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Psychosis disorder :shaved_ice: (other than Schiz) (:icecream: Brief…
Psychosis disorder
:shaved_ice:
(other than Schiz)
:icecream:
Schizophreniform disorder
Clinical features
:frame_with_picture:same as
Schizophrenia
So if symptoms reach criteria of Schiz but duration of symptoms still
<6 mo.
& during
Dx period still got
the symptoms -> Dx Schizophreniform disorder (provisional)
If symptoms then
persist > 6 months
-> change dx to
Schiz
Duration that have symptoms (ALL phase: prodromal, active & residual)
> 1 month & < 6 months
(
1-6 months
)
Treatment
Treat
Acute
phase just like
Schiz pt
Pt getting better then -> :arrow_down:dose gradually
If :arrow_down:dose then -> symptoms return
🤔🤔 then pt should likely be
Schiz
:icecream:
SchizoAffective disorder
Clinical picture
:frame_with_picture:
Like
Criteria A
of Schizophrenia
happens พร้อมๆกับ
Mood episode
(Major depressive episode or Manic) in which there’s some time “(
2 weeks up
) got only
Schiz symp
without Mood episode
Mood ep
isode
duration
are
loong
— being most of the ds when compared to Total duration of illness
Ddx
:koala:
Medical
conditions or
Drug/Substance
intoxication
Pt may CC: Schiz symp with Mood changes
If it’s
sudden
symptom -> pt got สับสน or got medical conditions
should evaluate scrutinizingly before R/O
Schizophrenia
&
Mood
disorder
Schiz
’s :shaved_ice: has Mood symptoms
not long
when compared to Total time that Schiz symp manifest
and
Mood abnormality
when
Mood symptom is better it
should not
found Delusion or Hallucination
Treatment
:green_book:
Med
May use Med like
Atypical
only — eg Risperidone
May use
Atypical
with
Mood stabilizers
If pt got
cc
: Depressed -> may need
Antidepressants
ร่วมด้วย
:!:Needs to give drugs
continuously
to prevent relapse of ds
:icecream:
Brief Psychotic disorder
Clinical picture
:frame_with_picture:
Normal (baseline)
turning into
obvious Psychotic state
within 2 wks
(sudden onset)
Usu happens
After
experience Highly pressured or Severe event (mayb multiple events)
พูดจาสับสน วกวน (M/C than Hallucination), Hallucination, Delusion (ช่วงเวลาหนึ่ง), Easy to change mood, ท่าทีconfusion
Duration of symptoms persists
≥ 1 day but < 1 month
When symptoms resolve -> Normal status
(symptoms usu got better within 1-2 days)
Other symptoms: weird behavior, กรีดร้องโวยวาย, เงียบเฉยไม่พูด, aggressive behavior, attempt at suicide
Common in Teenager & Early Adult & Refugee or during disaster
Some pt also got Depressed mood, Losing self esteem as a bonus (may persists > 1 mon and will eventually go to normal)
Causes
:white_square_button:
Symptoms usu. related to...
Symptoms related
Sudden &Highly pressured situation until mechanism of mindบกพร่องไป
Risk factors
of getting symptoms
Baseline personality ไม่มั่นคงอยู่แล้ว
Not strong mind mechanism
(กลไกทางจิตไม่เข็มแข็ง)
Personality disorders
like Paranoid, Histrionic, Narcissistic, Schizotypal, Borderline
Ddx
:blue_heart:
Delirium and Substance-related disorders
esp
drug intoxication
fr Alc, Amphetamine
(pressured event only just supporting Factor )
Mood disorder
Mood disorder
usu อาจกำเริบ with Psych symptoms after experience Highly pressured to Mind event
Mood disorder** & persists for long time
Treatment
:green_heart:
:star::!: consider this as
Acute condition that needed Rx
1.
Admit
in ALL cases
for PE & Lab to Ddx Medical conditions (to r/o)
for Changing environment
for Closer ดูแล & further Inx
((
except
Pt แรน่ใจว่า symp get better quick & ญาติ can help emselves))
Med
Start
Low dose
antipsychotic drugs
eg. Haloperidol (2 mg) bid or tid
When symp not r getting better in
2-3 days later
->
the Next day should :arrow_up: dose
If pt วุ่นวาย or กระวนกระวายมาก -> Haloperidol (5 mg) IM q 1 hr after อาการสงบ (usu need 2-3 times)
Condition
Pt in hospital when resolved fr Schi
can immediately stop drugs
IPD cases -> :arrow_down: dose gradually
q1-2days
Psychotherapy
Not appropriate adapatation , Unstable sensitive mind
ชี้ให้ ปัญหา behavior change
First Advice to begin with(so pt can know it’s adapation skill)
Advice family situation or Fix in case of Problematic family condition