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Psychosis

Version: February 2017
Legacy ID: 86

Rationale

Psychosis is a severe and disabling psychiatric symptom present in several disorders, the most common of which is schizophrenia. 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 a medical condition (e.g., seizure disorder, central nervous system tumors)
  3. Substance induced psychotic disorder (e.g., corticosteroids, cocaine)

Key Objectives

Given a patient with psychosis, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. In acute psychosis, particular attention should be paid to differentiating a primary psychotic disorder from delirium and from psychosis secondary to a medical condition or substance induced psychosis.

Enabling Objectives

Given a patient with psychosis, the candidate will

  1. list and interpret critical clinical findings, including
    1. mental status examination, with attention to risk factors for harm to self or others and assessment of capacity;
    2. collateral history (if available);
    3. physical examination (when safe to do so), with particular attention to findings suggesting an underlying or coexisting medical condition or substance use;
  2. list and interpret critical investigations, including
    1. appropriate laboratory investigations and other tests (e.g., neuroimaging);
  3. construct an effective management plan, including
    1. ensuring safety of patient and others (e.g., certification);
    2. ensuring ongoing assessment of capacity and the need for a substitute decision-maker;
    3. pharmacotherapy (both 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 patient/caregiver/family about psychosis;
    7. referring the patient for specialized care, if necessary.