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DDx of Psychosis (Substance/Medication-Induced (stimulants, hallucinogens,…
DDx of Psychosis
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Medical condition
neurologic - tumors, seizures, stroke, Parkinsons, Huntington, MS, ALS
endocrine - thyroid/PTH dysfct, adrenal disorder
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infectious - meningitis/encephalitis, HIV, neurosyphilis
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vitamin def - B12, folate
metabolic - acute intermittent porphyria, Na/K imbalance, hepatic encephalitis, uremic encephalitis, Wilson's disease
Brief Psychotic Disorder
more than 1 day, < 1 month
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treatment - may need hospitalization, usu self-limited, antipsychotics possibly, psychodynamic tx after recovery to better cope
Schizoaffective disorder
A. An uninterrupted period of illness during which there is a major mood episode concurrent w/ part A of schizophrenia
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C. S/s that meet criteria for a major mood episode present for the majority of the total duration of active and residual portions of illness
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Epi: < 1% prevalence, more common in women, tx should target both mood and psychotic s/s; SGA have mood stabilizing properties
Delusional Disorder
def'n - well-systemized delusions in presence of well-preserved personality; 1 mo+; no disorganized thoughts or negative s/s
epi - 0.2% general population; no major gender diff; middle-late adult life; generally employed and self-supporting
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treatment - poor response to antipsychotics; SSRIs maybe; somatic subtype responds to pimozide; no group tx
Schizophrenia
DSM-5
A. 2+ of following, at least one of 1), 2), 3)
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F. Autism spectrum or childhood communication disorder - schizophrenia diagnosed only if prominent delusions/hallucinations
Epi
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first episode: 18-25 men, 21-30 women
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Symptoms
Psychotic (positive)
Hallucinations: auditory, visual, somatic-tactile
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Treatment
Antipsychotics
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side effects
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sedation - seroquel, clozaril
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anticholinergic effects: dry mouth, urinary retention, blurry vision, constipation
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NMS - rigidity, fever, delirium, autonomic instability, elevated CK/LFT
metabolic changes: weight gain, glucose intolerance, hyperlipidemia
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