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Psychosis

Matthew J. Filippo, DO and Bernadette M. Stevenson, MD, PhD Reviewed 06/2019
 


BASICS

DESCRIPTION

A disorder where thoughts and emotions are significantly impaired (i.e., a loss of contact with reality). Seen in schizophrenia, affective, bipolar, depression, substance use, medica...

DIAGNOSIS

Rule out delirium: Psychosis shouldn’t have fluctuating consciousness/reduced clarity of awareness. 

HISTORY

  • Delusions (fixed false beliefs): persecutory (being monitored), bizarre (involving ...

TREATMENT

Before antipsychotic treatment: Screen for metabolic syndrome. Baseline fasting lipid panel and glucose, HgbA1c, CBC, CMP, LFTs, weight, waist circumference, AIMS testing. Continue monitorin...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Close follow-up for inpatient discharge (high risk for suicide), use therapy, exercise, teach smoking cessation, AIMS testing q3–6mo 

PATIENT EDUCATION

National All...

REFERENCES

1
National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. http://www.nice.org.uk/guidance/cg178. Accessed October 16, 2018. http:...

ADDITIONAL READING

SEE ALSO

Delirium; Schizophrenia 

CODES

ICD10

  • F29 Unsp psychosis not due to a substance or known physiol cond

  • F20.9 Schizophrenia, unspecified

  • F39 Unspecified mood [affective] disorder

  • F19.99 Other psychoactive substance use, unspecified ...

CLINICAL PEARLS

  • Antipsychotics mainstay of treatment; lead to decreased all-cause mortality pin adherent patients

  • Clozapine and LAIs may increase adherence.

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