1. What is psychosis?
    Impairment of reality testing manifested by delusions, hallucinations and/or disordered thought process.
  2. More common symptoms of psychosis.
    • Delusions
    • hallucinations
    • Disorganized thoughts
    • Incoherent speech
    • neologistic speech
    • disorganized behaviors
  3. Psychotic sysmtoms are not...
    diagnostic of a particular disorder but indicative of an underlying disorder.
  4. Differential diagnosis: Delusions
    Psychitic Disorders: Fixed with more stable themes and elaborate contents.

    Neuro/Systemic : tansiet, less systemized, homley
  5. Differential Diagnosis: Auditory Hallucinations
    Psych: Prominent in psych disorders; accusatory in schizophrenia, mood congruent in bipolar d/o or depression

    Neuro/Systemic: Less common, ill developed
  6. Differential Diagnosis: Visual Hallucinations
    Psych: Less common, tyically related to delusional themes, usually frighteneing

    Neuro/Systemic: Common in Alzheimers Disease, prakinsons treated with DA, not frightening.
  7. Differentail Diagnosis: Tactile
    Psych: Rare

    Neuro/Systemic: Hallmark of delirium
  8. Differential Diagnosis: Olfactory
    Psych: Uncommmon

    Neuro/Systemic: More common in temporal lobe disorders
  9. Differential Diagnosis: Incoherent or neologistic speech
    Psych: Meanings tend to be consistent and context specific

    Neuro/Systemic: Word salad more generalized and inconsistent, charactereistic aphasic symtoms per syndrome.
  10. Diffrential Diagnosis: Biazarre Behavior
    Psych: Maybe realated to delusional themes and tend to be sterotyped

    Neuro/Systemic:Little organization or purpose; often sporadic.
  11. True or false
    A person with a mental illness can have a worsening of symtoms related to systemic or neurological problems.
  12. True or false
    Differential diagnosis should be based on clincal history, inital onset of symtoms, frequency, changes over time and conext in which they occur.
  13. True or false
    A thorough medical work up is indicated in any patient with a new onset of psychotic symtoms and for the previously mental ill wih a worsening of symtoms.
  14. Name some neuro/systemic conditions that are associated with psychotic smtoms.
    • Head injury dementing illness
    • seizure disorder alzheimer
    • parkinsons huntington
    • picks stroke
    • korsakoffs subdermal hematoma
    • enchelphalitis meningitiis
    • neuro syphillis AIDS
    • CNS infections Substance abuse
    • brain tumor abssesses
    • systematis lupsus
    • chronic metabolic disturbances
    • hypo/per thyroidism
    • cushings porphira
    • pernicous anemia hydroceph
  15. How can psychotic symptoms of mental illness be distinguished from those of neurological systemic conditions?
    • Include knowledgable informant
    • History
    • phycail exam
    • mental status exam
    • neurological exam
    • lab studies
    • neurophysical eval
    • neuroimaging
    • electrophysiologcal studies
  16. True or false
    Delirium is not a medical emergnecy.
  17. True or false
    People with delirium have a great morbidity and mortality.
  18. Immediate clues that a patient is delirious.
    • intermittent disorientation to time/place
    • easily distracable
    • Mumbling/muttering
    • Hyper or hypo activity
    • sundowning
    • illusions
    • extreme emotional lability
    • sudden inability to remember the events of the previous day.
    • transient difficulties in word finding or disorganized speech
  19. how to clincal phenomena be easily differentiated from other psychiatric symtoms?
    • disorientaton and confusion fluctuates
    • flight of ideas usually with some coherence
    • neologisms are not mispronounced words as in dysarthic speech
    • manic hyperactivity is rare
    • illusions are misperceptions of real stimulus and halucinations are devoid of reality based stimulus
  20. How is the clinical presentation of psychotic patient different from the delirious patient?
    • the chronically psychotic are:
    • rarely disoriented
    • do not note confusion
    • nonsensical speech rather than incoherence
    • hallucinate more than misperceive
    • substitute the unfamiliar for the familiar (think the nurse is the relative) versus capgrass
  21. Factors that predispose someone to delirium.
    • dementia
    • head injury
    • CVA
    • being over 65
    • h/o significant substance abuse
    • major medical illness
    • recent major sx
  22. what common medical disorders are associated with delirium?
    infection, hypoxia, hypoglycemia, electrolyte disturbances, seizures, vit deficiencies, dehydration, anemia...etc
  23. Differential diagnosis: Schizophrenia
    • age of onset is rarely after 50;
    • auditory halucinations are more common
    • memory is intact
    • speech is not dysarthic
    • disorientation is rare
    • symptoms do not flucuate over the course of the day
  24. Differential diagnosis: mood disorders
    • persistent rather thatn labilie disorder of mood
    • gradual onset
    • cognitive performance is not impaired
    • flight of idea have a thread of coherence
    • disorientation is rare
    • more anhedonia than confusion
  25. Differnential Diagnoses: Brief Reaactive psychosis
    • memory intact
    • not disoriented
  26. Differential Diagnosis: Dementia
    • gradual decline in memory
    • higher cortical functioning (abstract reasoning,language,judgement)
Card Set
Psych Secrets