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Psychosis, Medical vs. Psychiatric, Emergency Medicine

Richard E. Wolfe Reviewed 06/2017
 


Basics

Description

Mental derangement involving hallucinations, delusions, or grossly disorganized behavior resulting in loss of contact with reality 
  • Complex and poorly understood pathophysiology

  • An exc...

Diagnosis

Signs and Symptoms

  • Psychosis characterized by:

    • Impaired reality testing

    • Inappropriate affect

    • Poor impulse control

  • Focal and diffuse CNS impairment may result in derangements of:

    • Perception

    • Thought ...

Treatment

Pre-Hospital

  • Ensure safety of patient, bystanders, and medical personnel.

  • Monitor vital signs, check finger stick.

Initial Stabilization/Therapy

  • Safety

  • Evaluation

  • Check O2 saturation and serum glu...

Follow-Up

Disposition

Admission Criteria

  • If primarily medical etiology, admission to medical service, criteria dictated by specific medical condition

  • If primarily psychiatric etiology (e.g., schizophreni...

Pearls and Pitfalls

  • Patients with psychosis may not be able to explain their symptoms in a typical way. Get collateral and maintain a high degree of suspicion.

  • Important to rule out organic causes prio...

Additional Reading

  • Baldwin  P, Browne  D, Scully  PJ, et al. Epidemiology of first-episode psychosis: Illustrating the challenges across diagnostic boundaries through the Cavan-Monaghan study at 8 yea...

Codes

ICD9

  • 292.9 Unspecified drug-induced mental disorder

  • 298.9 Unspecified psychosis

  • 780.1 Hallucinations

  • 297.9 Unspecified paranoid state

  • 781.99 Other symptoms involving nervous and musculoskeletal syste...

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