Psychotic Disorders

Description

Acute and transient psychotic disorders

Description

General measures

Medicine treatment

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Description

Psychosis is characterised by a loss of contact with reality. Psychotic disorders may present with:

• Delusions: Fixed beliefs which may manifest as disturbed speech content with persecutory, referential, grandiose, religiose, erotic, or bizarre themes.
• Hallucinations: Perceptual disturbances, e.g. auditory hallucinations, which are heard as voices distinct from the patients’ thoughts.
• Disorganised thinking: Manifests as disordered flow of speech which impairs communication.
• Grossly disorganised or abnormal motor behaviour (including catatonia).
• Negative symptoms: reduced emotional expression, avolition, lack of speech, anhedonia, lack of social interaction.

Psychotic symptoms may occur in other psychiatric conditions (e.g. bipolar mania, major depression), medical conditions (e.g. certain types of epilepsy), or substance use (intoxication or withdrawal).

Psychosis is often accompanied by a lack of insight into the symptoms, poor judgement, and aggressive behaviour. The risk to self and others must always be assessed. It may be necessary to treat as an Assisted or Involuntary User under the MHCA.

Acute and Transient Psychotic Disorders

ICD - 10 code: F23.0-3/F23.8-9 + (F10.0-F19.9/R45.0-8/Z65.0-5/Z65.8-9/Z81.0-4/Z81.8)

Description

Sudden onset of ≥ 1 psychotic symptom (usually delusions, hallucinations, or disorganised thinking) which resolve 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.

LoE: IIb^xIii

General Measures

Assess and manage in consultation with a psychiatrist.

• Assess risk to self and others.
• Exclude and treat medical causes of psychotic symptoms (e.g. delirium, dementia, epilepsy).
• Exclude and manage substance use (e.g. cannabis, alcohol, amphetamines, and cocaine).
• Assess and treat other mental illness, e.g. Anxiety And Obsessive-Compulsive Disorder and Trauma and Stress-related Disorders.
• Refer to social worker, psychologist or counselling services to address psychosocial stressors.
• Active follow-up is needed: commence treatment for schizophrenia or bipolar disorder if these become evident. (See Bipolar and Related Disorder and Schizophrenia Spectrum Disorders).

Medicine Treatment

• Manage severe aggressive or disruptive behaviour (see Aggressive Disruptive Behaviour in Adults).
• Treat according to underlying cause

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults_Chapter 15: Mental Health Conditions and Substance Misuse_NEMLC Recommendations for Medicine Amendments 2020-2023