psychosis

Introduction

Gross distortion or disorganization of a person's cognition, affective response, ability to recognize reality & communicate with others to the extend of interfering with the person's ability to cope with the demands of everyday life

Etiology

• organic
  • Korsakoff's syndrome
  • psychosis agitation in the elderly
  • drug-induced psychosis
    • steroid psychosis
• functional
  • schizophrenia
  • bipolar disorder
  • acute functional psychosis
• risk factors
  • early-childhood infection & low adolescent IQ are risk factors for adult non-affective psychosis in men

Clinical manifestations

• hallucinations
• delusions
• childhood nightmares may preceed adolescent psychosis

Radiology

• neuroimaging, brain MRI
  • 1 in 16 patients have clinically relevant findings after 1st episode of psychosis

Complications

• fear, anxiety, paranoia
• self-injury, suicide
• violence

• disease interaction(s) of psychosis with functional incontinence

Management

• Assess risk for suicide
• Assess risk for violence
• Assess risk for medical instability
• Assess risk for inability to maintain self at home or in community
• Does the person require immediate hospitalization?
• Follow legal mandates if the person refuses help or disengages
• Perform mental status examination
• Assess need for functional & psychosocial support
• Determine whether person uses alcohol or substances in a way that should be a focus of treatment
• Identify psychosocial needs
• Discuss treatment options with person/family;
  • select modalities to meet needs;
  • obtain person or legal guardian agreement to treatment plan
  • antipsychotics may be indicated for acute &/or chronic psychosis
  • antipsychotic agents & mood stabilizers may reduce violent crime
• Provide psychosocial rehabilitation based on identified needs
• Reevaluate level of recovery & degree to which the treatment plan has met the person's needs
• individualized health promotion including fitness & nutrition components may improve physical health

More general terms

• psychiatric disease; behavioral disorder
• altered mental status (AMS)

More specific terms

• acute functional psychosis (AFP)
• brief psychotic disorder
• Korsakoff's syndrome (amnesic psychosis)
• major depression with psychosis; psychotic/delusional depression
• psychosis in Alzheimer's disease
• psychosis, agitation & difficult behavior in the elderly
• puerperal psychosis; postpartum psychosis, puerperal bipolar disorder
• reactive psychosis
• schizophrenia
• steroid psychosis

Additional terms

• brief psychiatric rating scale