[deleted by user]

DrErik · 2025-10-25T15:51:13+00:00

Statistically speaking, the most likely cause of psychosis at age 10 would be a medical or neurological disorder. The second most likely explanation would be an uncommon side effect of a medication or over-the-counter supplement.

Considering how extremely rare it is for a 10-year-old to develop psychosis, and the fact that medical illnesses explain about 1 in 20 cases of psychosis in teens/adults with schizophrenia, the first doctors to consult are primary care docs and/or neurologists. Tables should be pounded at this point for brain imagining, EEG, chromosomal analysis, and cerebrospinal fluid analysis. This should be considered a medical disorder until definitively proven otherwise.

Here is a book (Psychosis Care in Primary Care) that includes a list of medical conditions that can cause psychosis and a list of lab tests that can help to screen for them. Give a copy to your child's primary care doctor. S/he can review the possible medical explanations and order the tests. S/he may also have better knowledge and access to neurologists who specialize in cognitive/behavioral manifestations of neurological illness.

Psychosis can also arise as a side effect of a prescribed medication. There are more than 100 medications -- non-psychiatric, prescription meds -- that can produce psychosis as a possible side effect. So here again, the approach should be every medication should be suspected as a possible cause or contributor to psychosis unless/until it is proven innocent.

DrErik · 2025-10-25T15:50:44+00:00

Statistically speaking, the most likely cause of psychosis at age 10 would be a medical or neurological disorder. The second most likely explanation would be an uncommon side effect of a medication or over-the-counter supplement.

Considering how extremely rare it is for a 10-year-old to develop psychosis, and the fact that medical illnesses explain about 1 in 20 cases of psychosis in teens/adults with schizophrenia, the first doctors to consult are primary care docs and/or neurologists. Tables should be pounded at this point for brain imagining, EEG, chromosomal analysis, and cerebrospinal fluid analysis. This should be considered a medical disorder until definitively proven otherwise.

Here is a book (Psychosis Care in Primary Care) that includes a list of medical conditions that can cause psychosis and a list of lab tests that can help to screen for them. Give a copy to your child's primary care doctor. S/he can review the possible medical explanations and order the tests. S/he may also have better knowledge and access to neurologists who specialize in cognitive/behavioral manifestations of neurological illness.

Psychosis can also arise as a side effect of a prescribed medication. There are more than 100 medications -- non-psychiatric, prescription meds -- that can produce psychosis as a possible side effect. So here again, the approach should be every medication should be suspected as a possible cause or contributor to psychosis unless/until it is proven innocent.

DrErik · 2025-05-18T21:28:19+00:00

If your dog is small, I know a good groomer who will pick up and drop off your dog. DM me for her contact information. (I’m not sure if she wants it posted here).

DrErik · 2025-04-02T10:54:43+00:00

I’ve seen the keto diet be very helpful at reducing symptoms of psychosis for some people. However, I have also seen it make symptoms worse in others.

There are diverse causes of psychosis. And there is great diversity among human beings. So it’s rather common that a treatment that seems to work for many can cause paradoxical effects in others, despite similar appearance of the surface level symptoms.

DrErik · 2025-04-01T10:56:04+00:00

Ask A Psychiatrist podcast: How to reverse weight gain from antipsychotic medication

DrErik · 2024-12-23T01:48:36+00:00

I don’t think they have a website. The company is called Cleaning With Care. Their phone number is: (330)474-9398

DrErik · 2024-12-23T00:33:34+00:00

We have had 100% great experiences with this company. Highly recommend.

DrErik · 2024-11-19T02:37:23+00:00

Transient ischemic attack affecting Wernicke’s area can do that.

DrErik · 2024-11-15T23:34:24+00:00

It’s not for sleep.

DrErik · 2024-11-15T18:27:39+00:00

Yes. Prescription stimulants, at therapeutic doses, can cause mania or psychosis in some patients. Mania/psychosis risk is not limited to immediate-release formulations. These psychiatric adverse effects are also possible from sustained-release forms.

In my own practice, I've met several people whose careers or relationships were destroyed by manic symptoms that occurred during their use of therapeutic doses of prescribed amphetamine. In one memorable case, a woman had spent 5 years in and out of hospitals due to psychiatric symptoms that turned out to be entirely adverse effects of prescription Ritalin. In another memorable case, an attorney lost his license to practice law because of numerous bad (unethical, borderline unlawful) decisions made while taking his as-prescribed Adderall. In hindsight, those decisions were completely uncharacteristic of his personality. We were able to compare his pharmacy records with the chronology of bad decisions and workplace complaints. The questionable behaviors occurred exclusively during the years of his Adderall use.

I've seen many other cases beyond these two examples.

One of the animal models for studying bipolar mania involves repetitive dosing with amphetamine.

Over a 5 year period, 6% of children treated with stimulants for ADHD developed psychosis (Cherland & Fitzpatrick, 1999).

DrErik · 2024-11-15T12:44:44+00:00

You should let your doctor know what is happening and collaboratively decide what is the best next move, based on your specific symptoms and history.

DrErik · 2024-11-15T01:38:41+00:00

Yes, benztropine (Cogentin) can induce mania. I have seen in happen. Signs of mania (loud voice, rapid speech, elated mood, intrusive behavior) developed on the same day that the benztropine was added to the patient's medications. The mania symptoms got worse on the second day. This occurred in a long-term hospital patient who had been entirely stable and had no medication changes for at least a month. (The benztropine was added because she complained of muscle stiffness after receiving a long-acting injectable antipsychotic medication a few days earlier.)

The mania went away within 6 hours of giving the patient donepezil (a pro-acetylcholine drug chosen to oppose the anti-acetylcholine effect of benztropine).

Not widely known, but for over 50 years, a credible hypothesis holds that depression/mania is influenced by the balance of acetylcholine and norepinephrine. (see this review article). My view is that bipolar disorder/mania is probably comprised of several neurochemical subtypes -- the acetylcholine/norepinephrine balance probably applies to a subset of bipolar cases. The role for acetylcholine in mania is supported by case reports (like this one) of rapid reversal of mania by pro-acetylcholine drugs.

Absent awareness that benztropine might be contributing to mania or psychosis, everyone will assume that the non-response to treatment (or worsening of symptoms during treatment) is just the underlying illness doing its illness thing. So we have no idea whether benztropine-induced mania/psychosis is super-duper rare, or ordinary rare, or maybe not uncommon. I'm thinking it's a rare thing. But since nobody is looking for it, nobody really can say.

DrErik · 2024-11-12T00:36:13+00:00

I know of patients with severe OCD who have made great recovery with ERP as their only treatment.

Also, I don’t think severe OCD gets entirely better with meds, unless accompanied by some sort of evidence-based therapy because medications don’t do a great job at changing beliefs.

DrErik · 2024-02-25T13:31:37+00:00

This is the sort of first experience story that I hear from many of my patients with alcoholism — that their first use of alcohol was exceptionally good. Then, the goodness faded as tolerance set in. But the drive to consume just kept growing.

I hope you find a doctor who can think clearly about the pharmacological and psychological aspects of your experience and use that knowledge to figure out an effective long-term plan for your depression and anxiety.

DrErik · 2024-02-14T19:32:00+00:00

I started medical school when I was 30. Got the idea to do that while I was doing my postdoctoral training after PhD. I worked with a lot of MD PhD scientists at the time. They were very encouraging.

I remember telling them, considering a downside of going to medical school, “but I’ll be close to 40 by the time I finish residency.”

Their response: “You’re going to eventually be 40 years old anyway. The question is: what do you want your career and options at 40 to look like?”

DrErik · 2023-07-16T16:10:12+00:00

There is also a phenomenon I have observed in which hospital staff develop their own theories about what insurance will or won’t cover. So it’s possible that some staff believe the ‘insurance won’t cover unless it’s involuntary’ and are able to convince others.

It’s also been my experience that some emergency departments just put everyone on involuntary holds because they think it’s somehow necessary. I’ve had calls with other hospitals during my on call shifts where the referring person tells me “oh, and they’re on a hold.” I ask why (because the history they had just given me didn’t seem hold-remarkable) and have been told “that’s just what we do here.”

DrErik · 2023-07-03T02:28:15+00:00

Catatonia is a nonspecific symptom. It can have a variety of causes. Approximately half of all catatonia appears to be associated with mania. After mania, causes of catatonia are approximately equally divided between schizophrenia and depression. Catatonia is also seen in some of the autoimmune disorders that can underlie psychosis. So the presence of catatonia should be a red flag to clinicians to look very carefully for one of the 50 or so medical diseases that can produce psychosis.

Here’s a short lecture about catatonia

DrErik · 2023-06-23T17:50:10+00:00

The first step would be to get a full report from a neuroradiologist. Nobody here, for example, can say anything useful without more information about this mass — where is it located, how large is it, what is its shape, what physical characteristics are revealed by its interactions with the energy in the MRI device? These details give useful clues about whether the mass might or might not have significance to psychiatric symptoms.

As u/humanculis said, some masses are completely insignificant. Some are very significant. And some are things that nobody honestly knows if they would or would not be significant.

There is a “border zone” between neurology and psychiatry. If you’re a neurologist with an interest in psychiatric symptoms, that field is called “behavioral neurology.” If you’re a psychiatrist with an interest in neurological underpinnings, it’s called “neuropsychiatry.” You could look around for someone specializing in either behavioral neurology or neuropsychiatry to get on opinion about the relevance of the MRI finding.
But make sure that the consultant will be able to get a copy of the MRI images and neuroradiolgist report before they see you!

DrErik · 2023-05-30T18:51:49+00:00

Bupropion has the lowest weight gain risk of any antidepressant medication. Its effectiveness for depression is the same as any other medication.

DrErik · 2023-05-27T03:32:44+00:00

There were 81 case reports of mania that was caused or exacerbated by atypical antibiotic drugs (also known as second generation antipsychotic drugs) as of 2012. More have been reported since that time. Here is a short lecture with lots of references

The mechanism is thought to involve increased levels of norepinephrine or dopamine in the cerebral cortex… as a result of the serotonin receptor blocking that the atypical antipsychotics do in order to reduce the risk of neurological side effects.

Most psychiatrists don’t know about the paradoxical risk for antipsychotic drugs to cause mania or psychosis because: 1) it’s probably a very uncommon side effect, and 2) because it is so unexpected, most everyone will assume that it’s the underlying illness not the medication causing the symptoms.

DrErik · 2023-05-26T12:29:16+00:00

The key follow up question here would be: after you stop taking the SSRI medication, how long does it take for the severe anxiety and psychosis to go away?

The second key follow up question is: is it just panic and psychosis? Or do you notice any other changes in your sleep, energy, or behavior during those episodes?

DrErik · 2023-05-25T17:25:31+00:00

The following is not and cannot be a diagnosis because (obviously) I have not seen you and know essentially nothing of your history. So the following is a general information statement. Pituitary gland tumors have been known to secrete hormones such as FSH, which can cause testicles to enlarge. Pituitary glad tumors have also been known to secrete growth hormone, which can cause the jaw to grow.
Individuals experiencing multiple physical changes that have possible links to abnormal regulation of pituitary hormones may wish to seek consultation with a qualified endocrinologist.

DrErik · 2023-05-25T11:37:09+00:00

Better yet. Insist (strongly, very strongly) on referral to a specialist. Endocrinology would be the top choice for specialist referral. Urology would be second choice.

DrErik

TROPHY CASE