Psychosis

Matthew J. Filippo, DO and Jennifer E Laflamme, DO Reviewed 05/2023

BASICS

DESCRIPTION

A disorder where thoughts and emotions are disrupted. Seen in schizophrenia, mood disorders, substance use, medical problems, delirium, and dementia;

Positive symptoms: hallucination...

DIAGNOSIS

Rule out delirium: Unlike delirium, psychosis should not have fluctuating mentation.

HISTORY

Delusions: persecutory, bizarre, somatic, referential, or grandiose
Hallucinations: auditory, visua...

TREATMENT

GENERAL MEASURES

Ensure safety of person and environment and rule out medical causes particularly delirium.

MEDICATION

Antipsychotics are mainstay of treatment (1)[B].
For mania with psychotic...

ONGOING CARE

Medication management, psychotherapy.

FOLLOW-UP RECOMMENDATIONS

Close follow-up for inpatient discharge (high risk for suicide); use therapy, exercise, smoking cessation, AIMS testing.

Patient Monitoring

REFERENCES

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.

ADDITIONAL READING

American Psychiatric Association. Clinical Practice Guidelines. https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines.

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; decrease all-cause mortality and increase quality of life
Aripiprazole shortens QTc
Clozapine and long acting injectables may increase adher...

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