Psychosis Flashcards
What key history would you obtain from a patient with psychosis?
Positive symptoms (auditory hallucinations, visual hallucinations)
Negative symptoms (e.g. blunted affect)
Cognitive symptoms (disorganized speech or thought patterns, paranoia)
Age of first symptoms and/or hospitalization
Previous psychiatric medications
Alcohol and substance abuse
What key physical exams would you perform on a patient with psychosis?
Vital signs
Mental status exam
19 yo M complains of receiving messages from his television set. He reports that he did not have many friends in high school. In college, he started to suspect his roommate of bugging the phone. In the same time frame he stopped going to classes because he felt that his professors were saying horrible things about him that no one else notices. He rarely showered or left his room and has recently been hearing a voice from his television set telling him to “guard against the evil empire.” Differentials?
Schizophrenia Schizotypal personality disorder Schizophreniform disorder Psychotic disorder due to a general medical condition Substance-induced psychoiss Depression with psychotic features
19 yo M complains of receiving messages from his television set. He reports that he did not have many friends in high school. In college, he started to suspect his roommate of bugging the phone. In the same time frame he stopped going to classes because he felt that his professors were saying horrible things about him that no one else notices. He rarely showered or left his room and has recently been hearing a voice from his television set telling him to “guard against the evil empire.” Differentials: schizophrenia, schizotypal personality disorder, pschotic disorder due to a general medical condition, substance-induced psychosis, depression with psychotic features. Workup?
Mental status exam
Urine toxicology
TSH
28 yo F complains of seeing bugs crawling on her bed over the past two days and reports hearing loud voices when she is alone in her room. She has never experienced symptoms such as these in the past. She recently ingested an unknown substance. Differentials?
Substance-induced psychosis Brief psychotic disorder Schizophreniform disorder Schizophrenia Psychotic disorder due to a general medical condition
28 yo F complains of seeing bugs crawling on her bed over the past two days and reports hearing loud voices when she is alone in her room. She has never experienced symptoms such as these in the past. She recently ingested an unknown substance. Differentials: substance-induced psychosis, brief psychotic disorder, schizophreniform disorder, schizophrenia, psychotic disorder due to a general medical condition. Workup?
Urine toxicology Mental status exam TSH CBC Electrolytes BUN/Cr AST/ALT
48 yo F presents with a one-week history of auditory hallucinations, stating “I am worthless” and “I should kill myself.” She also reports a two-week history of weight loss, early-morning awakening, decreased motivation and overwhelming feelings of guilt. Differentials?
Schizoaffective disorder Mood disorder with psychotic features Schizophrenia Schizophreniform disorder Psychotic disorder due to a general medical condition
48 yo F presents with a one-week history of auditory hallucinations, stating “I am worthless” and “I should kill myself.” She also reports a two-week history of weight loss, early-morning awakening, decreased motivation and overwhelming feelings of guilt. Differentials: schizoaffective disorder, mood disorder with psychotic features, schizophrenia, schizophreniform disorder, psychotic disorder due to a general medical condition. Workup?
Mental status exam
Beck Depression Inventory
TSH
CBC
