guidelines entitled “Violence and aggression: short term management in mental health, 1health and community settings”. ACUTE PHASE SYMPTOMS — The focus of treatment in schizophrenia changes as individuals enter different phases of the illness. Atypical Neuroleptics and Aggression K. N. Roy Chengappa, MD, of the University of Pittsburgh School of Medicine, reviewed the recent evidence for the effectiveness of the atypical neuroleptics on aggression in psychotic patients.

Chandigarh Acute Psychosis Study: This was a major study of acute onset psychosis cases where acute onset psychosis, defined by specific criteria were studied and the findings at the Chandigarh centre revealed that only 60% cases of acute psychosis fitted the criteria for diagnosis of schizophrenia and MDP as per ICD-9 (version used then) and catego. An acute psychotic episode can be a one-time occurrence, usually of sudden onset, or can occur repeatedly or may be the early phase of chronic psychosis. The greater tolerability of risperidone may make this the treatment in the acute situation.

(See [2009] Psychosis and schizophrenia in adults: treatment and management NICE clinical guideline 178

An acute phase occurs when patients with a prior history of schizophrenia have a psychotic relapse, or during the first episode of psychosis. It can occur following a life event (e.g.

The diagnosis of psychosis in general is far more important for treatment in the short term than diagnostic distinctions between various subcategories of psychosis.

The NICE guidelines focus on prevention, recognition and reducing the risk of violence, but does not deal in detail with Excited Delirium / ABD which is a very specific presentation of violence and aggression carrying significant clinical risk. Because of the short duration of brief psychotic disorder, treatment is brief and focused on being as nonrestrictive as possible. However, it remains clinically imperative to prevent patients from harming themselves or others. treatment despite the sequential use of adequate doses of at least 2 different antipsychotic drugs. loss, acute stress or trauma). The trauma of acute psychosis and possibly hospitalisation may therefore be prevented and long-term outcome improved. In postpartum psychosis, the delusions centre on the mother-child relationship. At least 1 of the drugs should be a non-clozapine second-generation antipsychotic. AUSTRALIAN CLINICAL GUIDELINES FOR EARLY PSYCHOSIS 4 The nature of psychosis 20 Definitions 20 Aetiology 21 Epidemiology 22 Course of illness 23 The clinical staging model 23 Stage 0: the premorbid phase 25 Stages 1a and 1b: the possible prodrome 26 Stage 2: the acute phase, recovery and the ‘critical period’ 31 At this time, the focus is on reducing the severity of psychotic thoughts and behaviors. Accordingly, patients experiencing an acute psychotic attack may have to be hospitalized briefly so that they can be evaluated and their safety ensured.

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