Acute confusion (Psychotic disorders)

Notes

## Basic introduction

  • Sudden onset of mental symptoms in an otherwise previously normal person

## Possible causes of acute confusion

  • Drug intoxication
  • Hypoglycemia
  • DKA
  • Acute meningitis
  • Encephalitis
  • Malaria
  • HIV
  • Brain abscess
  • Brain tumors
  • Subdural hematomas
  • Cerebrovascular accidents
  • Schizophrenia
  • Depression

Manic episode

Symptoms
  • The patient may be ill-looking
  • Patient who is not appreciating time, environment and even themselves
  • Poor memory
  • Poor concentration and attention
  • May be aggressive and excited
  • Illusion
  • Visual/auditory hallucination or delusion
  • Symptoms getting worse at night
Diagnosis
  • Blood glucose level
  • Blood urea & electrolytes
  • HB
  • Testing for malaria
  • Culture & sensitivity
  • CSF tests
  • X-Ray of the skull
  • Head CT
  • Head MRI
Differential
  • Refer to the causes listed above.
Prevention
  • Not applicable
Reference

a. Brown, H., Stoklosa, J and Freudenreich, O. 2012. How to stabilize an acutely psychotic patient Current Psychiatry.11(12):10-16

b. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

c. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

Management

## Management of acute psychotic patients in the Emergency Department

  • Initial clinical assessment (Triage)
  • Initial psychiatric stabilization (e.g. pharmacologic interventions)
  • Diagnostic testing
  • Further psychiatric evaluation
  • Determining safe disposition

## Treatment of underlying cause

## Treatment of psychosis

  • IM chlorpromazine 100 - 200mg STAT then BD IM or Orally OR
  • IM/Oral haloperidol 5-10mg BD
  • Follow up the patient for 6 months
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