Mini-Quiz: Secondary Psychosis

A thoughtful and deliberate differential diagnosis of possible medical and toxic causes of psychosis is necessary to avoid the mistaken attribution to a psychiatric disorder. A history and physical examination with an emphasis on the neurological and cognitive parts are the cornerstones for the initial approach to psychosis. Taking into account that psychosis can arise from a general medical condition, what of the choices below should clinicians suspect if a patient presents with symptoms of confusion, episodic violence, and catatonia? Take the quiz to test your knowledge.

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Answer: b, seizures

Confusion, episodic violence, and catatonia are clinical symptoms that should raise suspicion for seizures.

Discussion
If a seizure or epilepsy is suspected, the diagnosis needs to be pursued appropriately.  Other specific conditions of psychosis from a general medical condition include:

• Endocrine diseases
• Metabolic diseases
• Autoimmune diseases
• Infections
• Narcolepsy
• Seizures
• Space-occupying lesions
• Strokes
• Head injury
• Demyelinating diseases
• Basal ganglia disorders
• Nutritional deficiencies

For more on this topic, see "Differential Diagnosis of Psychotic Symptoms: Medical 'Mimics,'" by Oliver Freudenreich, MD, from which this quiz was adapted.