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  1. What is psychosis?

  2. What are the various psychotic disorders?

  3. How are psychotic disorders diagnosed?

  4. How is psychosis treated in the acute hospital setting?

  5. What are the complications of psychosis?

  6. 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. 0.5–2.5% of all (nonpsychiatric) hospitalized patients have a preexisting chronic psychosis and 5–25% of all referrals for psychiatric consultation are for a psychotic disorder. New-onset psychoses may be secondary to a general medical condition, iatrogenic or functional in nature (Table 226-1). Initiation of treatment for new cases and continuation (or resumption) of treatment for preexisting psychosis is of paramount importance. Neglecting or under treating the psychosis will likely lead to behavioral and medical complications. Psychosis can quickly erupt into a crisis, affecting the management of the medical disorder(s) and altering their outcome. The presence of comorbid psychiatric conditions, especially if unrecognized or under treated often increases the length of stay and cost of care.

Table 226-1 Key Points

The term psychosis was first used in the mid-19th century to denote an abnormal state of mind, and typically refers to a loss of touch with reality. In 1896, Emil Kraeplin dichotomized the functional psychoses into dementia precox and manic-depressive illness to denote a chronic deteriorating cognitive disorder and an intermittent mood disorder, respectively. In 1911, Eugen Bleuler renamed the former condition as schizophrenia. This dichotomization does not cover all psychotic disorders, and various other psychotic disorders have been described. These include ...

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