Psychotic Disorder Due to a Medical Condition

This article provides an overview of common medical conditions that can cause psychosis, with additional information on the symptoms, causes, complications, and best treatment options.

Key Takeaways:

• Many medical conditions can cause a psychotic disorder, such as seizures, autoimmune disorders, infections, dementia, and even nutritional deficiencies.

• This results in the classic symptoms of psychosis, such as hallucinations, delusions, and disorganized thoughts and behaviors. Individuals may also become agitated and pose a threat to themselves or others.

• Treatment is based on acute management of psychotic symptoms and then treating the underlying medical condition.

Understanding Psychotic Disorders Caused by Medical Conditions

Some cases of psychosis are directly attributable to medical causes. In these instances, there is evidence that the specific medical condition or event brought on the symptoms of psychosis, which were not present before. ^{[1] [2]}

Psychotic disorders caused by medical conditions are classified as secondary psychoses, since the symptoms can be explained by another cause. This is different from primary psychoses, in which psychotic symptoms can’t be attributed to another cause. The other type of secondary psychosis is psychosis caused by substance use. ^[2]

How Common is It?

The lifetime prevalence of a psychotic disorder secondary to a medical condition is 0.21% in the general population. For comparison, the overall prevalence of any psychotic disorder is around 3%. ^[3]

How Can a Medical Condition Result in Psychosis?

Psychosis is thought to result from abnormalities in brain and nervous system function. Therefore, many medical conditions can result in psychosis due to the effect they have on the brain and nervous system in general. Depending on the exact condition, they can affect brain blood flow and oxygen levels, neurotransmitter functioning, brain region structure and function, vitamin levels, and other factors.

Symptoms

The symptoms of a psychotic disorder due to a medical condition are similar to the symptoms of other psychotic disorders. Primarily, individuals experience the hallmark symptoms of psychosis, which include: ^{[1] [3]}

• Hallucinations

• Hearing voices or other sounds that don’t exist

• Seeing things that aren’t actually there

• Delusions

• Disorganized thoughts or speech

• Very odd or erratic behaviors

• Feeling disconnected from reality

Medical Conditions Linked with Psychosis

Numerous medical conditions have the potential to cause psychosis. Listed below are categories of medical conditions that may cause psychosis, with specific examples: ^{[1] [2] [3]}

• Epilepsy

• Head trauma/traumatic brain injury

• Dementia:

• Alzheimer’s disease

• Pick’s disease

• Lewy body dementia

• Cerebrovascular disorders:

• Stroke

• Subdural hematoma

• Autoimmune disorders:

• Systemic lupus erythematosus

• Autoimmune encephalitis

• Paraneoplastic syndromes

• Neuropsychiatric disorders:

• Huntington’s disease

• Wilson’s disease

• Parkinson’s disease

• Infections:

• Viral encephalitis

• HIV

• Neurosyphilis

• Toxoplasmosis

• Lyme disease

• Tuberculosis

• Endocrine disorders:

• Hyper- or hypothyroidism

• Hyper- or hypoparathyroidism

• Hypoglycemia

• Addison’s disease

• Cushing’s syndrome

• Dietary/nutritional disorders:

• Deficiencies in:

• Vitamin B12

• Zinc

• Vitamin D

• Vitamin A

• Niacin

• Magnesium

• Metabolic disorders:

• Hartnup disease

• Homocystinuria

• Phenylketonuria

• Fabry’s disease

• Wilson’s disease

• Phaeochromocytoma

• Space-occupying lesions/disorders:

• Primary brain tumors

• Metastases

• Tuberous sclerosis

• Hydrocephalus

• Narcolepsy

• Chromosomal abnormalities:

• Klinefelter’s syndrome

• Fragile X syndrome

Post-Ictal Psychosis (PIP)

Post-ictal psychosis (PIP) refers to psychosis that occurs soon after a cluster of seizures. It occurs in approximately 7% of individuals with temporal lobe epilepsy. PIP symptoms don’t appear immediately, but occur anywhere from several hours up to one week after the seizure cluster ends, with an average time of 1-3 days. ^[4]

Individuals with PIP typically develop warning signs, such as restlessness, irritability, and insomnia. In the acute phase, they often experience delusions, severe agitation, and hallucinations. They also become more likely to harm themselves and die by suicide, and may become aggressive or violent towards others. ^[4]

Causes

While the medical conditions listed above can cause episodes of psychosis, they only affect a certain percentage of the population. After all, not everyone with those medical conditions will experience psychosis.

Certain risk factors may make individuals more likely to experience a psychotic disorder from a medical condition. Examples of these risk factors include: ^{[1] [4] [5]}

• Severe (vs mild or moderate) medical conditions

• Genetic risk factors for psychosis

• History or current presence of psychiatric disorders, such as:

• Depression

• Anxiety

• Post-partum depression

• Older age

• Heightened stress levels

• Trauma

• Lack of sleep

Risks and Complications

Individuals who experience a psychotic disorder due to a medical condition may have an increased risk of harming themselves and others. This includes an increased risk of suicide. ^[4]

Psychosis can also disturb well-being and often makes it difficult or impossible to take care of oneself and complete daily living tasks. The stress brought on by psychosis may also lead to anxiety, depression, and other mental health issues. And some individuals may turn to substance use or other unhelpful behaviors to cope with stress. ^[2]

Prevention

It is not definitively known why some individuals experience psychosis after medical conditions, and others do not. Due to the complex, multifaceted nature of this disorder, total prevention is not possible. However, certain things can decrease the likelihood of experiencing a psychotic episode from a medical condition, such as:

• Prompt treatment at the first sign of unusual symptoms (e.g., irritability, sleep issues, trouble concentrating, changes in perceptual experiences)

• Proper and professional management of existing medical conditions

• Daily/regular stress management strategies

• Adequate nutrition and hydration

• Regular socialization

• Adequate sleep

Can You Identify Your Own Psychotic Episode?

It is possible to be aware of and identify your own psychotic episode. However, a significant percentage of individuals are unaware that their symptoms and behaviors constitute psychosis, and therefore may believe that nothing is wrong and that treatment isn’t needed. Thus, professional evaluation and identification are essential.

Treating a Psychotic Disorder Caused by a Medical Condition

Treatment for psychotic disorders caused by a medical condition primarily involves acute treatment for psychosis and treating/managing the underlying medical condition.

Symptoms of acute psychosis are often treated with antipsychotics. Examples of drugs that are used in these situations include: ^{[2] [3]}

• Haloperidol (which may be combined with lorazepam)

• Olanzapine

• Risperidone

• Aripiprazole

The exact medication utilized depends on several factors, including age, health risk factors, specific medical conditions, and presenting symptoms. Also, individuals experiencing agitation or other severe symptoms may benefit from hospitalization for a period of time. ^[3]

After the acute symptoms of psychosis are treated, the next portion of treatment revolves around treating the underlying medical condition that caused the psychotic episode. Some medical condition-induced psychoses respond rapidly to resolving the underlying condition, while others are more complex and may take longer. Moreover, some individuals will only experience one psychotic episode, while others may experience multiple future episodes. As a result, the exact length and intensity of treatment can vary widely. ^{[2] [3]}

Examples of psychotic disorder causes that are typically more rapid in treatment response include electrolyte imbalances, hypothyroidism, hypoglycemia, and acute infections. Contrarily, psychosis may take longer to resolve when it is caused by autoimmune encephalitis, neurodegenerative conditions, and epilepsy. (These are just several examples and do not constitute a definitive list.)

Medical Condition-Induced Psychosis FAQs

Listed below are frequently asked questions about psychotic disorders related to a medical condition.

Can genetics play a role in psychosis due to a medical condition?

Yes. Certain genetic risk factors, as well as having first-degree relatives with a history of psychosis, may increase the likelihood of experiencing psychosis after a medical condition.

Is psychosis caused by a medical condition a long-term disorder?

Psychosis caused by a medical condition can be acute or long-term, depending on the nature of the medical condition and treatment response. Some individuals may only have one episode of psychosis, while others may experience multiple future episodes, especially if their medical condition is long-term and/or not adequately treated.