Acute psychosis

What is it about ?

Acute psychosis is a mental state in which a person completely or partially loses normal contact with reality. The symptoms can be diverse and varied. The adjective “acute” means that the symptoms appear suddenly. The main ones psychotic symptoms can occur separately or at the same time.

Delusions

The delusions are stubborn thoughts or ideas, about yourself or those around you, which do not correspond to reality. The person with psychosis does not question these delusions; she is not able to tell the difference between what is real and what is not. There are different types of delusions, such as:

• The delusion of persecution, when the person thinks he is being followed constantly or being the object of a conspiracy;
• Delirium of grandeur (or delusional megalomania), when the person thinks they are an important religious figure (Christ, for example) or a famous person (Napoleon, for example).

Hallucinations

The person with psychosis can also perceive (hear, see, smell, feel, …) things that do not exist. This is what we call hallucinations. The most common hallucinations are auditory (the person hears voices) and visual (the person sees imaginary people).

Confusion

A third characteristic symptom of psychosis is the confusion : the person is not able to hold a coherent speech or suddenly forgets what he was doing.

Causes of acute psychosis

• Acute psychosis can be a condition in its own right or part of a larger, complex psychiatric problem.
• It can also be the consequence of physical illness, taking certain medicines or having withdrawal symptoms (for example after excessive use of medicines, drugs or alcohol).
• Likewise, a severe lack of sleep can trigger or worsen psychotic symptoms, as theinsomnia often leads to (over) stimulation of the senses and false perceptions.

Acute psychosis can frighten close relatives and friends of the person in question. All the more so when it comes to a first psychotic period.

How to recognize it?

In addition to delusions, hallucinations and confusion, acute psychosis still presents some characteristic manifestations :

• Incomprehensible or confused speech;
• Free associations: discourse is a succession of dissociated ideas, it is difficult to follow the course of history and the relationship between the ideas is not obvious to the interlocutor;
• Lack of reference to emotions, but only to concrete events or things;
• Adoption of a rigid posture, the person remains perfectly still (catatonia);
• Sideways gaze, with the person avoiding all eye contact;
• State of vigilance;
• Mistrust of others;
• Formulation of short, unclear responses, or even no response (‘I don’t know’).

How is the diagnosis made?

Reviews and discussion

The symptoms of delusions, hallucinations and / or confusion, associated with the story of the person and his entourage, provide a first idea of ​​diagnosis. The doctor will start by performing a physical examination and to a blood test complete in order to exclude a condition that is not a matter of psychiatry, such as:

• A neurological condition;
• The drug use ;
• THE’drug abuse subject to prescription;
• An intoxication ;
• An infection.

Then the doctor should identify psychotic symptoms.

• Does the person have sensory perceptions or ideas that do not correspond to reality?
• Does she see, hear or smell things that are not there?
• Does she imagine herself to be someone else?
• Is she afraid of something?

The doctor will also assess his state of mind : is she anxious and or depressed ? To do this, he can optionally use one or the other questionnaire.

Cause and duration of psychosis

Important information for the doctor is the duration of the psychotic episode and any triggering factors, such as severe lack of sleep, drug, alcohol or drug abuse, or very stressful events.

• Short-term psychotic disorders (less than a month) are usually the result of serious and stressful events. Psychoses triggered by taking substances (for example cannabis) or by abrupt abstinence fromalcohol or narcotics do not last more than a week, usually stopping just a few days after weaning.
• If psychotic symptoms are still present more than a week after withdrawal, it is a question of a primary psychotic disorder.

What can you do about an episode of acute psychosis?

When it comes to the first episode, those around you often notice that something is wrong. It is very important to ensure a calm and reassuring environment. The psychotic person can be very suspicious and often sees their perceptions and those around them as a threat.

• Keep a sufficient distance and avoid sudden and unpredictable movements.
• Maybe ask her a few questions or try to start a dialogue about how she feels, but don’t get into the debate.
• Explain to him that a lack of sleep can lead to over-stimulation of the senses, and therefore to unusual perceptions.
• If the situation does not return to normal, stop the conversation and contact your GP. If necessary, he will call on a crisis team coordinated by a psychiatrist.

What can you do ?

People with acute psychosis are often prescribed medications by the doctor or psychiatrist.

• Always take these medicines according to all instructions.
• Never change the dose.
• Never stop them on your own initiative.
• If you develop any side effects, contact your doctor.

What can your doctor do?

The main goal of treatment for psychosis is to alleviate psychological suffering and anxiety and to improve sleep. This is why the doctor may prefer not to start the antipsychotics right away.

Calming and sleeping pills (benzodiazepines)

Restlessness and anxiety can first be relieved by benzodiazepine such as diazepam or lorazepam, under strict supervision. These drugs have a calming effect and can also be used as a sleeping pill. Their disadvantage lies in the fact that they produce a addiction. If, however, the effect of the benzodiazepines is insufficient, a antipsychotic must be implemented immediately.

Antipsychotics

The antipsychotics will often be necessary, especially if the person is very agitated. Atypical antipsychotics are the drugs of choice because they have fewer side effects than conventional antipsychotics. Before prescribing these medicines, the doctor will take a blood test to check the cholesterol and other fats and the sugar level (blood sugar). In parallel, it will also measure weight, height and blood pressure. Antipsychotics can cause weight gain and affect the level of sugar (blood sugar) and fat in the blood.

If the person is already taking antipsychotics, the doctor must check whether the worsening of the psychological suffering is due to:

• A lack of medication, for example due to the person no longer taking their medication or taking too low a dose, or:
• A lack of effect, for example because a person who is already taking antipsychotics usually needs a higher dose than a person having a first episode of psychosis.

Medicines that have already had a positive effect in the past remain the first choice of treatment.

Mobile crisis and hospitalization team

In a crisis, your doctor may call for a mobile crisis team as an alternative or as a preamble to a hospitalization. Directed by a psychiatrist, the healthcare team (nurses, psychologists) goes to the person’s home to deal with the crisis and take charge of it. If this care is not sufficient, the person can be admitted to a general or psychiatric hospital.

Want to know more?

• Benzodiazepines – CBIP – Belgian Center for Pharmacotherapeutic Information
• Diazepam – CBIP – Belgian Center for Pharmacotherapeutic Information
• Lorazepam – CBIP – Belgian Center for Pharmacotherapeutic Information
• Atypical antipsychotics – CBIP – Belgian Center for Pharmacotherapeutic Information

Source

www.ebpnet.be