Psychotic disorders diagnosis

Chronic cocaine use can cause a syndrome of insomnia, hallucinations, delusions, and apathy. This syndrome develops around the time when the euphoria turns to a paranoid psychosis, which resembles paranoid schizophrenia. Further, after cessation of cocaine use, the hallucinations may stop, but the delusions can persist. Still, the incidence of a persistent cocaine-induced psychosis appears to be rare. One study found only 4 out of 298 chronic cocaine users receiving a diagnosis of psychotic disorder (Rounsaville et al. 1991). This incidence is approximately the... 

Brief Psychotic Disorder. This diagnosis also differs from schizophrenia by virtue of the duration of symptoms. The symptoms mnst last less than 1 month, and the patient must return to his/her previous level of social functioning when the illness subsides. Formerly called brief reactive psychosis, an episode of this illness usually arises in reaction to some markedly stressfnl event, thongh this is not always the case. 

Schizophreniform disorder in DSM-FV is somewhat different from schizotypal disorder in ICD-10. The diagnosis of schizophreniform disorder requires the identical criteria of schizophrenia (criterion A), except for two differences the total duration of the illness is at least 1 month, but less than 6 months (criterion B), and impaired social or occupational functioning during some part of the illness is not required. The delusional disorder in DSM-IV corresponds more or less to the category persistent delusional disorder of ICD-10, and brief psychotic disorder (DSM-IV) is similar to the ICD-10 category acute and transient psychotic disorder, whereas the shared psychotic disorder of DSM-IV corresponds to induced delusional disorder of ICD-10. 

Therefore, psychosis can be considered to be a set of symptoms in which a person s mental capacity, affective response, and capacity to recognize reality, communicate, and relate to others are impaired. Psychotic disorders have psychotic symptoms as their defining features, but there are other disorders in which psychotic symptoms may be present but are not necessary for the diagnosis. 

Those disorders that require the presence of psychosis (Table 10—1) as a defining feature of the diagnosis include schizophrenia, substance-induced (i.e., drug-induced) psychotic disorder, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, shared psychotic disorder, and psychotic disorder due to a general medical condition. Disorders that may or may not have psychotic symptoms (Table 10—2) as an associated feature include mania and depression as well as several cognitive disorders such as Alzheimer s dementia. 

Schizophrenia and drug induced psychotic disorders require the presence of psychosis as a defining feature of the diagnosis. True or False. 

Check the diagnosis Are depressive symptoms due to characterological disorder, medical illness, or psychotic disorder ... 

DSM-IV-TR (American Psychiatric Association 2000) recognizes inhalant-, anesthetic-, and solvent-related disorders (Table 13-8). Anesthetics are associated with substance-induced anxiety disorder. Inhalant-related disorders include intoxication, delirium, persisting dementia, psychotic disorders with delusions or hallucinations, mood or anxiety disorders, and disorders not otherwise specified. Diagnosis depends on history or laboratory studies described earlier in this chapter. Physical signs such as deposits from inhalants around the mouth or nose or on hands and clothing may indicate recent use (Westermeyer 1987). Nasal membranes may be inflamed (Wester-meyer 1987). 

Kamo, M. et al, Cultural Considerations in the Diagnosis of Schizophrenia and Related Disorders and Psychotic Disorders Not Otherwise Classified, DSM-IV Casebook for Cultural Psychiatry, 1994, Steering Committee, NIMH Group on Culture and Diagnosis. 

Most treatment-resistant depressed patients have received inadequate therapy. Issues to be considered in patients who have not responded to treatment include the following (1) Is the diagnosis correct (2) Does the patient have a psychotic depression (3) Has the patient received an adequate dose and duration of treatment (4) Do adverse effects preclude adequate dosing (5) Has the patient been compliant with the prescribed regimen (6) Was treatment outcome measured adequately (7) Is there a coexisting or preexisting medical or psychiatric disorder (8) Was a stepwise approach to treatment used (9) Are there other factors that interfere with treatment ... 

There are many illnesses that in one respect or another closely resemble schizophrenia. Therefore, it takes considerable skill to diagnosis this disorder reliably. It is so difficult to diagnose accurately at a single time point that a patient with psychotic symptoms may over time have his/her diagnosis changed to and from schizophrenia repeatedly. 

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