case presentation on acute pyschosis

1. Case Presentation On Acute
Pyschosis
By: Aarishta Shetty
4th Year Pharm D
Enrollment no. 201903102510031
1

2. • Name : Mathamal
• Age : 80
• Gender : Female
• Ward : General Medicine
• DOA : 30/01/23
Patient Demographic Details
2

3. Patient Complain
• H/O irrelevant talk for three days
• H/O decrease sleep
• H/O hearing some voices ( 3 days )
• H/O talking self
• H/O cough
• H/O breathing di
ffi
culty

4. Medical and Medication History
• K/c/o DM : SHT x 1year on Rx
Social History
• Mixed Diet
• Normal Bowel and Bladder habit
• N sleep (before 3 days)
4

5. Subjective Evidence General Examination
• Irrelevant talk for 3 days
• Decreased Sleep
• Hearing some voices
• Talking Self
5
• Patient Conscious
• Responding to oral commands
• Talk Relevant
• Taught Normal
• Perception Normal
Systemic Examination
• CVS - S1 S2 + • RS - BAE + • P/A - Soft • CNS - NFND

6. 1 2 3 4 5
Temp 98.5 98.5 98.6 98.4 98
BP 162/76mm Hg 116/72mm Hg 108/90mm Hg 110/70mm Hg 120/80mm Hg
PR 106/min 80/min 86/min 80/min 76/min
Vital - Signs
6

7. Parameters Range NR
PLT 444 x 10 /L 100-300x10 /L ↑
Hb 11.7g/dl 12-16/dl ↓
PCT 0.38% 0.108-0.282% ↑
MCHC 30.7g/dl 32-36g/dl ↓
FBS 206ng/dl 70-100ng/dl ↑
RBS 132ng/dl 80-120ng/dl ↑
PPBS 167ng/dl <140ng/dl ↑
Burea 35ng/dl 10-50ng/dl
Sr.Creatinine 1.2ng/dl 0.7-1.4ng/dl
q q
Laboratory Investigation
7

8. DIAGNOSIS
On the basis of subjective and objective evidence patient is suffering from Acute psychosis, DM, SHTN.
Goals of Treatment
• Reduce the severity of Psychosis and associated Symptoms
• Determine and address the factors that led to acute psychosis
• Control in Diet
• Decrease Sugar intake
• To prevent Acute Psychosis Complications and SHTN complication
• To improve Patient quality of life
8

9. Non Pharma Cological Treatment
• Engage in regular Excercise.
• Adopt a healthy eating habits (Make sure diet includes plenty of Adopt DASH
diet, fruits, vegetables and whole grains).
• Counselling about Risk factor.
• Taking patient proper care by talking to them clearly, talking them to
pyschologist.
• Talk clearly and use short sentences in a calm and non threatening voice.
9

10. Medication Chart
Sr no. DRUG NAME DOSE RTE FRQ DAYS
1 IVF< 1 2 3 4 5 6 7 8 9 10
2 Inj.Midazolam 2cc IV SOS
3 T.Amlodipine 2.5mg Po 1-0-0
4 Inj.VitaminB1, B12 20mg IV OO
5 T.Folic acid Po 1-0-0
6 T.Resperidone 2mg Po 0-0-1/2
7 T.Clonazapam 0.5mg Po 0-0-2
8 T.Metformin 500mg PO 1-0-0
9 Inj.Lorzepam 2cc IM SOS
10 T.Chlorpromazine 25mg PO 0-0-1
11 T.Donepezil 5mg PO 0-0-1
12 T.Aspirin 150mg PO 0-1/2-0
13 T.Clopidogrel 75mg PO 0-1-0
14 T.Atorvastatin 10mg PO 0-0-1
10
✓ ✓ ✓ ✓ ✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
NS
RL

11. 11
• ADOPT DASH DIET
• START diuretics
PHARMACIST INTERVENTION

12. Monitoring parameters
• Acute Psychosis : Quick searching questions for psychotic symptoms include.
• SHTN : Blood Pressure Renal function Test.
• DM : Fasting blood glucose postprandial blood glucose haemoglobin AIC.
Drug Related
• Netformin : Tasting blood glucose post prandial blood glucose heamoglobin AIC.
• Amolodipine : Blood Pressure blood test level K+
• IVF Normal saline Ringerlactate : Elecholytes
• Inj Midazolam : Respiratory test Blood Pressure Sedation
12

13. • Inj Vitamin B1, B12 : HeartRate Elecholyte level
• T.Clopidogrel : CBC LFT
• T.Aspirin : CBB LFT aaTT PT/ZNR
• T.Clonazepam : CBC LFT RFT
• T.donepezil : CBC SerumConCentration
• T.Resperidone : Serum Proloctin level hepatic function metabolic function
13

14. COUNSELLING POINTS
• HTN : A Condition in which the force of the blood against the artery walls is too
high
• DM :A group of diseases that result in too much sugar in the blood.
• Acute psychosis :It refers to an abnormal condition of the mind described as
involving a “loss of contact with the reality’’
(A) Diseaze Related
14

15. B) Drug Related
• Atorvastain : you can take atorvastatin with or without food ,but taking it after food
may help it makes you feel sick.
• Amlodipine : ADR - Fatigue, headache ,slow heart rate, feeling dizzy
• Clopidogrel : It is used for anti platelet drug .ADR : STOMACH UPSET diarrhoea
abdominal pain
• Aspirin : It used for anti platelet drug. ADR : stomach pain discomfort convulsions
• Metformin : take with meal to reduce stomach upset
• DONEPEZIL : admistered in the evening just before retiring
• ADR: nausea insomnia muscle cramp
• MIDAZOLAM : calming effect on the brain and nerves (CNS).
15

16. • ADR : CONFUSION amnesia drowsiness
• LORAZEPAM : relief of anxiety symptoms associated insomnia . ADR : blurred vision
change in appetite .
16

17. • LIFESTYLE MODIFICATION
• Exercise daily
• Brisk walking
• Adopt DASH diet
• Eat healthy diet ( whole grain fruits
vegetables )
• Reduce salt intake in your diet
• Avoid tight clothes
• Stay hydrated
• Try to talk to the family members and
psychiatrist
• Adopt ketogenic diet (low in carbohydrate
moderate in protein and high in fat.
• Reduce stress
• Take fresh air
• Explore and socialise
• Meditate daily
17

18. Thank you