Many physical disorders can present with psychosis.Examples for this category ( ‘psychosis due to a general medical condition’) include sarcoidosis, porphyria, Cushing’s disease, acquired immune deficiency syndrome, carcinoid tumor, toxic thyroid nodules, Wilson’s disease, neurosyphilis, Huntington’s disease and multiple sclerosis. Screening protocols for such conditions vary widely between countries.In Denmark and Germany Brain scans are done for all patients presenting with psychotic symptoms. The prevalence of neurological abnormalities that have therapeutic implications in patients presenting with psychotic symptoms is unclear.
Iris E. Sommer and team investigated the prevalence of clinically relevant neuropathology among 656 patients presented to services ( Netherlands) with psychotic episode and compared the rates to those of a matched group of healthy individuals from the community.
Normal brain MRI study was reported in 74.4% of the patients and in 73.4% of the controls. Clinically relevant pathology was found in 11.1% of the patients and in 11.8% of the controls. Brain tumors detected in 0.2% of the patients and in 0.3% of the controls.None of the neuropathological findings observed in the patient group was interpreted as a possible substrate for organic psychosis.
Conclusions: This study suggests that MRI scanning should not be a routine for patients presenting with psychosis.
Summary of the article:
How frequent are radiological abnormalities in patients with psychosis? A review of 1379 MRI scans. Sommer IE, de Kort GA, Meijering AL, Dazzan P, Hulshoff Pol HE, Kahn RS, van Haren NE.Schizophr Bull. 2013 Jul;39(4):815-9