Differential diagnosis

HALLUCINATION

HALLUCINATION

Hallucinations, defined as the perception of an object or event (in any of the 5 senses) in the
absence of an external stimulus, are experienced by patients with conditions that span several
fields

DIFFERENTIAL DIAGNOSTIC

1) Schizophrenia

2) Dementia

3) Delirium
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DEMENTIA
Dementia is a group of conditions characterized by
decreased brain function. Risk factors for dementia
include age; family history of dementia; personal history
of cardiovascular disease, cerebrovascular disease,
diabetes mellitus, or obesity
DEMENTIA

Alzheimer disease accounts for 60% to 80% of dementia cases.

Vascular dementia in isolation accounts for 10% of cases, but it
commonly presents as a mixed dementia with Alzheimer disease.

Lewy body dementia, Parkinson-related dementia, normal-pressure

hydrocephalus, and frontotemporal dementia represent most of the
remaining cases
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ALZEIMER
DEMENTIA
 Alzheimer’s disease is the most common dementia diagnosis
among older adults. Alzheimer’s dementia is typically associated
with abnormal buildups of proteins in the brain — these are
known as amyloid plaques and tau tangles

Risk factors:
Age
Family history of dementia
Hypertension
Hypercholesterolemia
Diabetes
Smoking
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VASCULAR
DEMENTIA
 Vascular dementia is a diagnosis of dementia in people who
have vascular changes in the brain, such as a stroke or injury to
small vessels carrying blood to the brain.
 People diagnosed with a vascular dementia may also show
changes in the brain’s white matter, the connecting "wires" of
the brain that relay messages between regions.
 These changes can be seen with an MRI.
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FRONTOTEMPOR
AL DEMENTIA
 Frontotemporal dementia (FTD) is rare and tends to occur in people
younger than 60.
 FTD is named for the areas of the brain affected. Changes in the frontal
lobe lead to behavioral symptoms, whereas changes in the temporal lobe
lead to problems with language and emotions.
 These changes include abnormal amounts or forms of the proteins tau and
TDP-43, and the loss of nerve cells
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MENTAL
RETARDATION
Mental retardation is a state of stopped or incomplete mental
development, which is mainly characterized by the
occurrence of impaired skills during development, so that it
affects the overall level of intelligence, such as cognitive,
language, motor, and social abilities.
Signs and Symptoms:
- Difficulty learning activities of daily living
- poor reasoning
- and poor memory
 SIGNS AND SYMPTOMS OF MENTAL RETARDATION

Diagnostic criteria for mental retardation According to PPDGJ III:

1. General intellectual function is significantly below average IQ of 70 or lower on
individualized tests (in infants because available intelligence tests cannot be
scored numerically, average intellectual function can be made on clinical
grounds).
2. At the same time, there is a deficiency or impairment in adaptive behavior that is
considered according to age and culture.
3. Appears before the age of 18

The provisions of the mental retardation subtype include:

 Light IQ Level: 50-69
 Medium IQ Level: 35-49
 Weight Level IQ: 20-34
 Very heavy IQ level: under 20
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DELLIRIUM
Delirium, a syndrome that involves an acute disturbance of consciousness as well
as a diminished ability to sustain attention, is caused by myriad medical
conditions, metabolic disturbances, infections, drug effects, and intracranial
processes.

Delirium’s signs and symptoms also include psychosis (eg, auditory and visual
hallucinations, paranoid delusions) and psychomotor agitation or retardation
that can be misconstrued as depression
DELIRIUM

To make a diagnosis of delirium, a patient must have a disturbance

of consciousness with a diminished ability to focus or to maintain
or shift attention, a change in cognition or the development of a
perceptual.
SIGNS AND SYMPTOMS OF DELIRIUM

Delirium Diagnosis Criteria According to PPDGJ III :

1. Disorders of consciousness and attention
• From foggy consciousness to coma
• Decreased ability to direct, focus, sustain and divert attention
2. General cognitive impairment
• Perceptual distortions, illusions and hallucinations – often visual
• Impaired thinking and abstract understanding, with or without delusions that
are temporary, but very characteristically there is a mild incoherence
• Immediate and short-term memory impairment, while long-term memory is
relatively intact
3. Psychomotor Disorder
• Hypo or hyperactivity and unexpected shifting of activity from one to
another Longer reaction time Flow of speech increased or decreased
• Shocked reaction increased
4. Sleep-wake cycle disorders
• Insomnia or in severe cases unable to sleep at all, or reversal of the sleep-
wake cycle; sleepy during the day
• Symptoms worsen at night. Disturbing dreams or nightmares that may
progress to hallucinations upon awakening.
5. Emotional disturbances: for example depression, anxiety or fear,
irritability, euphoria, apathy or loss of sense of mind
 Onset is usually rapid, the course of the disease disappears throughout the
day, and the condition lasts less than 6 months
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DEPRESSION
DISORDER
Depression is an emotional condition that is usually
characterized by extreme sadness, feelings of
meaninglessness and guilt (withdrawal, unable to sleep,
loss of appetite, interest in daily activities).
SIGNS AND SYMPTOMS OF DEPRESSION DISORDER

MAIN SYMPTOMS OF DEPRESSION:

1. Depressive Affect
2. Loss of Interest and Joy
3. Reduced energy leads to increased fatigue (real fatigue after a little work) and
decreased activity

 OTHER SYMPTOMS OF DEPRESSION:

1. Reduced Concentration and Attention
2. Reduced self-esteem and confidence
3. The idea of ​guilt and worthlessness
4. A gloomy and pessimistic view of the future
5. Ideas or acts of self-harm or suicide
6. Disturbed sleep
7. Decreased appetite

 With a minimum onset of 2 weeks

 REFERENC
●Holder S, Wayhs A.
ES
Schizophrenia - Read LB. Am Fam Physician.
2014;90(11):775-782.

●Lokko HN, Stern TA. Sadness: diagnosis, evaluation, and treatment. Prim Care
Companion CNS Disord. 2014 Nov 20;16(6):10

●Santacruz KS, Swagerty D. Early diagnosis of dementia. Am Fam Physician.

2001;63(4):703-713.

●Teeple RC, Caplan JP, Stern TA. Visual hallucinations: differential diagnosis
and treatment. Prim Care Companion J Clin Psychiatry. 2009;11(1):26-32.