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

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.

Tiih...

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 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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