Which metabolic or endocrine disorders should be included in the differential diagnoses of schizophrenia?

Updated: Mar 16, 2018
  • Author: Frances R Frankenburg, MD; Chief Editor: Glen L Xiong, MD  more...
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Patients with hypoxemia or electrolyte disturbances may present with confusion and psychotic symptoms. Hypoglycemia or hyperglycemia can produce confusion and irritability and may be mistaken for psychosis.

Delirium from whatever cause (eg, metabolic or endocrine disorders) is an important condition to consider, especially in the elderly or hospitalized patient. The clinical hallmarks are decreased attention span and a waxing-and-waning type of confusion.

Endocrine disorders

Severe hypothyroidism or hyperthyroidism can be associated with psychotic symptoms. Hypothyroidism is usually associated with depression, which if severe may be accompanied by psychotic symptoms. A hyperthyroid person is typically depressed, anxious, and irritable.

Both adrenocortical insufficiency (Addison disease) and hypercortisolism (Cushing syndrome) may result in mental status changes. Both disorders also produce physical signs and symptoms that can suggest the diagnosis. In addition, most patients with Cushing syndrome will have a history of long-term steroid therapy for a medical illness.

Hypoparathyroidism or hyperparathyroidism can on occasion be associated with vague mental status changes. These are related to abnormalities in serum calcium concentrations.

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