From the Guidelines
Causes of Psychosis
Psychosis in a 30-year-old male can be caused by various factors, including schizophrenia, bipolar disorder, substance-induced psychosis, or major depressive disorder with psychotic features 1. These conditions can lead to a range of symptoms, including delusions, hallucinations, disorganized speech or thought, and abnormal motor behavior.
Management of Psychosis
Management of psychosis typically involves the initiation of antipsychotic medication, such as risperidone 2-4 mg/day or olanzapine 10-20 mg/day, for a minimum duration of 6-12 months 1. Additionally, adjunctive therapy with mood stabilizers, such as valproate 500-1000 mg/day, or antidepressants, such as sertraline 50-100 mg/day, may be considered depending on the underlying diagnosis.
Key Considerations
- Close monitoring of symptoms, side effects, and medication adherence is crucial, with regular follow-up appointments and adjustments to the treatment plan as needed 1.
- Psychosocial interventions, such as cognitive-behavioral therapy, family therapy, and social skills training, can also play an important role in the management of psychosis 1.
- Antipsychotic polypharmacy may be considered in some cases, but should be approached with caution due to the potential for increased side effects 1.
Treatment Goals
The primary goals of treatment for psychosis are to:
- Reduce symptoms and improve functioning
- Enhance quality of life
- Prevent relapse and hospitalization
- Promote recovery and rehabilitation
By taking a comprehensive and individualized approach to treatment, healthcare providers can help individuals with psychosis achieve these goals and improve their overall well-being.
From the Research
Causes of Psychosis
- Psychosis can be caused by various factors, including substance abuse 2, corticosteroid use 3, and medical conditions such as infections, seizures, and cerebrovascular disease 4
- Illicit drug use is a common cause of acute psychosis 4
- Certain medications, such as chloroquine, can also induce psychosis 5
- Schizophrenia, a psychiatric disorder, can also cause psychosis, with a steep increase in incidence in males between 15-25 years old 6
Management of Psychosis
- Treatment of psychosis depends on the underlying cause, with antipsychotic medications being a common treatment option 2
- In cases of substance-induced psychosis, cessation of substance use is essential 2
- For corticosteroid-induced psychosis, reducing the dose or switching to a different medication may be necessary 3
- In cases of medication-induced psychosis, such as chloroquine, discontinuation of the medication may be necessary 5
- A comprehensive treatment plan, including medication, therapy, and social support, is crucial for managing schizophrenia and other psychiatric disorders that cause psychosis 6
Diagnosis and Assessment
- A thorough medical and psychiatric history, physical examination, and laboratory tests are necessary to determine the cause of psychosis 4
- Collateral history from family members and a complete neurologic and mental status assessment can also be helpful in establishing the diagnosis 4
- Initial laboratory tests may include a complete blood count, metabolic profile, thyroid function tests, and urine toxicology 4