GuidelinesPrimary Care STG
Acute and Transient Psychotic Disorders
Description General Measures Medicine Treatment Referral ICD-10 code: F23.0-F23.9/F24/F28/F29 + (F10.0-F19.9/R45.0-8/Z65.0-5/Z65.8-9/Z81.0-4/Z81.8) Description Sudden onset of ≥ 1 psychotic symptoms (usually delusions, hallucinations, or disorganised thinking) which resolves spontaneously, usually within 1 month, with a full return to premorbid social or occupational functioning. Stressful
ICD-10 code: F23.0-F23.9/F24/F28/F29 + (F10.0-F19.9/R45.0-8/Z65.0-5/Z65.8-9/Z81.0-4/Z81.8)
Description
Sudden onset of ≥ 1 psychotic symptoms (usually delusions, hallucinations, or disorganised thinking) which resolves spontaneously, usually within 1 month, with a full return to premorbid social or occupational functioning. Stressful events may precede the psychotic episode. Within 3 years, 40-50% will have a recurrent episode or develop schizophrenia or bipolar disorder.
General Measures
- Refer all new onset psychosis to hospital for a medical, substance use, and mental health evaluation (see Adult Hospital STG: Acute and transient psychotic disorders).
- For agitated and acutely disturbed patients, manage as for the aggressive or disruptive patient. See: Aggressive disruptive behaviour in adults and Aggressive disruptive behaviour in children and adolescents.
- Ensure the safety of the patient and those caring for them.
- Minimise stress and stimulation.
- Do not challenge what appear to be false statements or delusions.
After hospital discharge/ on return to PHC:
- Provide active follow-up with 6-monthly visits for three years with mental health and substance use screening and general health promotion.
- Psychoeducate the patient and their family regarding the condition and red flags to watch for if the psychosis worsens or recurs.
- Address psycho-social stressors – refer to social worker, counselling services.
Women of childbearing potential:
- Ensure family planning.
- If the patient is a parent/guardian – refer to social worker to assess home functioning and childcare.
Medicine Treatment
- See: Aggressive disruptive behaviour in adults and Aggressive disruptive behaviour in children and adolescents.
Referral
- All patients with active psychosis.
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Standard Treatment Guidelines and Essential Medicines List for South Africa Primary Healthcare Level_Chapter 16: Mental Health Conditions_NEMLC Recommendations for Medicine Amendments 2020_2023
ICD-10 codes
- F10.0Mental and behavioural disorders due to use of alcohol, acute intoxication
- F10.1Mental and behavioural disorders due to use of alcohol, harmful use
- F10.2Mental and behavioural disorders due to use of alcohol, dependence syndrome
- F10.3Mental and behavioural disorders due to use of alcohol, withdrawal state
- F10.4Mental and behavioural disorders due to use of alcohol, withdrawal state with delirium
- F10.5Mental and behavioural disorders due to use of alcohol, psychotic disorder
- F10.6Mental and behavioural disorders due to use of alcohol, amnesic syndrome
- F10.7Mental and behavioural disorders due to use of alcohol, residual and late-onset psychotic disorder
- F10.8Mental and behavioural disorders due to use of alcohol, other mental and behavioural disorders
- F10.9Mental and behavioural disorders due to use of alcohol, unspecified mental and behavioural disorder
- F11.0Mental and behavioural disorders due to use of opioids, acute intoxication
- F11.1Mental and behavioural disorders due to use of opioids, harmful use
- F11.2Mental and behavioural disorders due to use of opioids, dependence syndrome
- F11.3Mental and behavioural disorders due to use of opioids, withdrawal state
- F11.4Mental and behavioural disorders due to use of opioids, withdrawal state with delirium
- F11.5Mental and behavioural disorders due to use of opioids, psychotic disorder
- F11.6Mental and behavioural disorders due to use of opioids, amnesic syndrome
- F11.7Mental and behavioural disorders due to use of opioids, residual and late-onset psychotic disorder
- F11.8Mental and behavioural disorders due to use of opioids, other mental and behavioural disorders
- F11.9Mental and behavioural disorders due to use of opioids, unspecified mental and behavioural disorder
- F12.0Mental and behavioural disorders due to use of cannabinoids, acute intoxication
- F12.1Mental and behavioural disorders due to use of cannabinoids, harmful use
- F12.2Mental and behavioural disorders due to use of cannabinoids, dependence syndrome
- F12.3Mental and behavioural disorders due to use of cannabinoids, withdrawal state
- F12.4Mental and behavioural disorders due to use of cannabinoids, withdrawal state with delirium
- F12.5Mental and behavioural disorders due to use of cannabinoids, psychotic disorder
- F12.6Mental and behavioural disorders due to use of cannabionoids, amnesic syndrome
- F12.7Mental and behavioural disorders due to use of cannabinoids, residual and late-onset psychotic disorder
- F12.8Mental and behavioural disorders due to use of cannabinoids, other mental and behavioural disorders
- F12.9Mental and behavioural disorders due to use of cannabinoids, unspecified mental and behavioural disorder
- F13.0Mental and behavioural disorders due to use of sedatives or hypnotics, acute intoxication
- F13.1Mental and behavioural disorders due to use of sedatives or hypnotics, harmful use
- F13.2Mental and behavioural disorders due to use of sedatives or hypnotics, dependence syndrome
- F13.3Mental and behavioural disorders due to use of sedatives or hypnotics, withdrawal state
- F13.4Mental and behavioural disorders due to use of sedatives or hypnotics, withdrawal state with delirium
- F13.5Mental and behavioural disorders due to use of sedatives or hypnotics, psychotic disorder
- F13.6Mental and behavioural disorders due to use of sedatives or hypnotics, amnesic syndrome
- F13.7Mental and behavioural disorders due to use of sedatives or hypnotics, residual and late-onset psychotic disorder
- F13.8Mental and behavioural disorders due to use of sedatives or hypnotics, other mental and behavioural disorders
- F13.9Mental and behavioural disorders due to use of sedatives or hypnotics, unspecified mental and behavioural disorder
- F14.0Mental and behavioural disorders due to use of cocaine, acute intoxication
- F14.1Mental and behavioural disorders due to use of cocaine, harmful use
- F14.2Mental and behavioural disorders due to use of cocaine, dependence syndrome
- F14.3Mental and behavioural disorders due to use of cocaine, withdrawal state
- F14.4Mental and behavioural disorders due to use of cocaine, withdrawal state with delirium
- F14.5Mental and behavioural disorders due to use of cocaine, psychotic disorder
- F14.6Mental and behavioural disorders due to use of cocaine, amnesic syndrome
- F14.7Mental and behavioural disorders due to use of cocaine, residual and late-onset psychotic disorder
- F14.8Mental and behavioural disorders due to use of cocaine, other mental and behavioural disorders
- F14.9Mental and behavioural disorders due to use of cocaine, unspecified mental and behavioural disorder
- F15.0Mental and behavioural disorders due to use of other stimulants, including caffeine, acute intoxication
- F15.1Mental and behavioural disorders due to use of other stimulants, including caffeine, harmful use
- F15.2Mental and behavioural disorders due to use of other stimulants, including caffeine, dependence syndrome
- F15.3Mental and behavioural disorders due to use of other stimulants, including caffeine, withdrawal state
- F15.4Mental and behavioural disorders due to use of other stimulants, including caffeine, withdrawal state with delirium
- F15.5Mental and behavioural disorders due to use of other stimulants, including caffeine, psychotic disorder
- F15.6Mental and behavioural disorders due to use of other stimulants, including caffeine, amnesic syndrome
- F15.7Mental and behavioural disorders due to use of other stimulants, including caffeine, residual and late-onset psychotic disorder
- F15.8Mental and behavioural disorders due to use of other stimulants, including caffeine, other mental and behavioural disorders
- F15.9Mental and behavioural disorders due to use of other stimulants, including caffeine, unspecified mental and behavioural disorder
- F16.0Mental and behavioural disorders due to use of hallucinogens, acute intoxication
- F16.1Mental and behavioural disorders due to use of hallucinogens, harmful use
- F16.2Mental and behavioural disorders due to use of hallucinogens, dependence syndrome
- F16.3Mental and behavioural disorders due to use of hallucinogens, withdrawal state
- F16.4Mental and behavioural disorders due to use of hallucinogens, withdrawal state with delirium
- F16.5Mental and behavioural disorders due to use of hallucinogens, psychotic disorder
- F16.6Mental and behavioural disorders due to use of hallucinogens, amnesic syndrome
- F16.7Mental and behavioural disorders due to use of hallucinogens, residual and late-onset psychotic disorder
- F16.8Mental and behavioural disorders due to use of hallucinogens, other mental and behavioural disorders
- F16.9Mental and behavioural disorders due to use of hallucinogens, unspecified mental and behavioural disorder
- F17.0Mental and behavioural disorders due to use of tobacco, acute intoxication
- F17.1Mental and behavioural disorders due to use of tobacco, harmful use
- F17.2Mental and behavioural disorders due to use of tobacco, dependence syndrome
- F17.3Mental and behavioural disorders due to use of tobacco, withdrawal state
- F17.4Mental and behavioural disorders due to use of tobacco, withdrawal state with delirium
- F17.5Mental and behavioural disorders due to use of tobacco, psychotic disorder
- F17.6Mental and behavioural disorders due to use of tobacco, amnesic syndrome
- F17.7Mental and behavioural disorders due to use of tobacco, residual and late-onset psychotic disorder
- F17.8Mental and behavioural disorders due to use of tobacco, other mental and behavioural disorders
- F17.9Mental and behavioural disorders due to use of tobacco, unspecified mental and behavioural disorder
- F18.0Mental and behavioural disorders due to use of volatile solvents, acute intoxication
- F18.1Mental and behavioural disorders due to use of volatile solvents, harmful use
- F18.2Mental and behavioural disorders due to use of volatile solvents, dependence syndrome
- F18.3Mental and behavioural disorders due to use of volatile solvents, withdrawal state
- F18.4Mental and behavioural disorders due to use of volatile solvents, withdrawal state with delirium
- F18.5Mental and behavioural disorders due to use of volatile solvents, psychotic disorder
- F18.6Mental and behavioural disorders due to use of volatile solvents, amnesic syndrome
- F18.7Mental and behavioural disorders due to use of volatile solvents, residual and late-onset psychotic disorder
- F18.8Mental and behavioural disorders due to use of volatile solvents, other mental and behavioural disorders
- F18.9Mental and behavioural disorders due to use of volatile solvents, unspecified mental and behavioural disorder
- F19.0Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, acute intoxication
- F19.1Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, harmful use
- F19.2Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, dependence syndrome
- F19.3Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, withdrawal state
- F19.4Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, withdrawal state with delirium
- F19.5Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, other psychotic disorder
- F19.6Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, amnesic syndrome
- F19.7Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, residual and late-onset other psychotic disorder
- F19.8Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, other mental and behavioural disorders
- F19.9Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances, unspecified mental and behavioural disorder
- F23.0Acute polymorphic psychotic disorder without symptoms of schizophrenia
- F23.1Acute polymorphic psychotic disorder with symptoms of schizophrenia
- F23.2Acute schizophrenia-like psychotic disorder
- F23.3Other acute predominantly delusional psychotic disorders
- F23.8Other acute and transient psychotic disorders
- F23.9Acute and transient psychotic disorder, unspecified
- F24Induced delusional disorder
- F28Other nonorganic psychotic disorders
- F29Unspecified nonorganic psychosis
- R45.0Nervousness
- R45.1Restlessness and agitation
- R45.2Unhappiness
- R45.3Demoralization and apathy
- R45.4Irritability and anger
- R45.5Hostility
- R45.6Physical violence
- R45.7State of emotional shock and stress, unspecified
- R45.8Other symptoms and signs involving emotional state
- Z65.0Conviction in civil and criminal proceedings without imprisonment
- Z65.1Imprisonment and other incarceration
- Z65.2Problems related to release from prison
- Z65.3Problems related to other legal circumstances
- Z65.4Victim of crime and terrorism
- Z65.5Exposure to disaster, war and other hostilities
- Z65.8Other specified problems related to psychosocial circumstances
- Z65.9Problem related to unspecified psychosocial circumstances
- Z81.0Family history of mental retardation
- Z81.1Family history of alcohol abuse
- Z81.2Family history of tobacco abuse
- Z81.3Family history of other psychoactive substance abuse
- Z81.4Family history of other substance abuse
- Z81.8Family history of other mental and behavioural disorders