Impairment of reality testing manifested by delusions, hallucinations and/or disordered thought process.
More common symptoms of psychosis.
Delusions
hallucinations
Disorganized thoughts
Incoherent speech
neologistic speech
disorganized behaviors
Psychotic sysmtoms are not...
diagnostic of a particular disorder but indicative of an underlying disorder.
Differential diagnosis: Delusions
Psychitic Disorders: Fixed with more stable themes and elaborate contents.
Neuro/Systemic : tansiet, less systemized, homley
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
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.
Differentail Diagnosis: Tactile
Psych: Rare
Neuro/Systemic: Hallmark of delirium
Differential Diagnosis: Olfactory
Psych: Uncommmon
Neuro/Systemic: More common in temporal lobe disorders
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.
Diffrential Diagnosis: Biazarre Behavior
Psych: Maybe realated to delusional themes and tend to be sterotyped
Neuro/Systemic:Little organization or purpose; often sporadic.
True or false
A person with a mental illness can have a worsening of symtoms related to systemic or neurological problems.
True
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.
True
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.
True
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
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
True or false
Delirium is not a medical emergnecy.
False
True or false
People with delirium have a great morbidity and mortality.
True
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
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
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
Factors that predispose someone to delirium.
dementia
head injury
CVA
being over 65
h/o significant substance abuse
major medical illness
recent major sx
what common medical disorders are associated with delirium?
infection, hypoxia, hypoglycemia, electrolyte disturbances, seizures, vit deficiencies, dehydration, anemia...etc
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
