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INTRODUCTION

Key Clinical Questions

  • image What is psychosis?

  • image What are the various psychotic disorders?

  • image How are psychotic disorders diagnosed?

  • image How is psychosis treated in the acute hospital setting?

  • image What are the complications of psychosis?

  • image What is an optimal discharge plan for patients who are recovering from psychosis?

New-onset psychosis and recurring psychosis identified during the course of assessment and treatment of medical disorders, require immediate intervention. 0.5% to 2.5% of all (nonpsychiatric) hospitalized patients have a pre-existing chronic psychosis and 5% to 25% of all referrals for psychiatric consultation in a hospital setting are for a psychotic disorder. New-onset psychoses may be secondary to a general medical condition, iatrogenic or functional in nature. Initiation of treatment for new cases and continuation (or resumption) of treatment for pre-existing psychosis is of paramount importance. Psychosis in children and adolescents, postpartum period and in the elderly requires special attention to dosing and adverse effects. Neglecting or undertreating the psychosis will likely lead to behavioral and medical complications. Psychosis can quickly erupt into a crisis, affecting safety, the management of the medical disorder(s) and altering hospital course and outcome. The presence of comorbid psychiatric conditions, especially if unrecognized or undertreated often increases the length of stay and cost of care. Key point in the management of psychosis is outlined in Table 225-1.

TABLE 225-1Key Points to Managing Psychosis

DEFINITIONS AND TERMINOLOGY

The ...

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