Psychosis

  • Condition of the mind that is defined as a loss of contact with reality — affects a person's thinking, talking, behaviour and mood
  • Can be due to a number of mental health problems — schizophrenia, bipolar disorder, severe depression, alcohol/drug misuse, dementia
  • Some physical conditions can look like psychosis, eg epilepsy, delirium

Signs and symptoms may include

  • Delusions — strongly held false beliefs that are not true of a person's cultural or religious background
  • Hallucinations, auditory, visual and sensory — hears, sees, tastes, smells or feels things that are not really present
  • Thought disorganisation — not able to think straight, conversation hard to follow
  • Severe agitation, restlessness, anxiety, hostility, aggression, paranoia

Seek advice

  • For advice on talking with person who may have mental illness — see Mental health assessment
  • Some experiences can be culturally explained — important to ask ATSIHP or family member for advice
  • For help with immediate management and risk mitigation — medical/mental health team consult

Acute management

Ask

  • Assess risk of harm to others or self — driven by delusions or hallucinations
    • Delusions or beliefs that may lead to the person harming themself or others
    • Auditory hallucinations (voices) or other perceptual experiences (eg command hallucinations) that may drive the person to harm self or others

Check

Only if possible and safe

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • U/A, pregnancy test
  • ECG
  • Coma scale
    • Head-to-toe exam — with attention to head injury, infection (eg chest, ear, UTI), epilepsy (fits), encephalitis, medicine toxicity, electrolyte imbalance, thyroid dysfunction

Do

  • Mental health assessment
  • FBC, ESR, UEC, LFT, TFT, HbA1c, lipids, hepatitis, HIV, syphilis serology, urine drug screen, urine ACR

Antipsychotic medicines

  • Oral medicines are first choice when managing psychosis
    • Tablets work quicker, eg some calming effects often in a few hours
  • Need for long-term medicine usually decided by psychiatrist — can include oral tablets or depot injections
    • Effects may take several days or weeks
  • Always check manufacturer's directions for preparing and giving depot medicines
  • Some adverse effects of antipsychotic medications need urgent medical consult — Table 5.2

Table 5.2   Serious adverse effects

Ongoing management 

  • Usually multi-professional and multi-service provider approach
  • Medical follow-up to make management plan, mental health care plan — to help support person to stay in community
    • Must include relapse prevention strategies, physical health, psychological health, social and environmental health, support for carers, legal considerations
  • Antipsychotic medicines increase risk of metabolic syndrome (group of conditions that increase risk of chronic disease) — see Combined checks for chronic conditions 
  • If woman has changes in menstrual cycle, swollen/tender breasts and galactorrhoea (milk from breasts when not breastfeeding) — check blood prolactin levels