Pediatric emergency medicine trisk 1050

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or may be withdrawn, speaking only in monosyllables and describing only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.