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Secondary Schizophrenia

  • Oliver Freudenreich
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

The number of medical diseases that can present with psychotic symptoms (delusions, hallucinations) is legion. A thorough differential diagnosis of psychosis is necessary to avoid the mistaken attribution of psychosis to a psychiatric disorder instead of a medical condition, which requires very different treatment. I outline a clinical approach for a patient with psychosis of unknown etiology that emphasizes the need to be pragmatic about the medical work-up as indiscriminate screening is neither feasible nor helpful. To organize this chapter, I use the primary (psychiatric) versus secondary (“organic”) distinction to review the medical etiologies of schizophrenia-like psychosis. In this scheme, schizophrenia due to a medical condition is referred to as secondary schizophrenia.

Keywords

Differential diagnosis Primary psychosis Secondary psychosis Clinical presentation Diagnosis Medical work-up Secondary schizophrenia(s) Treatment 

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Additional Resources

    Books

    1. Cahalan S. Brain on fire: my month of madness. New York: Free Press; 2012. – The personal journey of a young woman who developed a serious neuropsychiatric disorder that ultimately ends well: after the correct diagnosis of an “organic” condition, anti-NMDR encephalitis is made.Google Scholar
    2. Lipska BK. The neuroscientist who lost her mind: my tale of madness and recovery. Boston: Houghton Mifflin Harcourt Publishing Company; 2018. – Excellent description of the effects of brain metastases on affect, cognition and perception as well as insight by a neuroscientist who developed metastatic melanoma.Google Scholar

    Articles

    1. Freudenreich O, Schulz SC, Goff DC. Initial medical work-up of first-episode psychosis: a conceptual review. Early Interv Psychiatry. 2009;3:10–8. – A conceptual article about the “organic” work-up of patients with psychosis.PubMedCrossRefPubMedCentralGoogle Scholar
    2. Pollak TA, Rogers JP, Nagele RG, Peakman M, Stone JM, David AS, et al. Antibodies in the diagnosis, prognosis, and prediction of psychotic disorders. Schizophr Bull. 2019;45:233–46. – An excellent review of antibodies and psychosis, including diagnostic antibodies for autoimmune encephalitis. This is an area of psychiatry where I have seen progress in my life-time, including the delineation of a new syndrome (NMDA receptor encephalitis) that psychiatrist must recognize in order to assure correct medical treatment.PubMedCrossRefPubMedCentralGoogle Scholar
    3. Hogan C, Little BP, Carlson JCT, Freudenreich O, Ivkovic A, Baron JM. Case 5–2019: a 48-year-dld woman with delusional thinking and paresthesia of the right hand. N Engl J Med. 2019;380:665–74. – A case discussion from the MGH clinico-pathological conference, highlighting the difficulties in deciding if an identified medical disease (vitamin B12 deficiency) is solely responsible for what appears to be a chronic psychotic illness.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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