acute psychosis-kabera rene md

8/4/2019 Acute Psychosis-KABERA Rene MD

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National University of Rwanda

Family and Community Medicine

Acute psychosis

KABERA Ren,MD

PGY IV Resident

Family and Community Medicine

National University of Rwanda


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Plan

Definition

Signs and Symptoms

Mechanisms

Etiology

Diagnosis

Treatment


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Definition

Loss of contact with reality,a psychiatric disorder

or mania that is marked by delusions,

hallucinations, incoherence, and distorted

perceptions of reality.


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Signs and symptomsDelusions 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


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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


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Signs and symptoms

Features suggesting an organic etiology

Sudden onset,

>40 years old,

fluctuating course,

Headaches, Speech difficulties,

Delusions are disorganized,

Incoherent speech,


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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


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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 orneurologic diseases, or neuroactive medications

Neurodevelopmental abnormalities in the dopaminergic and

serotonergic systems are implicated in functional psychosis


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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


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Etiology

Endocrine: Addison's disease, Thyroid dysfunction,

Parathyroid dysfunction

Others: Autoimmune disorders, Hepatic encephalopathy

,Renal failure


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Etiology

Pharmacologic

Psychoactive agents: Benzodiazepines ChlordiazepoxideAntidepressants Antiepileptics

Antibiotics: Isoniazid, Rifampin

Cardiovascular agents: Captopril Digoxin MethyldopaProcainamide Propranolol Reserpine

Drugs of abuse: Alcohol Amphetamines Cocaine Opioids

Hallucinogens

Others: Steroids Heavy metals Antihistamines Cimetidine

Disulfiram


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Etiology

Functional

Brief psychotic disorderUsually secondary to acute emotional stress

Schizophreniform disorder

Symptoms present 1-6 months Schizophrenia

Mood disorder with psychotic features or schizoaffective disorder


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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


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DiagnosisImaging/Special Tests

Head CT scan indicated in patients at risk for a neurologicetiology

Lumbar puncture


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TreatmentMedications

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


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The end

Thank you

acute psychosis-kabera rene md

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