Psychotic Disorders

1. The clinical presentation of a patient at the height of a manic episode may be indistinguishable from that of an acute exacerbation of paranoid schizophrenia, making accurate diagnosis difficult.

2. If the history is unavailable or if the patient is having an initial episode, it may be necessary to observe the patient over time to make an accurate diagnosis. A subsequent major depressive episode or manic episode that initially presents with mood symptoms prior to the onset of psychosis indicates that a mood disorder, rather than a psychotic disorder, is present.

3. A family history of either a mood disorder or psychotic disorder suggests the diagnosis of bipolar disorder or psychotic disorder respectively.

C. Substance-Induced Mood Disorder. The effects of medication or drugs of abuse should be excluded. Common organic causes of mania include sympathomimetics, amphetamines, cocaine, steroids, and H2 blockers (eg, cimetidine).

D. Mood Disorder Due to a General Medical Condition. Medical conditions that may present with manic symptoms include AIDS, Cushing's, hyperthyroidism, SLE, multiple sclerosis, brain tumors.

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