Diagnosis

• n/a

Investigation

• Physical Examination: BP; HR; Weight
• FBC
• U+E baseline before Lithium therapy
• TFTs Thyroid particularly a/w mood
• Alcohol dependency
• Toxicology screen
• ECG Baseline before Haloperidol Long QT
  • Note: Antipsychotics affect metabolism hence check wt, lipids, glucose
  • Note: Smoking cessation impact on antipsychotic metabolism

Management

Psychosis:

• Acute :Self-harm and suicide risk
• Risk to others: tranquilization (Lorazopam, Haloperidol incl Anti-Cholinergics)
• Conservative:
  • MDT approach assess bio-psych-social
• Medical:
  • Oral antipsychotic + psych intervention
• Antipsychotics:
  • 1st generation – non specific DA antagonist, led to S/E Pyramidal symptoms, akinesthesia prolactinaemia e.g. Acuphase also Haolperidol. S/E prolonging the QT interval
  • 2nd gen; S/E less pyramidal effects but metabolic syndrome e.g. Olanzapine. Neuroleptic malignant syndrome, autonomics
• Must weight up side effects:
  • Metabolic (including weight gain and diabetes)
  • Extrapyramidal (including dyskinesia and dystonia)
  • Cardiovascular (including prolong QT)
  • Hormonal (including increasing plasma prolactin)
• Psychological Intervention
• Family intervention & CBT

Affective (Bi-Polar) Disorder

• Don’t treat depression, may elevate to mania
• Conservative
  • Calming environments & reduced stimulation
• Medical - only treated in secondary care
  • Olanzapine
  • Sodium valproate: mood stabilizer, evidence
  • Lithium: mood stabilizer

NICE Source: CG178 Psychosis and schizophrenia in adults: prevention and management and CG185 Bipolar disorder: assessment and management. Summary compiled by Dr D P Sheppard MBBS.