Hi! Dr. B here demystifying the DSM and finishing up the psychotic disorders. So, we've been going over all the different psychotic disorders and the last you know 7 disorders here in this cluster are really not specifically psychotic disorders treated by psychiatrist. We have the substance abuse psychotic disorder, so this means that somebody is intoxicated, and they come in, and they're psychotic because they're intoxicated or someone who is going through withdrawal and has psychotic symptoms during withdrawal. Now we you can with long term use or sometimes if you don't come out of this psychotic episode, it could be a brief psychotic episode that turns into schizophrenia with long term use. So, this is that diagnosis that's given if somebody is intoxicated and they're psychotic, right? But if they continue with psychotic symptoms, and this is where it can start to get personal again. My brother, who I've talked about in other videos has had a substance abuse problem most of his life. Started with alcohol, then to cocaine and in the last five years he's been using meth and about two years ago he had a substance abuse psychotic episode. I told him please stop, please stop. I mean obviously I've been trying to get him to stop using for years. Everybody has this threshold for psychosis and, uh, a substance can throw you over that and you are not able to come back. And that's kind of where he is now. Five years of abusing meth and he meets criteria for schizophrenia and likely even with sobriety, will not go back to complete normalcy so. Obviously don't do drugs, but this is one of the diagnoses that you may see. The other is psychosis due to a medical condition, so you could have someone with Alzheimer's ALS, other kinds of dementias that are beginning to have psychotic symptoms. They're not schizophrenic. Their brain is changing, and it can't compensate, can't adjust and therefore they have this secondary psychosis due to their medical condition and it's important to differentiate that. For the family's sake and for the person's sake that this is not schizophrenia, it is due to their medical condition. A known neurological problem and the then you start to have psychotic symptoms then that is psychosis related to your neurological condition. But if you are completely normal, have no known diagnosis and abruptly start having psychotic symptoms that delirium needs to be ruled out, right? Because this is a delirium is like psychotic symptoms related to an acute medical condition, right? Something that can be treated. We see this a lot in elderly. They will be fine and then suddenly, it's like they have, you know dementia and psychosis. That is likely delirium. Go to the emergency room, get a medical work up. The most common reason is a UTI, which you wouldn't connect those two symptoms, right? So important that if it comes on acutely you get a full medical work up. If you don't have a diagnosis, you get a full medical work up. If somebody comes in my office at 65 or 70 years old, with psychotic symptoms and never having any mental health concerns. Maybe some depression but never any major psychotic concerns in their entire life. We need to do an MRI. We need to work that up medically because there likely is a dementia diagnosis now too. Providers out there, sometimes somebody will come in and tell me they have no history. And I will do the whole medical work up to find out when their brother calls me that they've been diagnosed with schizophrenia since they were 20. So, a good history is super important. But if it comes on late in life, schizophrenia, and other psychotic disorders are usually in the 20s. So, if they come up in an older aged person, you have somebody there to confirm that they have no psychotic history that needs to be worked up medically, acutely or long term. So that is the end of our psychotic series. The last couple are ones that we don't use very often and are very specific to specialties so thank you and