Psychosis Exam

Aka: Psychosis Exam, Examination Findings Suggestive of Psychosis, Schizophrenia Exam

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II. Precautions

  1. Interpret in the context of the patient's social history (e.g. cultural beliefs)

III. Findings: Appearance

  1. Unkempt clothing
  2. Poor grooming
  3. Bizarre dress

IV. Findings: Behavior and Psychomotor Disorder

  1. Bizarre and inappropriate behavior
  2. Agitation,
  3. Social isolation or withdrawal
  4. Deterioration in functioning
  5. Lack of initiative and motivation
  6. Identity disturbances
  7. Catatonic stupor
    1. Lack or reduction in spontaneous movement
  8. Stereotyped behavior (repetition)
  9. Negativism (uncooperative)
  10. Impulsive unpredictable behavior
  11. Anhedonia
  12. Somatic complaints
  13. Emotional withdrawal
  14. Poor rapport
  15. Passive, apathetic or avolitional
  16. Anergia (lack of persistence at work or school)

V. Findings: Speech

  1. Word Salads
  2. Echolalia
  3. Perseveration
  4. Mutism
  5. Neologisms
  6. Lack of spontaneity and conversation flow
  7. Alogia (marked poverty of speech or content of speech)

VI. Findings: Mood

  1. Anxiety
  2. Anger
  3. Fearfulness
  4. Depression
  5. Dysphoria

VII. Findings: Affect

  1. Blunted
  2. Flat
  3. Inappropriate

VIII. Findings: Perception

  1. Auditory or command Hallucinations
  2. Depersonalization
  3. Derealization

IX. Findings: Thought Process

  1. Disorganized
  2. Illogical
  3. Blocking
  4. Loosening of associations
  5. Circumstantiality
  6. Tangentiality
  7. Flight of ideas
  8. Verbigeration
  9. Stereotyped thinking

X. Findings: Thought Content

  1. Delusions of being controlled by an outside force
  2. Thought insertion
  3. Thought withdrawal
  4. Thought broadcasting
  5. Delusions of grandeur or persecution
  6. Religious, nihilistic and somatic Delusions
  7. Ideas of reference

XI. Findings: Impaired judgment

  1. Acts on Delusions
  2. Obey command Hallucinations

XII. Findings: Cognition

  1. Impaired
  2. Attentional Impairment
  3. Difficulty in abstract thinking

XIII. Findings: Premorbid

  1. Withdrawn
  2. Eccentric
  3. Passive
  4. Impulsive
  5. Schizotypal
  6. Schizoid

XIV. References

  1. (2000) DSM IV, APA, p. 297-343
  2. Freedman (2003) N Engl J Med 349:1738-49 [PubMed]
  3. Schultz (2007) Am Fam Physician 75:1821-9 [PubMed]

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