Acute psychosis

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Background

  • Caused by many psychiatric and medical conditions
  • Examples: schizophrenia, mania

Clinical Presentation

  • Agitation
  • Restlessness
  • Irritability
  • Decreased attention
  • innappropriate or hostile behaviors

Differential Diagnosis

see Altered mental status

Diagnosis

  • Vital signs
  • Blood glucose
  • signs or symptoms of intoxication or withdrawal
  • signs of trauma

Management

  • Non-pharmacologic
    • Verbal de-escalation
    • Offer comforting items: blanket, meal, pillow, etc
    • Quiet room
    • Physical restraints
      • should administer medications if restraints used (decreases restraint time)
  • Pharmacologic: Goal is to calm pt without oversedation
    • No history of psychosis
      • Haloperidol 0.5mg-5mg + lorazepam 0.25-2mg (PO/IM/IV)
      • Consider adding benztropine 0.5-2mg OR diphenhydramine 25-50mg (PO/IV/IM)
        • reduces dystonia or EPS
      • Consider risperidone 0.5-2mg PO OR olanzapine 2.5-20mg (PO/IM/SL) OR ziprasidone 10-20mg IM

Disposition

See Also

External Links

References