acute psychosis-kabera rene md
Post on 07-Apr-2018
217 Views
Preview:
TRANSCRIPT
-
8/4/2019 Acute Psychosis-KABERA Rene MD
1/16
National University of Rwanda
Family and Community Medicine
Acute psychosis
KABERA Ren,MD
PGY IV Resident
Family and Community Medicine
National University of Rwanda
-
8/4/2019 Acute Psychosis-KABERA Rene MD
2/16
Plan
Definition
Signs and Symptoms
Mechanisms
Etiology
Diagnosis
Treatment
-
8/4/2019 Acute Psychosis-KABERA Rene MD
3/16
Definition
Loss of contact with reality,a psychiatric disorder
or mania that is marked by delusions,
hallucinations, incoherence, and distorted
perceptions of reality.
-
8/4/2019 Acute Psychosis-KABERA Rene MD
4/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
5/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
6/16
Signs and symptoms
Features suggesting an organic etiology
Sudden onset,
>40 years old,
fluctuating course,
Headaches, Speech difficulties,
Delusions are disorganized,
Incoherent speech,
-
8/4/2019 Acute Psychosis-KABERA Rene MD
7/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
8/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
9/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
10/16
Etiology
Endocrine: Addison's disease, Thyroid dysfunction,
Parathyroid dysfunction
Others: Autoimmune disorders, Hepatic encephalopathy
,Renal failure
-
8/4/2019 Acute Psychosis-KABERA Rene MD
11/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
12/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
13/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
14/16
DiagnosisImaging/Special Tests
Head CT scan indicated in patients at risk for a neurologicetiology
Lumbar puncture
-
8/4/2019 Acute Psychosis-KABERA Rene MD
15/16
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
-
8/4/2019 Acute Psychosis-KABERA Rene MD
16/16
The end
Thank you
top related