Related Subjects:
|Depression
|Mania
|Schizophrenia
|Suicide
|Acute Psychosis
|General Anxiety Disorder
|Obsessive-Compulsive disorder
|Wernicke Korsakoff Syndrome
|Medically Unexplained symptoms
ℹ️ About
- Psychosis is when people lose some contact with reality.
- This may involve hallucinations (seeing or hearing things that others cannot).
- They may have delusions —strong beliefs not grounded in reality.
- Experiencing these symptoms is often called a psychotic episode .
Symptoms of Psychosis
- Hallucinations: Where a person hears, sees, or senses things not present outside their mind.
- Delusions: Strong beliefs not shared by others, like conspiracy beliefs.
- The combination of hallucinations and delusional thinking can lead to severe distress and changes in behavior.
Risks
- The one-year prevalence of non-organic psychosis is 4.5 per 1000 community residents.
- Most new cases occur in men under 30 and women under 35 .
- Schizophrenia has a one-year prevalence of 3.3 per 1000 people.
- Drug abuse (e.g., cocaine, methamphetamine) is also a risk factor.
🩺 Clinical Features
- Paranoid delusions: Delusions that refer back to the self, often persecutory.
- Grandiose delusions: Beliefs in special powers or missions, seen in schizophrenia and bipolar disorder.
- Delusions of thought interference: Beliefs that others can influence one’s thoughts.
- Passivity phenomena: Delusional beliefs that others control one’s will or bodily functions.
- Thought echo: Hearing one's own thoughts spoken aloud.
- Third-person auditory hallucinations: Voices commenting on the patient's actions.
Examination
- Cardiovascular: Look for tachycardia, heart failure, or anxiety.
- Respiratory: Signs of lung tumours or smoking history.
- Gastrointestinal: Exclude hepatic encephalopathy or alcohol withdrawal.
- Neurological: Check for lateralizing signs, meningitis, encephalitis, or epilepsy.
- Endocrine: Hyperthyroidism or steroid effects.
Differential Diagnoses
- First episode psychosis or acute psychosis (e.g., drug-induced, schizophrenia).
- Bipolar affective disorder: Manic or depressive episodes.
- Schizoaffective disorder and severe depressive episode with psychotic features.
- Obsessive-compulsive disorder or PTSD .
🔎 Investigations
- Urine drug screen: Check for cannabis, amphetamines, cocaine, and alcohol.
- Pregnancy test: For females, as it affects management decisions.
- Blood tests:
- Full blood count: Rules out anaemia and infection; check alcohol markers.
- U&E: Check for dehydration, renal impairment, or electrolyte imbalances.
- Random glucose: Diabetes check.
- LFTs: Raised levels can indicate alcohol misuse; hepatitis C antibodies if IV drug use.
- Other tests: Calcium, thyroid hormones, cortisol for endocrine issues.
- LP: If meningitis or encephalitis is suspected.
- ECG: Check for QTc interval or cardiac issues.
- EEG: Rule out temporal lobe epilepsy if suspected.
- Imaging:
- CT brain: For tumours, strokes, or other causes.
- MRI brain: For more detailed assessment if needed.
💊 Management
- Identify and adjust environmental factors contributing to symptoms.
- Consult with early intervention team; assess for persistent substance misuse .
- Medications:
- Oral medications preferred; injectables for compliance issues.
- Mania: Use benzodiazepines with antipsychotics.
- Schizophrenia: Antipsychotics with benzodiazepines.
- Monitor weight, CVS/metabolic markers regularly.
- Acute management:
- Document nursing observations (BP, P, Temp).
- Monitor fluid balance and daily weight in acutely ill patients.
- Ensure proper nutrition and perform physical examination regularly.
- Mental health support:
- Start psychosocial interventions early.
- Engage allied professionals and support workers for reintegration into the community.
- Smoking cessation:
- Nicotine replacement therapy (e.g., patches, inhalators, gum).
- Monitor neuropsychiatric symptoms closely, especially early on.
References
