Sandbox/JRH

1.- Substance/Medication-Induced Psychotic Disorder

Synonyms and keywords: Medication induced psychotic disorder; substance induced psychotic disorder; substance-medication induced psychotic disorder;

Differential Diagnosis

• Alcohol withdrawal
• Brief psychotic disorder
• Cannabis intoxication
• Delusional disorder
• Flashback hallucinations
• Intoxication with stimulants
• Phencyclidine
• Schizophrenia
• Schizoaffective disorder
• Schizophrenia spectrum
• Delusional disorder
• Opioid meperidine

Epidemiology and Demographics

Prevalence

The prevalence of substance/medication-induced psychotic disorder is unknown of the overall population.

Risk Factors

• Cocaine usage
• Heavy and constant ingestion of alcohol
• History of psychopathic disorder

Natural History, Complications and Prognosis

Poor prognosis factors include:

• Depersonalization
• Flashbacks
• Hallucinations
• Marked anxiety
• Persecutory delusions

Diagnostic Criteria

• A. Presence of one or both of the following symptoms:

1. Delusions

2. Hallucinations

AND

• B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.

2. The involved substance/medication is capable of producing the symptoms in Criterion A.

AND

• C. The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced. Such evidence of an independent psychotic disorder could include the following:

The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication: or there is other evidence of an independent non-substance/medication-induced psychotic disorder (e.g., a history of recurrent non-substance/medication-related episodes).

AND

• D. The disturbance does not occur exclusively during the course of a delirium.

AND

• E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

2.- Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

Synonyms and keywords: Catatonia

Epidemiology and Demographics

Prevalence

The prevalence of catatonia associated with another mental disorder is unknown of the overall population.

Risk Factors

• Bipolar disorders
• Depressive disorders
• Schizophrenia

Natural History, Complications and Prognosis

Poor prognostic factors include:

• Bipolar disorder
• Depressive disorder
• Mental disorder
• Metabolic conditions
• Infectious conditions
• Psychotic disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Catatonic Disorder Due to Another IVIedical Condition

“

A. The clinical picture is dominated by three (or more) of the following symptoms: Stupor (i.e., no psychomotor activity; not actively relating to environment). Catalepsy (i.e., passive induction of a posture held against gravity). Waxy flexibility (i.e., slight, even resistance to positioning by examiner). Mutism (i.e., no, or very little, verbal response [Note: not applicable if there is an established aphasia]). Negativism (i.e., opposition or no response to instructions or external stimuli). Posturing (i.e., spontaneous and active maintenance of a posture against gravity). Mannerism (i.e., odd, circumstantial caricature of normal actions). Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). Agitation, not influenced by external stimuli. Grimacing. Echolalia (i.e., mimicking another’s speech). Echopraxia (i.e., mimicking another’s movements).

”

3. Catatonic Disorder Due to Another Medical Condition

Differential Diagnosis

• Brief psychotic disorder
• Cerebrovascular disease
• Diabetic ketoacidosis
• Encephalitis
• Neoplasms
• Head trauma
• Hepatic encephalopathy
• Hypercalcemia
• Homocystinuria
• Schizoaffective disorder
• Schizophrenia
• Schizophreniform disorder
• Substance/medication-induced psychotic disorder

Epidemiology and Demographics

Prevalence

The prevalence of catatonia associated with another medical disorder is unknown of the overall population.

Natural History, Complications and Prognosis

Poor prognostic factors are:

• Neuroleptic malignant syndrome
• Neuroleptic medication intake

Diagnostic Criteria

DSM-V Diagnostic Criteria for Paranoid Personality Disorder

“

A. The clinical picture is dominated by three (or more) of the following symptoms: Stupor (i.e., no psychomotor activity; not actively relating to environment). Catalepsy (i.e., passive induction of a posture held against gravity). Waxy flexibility (i.e., slight, even resistance to positioning by examiner). Mutism (i.e., no, or very little, verbal response [Note: not applicable if there is an established aphasia]). Negativism (i.e., opposition or no response to instructions or external stimuli). Posturing (i.e., spontaneous and active maintenance of a posture against gravity). Mannerism (i.e., odd, circumstantial caricature of normal actions). Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). Agitation, not influenced by external stimuli. Grimacing. Echolalia (i.e., mimicking another’s speech). Echopraxia (i.e., mimicking another’s movements). AND B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. AND C. The disturbance is not better explained by another mental disorder(e.g.,amanicepisode). AND D. The disturbance does not occur exclusively during the course of a delirium. AND E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

”

Sleep-Related Hypoventilation

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Differential Diagnosis

• Lung diseases
• Skeletal malformations
• Neuromuscular disorders
• Sleep-related hypoxemia
• Obstructive sleep apnea hypopnea
• Central sleep apnea

Epidemiology and Demographics

Prevalence

The prevalence of paranoid personality disorder is unknown of the overall population.

Risk Factors

• Central nervous system depressants intake (e.g. benzodiazepines, opioid, alcohol)
• Hypothiroidism
• Neuromuscular or chest wall disorder
• Pulmonary disorder

Diagnostic Criteria

• A. Polysomnograpy demonstrates episodes of decreased respiration associated with elevated CO2 levels.

(Note: In the absence of objective measurement of CO2, persistent low levels of hemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.)

• B. The disturbance is not better explained by another current sleep disorder.

Specify whether:

Idiopathic hiypoventilation: This subtype is not attributable to any readily identified condition.

Congenital central alveolar hypoventilation: This subtype is a rare congenital disorder in which the individual typically presents in the perinatal period with shallow breathing, or cyanosis and apnea during sleep.

Comorbid sleep-related hypoventilation: This subtype occurs as a consequence of a medical condition, such as a pulmonary disorder (e.g., interstitial lung disease, chronic obstructive pulmonary disease) or a neuromuscular or chest wall disorder (e.g., muscular dystrophies, postpolio syndrome, cervical spinal cord injury, kyphoscoliosis), or medications (e.g., benzodiazepines, opiates). It also occurs with obesity (obesity hypoventilation disorder), where it reflects a combination of increased work of breathing due to reduced chest wall compliance and ventilation-perfusion mismatch and variably reduced ventilatory drive. Such individuals usually are characterized by body mass index of greater than 30 and hypercapnia during wakefulness (with a PCO2 of greater than 45), without other evidence of hypoventilation.

Specify current severity:

Severity is graded according to the degree of hypoxemia and hypercarbia present during sleep and evidence of end organ impairment due to these abnormalities (e.g., right sided heart failure). The presence of blood gas abnormalities during wakefulness is an indicator of greater severity.

Circadian Rhythm Sleep-Wake Disorders

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Non-Rapid Eye Movement Sleep Arousal Disorders

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Other Hallucinogen Use Disorder

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Hallucinogen Persisting Perception Disorder

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Other Hallucinogen-Induced Disorders

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Unspecified Phencyclidine-Related Disorder

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Stimulant Use Disorder

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Stimulant Intoxication

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Stimulant Withdrawal

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Other (or Unknown) Substance Use Disorder

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Other (or Unknown) Substance Intoxication

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Other (or Unknown) Substance Withdrawal

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Other (or Unknown) Substance-Induced Disorders

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Personality Change Due to Another Medical Condition

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Exhibitionistic Disorder

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Frotteuristic Disorder

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Other Specified Mental Disorder Due to Another Medical Condition

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