Pediatric emergency medicine trisk 1050

psychological processes, including perception, thinking, affect, capacity torelate, and behavior Table 126.27.. Impaired thought content includes delusions, illogical thinking, and loos

psychological processes, including perception, thinking, affect, capacity to

relate, and behavior ( Table 126.27 ) Impaired thought content includes

delusions, illogical thinking, and loose associations Auditory hallucinations are common and may include direct commands for suicide or violence to others Typically, but not always, the voices talk to the patient in the third person, with a highly critical and demeaning message Affect may be blunted and flat or inappropriate and bizarre Sudden and unpredictable changes in mood may occur These teenagers may appear extremely agitated

or may be withdrawn, speaking only in monosyllables and describing only concrete objects Schizophrenic patients typically have significant distortions

of their identity and their abilities and demonstrate behavior that is not goal directed

TABLE 126.24

CAUSES OF MEDICALLY BASED PSYCHOSIS

Medical conditions (acute and chronic)

Trauma (acute and chronic)

Prescribed medications (toxicity/side effects/withdrawal)

Drug intoxications

Accidental including misuse of proprietary medication

Drug abuse/experimentation

Alcohol abuse (alone or with drugs)

Deliberate suicide attempt

TABLE 126.25

MEDICAL CONDITIONS THAT MAY LEAD TO PSYCHOSIS

Central nervous system lesions

Tumors

Brain abscess

Cerebral hemorrhage

Meningitis or encephalitis (including autoimmune encephalitis) Temporal lobe epilepsy

Cerebral hypoxia

Pulmonary insufficiency

Severe anemia

Cardiac failure

Carbon monoxide poisoning

Metabolic and endocrine disorders

Celiac disease

Electrolyte imbalance

Hypoglycemia

Hypocalcemia

Thyroid disease (hyper and hypo)

Adrenal disease (hyper and hypo)

Uremia

Hepatic failure

Diabetes mellitus

Porphyria

Rheumatic diseases

Systemic lupus erythematosus

Polyarteritis nodosa

Infections

Malaria

Typhoid fever

Subacute bacterial endocarditis

Subacute sclerosing panencephalitis

Syphilis

Miscellaneous conditions

Wilson disease

Reye syndrome

The history often reveals a prodromal phase that includes social withdrawal, peculiar behavior, failure to look after one’s appearance, and significant reduction in performance in school or work An acute phase follows in which the previously described symptoms develop, sometimes as

a result of an acutely stressful event The overall course of schizophrenia is often chronic and associated with remissions and exacerbations Exacerbations often occur when treatment, including medication, is suspended However, other individuals experience a schizophrenic-like acute psychosis and recover completely with appropriate treatment, experiencing

no further deterioration