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

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

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 mainstay of treatment; lead to decreased all-cause mortality pin adherent patients
Clozapine and LAIs may increase adherence.

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