Components of Mental Status Exam
- Physical appearance
- Arousal/attention (consciousness/concentration)
- Speech (rate, rhythm, prosody, articulation, coherence, vocabulary)
- Mood (pt’s self reported emotional state)
- Affect (pts immediate visible emotions)
- Thought process (organization of pts thoughts)
- Thought content (nature of thought)
- Cognition (includes memory and exec functioning; i.e. MMSE/MOCA)
- Insight (does pt understand illness/impact on their life)
- Judgement (ability to follow provider instructions)
Schizophrenia diagnostic criteria
2+
??
Etiology of Schizophrenia
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Schizophrenia Treatment
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Major Depressive disorder
?
examples of Mood disorders with psychotic features
Major Depressive Disorder (MDD) w/psychotic features
BIpolar disorder with psychotic features
Schizoaffective disorder
MDD with psychotic features definition/treatment
- meets major depressive episode criteria plus has delusions and/or hallucinations
- occurs in about 18.5% those diagnosed with MDD
Treat: Antidepressants with antipsychotics; ECT (esp in pregnant and elderly)
Bipolar with psychotic features definition/treatment
- Pt experiencing bipolar disorder and delusions or hallucinations
- Prevalence may be as high as 25% of those with bipolar
Treat:
- Mood Stabilizer and antipsychotic (atypical often used since they allow use of one medication)
- ECT may be considered if poor medication response
- Pt may present w/catatonia, which responds to treatment with benzodiazepines
Schizoaffective Disorder Dx and treatment
?
Delusional disorder
- presence of 1+ delusions lasting at least 1 month
- never met criteria for schizophrenia
- little to no functional impairment and behavior appears relatively normal
- Not due to mood disorder or substance
- Lifetime prevalence about 0.2%
- Mean onset = 40
Delusional Disorder subtypes
Erotomanic (more frequent in women) Grandiose Jealous Persecutory- more often in men Somatic Mixed Unspecified
Brief Psychotic disorder
Presence of 1+ of the following with at least 1 of the first 3
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Lasts from 1 day to
Schizophreniform Disorder
?
Substance/med induced psychotic disorder characteristics
- Significant hallucinations/delusions
- Evidence from hx, physical, or lab findings of both:
hallucinations or delusions developed during or within a reasonable pd of substance intoxication or withdrawal or after exposure to such a medication - Substance in question can produce hallucinations or delusions
**Sxs should not precede ingestion of substance/meds, nor should they persist for substantial pd of time (typically > 1 month) after acute withdrawal or severe intoxication)
Substance known to induce psychosis
Alcohol Cocaine amphetamine cannabis opioids synthetic cannabinoids and cathinones (bath salts) LSD Psilocybins (mushrooms) MDMA/ecstasy Inhalants Phencyclidine (PCP, angel dust, ketamine)
Medications that can cause psychosis
Levodopa
Anabolic steroids
corticosteroids
antimalarial drugs
Psychotic disorder due to another medical condition
- Prominent hallucinations or delusions-
- Doesn’t occur solely during course of delirium
- Significant distress or impairment in social, occupational, or other important areas of functioning evident
Disorders mimicing psychosis
PTSD
Borderline personality disorder
OCD
Schizotypal personality disorder
Medical conditions that can cause psychosis
Parkinsons Lupus HIV/AIDS Brain tumors Seizure disorders Delirium Huntingtons Thyroid MS Cushing's syndrome vitamin deficiency Electrolyte abnormalities SLE Uremia
