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psychosis

Gross distortion or disorganization of a person's cognition, affective response, ability to recognize reality & communicate with others to the extend of interfering with the person's ability to cope with the demands of everyday life Etiology: 1) organic a) Korsakoff's syndrome b) psychosis agitation in the elderly c) drug-induced psychosis - steroid psychosis 2) functional a) schizophrenia b) bipolar disorder c) acute functional psychosis 3) risk factors - early-childhood infection & low adolescent IQ are risk factors for adult non-affective psychosis in men [8] Clinical manifestations: 1) hallucinations 2) delusions 3) childhood nightmares may preceed adolescent psychosis [3] Radiology: - neuroimaging, brain MRI - 1 in 16 patients have clinically relevant findings after 1st episode of psychosis [12] Complications: - fear, anxiety, paranoia - self-injury, suicide - violence Management: - Assess risk for suicide - Assess risk for violence - Assess risk for medical instability - Assess risk for inability to maintain self at home or in community - Does the person require immediate hospitalization? - Follow legal mandates if the person refuses help or disengages - Perform mental status examination - Assess need for functional & psychosocial support - Determine whether person uses alcohol or substances in a way that should be a focus of treatment - Identify psychosocial needs - Discuss treatment options with person/family; - select modalities to meet needs; - obtain person or legal guardian agreement to treatment plan - antipsychotics may be indicated for acute &/or chronic psychosis - antipsychotic agents & mood stabilizers may reduce violent crime [6] - Provide psychosocial rehabilitation based on identified needs - Reevaluate level of recovery & degree to which the treatment plan has met the person's needs - individualized health promotion including fitness & nutrition components may improve physical health [7]

Interactions

disease interactions

Related

brief psychiatric rating scale

Specific

acute functional psychosis (AFP) brief psychotic disorder Korsakoff's syndrome (amnesic psychosis) major depression with psychosis; psychotic/delusional depression psychosis in Alzheimer's disease psychosis, agitation & difficult behavior in the elderly puerperal psychosis; postpartum psychosis, puerperal bipolar disorder reactive psychosis schizophrenia steroid psychosis

General

psychiatric disease; behavioral disorder altered mental status (AMS)

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1025-27
  3. Fisher HL et al Childhood Parasomnias and Psychotic Experiences at Age 12 Years in a United Kingdom Birth Cohort. Sleep. March 2014 http://www.journalsleep.org/ViewAbstract.aspx?pid=29352
  4. Weintraub D, Hurtig HI. Presentation and management of psychosis in Parkinson's disease and dementia with Lewy bodies. Am J Psychiatry. 2007 Oct;164(10):1491-8. Review. No abstract available. PMID: 17898337
  5. Chou KL, Borek LL, Friedman JH. The management of psychosis in movement disorder patients. Expert Opin Pharmacother. 2007 May;8(7):935-43. Review. PMID: 17472539
  6. Fazel S et al Antipsychotics, mood stabilisers, and risk of violent crime. The Lancet, Early Online Publication, 8 May 2014 PMID: 24816046 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960379-2/abstract
  7. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - SHAPE: Shaping Health as Partners in Education (GRS11) - Westman J, Eberhard J, Gaughran FP et al. Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT). Schizophr Res. 2019;208:138-144 PMID: 30979666 https://www.sciencedirect.com/science/article/abs/pii/S0920996419301203 - Gaughran F, Stahl D, Ismail K et al. Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT). BMC Psychiatry. 2017;17(1):413 PMID: 29284438 PMCID: PMC5745644 Free PMC article https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1571-0
  8. Khandaker GM, Dalman C, Kappelmann N et al Association of Childhood Infection With IQ and Adult Nonaffective Psychosis in Swedish Men. A Population-Based Longitudinal Cohort and Co-relative Study. JAMA Psychiatry. Published online February 14, 2018. PMID: 29450471 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671412
  9. Lieberman JA, First MB. Psychotic Disorders. N Engl J Med 2018; 379:270-280. July 19, 2018 PMID: 30021088 https://www.nejm.org/doi/full/10.1056/NEJMra1801490
  10. Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc. 2006 Oct;81(10):1361-7. PMID: 17036562 Review.
  11. Rothenberg KG, Rajaram R. Advances in management of psychosis in neurodegenerative diseases. Curr Treat Options Neurol. 2019;21(1):3 PMID: 30673880 Review. https://link.springer.com/article/10.1007/s11940-019-0545-6
  12. Blackman G, Neri G, Al-Doori O et al. Prevalence of neuroradiological abnormalities in first-episode psychosis: A systematic review and meta-analysis. JAMA Psychiatry 2023 Oct; 80:1047. PMID: 37436735 PMCID: PMC10339221 Free PMC article https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2806887