Psychosis

Last updated 20.09.12

 

Definition

-  Impaired insight w disruption of reality associated w delusions &/or hallucinations

 

Features

-  Onset typically in adolescence or early adulthood

-  Disability can be prolonged

-  Broadly divided into schizophrenic or affective

-  Associated w anxiety, panic & somatisation

-  Substance abuse common

-  Prevelance 3% of population

 

DSM IV Classification

-  Schizophrenia

-  Delusional disorder

-  Major depression w psychotic features

-  Bipolar disorder w psychotic features

-  Brief psychotic disorder

-  Schizophreniform disorder

-  Schizoaffective disorder

-  Psychotic disorder due to general medical condition/substance-induced psychotic disorder (LSD, speed, cannabis)

 

Causes

-  Genetic, pregnancy & birth (complications)

-  Cannabis use (esp prior to 15 yrs)

-  Grey matter volume reduction (post mortem)

-  Stress: family dysfunction, social deprevation

 

Associated S/S

-  Positive Symptoms

-  Delusions

-  Hallucinations

-  Impaired insight

-  Negative Symptoms

-  Blunted affect

-  Reduced/poverty of speech

-  Diminished motivation, energy & social engagement

-  Disorganisation

-  Formal thought disorder (loosening of associations)

-  Impared attention

-  Innappropriate/incongruous affect

-  Disorganised behaviour

-  Speech disorder (derailment, word salad)

-  Neurocognitive Impairment

-  Reduced reaction times

-  Memory impairment

-  Executive dysfunction (planning, maintaining focus)

-  Short attention span

-  Difficulty planning new tasks

-  Affective Features

-  Mania

-  Depression

 

Mx

- Ensure safety of pt & others

-  Acute behavioural management

-  Calm, quiet observation room

- Quick relevant Hx & MSE

-  Why presenting

-  Key problems

-  Substance abuse

-  No physical exam unless essential

-  Assess for medical stability

-  Fever, tachycardia, HTN indicate medical cause

-  Possible use of anxiolytic/antipsychotics prior to assessment

   

 

 

References