Psychosis

Question 1

Key History for psychosis is based on what three symptomatic categories?

Answer 1

Positive Symptoms

Negative Symptoms

Cognitive Symptoms

*also imp to note the age in which symptoms started

Question 2

Positive symptoms to look for/ask for in psychosis HPI

Answer 2

Delusions
Hallucinations
Disorganized thoughts
disorganzied or catatonic behaviors

Question 3

Negative symptoms to look for/ask for in psychosis HPI

Answer 3

blunted affect
social withdrawal
decreased motivations
decreased speech or thought

Question 4

Cognitive symptoms to look for/ask for in psychosis HPI

Answer 4

disorganzied speech or thought patterns

paranoia

Question 5

Key “physical” for psychosis includes what two elements

Answer 5

VS

Mental status exam (ABS MATT JOI)

Question 6

List Ddx for psychosis

Answer 6

Schizo’s

• schizophrenia
• schizophreniform
• schizoid or schizotypal personality dzd
• schizoaffective

Inudcible

• psychsosis dzd 2/2 medical dzd
• psychsosis dzd 2/2 substances

Depression with psychotic features

Question 7

Workup for general psyhotic issues (basically same as depressed dzd)

Answer 7

cbc
tsh
chemistries (electrolytes)

urine toxicology
blood alcohol

Mental status exam

Question 8

19 yo receiving messages from his TV – reports of not having friends in high school – in college he started to suspect his rrommate of bugging the phone – he stopped going o classes bc he felt his profs were saying horrible things about him – he rarely showers or leaves his room

Dx?
Ddx?

Answer 8

Schizophrenia

Ddx

• all the schizos
• inducibles (medically related/drug induced)

Question 9

28 yo F c/o seeing bugs crawling in her bed for past 2 days – hears loud voices – no past h/o of these voices or hallucinations existed before now – recently ingested an unkonwn substance

Dx?
DDx?

Answer 9

Substance induced psychosis*

Ddx

• brief psychotic dzd
• schizophreniform
• schizophrenia
• pscyotic dzd 2/2 medical conditons
• add BUN/Cr and AST/ALT
• or just put Chem 7/8 for all dx

Question 10

48 yo F with 1 week h/o auditory hallucinatinos = “i am worthless” and want to “kill myself” – also reports 2 week h/o wt loss - ealry morning satiety awakening – decreased motivation and overwhelming feelings of guilt

Answer 10

schizoaffective dzd
- notice the blend of schizo with depressive moods

Ddx

• mood dzd with pscyotic features
• schizophrenia
• schizophreniform
• psychosis 2/2 medical condtions