Acute psychosis

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