Medical Conditions That May
Present with Psychosis
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Temporal lobe epilepsy
Tumor
Stroke
Trauma
Endocrine/metabolic abnormalities
Infections
Multiple Sclerosis
Autoimmune diseases
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Evaluating
Psychosocial
Function
• Premorbid
• Current
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Aspects of Psychosocial
Function
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Relationship to parents
Relationship to siblings
Relationship to peers
Sexual adjustment
Educational history
Work function
Recreational activities and
interests
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Laboratory Workup
• No standard set of laboratory
tests
• Test selected on basis of
clinical presentation, mode of
onset, and past history
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Some Common
Laboratory Tests
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Complete blood count
Urinalysis
Endocrine tests
Liver function tests
Electroencephalogram
Computerized Tomography
Magnetic Resonance Imaging
Neuropsychological tests
Projective tests
WPA
Cross Cultural Issues:
Similarities Across Cultures
• Schizophrenia is found
throughout the world
• Some symptoms tend to be
identical worldwide
Negative symptoms
Thought Disorder
Cognitive Impairment
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Differences Across
Cultures
• Content of psychotic
symptoms
• Outcome
• Frequency of acute psychotic
episodes
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Reasons for
Frequency of Acute
Psychosis
• Infections
• Nutrition
• Delays in provision of
medical care
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Social Outcome in First Episode
Schizophrenia: Nagasaki
Follow-up
after 2 years
1981-1982
Follow-up
after 5
years 19841985
Follow-up
after 10
years 19891990
64
65
58
Good Outcome
34.4
44.6
36.2
Poor Outcome
24.4
35.4
35.5
Hospitalized
31.3
20.0
29.3
With good outcome
39.1
50.8
44.8
With poor outcome
60.9
49.2
55.2
Number of cases at follow-up
DAS overall evaluation (includes
cases in the hospital)
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Poor Outcome: Predictors
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Prominent negative symptoms
Early age of onset
Insidious onset
Poor premorbid adjustment
Low educational achievement
Low parental social class
Male gender
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Comparison of Course in Developed
and Developing Countries
Pattern of Course *
1
2
3
4
5
6
7
8
9
Developed Countries (n-604)
15.7
17.4
6.2
5.3
14.7
12.1
17.1
2.3
--
Developing Countries (n-474)
37.1
11.6
6.5
2.3
19.0
10.6
11.2
1.1
0.6
* 1. Single psychotic episode, complete remission
2. Single psychotic episode, incomplete remission
3. Single psychotic episode, non-psychotic episodes complete remission
4. Single psychotic episode, non-psychotic episodes incomplete remission
5. 2+ psychotic episodes, complete remission
6. 2+ psychotic episodes, incomplete remission
7. Continuous psychotic illness, no remission
8. Continuous non-psychotic illness
9. Not known
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Reasons for Better
Outcome in Developing
Countries
• Better social support from
extended families
• Less social pressure to achieve
occupationally
• Lower stress in rural
environments and small villages
• Less stigma toward mental
illness
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