Acute Psychosis

10.2310/fm.4374 ◽

2015 ◽

Author(s):

James Kimo Takayesu ◽

Suzanne Bird

Keyword(s):

Mental Status ◽

Negative Symptoms ◽

Motor Behavior ◽

Psychotic Patient ◽

Definitive Treatment ◽

Acute Psychosis ◽

Physical Restraints ◽

Status Change ◽

Screening Assessment ◽

Psychotic Behavior

Acute psychosis can be a true emergency, and the primary goal in the evaluation of an acutely psychotic patient should be to maintain safety and prevent harm to the patient and staff. The defining symptoms of psychosis include hallucinations, delusions, disorganized thought or speech, abnormal motor behavior, and negative symptoms. This review covers the approach to the patient, and definitive treatment, disposition and outcomes for patients experiencing acute psychosis. The figure shows an interview setting in a triangular arrangement, allowing for safe egress. Tables list goals in the evaluation of the acutely psychotic patient; causes of secondary psychosis; common medication classes causing mental status change; four key questions for assessing psychotic behavior; screening assessment for psychosis; clinical features of dementia, delirium, and psychiatric illness; brief mental status examination; common medications for the treatment of acute psychosis and chemical sedation; QT-prolonging effects of commonly used antipsychotic medications; and documentation required in the use of chemical and/or physical restraints. This review contains 1 highly rendered figure, 10 tables, and 57 references.

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Acute Psychosis

10.2310/em.4374 ◽

2015 ◽

Author(s):

James Kimo Takayesu ◽

Suzanne Bird

Keyword(s):

Mental Status ◽

Negative Symptoms ◽

Motor Behavior ◽

Psychotic Patient ◽

Definitive Treatment ◽

Acute Psychosis ◽

Physical Restraints ◽

Status Change ◽

Screening Assessment ◽

Psychotic Behavior

Acute psychosis can be a true emergency, and the primary goal in the evaluation of an acutely psychotic patient should be to maintain safety and prevent harm to the patient and staff. The defining symptoms of psychosis include hallucinations, delusions, disorganized thought or speech, abnormal motor behavior, and negative symptoms. This review covers the approach to the patient, and definitive treatment, disposition and outcomes for patients experiencing acute psychosis. The figure shows an interview setting in a triangular arrangement, allowing for safe egress. Tables list goals in the evaluation of the acutely psychotic patient; causes of secondary psychosis; common medication classes causing mental status change; four key questions for assessing psychotic behavior; screening assessment for psychosis; clinical features of dementia, delirium, and psychiatric illness; brief mental status examination; common medications for the treatment of acute psychosis and chemical sedation; QT-prolonging effects of commonly used antipsychotic medications; and documentation required in the use of chemical and/or physical restraints. This review contains 1 highly rendered figure, 10 tables, and 57 references.

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Hyperactivity of Associations in Psychosis

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048678909062141 ◽

1989 ◽

Vol 23 (2) ◽

pp. 241-248 ◽

Cited By ~ 17

Author(s):

Robert Miller

Keyword(s):

Negative Symptoms ◽

Inductive Inference ◽

Great Variability ◽

Acute Psychosis ◽

Variable Response ◽

Neuroleptic Treatment ◽

High Anxiety ◽

Associative Processes ◽

Psychotic State ◽

Anxiety Levels

Disordered associative processes have long been regarded as central to the psychological description of psychotic states such as acute schizophrenia. Previous work is briefly summarised concerning the idea that hyperactive associative processes of thought underlie many of the symptoms of psychosis. The idea is developed further, with respect to several features of the psychotic state. Schneiderian symptoms are seenas a consequence of hyperactive associations of thought, combined with perceptual hypersensitivity characteristic of many psychotic individuals. Anxiety in psychotic states is seen as arising from the great ambiguity of mental images when associations are loosened. A vicious circle between high anxiety and hyperactive associations is postulated. The slow and variable response to neuroleptic treatment is seen as being determined in part by the dynamics of change of the memories acquired during a period of hyperactive associations. This essay has dealt exclusively with the positive (productive) symptoms of psychosis, and their treatment. It has briefly traced the origin of the idea that hyperactive associations of thought (i.e. of inductive inference) play an important part in the psychology of acute psychosis. Further it has attempted to show that this idea can be extended to give an account of Schneiderian symptoms, the high anxiety levels commonly found in acute psychosis, as well as the great variability in the rate and extent of response to drug treatment. The negative symptoms of schizophrenia are not included in the discussion. Some of these symptoms are not responsive to neuroleptic drugs. This leads one to suspect that other pathological processes in addition to those discussed above may be involved in the genesis of the negative symptoms.

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