Sub/Med Induced Psychotic Disorder + Due to AMC Flashcards by Alana Meikle

criterion A for substance/medication induced psychotic disorder

presence of ONE OR BOTH of the following symptoms:

delusions
hallucinations

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criterion B for substance/medication induced psychotic disorder

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

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

AND

the involved substance/med is capable of producing the symptoms in criterion A

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criterion C for substance/medication induced psychotic disorder

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

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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)

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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criterion D substance/medication induced psychotic disorder

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

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criterion E substance/medication induced psychotic disorder

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

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

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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what specifiers are there for substance/medication induced psychotic disorder

with onset during intoxication–> if criteria are met for intox with the substance and the symptoms develop during intoxication
with onset during withdrawal

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

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

alcohol withdrawal

cannabis intoxication

sedative, hypnotic or anxiolytic withdrawal

stimulant intoxication

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which drugs of abuse can cause psychosis in the intoxication phase

cannabis

alcohol

hallucinogens

inhalants

sedative, hypnotics, anxiolytics

stimulants

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which drugs of abuse can cause psychosis in the withdrawal phase

alcohol

sedative, hypnotic or anxiolytic drugs

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list medication classes reported to cause psychotic symptoms

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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list toxins known to cause psychotic symptoms

anticholinesterase

organophosphate insecticides

sarin and other nerve gasses

carbon monoxide

carbon dioxide

volatile substances such as fuel or paint

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

unknown

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

7-25% (depending on setting)

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in what situation is psychosis due to alcohol use most likely

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

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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what is formication

hallucination of bugs or vermin crawling in or under the skin

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how might cannabis induced psychotic disorder present

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

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

cocaine

phencyclidine

amphetamines

what is the course of substance/medication induced psychotic disorder

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

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

what opioid may cause psychosis

meperidine

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

“hallucinogen persisting perception disorder”

criterion A for psychotic disorder due to another medical condition

prominent hallucinations or delusions

criterion B for psychotic disorder due to another medical condition

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

criterion C for psychotic disorder due to another medical condition

disturbance not better explained by another mental disorder

criterion D for psychotic disorder due to another medical condition

disturbance does not occur exclusively in the course of a delirium

criterion E for psychotic disorder due to another medical condition

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

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

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"

olfactory hallucinations suggest which etiology?

temporal lobe epilepsy

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

no not usually

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

persecutory

lifetime prevalence of psychotic disorder due to another medical condition

0.21-0.54%

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

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

what are the medical conditions most commonly associated with psychosis

untreated endocrine and metabolic disorders autoimmune disorders (i.e SLE, NMDA receptor autoimmune encephalities) temporal lobe epilepsy

how might you classify psychosis associated with epilepsy

ictal, post ictal or interictal psychosis

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

postictal psychosis

what is the prevalence of post ictal psychosis

2-7.8% of epilepsy patients

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

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

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

head trauma epilepsy autoimmune neoplastic diseases of early to mid life

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

stroke disease anoxic events multiple system comorbidities

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

vision and hearing impairments preexisting cognitive impairment

list neurological conditions that may be associated with symptoms of psychosis

neoplasms CV disease Huntingtons MS epilepsy auditory or visual nerve injury or impairment deafness migraine CNS infections

list endocrine conditions that may be associated with psychosis

hyper or hypothyroidism hyper or hypoparathyroidism hyper or hypoadrenocorticism

list metabolic conditions that may be associated with psychosis

hypoxia hypercarbia hypoglycemia

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

fluid or electrolyte imbalances hepatic or renal diseases autoimmune disorders with CNS involvement

name two medical conditions associated with higher risk of suicide

epilepsy MS