What is psychosis?
--Psychosis is a disturbance in the perception of reality, evidenced by hallucinations, delusions, or thought disorganization.
--Psychotic states are periods of high risk for agitation, aggression, impulsivity, and other forms of behavioral dysfunction.
What are the DSM-V criteria for schizophrenia?
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated), and continuous signs of the disturbance persist for at least 6 months.
At least one of these should include 1 - 3
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e. diminished emotional expression or avolition)
Risk factors for schizophrenia
- Living in an urban area
- Obstetrical complications
- Late winter-early spring time of birth (perhaps reflecting exposure to influenza virus during neural development).
- Advanced paternal age at conception
What is the difference between schizophrenia and brief reactive psychosis?
Brief psychotic disorder is currently classified with schizophrenia spectrum and other psychotic disorders. It is differentiated by its sudden onset, its relatively short duration (< 1 month), and the full return of functioning.
Signs and symptoms
Brief psychotic disorder is characterized by the abrupt onset of 1 or more of the following symptoms:
- Bizarre behavior and posture
- Disorganized speech
Associated symptoms may include the following:
- Affective symptoms
- Impaired attention
- Catatonic behavior
What are the criteria for a manic episode of Bipolar disorder?
--A distinct period of abnormally and persistently elevated, expansive, or irritable mood for at least 1 week (or any duration if hospitalization is necessary).
--During the period of mood disturbance, three or more of the following symptoms have been present to a significant degree:
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
List some of the common substances of abuse that are associated with development of psychosis.
What is the medical treatment for alcohol withdrawal?
- Benzodiazepine, e.g. lorazepam
- Thiamine then glucose
- NO haloperidol, NO beta-blockers
Prophylaxis: chlordiazepoxide (Librium)
List the s/s of alcohol withdrawal, in chronological order they are likely to occur after the last drink.
- Anxiety, HA, tremulous (6-48 hrs)
- Hallucinations (12-48 hrs)
- Seizures (within 48 hrs)
- Delirium tremens (48-96 hrs):
- increased HR, BP, temp
- lasts 5-7 days
What are the symptoms of opioid withdrawal?
● Three to four hours after last dose — Drug craving, anxiety, fear of withdrawal
● 8 to 14 hours after last dose — Anxiety, restlessness, insomnia, yawning, rhinorrhea, lacrimation, diaphoresis, stomach cramps, and mydriasis
●One to three days after last dose — Tremor, muscle spasms, vomiting, diarrhea, tachycardia, chills, and piloerection
How is opioid withdrawal treated?
- Buprenorphine + naloxone
What are the medical and non-medical approaches to managing an agitated/aggressive patient?
- Move patients to a calm, quiet environment
- Remove objects that could be used to inflict harm to self or others
- Express sympathetic concern for patient and their complaints
- Respond in a confident yet supportive manner
- Inquire what can be done to resolve the cause of the anger
- Quetiapine, risperidone, other atypical antipsychotics
--Physical restraints if imminent harm to self/others; remove as soon as chemical restraint is achieved