A mental condition characterized by distortions of thinking and perception, as well as inappropriate or narrowed range of emotions.
Causes
- Not known, but there are associated biological, genetic and environmental factors
Clinical features
Any one or more of these may be diagnostic:
- Delusions (abnormal, fixed, false beliefs) or excessive and unwarranted suspicions (may be multiple, fragmented or bizarre)
- Disconnected ideas with vague or incoherent speech and inadequate in content
- Hallucinations: hearing voices or seeing things that are not witnessed by others Severe behaviour abnormalities: agitation or disorganised behaviour, excitement, inactivity or overactivity
- Disturbance of emotions such as marked apathy or disconnection between reported emotions and observed
effect - Mood is usually inappropriate
- Difficulty in forming and sustaining relationships
- Social withdrawal and neglect of usual responsibilities
Chronic psychosis or schizophrenia
- Symptoms of psychosis lasting for 3 or more months
- Accompanied by deterioration in social, general and occupational functioning
Differential diagnosis
- Alcohol and drug intoxication or withdrawal
- Organic delirium, dementia, mood disorders
Investigations
- Good social, personal and family history
- Laboratory investigations for infectious diseases e.g. HIV, syphilis
Management
Acute psychosis
- Counselling/psychoeducation of patient and carers
Antipsychotic drugs
- Chlorpromazine: starting dose 75-150 mg daily and maintenance dose of 75-300 mg daily. Up to
1000 mg daily in divided does may be required for those with severe disturbance - Or Haloperidol: starting dose 5-10 mg daily (lower in elderly) and maintenance dose of 5-20
mg daily in divided doses - Administer orally or IM for those with agitation
- Only use one antipsychotic at a time
- Gradually adjust doses depending on response
- Monitor for side effects e.g. extrapyramidal side effects
- Use therapeutic dose for 4-6 weeks to assess effect
- Psychological interventions (family therapy or social skills therapy) if available
- Ensure follow up
- For acute psychosis, continue treatment for at least 12 months. Discuss discontinuation with
patient, carers and specialist
If extrapyramidal side-effects
- Add an anticholinergic: Benzhexol initially 2 mg every 12 hours then reduce gradually to once daily
and eventually give 2 mg only when required
If no response
- Refer to specialist
Chronic psychosis
Treat as above, but if adherence is a problem or the patient prefers, use:
- Fluphenazine decanoate 12.5-50 mg every 2-5 weeks deep IM into gluteal muscle
- Or Haloperidol injection (oily) 50-200 mg (300 mg) deep IM into gluteal muscle every 3-4 weeks