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WHAT: Psychosis. Psychosis: a loss of contact with reality, a thought disorder, or a change of personality or behavior often associated with delusions, illusions, or hallucinations. WHY: Psychosis may occur in systemic lupus erythematosus, mixed connective tissue disease, or with the administration of steroids, cimetadine (Tagemet), or reserpine. HOW: A psychosis probably exists if a patient demonstrates one or more of the following major criteria: MAJOR CRITERIA LOSS OF CONTACT WITH REALITY -- evidenced by the misinterpretation of the environment as hostile when friendly or vice versa, generally causing bizarre responses to normal and usual environmental stimuli. THOUGHT DISTURBANCE -- evidenced by incoherence, marked illogical content, marked loose associations, or patient\'s admission of mental confusion and abnormal rate of mental activity. PERSONALITY/BEHAVIOR CHANGES -- characterized by rapid onset and reversals of previous behavior patterns, often observed by reliable family member or friend. The diagnosis is further strengthened by the presence of one or more of the following minor criteria: MINOR CRITERIA DELUSIONS -- firmly held beliefs that cannot be dissuaded by logical discussion; generally of a threatening, powerful, or grandiose nature. ILLUSIONS -- misperceptions of environmental stimuli, e.g. perceiving a person instead of an actual tree shadow. HALLUCINATIONS -- perceptions without environmental stimuli, e.g. hearing voices/noises or seeing a face/vision. REFS: 1) \'Differential Diagnosis of Psychotic Features\'. In Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM III). Washington, D.C.: American Psychiatric Association, 1980. 2) Rothfield, N: \'Clinical Features of Systemic Lupus Erythematosus\'. In Textbook of Rheumatology (Ch. 69). Philadelphia: W.B. Saunders Co., 1981. 3) Bennet, RM and Spargo, BH: Neuropsychiatric problems in mixed connective tissue disease. Am J Med 65(6), December 1978, pp. 955-62. DN19307-1. 4) Steinberg, AD: \'Management of Systemic Lupus Erythematosus\'. In Textbook of Rheumatology (Ch. 70). Philadelphia: W.B. Saunders Co., 1981.
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