Psychosis
Madeline Goodman D.O.
April 28, 2010
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Common in both the medical and
psychiatric settings
First break is poorly understood
3-5% of the population
Responds well to treatment
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Disturbance in perception of realty as
evidenced by hallucinations, delusions
and thought disorganization (Up to Date
2007)
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Auditory
Visual
Tactile
Olfactory
Gustatory
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Primary Psychotic Disorder
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Schizophrenia
Schizoaffective Disorder
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Primarily Medical Disorders
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Delirium
Neoplasm of the Central Nervous
System
ETOH Withdrawal
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tactile being the most common
bugs crawling on their skin
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Fixed False Belief that is not typical of
patients faith, culture or family.
Cultural
Religious
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Looseness of Association
Nonsensical speech
Bizarre Behavior
High level of functional impairment
High risk of agitated or aggressive
behavior
Difficult to obtain coherent history
Unable to consent to treatment
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Acute state of anxiety
Heightened emotional arousal
Increased motor activity
Commonly seen in both psychiatric and
medical conditions
Patients awareness
External factors
Treat both anxiety and psychosis
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Acts or threats of violence
Common in acute psychotic states
Persecutory delusions, thought
disorganization, poor impulse control
Never challenge the delusions
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Severe
Chronic
Social, occupational and scholastic
deterioration
Prevalence rate 1.1% (NIMH)
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Urban Living
Social Disadvantage
Childhood Trauma
Poverty
Genetic Links
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Twin and adoption studies have shown
high rate of heritability
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Add to normal experience
Hallucinations
Delusions
Thought disorganization
Highly correlated to Hospital admission
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Take away from normal experience
Loss of motivation
Anhedonia
Alogic
Asociality
Moderately correlated with functional
impairment
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Loss of basic domains of intellectual
functioning
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Memory
Attention
Verbal processing
Executive Functioning
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Psychotherapy
Group Home Living
Community Teams
Antipsychotic Medication
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Atypical vs. Typical agents
Metabolic Syndromes
Side effects may decrease compliance
Long acting preparations may be better
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Maine Medical Center Peer Program
Early treatment with antipsychotic
medication can decrease the severity of
the illness
Education
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Teaching children who might be
predisposed to avoid street drugs
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Discreet sustained period of elevated or
irritable mood
Decreased need for sleep
Increased in goal directed activities
Grandiosity
Rapid/pressured speech
Poor Judgment
Engaging in high risk behaviors
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Antipsychotics
Benzodiazepines
Anti-convulsants
Electroconvuslive Therapy
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Lithium Carbonate
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BUN, Creatinine, GFR, TSH
Lithium levels every three months in the first
year along with BUN and Creatinine, then
every six months. TSH should be evaluated
yearly
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Liver Function
CBC
Can decrease Platlets
V.A. level every three months for the first
year and then every six months.
Recheck LFT’s and CBC every six
months
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Can slow down mania
Help with sleep
Decrease anxiety
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Mood Congruent
Nihilistic thinking
Responds best to combination therapy
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Antidepressant Plus Antipsychotic
Psychotherapy
Benzodiazepine
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Diagnostic criteria for Schizophrenia and
Mood Disorder
Both sets of symptoms prominent in the
course of the illness
Two week period free from prominent
mood symptoms
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40% experience psychotic symptoms
Behavioral disturbance associated with
psychosis
Lewy Body Type associated visual
hallucinations
Treatment with antipsychotics
Black Box Warning!
Increased mortality in this population
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Delirium
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Acute change in mental status
This is a true medical emergency
Inability to focus and maintain
attention
Disorientation
Memory impairment
Language disturbance
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Medical conditions
Medications
ETOH Withdrawal
Substance Abuse
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Non-bizarre delusions
Does not respond to antipsychotic
medication
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Believe that bugs are infesting their
bodies
Multiple visits to PCP, dermotologist
Can respond to low dose antipsychotic
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Many causes of psychosis
Can be challenging to diagnose but in
most instances is highly treatable
Difficulty arises when patients become
non-compliant
Delirium IS a medical emergency!
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Lets Take a 10 minute break!