The Diagnosis of Psychosis

by Rudolf N. Cardinal , Edward T. Bullmore

• ISBN13: 9780521164849
• ISBN10: 0521164842
• Edition: 1st
• Format: Paperback
• Copyright: 2011-04-29
• Publisher: Cambridge University Press

Summary

Psychosis has many causes. Psychiatrists typically receive a thorough training in its diagnosis, but the diagnosis of psychosis secondary to non-psychiatric conditions is often not emphasized. An understanding of the underlying cause is important so that effective management programs can be implemented. The Diagnosis of Psychosis bridges the gap between psychiatry and medicine, providing a comprehensive review of primary and secondary causes of psychosis. It covers both common and rare causes in a clinically focused guide. Useful for both teaching and reference, the text covers physical and mental state examination, describes key investigations, and summarises the non-psychiatric features of medical conditions causing psychosis. Particularly relevant for psychiatrists and trainees in psychiatry, this volume will also assist neurologists and general physicians who encounter psychosis in their practice.

Author Biography

Rudolf N. Cardinal is Academic Clinical Fellow and Specialty Registrar, Department of Psychiatry, University of Cambridge and Cambridgeshire and Peterborough NHS Foundation Trust. Edward T. Bullmore is Professor of Psychiatry, Department of Psychiatry, University of Cambridge; Clinical Director of the Behavioural and Clinical Neurosciences Institute, Cambridge; and Vice-President of Experimental Medicine and Head of the Clinical Unit, GlaxoSmithKline, Cambridge, UK.

Table of Contents

Preface	p. xv
Acknowledgements	p. xvii
Abbreviations and symbols	p. xix
The causes of psychosis
Introduction	p. 3
The definitions of psychosis	p. 3
Scope and threshold for inclusion	p. 3
Emphasis on non-psychiatric phenotype in diagnosing secondary psychosis, and on psychopathology in diagnosing primary psychosis	p. 4
Two useful approaches to the diagnosis of psychosis	p. 5
Arrangement of this book	p. 5
Methods	p. 6
Delirium	p. 7
Causes	p. 7
Exclusion	p. 8
Neurodevelopmental disorders and chromosomal abnormalities	p. 10
Velocardiofacial syndrome	p. 10
Trisomy 21	p. 11
Other chromosomal abnormalities	p. 11
Agenesis of the corpus callosum	p. 12
Prader-Willi syndrome	p. 12
Phenylketonuria	p. 13
X-linked mental retardation syndromes	p. 13
Other rare genetic conditions presenting early in life	p. 13
Other rare neurodevelopmental disorders	p. 15
Neurodegenerative disorders	p. 16
Alzheimer's disease	p. 16
Vascular dementia	p. 17
Parkinson's disease and ôParkinson's plusö syndromes	p. 17
Dementia with Lewy bodies	p. 18
Asymmetric cortical degeneration syndromes, including frontotemporal dementia and Pick's disease	p. 18
Motor neuron disease	p. 19
Huntington's disease	p. 20
Dentatorubropallidoluysian atrophy	p. 21
Spinocerebellar ataxia	p. 21
Neuroacanthocytosis	p. 21
Basal ganglia calcification	p. 22
Pantothenate kinase-associated neurodegeneration	p. 22
Neuroferritinopathy	p. 23
Argyrophilic grain disease	p. 23
Thalamic degeneration	p. 24
Other rare genetic conditions presenting late in life	p. 24
Focal neurological disease	p. 25
Cerebrovascular disease	p. 25
Epilepsy	p. 27
Classification of seizures	p. 27
Psychosis and epilepsy	p. 28
EEG features of relevance and underlying causes	p. 31
Migraine	p. 31
Hypertensive encephalopathy and posterior reversible encephalopathy syndrome	p. 33
Head injury (traumatic brain injury)	p. 33
Normal-pressure hydrocephalus	p. 34
Intracranial mass lesions (tumours) and obstructive hydrocephalus	p. 34
Multiple sclerosis	p. 35
Central pontine and extrapontine myelinolysis	p. 36
Tuberous sclerosis	p. 36
Malignancy	p. 38
Infectious and postinfectious syndromes	p. 40
Bacterial infection	p. 41
Pyogenic bacterial infection	p. 41
Neurosyphilis	p. 41
Lyme disease (borreliosis)	p. 42
Bartonella infection	p. 44
Leptospirosis	p. 44
Tuberculosis	p. 44
Brucellosis	p. 45
Whipple's disease	p. 46
Other systemic bacterial infections with prominent neuropsychiatric effects	p. 47
Viral infection	p. 48
Herpesvirus encephalitis	p. 49
HIV encephalitis and AIDS dementia	p. 51
Other acute viral encephalitides	p. 52
Other subacute viral encephalitides	p. 53
Protozoal infection	p. 54
Malaria	p. 54
Toxoplasmosis	p. 54
Trypanosomiasis	p. 55
Fungal infection (mycosis)	p. 56
Eosinophilic meningitis and meningoencephalitis, helminths, and macroparasites	p. 56
Protein infection: Creutzfeldt-Jakob disease and other prion diseases	p. 57
Autoimmune disease following infection	p. 58
Sydenham's chorea and PANDAS	p. 58
Encephalitis lethargica	p. 59
Postinfectious encephalomyelitis and acute disseminated encephalomyelitis	p. 59
Endocrine disease	p. 60
Hypothyroidism and hyperthyroidism	p. 60
Glucocorticoid excess	p. 63
Adrenal failure	p. 64
Hypopituitarism	p. 65
Hypoparathyroidism and hyperparathyroidism	p. 65
Sex hormones and psychosis	p. 66
Schizophrenia and sex hormones	p. 66
Puerperal (postpartum) psychosis and other oestrogen withdrawal states	p. 66
Other relationships between sex hormones and psychosis	p. 67
Inborn errors of metabolism	p. 68
Hyperammonaemia and urea cycle disorders	p. 68
Porphyria	p. 69
Disorders of amino acid metabolism	p. 71
Hereditary tyrosinaemia	p. 71
Hyperhomocysteinaemia and homocystinuria	p. 71
Hartnup's disease	p. 72
Maple syrup urine disease	p. 72
Wilson's disease	p. 73
Storage diseases	p. 74
Neuronal ceroid lipofuscinosis	p. 74
Niemann-Pick disease, type C	p. 74
Hexosaminidase deficiency (GM2 gangliosidosis)	p. 75
Mucopolysaccharidosis	p. 75
Fabry's disease	p. 76
Aspartylglucosaminuria	p. 76
Metachromatic leukodystrophy	p. 77
X-linked adrenoleuko-dystrophy	p. 77
Cerebrotendinous xanthomatosis	p. 78
Alpha-mannosidosis	p. 78
Krabbe's disease (globoid cell leukodystrophy)	p. 79
Gaucher's disease	p. 79
Vanishing white matter leukoencephalopathy	p. 80
Diffuse sclerosis	p. 80
Mitochondrial encephalopathies	p. 80
Glucose-6-phosphate dehydrogenase deficiency	p. 81
Nutritional deficiency	p. 82
Thiamine (vitamin B1) deficiency	p. 82
Niacin (vitamin B3, nicotinic acid) deficiency	p. 83
Pyridoxine (vitamin B6) deficiency	p. 84
Cobalamin (vitamin B12) deficiency, and methylmalonic aciduria	p. 85
Folate (vitamin B9) deficiency	p. 87
Zinc deficiency	p. 88
Omega-3 fatty acids	p. 88
Starvation	p. 88
Other acquired metabolic disorders	p. 89
Global cerebral hypoxia	p. 89
Disturbances of pH and hypercapnic encephalopathy	p. 89
Hypoglycaemia	p. 90
Organ failure	p. 91
Renal failure	p. 91
Hepatic encephalopathy	p. 92
Pancreatic encephalopathy	p. 93
Reye's syndrome	p. 93
Electrolyte disturbances	p. 94
Hyponatraemia	p. 94
Hypernatraemia	p. 95
Hypocalcaemia	p. 95
Hypercalcaemia	p. 96
Hypokalaemia	p. 96
Hypomagnesaemia	p. 97
Hypophosphataemia	p. 97
Autoimmune rheumatic disorders and vasculitides	p. 99
Connective tissue disorders	p. 99
Systemic lupus erythematosus	p. 99
Antiphospholipid syndrome	p. 102
Sjögren's syndrome	p. 102
Systemic sclerosis	p. 103
Mixed connective tissue disease	p. 103
Vasculitis	p. 103
Giant cell (temporal) arteritis	p. 104
Primary CNS angiitis	p. 105
Polyarteritis nodosa	p. 105
ANCA-associated small-vessel vasculitides	p. 106
Other forms of CNS vasculitis	p. 108
Behçet's disease	p. 109
Reiter's disease (reactive arthritis)	p. 109
Sarcoidosis	p. 109
Scleromyxoedema	p. 111
Thrombotic thrombocytopenic purpura	p. 111
Hyperviscosity and cryoglobulinaemia	p. 111
Other autoimmune encephalopathies	p. 113
Hashimoto's encephalopathy	p. 113
Autoimmune limbic encephalopathy, including paraneoplastic limbic encephalitis	p. 113
Antibodies against voltage-gated potassium channels	p. 114
Antibodies against NMDA glutamate receptors	p. 115
Other antibodies against neuropil and neuronal surface proteins	p. 116
Other antibodies against intraneuronal antigens	p. 116
Non-vasculitic autoimmune inflammatory meningoencephalitis	p. 116
Poisoning	p. 118
Therapeutic drugs	p. 118
Serotonin syndrome	p. 124
Recreational drugs, drugs of abuse, and withdrawal states	p. 125
Anticholinergic poisoning	p. 129
Animal, plant, and fungus poisoning	p. 129
Spider venom (neurotoxic araneism)	p. 129
Amphibian venom	p. 129
Fish poisoning (ichthyoallyeinotoxism)	p. 130
Plant and fungus poisoning	p. 130
Metal and metalloid poisoning	p. 131
Mercury (Hg) poisoning	p. 131
Arsenic (As) poisoning	p. 132
Thallium (TI) poisoning	p. 132
Lead (Pb) poisoning	p. 133
Manganese (Mn) poisoning	p. 134
Copper (Cu) poisoning	p. 134
Aluminium (AI) poisoning	p. 135
Bismuth (Bi) poisoning	p. 135
Molybdenum (Mo) poisoning	p. 135
Poisoning by other organic and non-metallic substances	p. 135
Carbon monoxide (CO) poisoning	p. 136
Poisoning by other organic compounds	p. 136
Sleep disorders	p. 140
Sensory deprivation and impairment	p. 142
Miscellaneous	p. 143
Coeliac disease	p. 143
Idiopathic hypereosinophilic syndrome	p. 144
Idiopathic intracranial pachymeningitis	p. 144
Irradiation	p. 144
Serine- and glycine-evoked psychosis	p. 144
Atrial myxoma	p. 145
Tinnitus	p. 145
Radio reception	p. 145
Catatonia	p. 146
Definition	p. 146
Malignant catatonia and neuroleptic malignant syndrome	p. 147
Other catatonic syndromes	p. 148
Mimics and causes of catatonia	p. 148
Agitation and bizarre behaviour	p. 151
Primary psychiatric disease	p. 152
Schizophrenia (F20)	p. 152
Manic psychosis (psychotic mania)	p. 155
Depressive psychosis (psychotic depression)	p. 156
Schizoaffective disorders (F25)	p. 157
Other affective psychoses	p. 157
Schizotypal disorder (F21)	p. 157
Persistent delusional disorder (F22)	p. 158
Acute and transient psychotic disorders (F23)	p. 159
Induced delusional disorder (F24)	p. 160
Obsessive-compulsive disorder (F42)	p. 160
Panic attacks with psychotic features	p. 161
Post-traumatic stress disorder (F43.1)	p. 161
Psychosis in the context of eating disorders (F50)	p. 161
Psychotic and near-psychotic phenomena in the context of personality disorder	p. 161
Paranoid personality disorder (F60.0)	p. 162
Schizoid personality disorder (F60.1)	p. 162
Emotionally unstable personality disorder, borderline type (F60.31)	p. 162
Chronic hallucinatory psychosis and other nonorganic psychotic disorders (F28)	p. 163
Unspecified nonorganic psychosis (F29)	p. 163
Late-onset psychosis	p. 163
Conditions labelled as ôpsychoticö historically	p. 164
Bereavement	p. 165
Normal and prodromal symptoms	p. 165
Pseudohallucinations	p. 165
Personality and predisposition to psychosis	p. 165
Stress and psychosis	p. 166
Prodromes and prediction of serious mental illness	p. 166
Factitious disorder and malingering	p. 168
Multiple simultaneous causes of psychosis, and questions of causality	p. 169
A clinical approach to the diagnosis of psychosis
History and examination	p. 173
Overview and method	p. 173
Probe questions for psychotic symptoms	p. 177
Probe questions for depression and mania	p. 180
Rapid exclusion of medical emergencies presenting as psychosis	p. 182
Initial investigations relevant to psychosis	p. 183
Suggested initial investigations in psychosis	p. 183
Clues from routine and other first-line investigations	p. 185
Putting it together: clinical and paraclinical clues	p. 190
Further investigations relevant to psychosis	p. 230
Classificatory approach for psychosis of unknown aetiology	p. 248
Classificatory approach to psychosis of unknown aetiology, based on ICD-10	p. 249
ICD-10 criteria for mood disorders	p. 252
ICD-10 criteria for schizophrenia	p. 256
ICD-10 criteria for schizotypal disorder and personality disorders associated with psychotic symptoms	p. 259
Classifactory approach to psychosis of unknown aetiology, based on DSM-IV-TR	p. 262
DSM-IV criteria for mood disorders	p. 267
DSM-IV criteria for schizophrenia	p. 271
DSM-IV criteria for personality disorders associated with psychotic symptoms	p. 273
Examination for catatonia	p. 277
Fink & Taylor criteria for catatonia	p. 278
Conclusion	p. 279
Selected conditions not known to cause psychosis	p. 281
Relevant changes proposed in DSM-V	p. 284
References	p. 289
Index	p. 362
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