see also: [[Agitation]], [[Delirium vs psychosis]], [[Medical Clearance of psych patients#screening for underlying causes "organic screen"]] # Classification | disorder | definition | | ------------------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------ | | brief psychotic disorder | > 1 day - < 1 month<br>may be drug-related | | schizophreniform | 1 - 6 months | | schizophrenia | > 6 months; 60% of all psychosis | | schizoaffective | > 2 weeks of psychosis without predominant mood symptoms<br>- psychotic features w/ either major depressive episode, manic episode, or a mixed episode | | bipolar affective disorder w/ psychotic features | | | delusional disorder | > 1 month of non-bizarre delusions w/o active-phase sx of schizophrenia | | post-partum psychosis | within 6 weeks of delivery | | psychosis a/w medical illness | - CNS pathology<br>- [[Encephalopathy\|Encephalitis]]<br>- metabolic derangements<br>- usually a/w [[Delirium vs psychosis\|delirium]] | | drug-induced psychosis | - amphetamines<br>- cannabis<br>- LSD | # Schizophrenia - delusions - hallucinations - disorganised speech - disorganised or catatonic behaviour - *negative symptoms* - lack of motivation - poor self-care - blunted affected - reduced speech output - social withdrawl - things pt feels have been "taken away" from them - impaired cognitive f(x) common (eg impaired planning, mental flexibility, memory, and insight) ## Assessment - organic vs psychiatric cause - EtOH and drug abuse 75% lifetime risk for schizophrenia - complications of IVDU - high rates of smoking and COPD - complications of antipsychotic tx - anticholinergic side effects - orthostatic hypotension from alpha-blocking - serotonin tox - acute dystonia - parkinsonian symptoms - clozapine sx: - cardiomyopathy - neutropenia - diabetes common - socioeconomic crisis due to schizophrenia (poverty, homelessness, social isolation, failure of support systems) - neglected/disshevelled - mannerisms -- repeated urposeful movements out of context , tics - restless, agitated, or psychomotor retardation - response to auditory hallucinations ## Thought disorder - loosening of associations -- absence of logical thought progression - may give concrete answers - **thought blocking** -- sudden cessation of thought or speech - **tangental** -- getting off track of the subject and failiing to return - **circumstantial** -- digressive but able to return to subject - **neologisms** -- use of words that only have meaning to the person using them, independent of their common meaning others: - *perseveration* - *echolalia* -- repetition of statements used in the presence - *verbigeration* -- repetition of words or phrases Thought content: - thought insertion or withdrawl - delusions (often bizarre or paranoid) emotions: - inappropriate affect - emotional blunting *hallucinations* - occur in clear consciousness - not related to actual occurrences - auditory (75%) more common than visual # Drug-induced psychosis vs schizophrena #tables | features | drug-induced | schizophrenia | | ---------------------------------- | ---------------------- | --------------------------------- | | onset | sudden | slow | | age | in 20s | late teens | | duration | usually < 1 week | > 6 months | | Hx mental illness? | may be absent | may be first episode of psychosis | | agitation / violence | common | less common | | auditory hallucinations | rare | common | | paranoia | very common | common | | delusions | uncommon, variable | common, variable | | affect | appropriate to beliefs | blunted, inappropriate | | thought blocking and perseveration | rare | common |