Assessing Psychotic Episodes

 

 

 

 

 

 

 

 

  • new
    assessments
  • making a
    diagnosis
  • ongoing
    followup

New Assessments

 

A full history should be carried out, with particular attention paid to:

A full mental status exam should also be completed, including evaluation of capacity to consent.

 

Collateral history is extremely valuable, and seek it from many sources. Interview with family members if possible and consent is given.

 

Signs and Symptoms of first-episode psychosis include:

  • withdrawal from usual activities with friends and family
  • persistent decline in functioning in everyday activities, at school or at work
  • persistent dysphoria, anxiety, or irritability, especially in the absence of stressors
  • rapid fluctuations in mood (emotional lability) or with little emotion or affect
  • unreasonable suspiciousness
  • insomnia or restless pacing at night
  • unusual or bizarre behaviour
  • unusual perceptions: hypersensitivity, illusions, or hallucinations
  • difficulties thinking or expressing thoughts
  • problems with attention and concentration

Substance use, especially marijuana, is very common in people with psychosis. It is important to avoid diagnosing substance-induced psychosis when a primary condition is present. Look for:

  • symptoms preceding subtance use or persisting after use and withdrawal
  • bizarre symptoms or marked thought disorder

There is evidence that marijuana can trigger psychotic disorders - see under schizophrenia - causes and risk factors.

Making a Diagnosis

 

Diagnoses are made based on comprehensive assessment

  • phase of disorder
  • review medical history
  • get collateral information from family if consent is given
  • assess substance use
  • mental status examination

 

Querying medical conditions

A physical and neurological exam should be carried out

lab work includes

A head CT is usually done, primarily for patients and families to know you've ruled everything else out.

Ongoing Followup

 

Followup assessments should be set up weekly at first and then tapered according to patient progress.

 

 

History

continue to assess positive symptoms, negative symptoms, mood disturbances, cognitive effects. A mental status exam should be carried out during each meeting.

Follow up with substance use.

 

 

Clinical Ratings Scales

Clinical rating scales can be used to monitor symptoms and recovery. These include:

Clinical global impression scale for severity (CGI-S) and CHange (CGI-C) and global assessment of functioning (GAF)

 

 

Physical examination

Evaluate extrapyramidal signs and symptoms.

assess weight, BMI, waist circumference, and blood pressure regularly

 

Laboratory Investigations

follow especially fasting glucose and lipid levels