Diferencia entre revisiones de «Schizophreniform disorder»
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==Background== | ==Background== | ||
A mental disorder with characteristic symptoms identical to [[schizophrenia]], distinguished by the total duration of illness of at least 1 month but less than 6 months | *A mental disorder with characteristic symptoms identical to [[schizophrenia]], distinguished by the total duration of illness of at least 1 month but less than 6 months | ||
==Clinical Features== | ==Clinical Features== | ||
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==Evaluation== | ==Evaluation== | ||
Rule out other organic causes including substance abuse, medication effect or other medical conditions. Consider emergency psychiatric evaluation in addition to medical evaluation. | *Rule out other organic causes including substance abuse, medication effect or other medical conditions. Consider emergency psychiatric evaluation in addition to medical evaluation. | ||
{{General ED Psychiatric Workup}} | {{General ED Psychiatric Workup}} | ||
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==Disposition== | ==Disposition== | ||
* | *Generally may be discharged | ||
*May require admission if unable to care for self or other indication for psychiatric hold | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
==References== | ==References== | ||
Revisión del 22:17 21 oct 2017
Background
- A mental disorder with characteristic symptoms identical to schizophrenia, distinguished by the total duration of illness of at least 1 month but less than 6 months
Clinical Features
- A. Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one of these must be (1), (2), or (3):[1]
- 1. Delusions
- 2. Hallucinations
- 3. Disorganized speech (e.g., frequent derailment or incoherence)
- 4. Grossly disorganized or catatonic behavior
- 5. Negative symptoms (i.e., diminished emotional expression or avolition)
- B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”
- C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either:
- 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or
- 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
- D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
Differential Diagnosis
Psychiatric Disorders with Psychotic Symptoms
- Acute psychosis
- Schizophrenia
- Schizoaffective disorder
- Delusional disorder
- Schizotypal personality disorder
- Schizoid personality disorder
- Bipolar disorder with psychotic features
Organic Causes
- Meningitis
- Encephalitis
- Thyroid (Main)
- Toxin ingestion
- Medication effect
Evaluation
- Rule out other organic causes including substance abuse, medication effect or other medical conditions. Consider emergency psychiatric evaluation in addition to medical evaluation.
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
General ED Psychiatric Management
- Non-pharmacologic
- Verbal de-escalation
- Offer comforting items: blanket, meal, pillow, etc
- Quiet room
- Physical restraints (should administer medications if restraints used, as decreases restraint time)
- Pharmacologic: Goal is to calm patient 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 extrapyramidal reaction)
- Consider risperidone 0.5-2mg PO or olanzapine 2.5-20mg (PO/IM/SL) or ziprasidone 10-20mg IM
- Haloperidol 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV)
- 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
- Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
- No history of psychosis
Disposition
- Generally may be discharged
- May require admission if unable to care for self or other indication for psychiatric hold
See Also
External Links
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.