Diagnosis of CHRONIC PSYCHOTIC DISORDERS F20

Presenting Complaints

• Patients may present with:
  • Problems with thinking or concentration
  • Hearing voices
  • Strange beliefs (e.g., having supernatural powers, being persecuted)
  • Strange physical complaints (e.g., having animals or unusual objects inside one's body)
  • Problems or questions with antipsychotic medication
    
    
• Families may ask for help with apathy, withdrawal, poor hygiene, or strange behaviour.
• There will be problems managing work or studies.

Diagnostic Features

• Chronic problems with the following features:
  • Social withdrawal
  • Low motivation or interest, self neglect
  • Disordered thinking - exhibited by strange or disjointed speech.
    
    
• Periodic episodes of:
• agitation of restlessness
• bizarre behaviour
• Hallucinations - False or imagined perceptions (e.g. hearing voices)
• Delusions - Firm beliefs which are plainly false (e.g. patient is related to royalty, receiving messages from TV, being followed or persecuted)

Differential Diagnosis

• If symptoms of depression are prominent (low or sad mood, pessimism, ideas of guilt) see section on Depression.
  
  
• If symptoms of mania (excitement, elevated mood, exaggerated self-worth) are prominent, see section on Bipolar Disorder.
  
  
• Chronic intoxication or withdrawal from alcohol or other substances(stimulants, hallucinogens) can cause psychotic symptoms. See Alcohol use disorders and Drug use disorders.

Edited by Gavin Andrews MD, UNSW, Jan 03
© 2003 CRUfAD