Psychosis

Psychosis is a syndrome where one experiences hallucinations, delusions, and disorganised thoughts and actions. It can be classed into primary and secondary types:

• Primary - Schizophrenia, Schizoaffective disorder, Psychotic depression, Delusional disorder, Brief psychotic disorder - It typically presents with:

  • Auditory hallucinations, delusions, and disorganised thought process, minimal cognitive deficits

  • Normal vital signs

• Secondary - Drug-induced, Infection, Metabolic, Neurological disease - It typically presents with:

  • Visual/Tactile hallucinations, Severe cognitive impairment (confusion, disorientation)

  • Altered vital signs

Presentation

Positive symptoms - Characteristics that are added to someone’s state of being, including:

• Hallucinations - Perceptions in the absence of stimuli - Can be auditory, visual, olfatory, or tactile

• Delusions - Fixed, false beliefs

• Thought disorder - thought insertion (put into head), thought withdrawal (removed from head), thought broadcasting (others can hear)

Negative symptoms - Characteristics that are removed from someone’s state of being, including:

• Blunted affect

• Reduced speech (Alogia)

• Anhedonia

• Loss of motivation

• Self-neglect

• Social withdrawal

Investigations

• General and neurological examination

• Bloods - FBC, LFTs, U&E, Glucose, TFTs

• Urine toxicology

• STI screen

Management

• Stop any causative agents e.g. drugs, in secondary type

• Sedation if agitated - PO/IM Benzos/Antipsychotics e.g. Lorazepam