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Psychosis

Matthew J. Filippo, DO and Bernadette M. Stevenson, MD, PhD Reviewed 06/2018
 


BASICS

DESCRIPTION

A mental disorder in which thoughts and emotions are significantly impaired. Seen in schizophrenia, schizoaffective, bipolar, depression, substance use, medical problems, delirium, a...

DIAGNOSIS

First, rule out delirium: Psychosis should not have fluctuating consciousness/reduced clarity of awareness. 

HISTORY

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

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 CBT, exercise, teach smoking cessation, AIMS testing q3–q6mo (typicals vs. atypicals) 

PATIENT EDUCATION

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 November 16, 2017.
2
Tiih...

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 are the mainstay of treatment; lead to decreased all-cause mortality in medication adherent patients

  • Clozapine and LAIs may increase adherence, whereas newer atypicals qu...

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