PSYCHIATRY
PSYCHOSIS/SCHIZOPHRENIA
PromptFeatures of organic cause for psychosis (Delirium)
ResponseAcute onset
Fluctuating course
Attention deficits/Clouded consciousness
Deranged vital signs
Generalised, severed, disorganised behavior
Changes in arousal (Hyper/hypoactive)
Altered sleep wake cycle
Visual hallucination
Fluctuating course
Attention deficits/Clouded consciousness
Deranged vital signs
Generalised, severed, disorganised behavior
Changes in arousal (Hyper/hypoactive)
Altered sleep wake cycle
Visual hallucination
PromptMimics of ‘psychiatric’ psychosis
ResponseMetabolic - Thyroid storm, hypertensive encephalopathy
Head injury
Drugs - intoxication - Anticholinergic toxicity, Serotonin syndrome, Neuroleptic malignant syndrome
Drugs - Illicit - Stimulant toxicity
Drugs - withdrawal - Benzos/opioidsl
Encephalitis
Temporal lobe epilepsy/Post ictal state
AEIOUTIPS
Head injury
Drugs - intoxication - Anticholinergic toxicity, Serotonin syndrome, Neuroleptic malignant syndrome
Drugs - Illicit - Stimulant toxicity
Drugs - withdrawal - Benzos/opioidsl
Encephalitis
Temporal lobe epilepsy/Post ictal state
AEIOUTIPS
PromptFactors favouring drug induced psychosis over schizophrenia
ResponseHistory of substance misuse
Abrupt onset
Relatively short duration
Responds rapidly to neuroleptic medications
Abrupt onset
Relatively short duration
Responds rapidly to neuroleptic medications
PromptFeatures suggestive of primary psychosis (psychiatric cause)
ResponseHistory
Age of onset (75% of schizophrenia 15-25 years old)
FHx of schizophrenia, personal history of psychiatric disorder.
Alcohol/drug intoxication or abuse
Subacute/gradual onset (vs drug induced = acute)
Impaired social/occupational functioning
Not intoxicated
Examination:
Normal vital signs, normal physical examination
No medical symptoms/complaints
Appearance and behaviour -restless, adgitated, neglected/dischevelled, mannerisms
Thought disorder - lack of logical thought processes, tangential, circumstantial
Emotions - inappropriate affect, emotional blunting
Hallucinations - predominantly auditory, occurs despite normal LOC
Insight - lack of
Judgment - impaired
Delusions - most commonly multiple different types rather than single
MSE:
Positive symptoms
Hallucinations, delusions, disorganised speech, disorganised behaviour, catatonic
Negative symptoms - blunted affect, emotional withdrawal, anhedonia, attention impairment
Functional decline
Appearance
Lack of insight
Age of onset (75% of schizophrenia 15-25 years old)
FHx of schizophrenia, personal history of psychiatric disorder.
Alcohol/drug intoxication or abuse
Subacute/gradual onset (vs drug induced = acute)
Impaired social/occupational functioning
Not intoxicated
Examination:
Normal vital signs, normal physical examination
No medical symptoms/complaints
Appearance and behaviour -restless, adgitated, neglected/dischevelled, mannerisms
Thought disorder - lack of logical thought processes, tangential, circumstantial
Emotions - inappropriate affect, emotional blunting
Hallucinations - predominantly auditory, occurs despite normal LOC
Insight - lack of
Judgment - impaired
Delusions - most commonly multiple different types rather than single
MSE:
Positive symptoms
Hallucinations, delusions, disorganised speech, disorganised behaviour, catatonic
Negative symptoms - blunted affect, emotional withdrawal, anhedonia, attention impairment
Functional decline
Appearance
Lack of insight
PromptProblems with assessing psychotic patient in ED setting
ResponseSafety of patient and staff
Additional resources required - MH, Security
Capacity of the patient to decline treatment
Differentiating organic vs psychiatric cause for behavioral disturbances
Additional resources required - MH, Security
Capacity of the patient to decline treatment
Differentiating organic vs psychiatric cause for behavioral disturbances
PromptFeatures suggestive of admission
ResponseFirst presentation
History of depression and self harm - high risk
Carer fatigure
Delay to follow up (eg: weekend)
History of depression and self harm - high risk
Carer fatigure
Delay to follow up (eg: weekend)
PromptPOSTPARTUM PSYCHOSIS
Response
PromptFeatures concerning for post partum psychosis
ResponseDisorganisation/confusion
Depersonalisation
Abnormal thought content (Delusions/hallucinations)
Abnormal mood (mania/adgitation vs Depression vs mixed
Depersonalisation
Abnormal thought content (Delusions/hallucinations)
Abnormal mood (mania/adgitation vs Depression vs mixed
PromptManagement of postpartum psychosis
ResponseInvestigate and treat underlying causes
Urgent referral to specialist mental health unit (inpt vs close outpt management)
Arrange review and follow up of baby with involvement of pediatrics
Mandatory reporting
Urgent referral to specialist mental health unit (inpt vs close outpt management)
Arrange review and follow up of baby with involvement of pediatrics
Mandatory reporting