Objective: A systemic disorder that affects brain functions may cause psychotic symptoms that is known as Psychotic Disorder Due to General Medical Condition or Secondary Psychosis. Psychotic symptoms in cerebrovascular disorders is informed between %14-60. The aims of this paper is; to emphasize the importance of calling the general medical conditions to mind in a patient with first episode psychotic symptoms and investigating organic ethyologies, to revise primary and secondary psychosis cases.
Case: A-51-year-old, married, right-handed, male with no history of epilepsy, trauma or substance abuse. The patient is brought tor the emergency ward of our hospital by his parents because of showing strange behaviors, absurd speech and saying that he is seeing some people and hearing their voices and feeling frightened of being harmed by other people. After first examination the patient was consulted to psychiatry department. Psychotic Disorder Due to General Medical Condition is thought as prediagnosis and to prove this; cranial CT, blood tests were planned. CT was reported as “left thalamic hematoma 14x10 mm sized, spreaded to ventricular system”. Then the patient hospitalized in neurology department. Blood glucose level and blood tension is regulated in the follow-up as inpatient. Medical treatment for hematoma resorptionapplicated at the same time. Improvement in clinical examination was observed as compatible with hematoma resorption in control cranial CT. Although no treatment applicated specific as antpsychotics, psyhcotic symptoms relieved significantly and the patient discharged from hospital with medical advices after hospitalization for a week. In the control cranial CT after 3 week; hematoma was observed minimally and there were no psychotic symptoms in psychiatric examination.
Conclusion: The prevalence of clinical table called “Psychotic Disorder Due to General Medical Condition” in DSM-IV and also known as Secondary Psychosis is not known definitely. In clinical practice it is known that symptoms like schizophrenia could be seen in the cerebrovascular, degenerative, traumatic and metabolic diseases that affects functions of brain especially, in frontal, temporal and limbic parts. Although the literature data is limited it is advocated that the decreased or disrupted connections between the thalamus, limbic system and frontal lobe neurons is a risk factor or precipitant of psychotic disorder. Clinical observations also supports the disconnectivity syndrome model. Atypical clinical table as undulation in consciousness, disruption in cognitive functions, late-onset of first psychotic symptoms, absence of psychosis in family history in the case we presented caused the choice of advanced radiological screening methods and the thalamic hematoma is detected. In the cases with atypical clinical symptoms comprehensive differential diagnosis should be made including neurological, psychiatric and general medical disorders. This case is presented to emphasize the importance of calling the general medical conditions to mind in a patient with first episode psychotic symptoms, the role of the cerebrovascular events in this clinical table, and the importance of radiological screening methods. Especially in emergency outpatient psychiatry policlinics secondary psychosis should be thought in differential diagnosis.