PSYCHOBEHAVIORAL DISORDERS■ Benzodiazepines and barbiturates are most often coingested with other
agents. Consider giving dextrose, narcan, thiamine, and performing gastric
lavage and/or activated charcoal.
■ Flumazenil is a selective benzodiazepine antagonist that can cause gener-
alized seizures in patients with chronic benzodiazepine dependence. It
can also increase intracranial pressure (ICP).
MOOD AND THOUGHT DISORDERSAcute Psychosis
SYMPTOMS/EXAM
Delusions, prominent hallucinations, disorganized speech, disorganized or
catatonic behavior. A brief psychotic disorderis defined as psychotic symp-
toms lasting >1 day but <1 month. Schizophreniform disorder is defined as
psychotic symptoms lasting 1–6 months (see Figure 16.1).
DIFFERENTIAL
Delirium, substance use/intoxication, schizophrenia, psychotic disorder
secondary to a medical condition (hypoxia, hypoglycemia, hepatic or renal
disease, metabolic abnormalities, endocrine disorder, neurologic condition
such as CVA, multiple sclerosis, infection), mood disorder with psychotic
features
FIGURE 16.1. Decision tree for evaluating psychosis.
(Reproduced, with permission, from Tintinalli JE, Kelen, GD, Stapczynski SJ. Emergency Medicine: A Comprehensive Study
Guide,6th ed.New York: McGraw-Hill, 2004:1809.)
Marked disorientation, confusion,
fluctuating consciousnessDue to direct physiologic effect of
medical condition or substanceOccuring exclusively during an
episode of depression or maniaPsychosis limited to nonbizarre
delusionsDuration <1 month; full recoveryPsychotic Behavior
(hallucinations, delusions, disorganized
speech, or disorganized behavior)Deliriumor
DementiaPsychotic Disorder Due to General
Medical Disorder or
Substance-Induced Psychotic
DisorderMajor Depressive or Manic
Episode with Psychotic FeaturesDelusional DisorderBrief Psychotic DisorderSchizophrenia or
Schizophreniform Disorder
(Duration <6 months)Flumazenil is contraindicated
in the unknown overdose
patient and in patients with
increased ICP.