Psychosis

Rationale

Psychosis is a severe and disabling psychiatric condition present in multiple disorders. It can be associated with severe psychosocial dysfunction and can be life threatening.

Causal Conditions

(list not exhaustive)

1. Psychotic disorders (e.g., schizophrenia, schizoaffective disorder)
2. Psychotic disorder due to another medical condition (e.g., epilepsy, central nervous system tumours)
3. Substance/medication-induced psychotic disorder (e.g., corticosteroids, cocaine)

Key Objectives

Given a patient with psychosis, the candidate will diagnose the cause, severity, and complications, and initiate an appropriate management plan. In acute psychosis, particular attention should be paid to distinguishing primary psychotic disorders from other causes of psychosis, including delirium, psychotic disorder due to another medical condition, and substance/medication-induced psychotic disorder.

Enabling Objectives

Given a patient with psychosis, the candidate will

1. list and interpret critical clinical findings, including those derived from
   1. a mental status examination, with attention to risk factors for harm to self or others and assessment of capacity,
   2. a collateral history, if available, and
   3. a physical examination (when safe to do so), with particular attention to findings suggesting an underlying or coexisting medical condition or substance use;
2. list critical investigations and interpret the results of the investigations, including
   1. appropriate laboratory investigations and other tests (e.g., neuroimaging);
3. construct an effective management plan, including
   1. determining the voluntary or involuntary status of the patient to ensure their safety and the safety of others,
   2. ensuring ongoing assessment of capacity and the need for a substitute decision-maker,
   3. initiating pharmacotherapy (acute and maintenance),
   4. attending to the patient’s psychosocial needs (e.g., community and family resources, housing),
   5. treating underlying disorders or comorbidities,
   6. counselling and supporting the patient and their caregiver and/or family about psychosis, and
   7. referring the patient for specialized care if necessary.