Acute Psychosis in a Young Man from Sub-Saharan Africa.
K.A, a 28-year-old university student, was brought to the emergency department by his family due to sudden-onset agitation, hallucinations, and paranoia over the past week. K.A has been experiencing intense fear that people are plotting against him and has reported hearing voices accusing him of wrongdoing. His behaviour has become increasingly erratic; he has stopped attending classes, withdrawn from family and friends, and has exhibited aggressive outbursts.
- A’s family mentioned that he had been under significant stress recently due to academic pressures and personal issues but had no previous history of mental illness. He had been using traditional herbal remedies for stress relief but otherwise had no substance abuse history or recent changes in medication.
- No significant psychiatric or medical history.
- No history of substance abuse or major illnesses.
Family History:
- No family history of mental illness or psychotic disorders.
Social History:
- Living Conditions: Lives alone in a shared apartment near the university. The family resides in a nearby town.
- Education: Currently enrolled in a university program.
- Substance Use: No known substance abuse; occasional use of herbal remedies
- General Appearance: K.A is dishevelled and appears agitated. He is sweating profusely and speaks rapidly.
- Vital Signs: Temperature: 37.2°C, Heart Rate: 92 bpm, Respiratory Rate: 20 breaths/min, Blood Pressure: 130/85 mmHg.
- Neurological Examination: Alert but disoriented; exhibits paranoia and auditory hallucinations. No focal neurological deficits.
- Mental Status Examination:
- Mood: Anxious and paranoid.
- Thought Process: Disorganized; responses are tangential and delusional.
- Thought Content: Reports hallucinations and paranoid delusions.
- Insight: Poor; believes that the voices and conspiracies are real.
- Complete Blood Count (CBC): Normal
- Basic Metabolic Panel: Normal
- Thyroid Function Tests: Normal
- Urinalysis: No evidence of substance abuse.
- Head CT scan: Normal
- Acute Psychotic Episode: Likely due to the sudden onset of symptoms and lack of prior psychiatric history.
- Substance-Induced Psychosis: Less likely given negative urinalysis for drugs.
- Brief Psychotic Disorder: Considered but less probable given the recent stressors and acute presentation.
- Schizophrenia: Could be a consideration but less likely due to the acute onset and lack of previous symptoms.
- Pharmacological Management: Initiate treatment with antipsychotic medication (e.g., risperidone) to manage acute symptoms.
- Psychiatric Evaluation: Arrange for a comprehensive psychiatric assessment to confirm diagnosis and rule out other conditions.
- Supportive Care: Provide a calm and safe environment, ensure close monitoring, and support K.A through his acute episode.
- Family Education: Educate the family about psychosis, treatment options, and the importance of adherence to the treatment plan.
- Follow-Up: Schedule regular follow-up appointments to monitor progress, adjust treatment as needed, and address any ongoing issues.
K.A was diagnosed with an acute psychotic episode, likely triggered by significant stress. He responded well to antipsychotic treatment and supportive care, with gradual improvement in symptoms. The family was educated about managing the condition, and K.A was scheduled for ongoing psychiatric follow-up to address any underlying issues and prevent recurrence.
A). Schizophrenia
B). Acute Psychotic Episode
C). bipolar disorder
D). Major Depressive Disorder
A). Antidepressants
B). Antipsychotics
C). Anxiolytics
D). Stimulants
A). Urinalysis
B). Electrocardiogram (ECG)
C). Liver Function Tests
D). MRI of the Brain
A). Immediate hospitalization and antipsychotic medication
B). Immediate discharge with follow-up instructions
C). Long-term psychotherapy without medication
D). Increase dosage of herbal remedies
