Abstract

Disordered cognition, commonly but inaccurately referred to as "psychosis", is a challenging symptom to evaluate and manage in the critical care or emergency department setting. Although exacerbation of a primary psychiatric disorder may indeed be associated with psychosis, a large number of medical illnesses may present similarly. Often, there is no single test to establish a definitive diagnosis. As history is usually limited in critically ill patients, a wide differential diagnosis may be the most important tool utilized by the clinician. In addition, the presence of multiple comorbidities not only makes a medical cause more likely but also complicates subsequent management. Although the use of antipsychotics may prove successful in addressing symptoms, failure to treat the underlying medical cause may lead to increased morbidity and mortality. Incorporating a wide differential diagnosis, establishing the primary cause, and intervening in a goal-oriented manner are the keys to successful management of critical care psychosis.

Authors and Affiliations