Acute Psychosis Flashcards
Define
Sudden onset psychosis (significant alterations to a person’s perception, thoughts, mood and behaviour), tend to LACK insight, resolving in <3 months
- Psychosis interferes with the ability to function.
- It refers to distorted thinking and perception- people lose touch with reality
- Often includes delusions and hallucinations
Delusion: false, fixed, strange or irrational belief that is firmly held despite rational argument, or evidence to the contrary (out of the keeping with cultural context)
Hallucinations: sensory perception (hearing, seeing, feeling, smelling) without an appropriate stimulus
- Mainly auditory
This occurs in a number of serious mental illnesses and not just schizophrenia e.g. depression, BPAD, puerperal psychosis and sometimes with drug and alcohol use
Epidemiology
80% between 16-30 years
Higher prevalence in BME individuals
Discrimination? Perinatal infection?
Aetiology/ Risk factors
- Affective psychosis- depression, BPAD
- Transient psychotic disorder- usually substance misuse
- Psychosis due to medical disorders- brain tumour, head injury
- Schizophrenia-like non-affective disorders- brief psychotic disorder, delusional disorder, schizophreniform disorder
- Puerperal psychosis
- Schizophrenia
Symptoms and signs
Positive symptoms
- Hallucinations (perceptions in the absence of stimulus)
- Delusions (fixed or falsely held beliefs)
- Disorganised behaviour, speech and/or thoughts (thought disturbance)
- Passivity phenomena
- Bodily sensations are being controlled by an external influence
- Actions/ impulses/ feelings- experiences which are imposed on the individual or influenced by others
Negative symptoms
- Blunting of affect/ incongruity
- Anhedonia
- Reduced speech (alogia)
- Loss of motivation (avolition)
- Self-neglect
- Social withdrawal
Other features:
- Impaired insight
- Neologisms
- Charles-Bonnet Syndrome – persistent/ recurrent hallucinations with a clear consciousness (insight preserved); usually on BG of visual impairment
Investigations
- Collateral history
- Brief Psychiatric Rating Scale (BPRS) - https://www.smchealth.org/sites/main/files/file-attachments/bprsform.pdf?1497977629
Severity of various psych symp
- Positive and Negative Syndrome Scale (PANSS)- used for assessing severity of schizophrenia
- MMSE
- Physical examination
- Basic observations
- Urine drug screen
- Bloods- abnormal LFTs and macrocytosis on FBC suggests alcohol abuse
- Serological tests for syphilis, HIV- ruling out organic causes
- Imaging if indicated
- MRI - hypofunction in the prefrontal cortex
- EEG - if epilepsy or another organic cause suspected
Differentials
Organic – porphyria, dementia, delirium, epilepsy, steroids, tumours, stroke, systemic infection (syphilis, HIV), hyperthyroidism/hypothyroidism, Huntington’s etc.
Acute/transient psychotic episodes – can have psychosis (doesn’t mean you are schizophrenic)
Mood disorder – depression and mania can cause psychotic symptoms; check order of symptoms
Schizoaffective disorder – schizophrenic and affective symptoms develop together and are balanced
Delirium
Persistent delusional disorder – only delusions
Drug-induced psychosis - cannabis, ketamine can induce paranoia and thought disorder (rarely produces -ve symp)
Schizotypal disorder – eccentricity with abnormal thoughts (not full schizophrenia)
Management
Risk assessment!
Biological:
- Short term antipsychotics/BDZ (acute behavioural disturbance) - High-dose olanzapine
- Antidepressants/mood stabilisers useful to prevent relapse - Low-dose aripiprazole
Psychosocial:
- Specific social issues
- Reality-oriented/adaptive/supportive psychotherapy
E.G. 1st line “start low, go slow”
- Low-dose aripiprazole
- Education and support
