Acute psychosis: A neuropsychiatric dilemma

Abstract

The acute onset of psychotic symptoms in elderly can be the presenting clinical feature for various Central Nervous System as well as other systemic illnesses. The diagnosis and treatment of such presentation require a cautious medical work up and high level of suspicion even if the patient is not showing any cardinal symptoms for organic pathology.

Massive pulmonary embolism presenting initially as acute psychosis

“…Infections and ingestion of various substances can also result in acute psychosis. Initial work-up to rule out common causes usually includes a complete blood count, comprehensive metabolic panel, serum B 12 , folate, thyroid function tests, blood and urine culture, toxicology screen, chest X-ray, ECG and brain CT scan 1. In our patient’s case, all these tests were non-contributory.…”

Spotlight on non-motor symptoms and Covid-19

“…All dopaminergic medication can induce psychosis; levodopa in a lesser degree ( Simonet et al, 2020 ). On the other hand, psychotic features can emerge secondarily due to other medication, like antidepressants, pain-killers or steroids, alcohol abuse or withdrawal, systematic or CNS infections, including Covid-19, CNS lesions, acute vascular events, or they can be part of the clinical spectrum of delirium, especially in elderly hospitalized patients ( Dubovsky, Arvikar, Stern, & Axelrod, 2012 ; Parra et al, 2020 ; Saldanha, Menon, Chaudari, Bhattacharya, & Guliani, 2013 ; Webster & Holroyd, 2000 ). In the Covid-19 context, incident psychosis has not been very common, although more findings have been based on case reports and case series.…”