Sudden onset of mental symptoms in an otherwise previously normal person.

Aetiology

• Organic causes:

- cerebrovascular accidents (CVA), brain tumours, subdural haematomas, brain abscess

• Infections

- acute meningitis, encephalitis, malaria, HIV

• Metabolic/toxic causes:

- metabolic derangements e.g DKA, hypogylcaemia

- drug intoxication

• Psychiatric causes: Schizophrenia, depression and manic episode.

Clinical Features

Good history, physical examination are essential. The patient may be: ill looking, not appreciating surroundings, not alert. Not aware of time, place or who they are. Unable to remember and forgets easily. Poor attention and concentration. Visual/auditory hallucinations. Delusions (grandiose or paranoid). Aggressive and excited. Illusions (e.g. a stick is mistaken for a snake); in general, symptoms get worse at night.

Investigations

• HB, WBC, Blood slide for MPS, C&S, sugar, urea and electrolytes

• CSF examination (after fundoscopy)

• X-rays - skull.

Management - General

• Identify and manage physical (underlying) causes.

Management - Pharmacologic

• Chlorpromazine 50-100 mg TDS OR haloperidol 5-10 mg TDS.

Refer If

• No physical cause found (to a psychiatrist for treatment of schizophrenia, mania or depression).