Differential diagnosis

Differential Diagnosis table forSchizophrenia Condition

Differentiating signs/symptoms Substance-related disorders are great imitators of psychopathology. Delusions are not as crystallised as in schizophrenia, but auditory hallucinations may still be present. A drug history should include evaluation of the duration, frequency, dosage, and time since last use. [63] The drugs most often associated with psychosis are heavy and persistent use of marijuana; stimulant drugs such as methamphetamine, cocaine, and amphetamines; psychotomimetics such as LSD and ketamine-like drugs; and inhalants such as toluene, gasoline, and various types of glues. Past history of extensive use may result in long-term persistent psychotic symptoms, years after the last exposure.

Differentiating tests

Substance-induced psychotic disorder Gangguan psikotik yang diinduksi zat (Substance-induced psychotic disorder)

Urine drug screen identifies the causative drug.

Dementia with psychosis

Delusions may be similar, but are without a history of psychosis prior to dementia onset. An older age, family history of dementia and gradual cognitive decline suggests dementia.

CT or MRI of the head may reveal characteristic signs of the causative dementia.

Depression with psychosis

Depression typically occurs before psychotic symptoms appear. In schizophrenia, the psychotic symptoms occur first. Typically, the mood disorder occurs before psychotic symptoms appear. In schizophrenia, the psychotic symptoms occur first. Patients may need constant reassurances due to consciously or unconsciously feigned physical symptoms. Particular attention should be given to

Clinical diagnosis

Bipolar disorder with psychosis

Clinical diagnosis.

Malingering and factitious disorders

Clinical diagnosis.

any inconsistencies in history, atypical disease presentations, and evasiveness when asked about symptom details. Helpful to get collateral information from other carers or close contacts. Should be distinguished from somatisation; schizophrenics with true somatisation are not typically evasive or needy of reassurances. Patients suffer from a singular delusion but do not meet DSM IV-TR criteria for schizophrenia. This disorder is differentiated by a short duration of psychosis (<1 month), unaccompanied by a functional deterioration. A schizophrenia diagnosis is given in patients with PDD only if prominent delusions and hallucinations occur for at least 1 month (or less if treated successfully). Clinicians should gather a childhood history, looking for pervasive deficits. In PDD, the debut of deviant interpersonal interactions, delayed and aberrant communication skills, and limited repertoire of activities and interests occurs in the first years of life. Childhood schizophrenia (before age 5) is rare, even though patients with PDD may experience hallucinations at one time or another. Numerous medical conditions can cause psychiatric symptoms. Conditions affecting the brain can cause psychosis, such as epilepsy, tumours (not only brain tumours), traumatic brain injuries, HIV, neurosyphilis, pellagra, B12 deficiency, herpes encephalitis, and Wilson's disease, among others. History and physical examination help differentiate diagnoses.

Delusional disorder

Clinical diagnosis.

Brief psychotic disorder

Clinical diagnosis.

Pervasive developmental disorder (PDD)

Clinical diagnosis.

Organic psychosis

Laboratory studies will help differentiation, such as RPR, HIV test, HSVPCR in CSF fluid, copper urine level, ceruloplasmin in blood and vitamin B12

level.

Carbon monoxide poisoning

Psychosis due to carbon monoxide is without a long history of psychosis as in schizophrenia. A careful history should be taken, looking for possible toxic exposure.

Toxic screen for carboxyhaemog lobin may be performed in the emergency department. Toxic screen for a bromide or mercury level may be performed in the emergency department. A serum bromide test will show results of >50 mg. Symptoms resolve on withdrawal of the offending agent. A quantitative level of agents should be taken if available. Liver function tests exhibiting abnormal results.

Heavy metal poisoning

Psychosis due to heavy metals (e.g., bromide, mercury) is without a long history of psychosis as in schizophrenia. A careful history should be taken, looking for possible toxic exposure. Psychosis may present suddenly and, when exposure is treated, symptoms will remit.

Medicine-induced psychosis

Some patients are more susceptible to psychosis and confusion with prescribed medicines. Steroids, anticholinergics, disulfiram, digitalis, and L-dopa medicines are the most common causes. A careful review of a patient's medicines, including OTC drugs, should be taken. Fatigue, anxiety, depression, and irritability are associated with physical signs of liver dysfunction. Psychosis is accompanied by physical signs such as tachycardia, goitre, unexplained weight loss, palpitations, tremor, muscle weakness, or unexplained protrusion of the eyes (in Graves' disease). May precipitate psychosis. [64] [65] [66] Anxiety and depression are commonly

Liver diseases (e.g., hepatitis, cirrhosis)

Hyperthyroidism

Elevated serum T3 and T4 with a low TSH.

Hyperparathyroidis m

Serum calcium is normal or elevated in

seen. Physical symptoms and signs may include bone pain, fractures (due to osteoporosis), poor sleep, fatigue, renal colic due to nephrolithiasis, myalgias, paraesthesias, and muscle cramps. Signs of the cause may be present, such as a hard and dense neck mass or a jaw mass, features of chronic renal failure, or features of a malabsorption syndrome.

primary hyperparathyroi dism and decreased in secondary hyperparathyroi dism. Serum PTH is elevated in primary and secondary hyperparathyroi dism.

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