Diferencia entre revisiones de «Acute psychosis»
| Línea 24: | Línea 24: | ||
***should administer medications if restraints used (decreases restraint time) | ***should administer medications if restraints used (decreases restraint time) | ||
*Pharmacologic: Goal is to calm pt without oversedation | *Pharmacologic: Goal is to calm pt without oversedation | ||
**No history of psychosis | **'''No history of psychosis''' | ||
***Haloperidol 0.5mg-5mg + lorazepam 0.25-2mg (PO/IM/IV) | ***Haloperidol 0.5mg-5mg + lorazepam 0.25-2mg (PO/IM/IV) | ||
***Consider adding benztropine 0.5-2mg | ***Consider adding benztropine 0.5-2mg '''or''' diphenhydramine 25-50mg (PO/IV/IM) | ||
****reduces dystonia or EPS | ****reduces dystonia or EPS | ||
***Consider risperidone 0.5-2mg PO | ***Consider risperidone 0.5-2mg PO '''or''' olanzapine 2.5-20mg (PO/IM/SL) '''or''' ziprasidone 10-20mg IM | ||
**'''Known or suspected underlying psychotic illness''' | |||
***Continue treatment with previous antipsychotic '''or''' | |||
***PO: olanzapine 5-10mg '''or''' risperidone 0.5-2mg +/- lorazepam: 0.5-2mg | |||
***IM: olanzapine 2.5-20mg or ziprasidone 10-20mg '''or''' | |||
***(PO/IM/IV) Haloperidol 0.5-5mg + lorazepam 0.5-2mg | |||
==Disposition== | ==Disposition== | ||
Revisión del 17:03 25 mar 2015
Background
- Caused by many psychiatric and medical conditions
- Examples: schizophrenia, mania
Clinical Presentation
- Agitation
- Restlessness
- Irritability
- Decreased attention
- innappropriate or hostile behaviors
Differential Diagnosis
Altered mental status
Diffuse brain dysfunction
- Hypoxic encephalopathy
- Acute toxic-metabolic encephalopathy (Delirium)
- Hypoglycemia
- Hyperosmolar state (e.g., hyperglycemia)
- Electrolyte Abnormalities (hypernatremia or hyponatremia, hypercalcemia)
- Organ system failure
- Hepatic Encephalopathy
- Uremia/Renal Failure
- Endocrine (Addison's disease, Cushing syndrome, hypothyroidism, myxedema coma, thyroid storm)
- Hypoxia
- CO2 narcosis
- Hypertensive Encephalopathy
- Toxins
- TTP / Thrombotic thrombocytopenic purpura
- Alcohol withdrawal
- Drug reactions (NMS, Serotonin Syndrome)
- Environmental causes
- Deficiency state
- Wernicke encephalopathy
- Subacute Combined Degeneration of Spinal Cord (B12 deficiency)
- Vitamin D Deficiency
- Zinc Deficiency
- Sepsis
- Osmotic demyelination syndrome (central pontine myelinolysis)
- Limbic encephalitis
Primary CNS disease or trauma
- Direct CNS trauma
- Diffuse axonal injury
- Subdural/epidural hematoma
- Vascular disease
- SAH
- Stroke
- Hemispheric, brainstem
- CNS infections
- Neoplasms
- Paraneoplastic Limbic encephalitis
- Malignant Meningitis
- Pancreatic Insulinoma
- Seizures
- Nonconvulsive status epilepticus
- Postictal state
- Dementia
Psychiatric
Diagnosis
- Vital signs
- Blood glucose
- signs or symptoms of intoxication or withdrawal
- signs of trauma
Management
- Non-pharmacologic
- Verbal de-escalation
- Offer comforting items: blanket, meal, pillow, etc
- Quiet room
- Physical restraints
- should administer medications if restraints used (decreases restraint time)
- Pharmacologic: Goal is to calm pt without oversedation
- No history of psychosis
- Haloperidol 0.5mg-5mg + lorazepam 0.25-2mg (PO/IM/IV)
- Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM)
- reduces dystonia or EPS
- Consider risperidone 0.5-2mg PO or olanzapine 2.5-20mg (PO/IM/SL) or ziprasidone 10-20mg IM
- Known or suspected underlying psychotic illness
- Continue treatment with previous antipsychotic or
- PO: olanzapine 5-10mg or risperidone 0.5-2mg +/- lorazepam: 0.5-2mg
- IM: olanzapine 2.5-20mg or ziprasidone 10-20mg or
- (PO/IM/IV) Haloperidol 0.5-5mg + lorazepam 0.5-2mg
- No history of psychosis