1/9/2024 0 Comments Paranoid schizophrenicDelirium due to infection, metabolic or toxic disturbance, neurological disease, endocrine cause, etc.Drug-induced psychosis - amfetamine, LSD, cannabis.See also the separate Psychosis - Diagnosis and Management article. Cognition - attention, concentration, orientation and memory should be assessed (significant impairment suggests delirium or severe dementia).Abnormal experiences - hallucinations, especially auditory.Abnormal beliefs - delusional percepts, delusions concerning thought control or broadcasting, passivity experiences.Mood/affect - flattened, incongruous or 'odd'.Speech - interruptions to the flow of thought (thought blocking), loosening of associations/loss of normal thought structure (knight's move thinking).Appearance and behaviour - withdrawal, suspicion, or (rarely) stereotypical behaviours (repetition of purposeless movements) and mannerisms (eg, saluting).In the mental state examination, be alert for: SignsĬonduct a full physical examination to exclude/support possibility of organic psychosis. There is significant comorbidity with alcohol and substance misuse. Patients may manifest symptoms of other psychiatric diseases (eg, depression, anxiety, obsessions and compulsions). Many young people with such symptoms do not go on to develop schizophrenia but there is a higher risk of it developing in the presence of such a condition within ten years of initial presentation. Transient or attenuated first-rank symptoms may occur but these are not pathognomonic. In children and adolescents, there may be a prodromal period in which family and friends may notice subtle changes in behaviour and personality.
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