Psychosis due to another medical condition

Question 1

Primary psychotic disorders most commonly present with __ hallucinations as opposed to __

Answer 1

Primary psychotic disorders most commonly present with auditory hallucinations as opposed to visual, olfactory, gustatory

Question 2

Formication

Answer 2

Tactile hallucination of insects crawling on or under the skin

Associated with heavy use of cocaine and/or amphetamines

Question 3

Psychosis in epilepsy

Answer 3

• Most classically associated with temporal lobe epilepsy
• May occur in the ictal, post-ictal, or inter-ictal period
  
  • Of these, post-ictal psychosis is most common, occuring in 8% of patients with epilepsy
  • There will often be a “lucid interval” following seizures and preceding post-ictal psychosis
  • Interictal psychosis most commonly occurs after long-term inadequately treated epilepsy or treatment resistant childhood onset epilepsy

Question 4

Risk factors for psychosis in epilepsy

Answer 4

• Family history of psychiatric illness
• Bilateral seizure foci

Question 5

Diagnostic criteria for psychosis due to another medical condition

Answer 5

• Prominent hallucinations or delusions
• Evidence that disturbance is the direct pathophysiologic consequence of a medical condition (based on history, PE, laboratory studies)
• Symptoms not accounted for by another mental illness
• Symptoms do not occur only during delirium

Question 6

When should the diagnosis of substance/medication induced psychosis be considered?

Answer 6

When symptoms occur during intoxication or withdrawal phase or within 4 weeks of exposure to a new substance