Essential Information for Patient and Family

• Agitation and strange behaviour are symptoms of a mental illness.
• Acute symptoms preceded by stressor usually resolve, but may recur.
• Acute episodes often have a good prognosis, but long-term course of the illness is difficult to predict from an acute episode.
• Continued treatment may be needed after symptoms resolve

  Advise family about legal issues related to mental health treatment.

Specific Counselling to Patient and Family

• Assess and secure the safety of the patient and those caring for him or her.
  • family or friends should stay with the patient
  • ensure that the patient's basic needs (e.g., food and drink) are met
• Minimize stress and stimulation
  • Do not argue with psychotic thinking. (You may disagree with the patients beliefs, but you should not try to convince him or her)
  • Avoid confrontation or criticism, unless it is necessary to prevent harmful or disruptive behaviour.
• Agitation which is dangerous to the patient, the family or the community requires hospitalization or close observation in a secure place. If patients refuse treatment, legal measures may be needed.
• Encourage resumption of normal activities after symptoms improve.
  
  

Medication

• Antipsychotic medication will reduce agitation, hallucinations, and delusions. (e.g. risperidone 1-6mg per day titrated slowly)
• Dose should be the lowest possible which relieves symptoms, but some patients will require higher doses.
• Anti-anxiety medication may also by used in conjunction with neuroleptics to control acute agitation. (e.g. diazepam 5-10mg mg up to four times per day)
• Continue antipsychotic medication for at least three months after symptoms resolve.
  
  
• Monitor for side effects of medication:
  • Acute dystonias or spasms may be managed with injectable benzodiazepanes or anitparkinsonian drugs.
  • akathisia (severe motor restlessness) may be managed with dose reduction or beta-blockers.
  • Anti-parkinsonian medication (e.g. benztropine 0.5 to 2 mg up to three times per day) will relieve acute dystonic reactions(muscle spasms) and marked extra-pyramidal symptoms (stiffness, tremors). Routine use is not necessary.
  • Parkinson symptoms (tremor, akinesia) may be managed with oral antiparkinsonian drugs.

Specialist Consultation

• Arrange a specialist consultation in all new cases of psychotic disorder.

  In case of severe motor side effects or the appearance of fever, rigidity, hypertension; stop antipsychotic medication and get a second opinion.

What a doctor might say to a person with an acute psychotic disorder