Question: Behavior

A) Auditory, as opposed to visual, hallucinations
Psychiatric cause of psychosis is a diagnosis of exclusion, and medical causes must be considered. Bedside glucose and pulse oximetry to quickly rule out hypoglycemia and hypoxia should be performed in anyone with altered mentation. Acute onset of symptoms after an event such as a party suggests drug toxicity. Physical exam signs and historical clues (e.g. from interviewing friends and relatives) of drug use should also be sought. Look for signs of seizure disorder such as episodes of inattentiveness, rhythmic blinking, incontinence. Tachycardia, tremor, palpitations, weight loss, and goiter point toward hyperthyroidism. An abnormal neurologic exam raises concerns for a space-occupying lesion or CNS infection. Acute intermittent porphyria may be precipitated by certain medications and is sometimes correlated with the luteal phase of the menstrual cycle. The differential diagnosis also includes other metabolic and autoimmune diseases. A more gradual onset of symptoms, auditory as opposed to visual or tactile hallucinations, and grandiosity are more associated with psychiatric etiology.