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National University of Rwanda Family and Community Medicine
National University of Rwanda
Family and Community Medicine

Acute psychosis

KABERA René,MD PGY IV Resident Family and Community Medicine National University of Rwanda

Medicine Acute psychosis KABERA René,MD PGY IV Resident Family and Community Medicine National University of Rwanda
Plan • Definition • Signs and Symptoms • Mechanisms • Etiology • Diagnosis • Treatment

Plan

Definition

Signs and Symptoms

Mechanisms

Etiology

Diagnosis

Treatment

Plan • Definition • Signs and Symptoms • Mechanisms • Etiology • Diagnosis • Treatment
Definition Loss of contact with reality, a psychiatric disorder or mania that is marked by

Definition

Loss of contact with reality, a psychiatric disorder or mania that is marked by delusions, hallucinations, incoherence, and distorted perceptions of reality.

disorder or mania that is marked by delusions, hallucinations, incoherence, and distorted perceptions of reality .
Signs and symptoms Delusions are erroneous beliefs that : • Involve a misinterpretation of perceptions

Signs and symptoms

Delusions are erroneous beliefs that:

Involve a misinterpretation of perceptions

Are clearly implausible

Are often persecutory, religious, or somatic in nature Hallucinations

Sensory experiences that exist only in the mind of the patient

Can involve any sense; auditory and visual are most common Disorganized speech

Loose associations

Neologisms

Perseverations

Poverty of content

Word salad

Disorganized speech • Loose associations • Neologisms • Perseverations • Poverty of content • Word salad
Signs and symptoms Disorganized or catatonic behavior • Unable to perform goal-directed behavior • Unaware

Signs and symptoms

Disorganized or catatonic behavior

Unable to perform goal-directed behavior

Unaware of the environment

Negative symptoms

Flattened affect

Poverty of speech

Unable to maintain goal-directed activities

Negative symptoms • Flattened affect • Poverty of speech • Unable to maintain goal-directed activities
Signs and symptoms Features suggesting an organic etiology • Sudden onset, • >40 years old,

Signs and symptoms

Features suggesting an organic etiology

Sudden onset,

>40 years old,

fluctuating course,

Headaches,

Speech difficulties,

Delusions are disorganized,

Incoherent speech,

fluctuating course, • Headaches, • Speech difficulties, • Delusions are disorganized, • Incoherent speech,
Signs and Symptoms • Confusion • Loss of consciousness • Focal neurologic symptoms • Abnormal

Signs and Symptoms

Confusion

Loss of consciousness

Focal neurologic symptoms

Abnormal vital signs

Disorientation

Psychomotor retardation

Visual hallucinations

Global impairment of attention and cognitive function

Labile affect

Social immodesty

Visual hallucinations • Global impairment of attention and cognitive function • Labile affect • Social immodesty
Mechanisms • A description of behavior that does not imply a specific cause or diagnosis

Mechanisms

A description of behavior that does not imply a specific cause or diagnosis in general

The psychosis may be secondary to functional (psychiatric) or organic (medical) causes

Medical psychoses are generally secondary to systemic or neurologic diseases, or neuroactive medications

Neurodevelopmental abnormalities in the dopaminergic and serotonergic systems are implicated in functional psychosis

• Neurodevelopmental abnormalities in the dopaminergic and serotonergic systems are implicated in functional psychosis
Etiology Organic • Central nervous system : Encephalopathy, Seizure, Head injury, Neoplasms, Migraine,(stroke(CVA) •

Etiology

Organic

Central nervous system: Encephalopathy, Seizure, Head injury, Neoplasms, Migraine,(stroke(CVA)

Genetics: Huntington's chorea

Metabolic: Intoxication or withdrawal, Hypercarbia, Hypoglycemia, Hypoxia, Poisoning ,Electrolyte imbalance

chorea • Metabolic : Intoxication or withdrawal, Hypercarbia, Hypoglycemia, Hypoxia, Poisoning ,Electrolyte imbalance
Etiology • Endocrine : Addison's disease, Thyroid dysfunction, Parathyroid dysfunction • Others : Autoimmune

Etiology

Endocrine: Addison's disease, Thyroid dysfunction, Parathyroid dysfunction

Others: Autoimmune disorders, Hepatic encephalopathy ,Renal failure

Thyroid dysfunction, Parathyroid dysfunction • Others : Autoimmune disorders, Hepatic encephalopathy ,Renal failure
Pharmacologic Etiology • Psychoactive agents : Benzodiazepines Chlordiazepoxide Antidepressants Antiepileptics •

Pharmacologic

Etiology

Psychoactive agents: Benzodiazepines Chlordiazepoxide Antidepressants Antiepileptics

Antibiotics: Isoniazid, Rifampin

Cardiovascular agents: Captopril Digoxin Methyldopa Procainamide Propranolol • Reserpine

Drugs of abuse: Alcohol Amphetamines Cocaine Opioids Hallucinogens

Others: Steroids Heavy metals Antihistamines Cimetidine Disulfiram

Amphetamines Cocaine Opioids Hallucinogens • Others: Steroids Heavy metals Antihistamines Cimetidine Disulfiram
Etiology Functional • Brief psychotic disorder Usually secondary to acute emotional stress • Schizophreniform

Etiology

Functional

Brief psychotic disorder

Usually secondary to acute emotional stress

Schizophreniform disorder

Symptoms present 1-6 months

Schizophrenia

Mood disorder with psychotic features or schizoaffective disorder

disorder Symptoms present 1-6 months • Schizophrenia Mood disorder with psychotic features or schizoaffective disorder
Diagnosis History and physical examination Laboratory • Routine "screening labs" not helpful •

Diagnosis

History and physical examination Laboratory

Routine "screening labs" not helpful

Specific studies should be guided by the suspected underlying

etiologies Serum glucose

Toxicologic screen

Serum electrolytes

Urinalysis

by the suspected underlying etiologies Serum glucose Toxicologic screen Serum electrolytes Urinalysis
Diagnosis Imaging/Special Tests Head CT scan indicated in patients at risk for a neurologic etiology

Diagnosis

Imaging/Special Tests Head CT scan indicated in patients at risk for a neurologic etiology Lumbar puncture

Diagnosis Imaging/Special Tests Head CT scan indicated in patients at risk for a neurologic etiology Lumbar
Treatment Medications • Antipsychotics Droperidol: 2.5-5.0 mg i.v. or i.m. Haloperidol: 2-5 mg i.v. or

Treatment

Medications Antipsychotics Droperidol: 2.5-5.0 mg i.v. or i.m.

Haloperidol: 2-5 mg i.v. or i.m. or PO; 0.5-2.0 mg for elderly Risperidone: 1-2 mg PO

Benzodiazepines

Lorazepam 1.0-2.0 mg i.v. or i.m. or PO

Treatment of medication side effects

Benztropine: 2 mg i.m. or i.v. Dantrolene: 1 mg/kg i.v. repeated to symptom resolution or total of 10 mg/kg

Diphenhydramine: 50 mg i.v., i.m., or PO

i.v. Dantrolene: 1 mg/kg i.v. repeated to symptom resolution or total of 10 mg/kg Diphenhydramine: 50
The end Thank you

The end

Thank you

The end Thank you