Psychosis (e.g., Delusions andor Hallucinations)

Info

🌱 來自: Huppert’s Notes

Psychosis (e.g., Delusions andor Hallucinations)🚧 施工中

Psychosis (e.g., Delusions and/or Hallucinations)

•   Definitions:

-   Delusions: False, fixed beliefs that persist in the face of challenging/contrary evidence and which are not typical of a patient’s culture or religion; subtypes include erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified

-   Hallucinations: Perceptions of sensory experiences in the absence of external stimuli

•   Differential diagnosis:

-   Primary psychotic disorder

-   Substance use disorder

-   Mood disorder with psychotic symptoms

-   Delirium

-   Dementia (especially Lewy body dementia)

-   Psychosis due to another medical condition

•   Endocrine (hyperparathyroidism, hyperthyroidism)

•   Metabolic (hepatic encephalopathy, uremic encephalopathy, vitamin B12 deficiency, Wilson’s disease, acute intermittent porphyria)

•   Infectious (HIV, neurosyphilis, herpes simplex encephalitis, Lyme’s disease)

•   Inflammatory or demyelinating disorders (anti-NDMA encephalitis, systemic lupus erythematosus, multiple sclerosis)

•   Neurodegenerative disease (particularly Lewy body dementia; also Alzheimer’s disease, Parkinson’s disease, Huntington’s disease)

•   Other neurological disorders (epilepsy, intracranial tumor, prion disease)

•   Approach by hallucination subtype:

-   Auditory: More commonly a feature of primary psychiatric illness, but other causes also occur

-   Visual: More commonly a feature of substance use or medical illness, but other causes also occur, including primary psychiatric disease

-   Tactile: Most common in setting of substance use (e.g., alcohol withdrawal; stimulant intoxication), although delusional parasitosis (the belief that one is infested with a pathogen) is on the differential diagnosis as well

-   Olfactory: Most commonly an aura of temporal lobe epilepsy or in the setting of an intracranial mass

-   Gustatory: Very rare; occurs occasionally in epilepsy

-   Hypnagogic: Occurs while going to sleep; not typically pathologic

-   Hypnopompic: Occurs while waking from sleep; not typically pathologic

•   Work-up: Basic labs, UA, urinary toxicology; consider other testing, such as head imaging, based on clinical features and context

•   Management:

-   Acute therapy

•   Treat underlying cause if identified

•   If risk of harm, consider rapid sedation with benzodiazepine, antipsychotics (PO or IM)

-   Maintenance therapy for primary psychotic disorder: See Table 13.4