

criterion C for psychotic disorder due to another medical condition

A

disturbance not better explained by another mental disorder

28
Q

criterion D for psychotic disorder due to another medical condition

A

disturbance does not occur exclusively in the course of a delirium

29
Q

criterion E for psychotic disorder due to another medical condition

A

disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning

30
Q

what are the two specifiers for psychotic disorder due to another medical condition

A

with delusions

with hallucinations

*also make sure to list the medical conditions felt to be causing the psychosis ie “psychotic disorder due toa malignant lung neoplasm, with delusions”

31
Q

olfactory hallucinations suggest which etiology?

A

temporal lobe epilepsy

32
Q

do you diagnose psychotic disorder due to another medical condition if the person maintains reality testing?

A

no not usually

33
Q

what are the most common delusions seen with psychotic disorder due to another medical condition

A

persecutory

34
Q

lifetime prevalence of psychotic disorder due to another medical condition

A

0.21-0.54%

35
Q

how does prevalence of psychotic disorder due to another medical condition change over the lifespan

A

much higher in people older than 65 years (i.e prevalence of 0.74%)

36
Q

what are the medical conditions most commonly associated with psychosis

A

untreated endocrine and metabolic disorders

autoimmune disorders (i.e SLE, NMDA receptor autoimmune encephalities)

temporal lobe epilepsy

37
Q

how might you classify psychosis associated with epilepsy

A

ictal, post ictal or interictal psychosis

38
Q

which of the three forms of psychosis associated with epilepsy is the most common

A

postictal psychosis

39
Q

what is the prevalence of post ictal psychosis

A

2-7.8% of epilepsy patients

40
Q

what is the course of psychotic disorder due to another medical condition

A

while treatment of the medical condition often results in resolution of symptoms, sometimes the psychosis persists beyond this–> i.e with psychosis due to focal brain injury

in MS or chronic interictal psychosis of epilepsy, psychosis may assume a long term course

41
Q

what medical conditions are more likely to be found in younger populations that may be related to psychosis?

A

head trauma

epilepsy

autoimmune

neoplastic diseases of early to mid life

42
Q

what medical conditions are more likely to be found in older populations that may lead to psychosis

A

stroke disease

anoxic events

multiple system comorbidities

43
Q

what accumulated events of older age may lower threshold for experiencing psychosis

A

vision and hearing impairments

preexisting cognitive impairment

44
Q

list neurological conditions that may be associated with symptoms of psychosis

A

neoplasms

CV disease

Huntingtons

MS

epilepsy

auditory or visual nerve injury or impairment

deafness

migraine

CNS infections

45
Q

list endocrine conditions that may be associated with psychosis

A

hyper or hypothyroidism

hyper or hypoparathyroidism

hyper or hypoadrenocorticism

46
Q

list metabolic conditions that may be associated with psychosis

A

hypoxia

hypercarbia

hypoglycemia

47
Q

other than those already reviewed, what other conditions may cause psychosis

A

fluid or electrolyte imbalances

hepatic or renal diseases

autoimmune disorders with CNS involvement

48
Q

name two medical conditions associated with higher risk of suicide

A

epilepsy

MS

3. Psychosis (10 decks)

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