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DELIRIUMS AND HALLUCINATIONS (ACUTE PSYCHOSIS)

This is a clinical condition that can be produced by many disorders, such as mania, schizophrenia and alcohol or drug abuse.

In psychosis, the patient loses his sense of reality, appears agitated, has spasms, uncontrolled movements, hallucinations (perceives something through his senses that does not exist), illusions, (false interpretations of real images) and deliriums (incoherent ideas contrary to reality and common sense). They are difficult to deal with, as they are excitable and unable to reason. Acute psychosis is a heightened psychiatric disorder that requires hospital treatment.

The symptoms and signs of this illness appear over a short space of time, ranging from a few days to two weeks, demonstrating:

• Thought disorders (from a poor and slow thought process to an accelerated one with rapid changes from one topic of conversation to another) and deliriums (believe they are someone else, that they are being pursued, that there partner is unfaithful, etc.).



• Abnormal ideas that do not correspond to reality. The subject hallucinates, sees things and hears voices that send out messages or speak to them. They believe that everything that takes place around them, normal day-to-day occurrences, have special significance for them. So, for example, they are convinced that television and radio programmes and peoples' conversations are directed at them, they may also speak to aliens or suffer celestial apparitions in which they receive commands.



• Other symptoms : insomnia, agitation, unbalanced emotions, heightened activity ("can't stop moving"), the subject feels the need to keep moving.

Norms of action when dealing with acute psychosis sufferers

Psychosis is a MEDICAL EMERGENCY. The patient suffers thought and judgement alternations that, combined with agitation, can lead to violent acts. In these cases immediate MEDICAL ADVICE VIA RADIO should be sought, which will indicate the treatment that should be applied. In addition to this, it would be advisable to put other measures into practice:

• Guarantee the safety of the patient and the rest of the crew (see SUICIDAL PERSONALITY and VIOLENT PATIENTS in this chapter).
• Even if the subject is not violent, it is advisable to confine them in a cabin without excessive noise or lighting and removing dangerous objects, such as cigarette lighters, belts, sharp objects, blunt instruments and even unnecessary furniture, from their reach.
• Someone in which the subject confides and whose presence is calming should remain with them and explain the necessity for them being there as long as their agitation lasts.
• It is important to respect the dignity of the patient at all times. We should bear in mind that between their deliriums and hallucinations, they have lucid moments in which they are conscious of their situation and a disparaging or condescending attitude could make them violent. It is therefore necessary to explain the measures that have been adopted by telling them: "THE SYMPTOMS OF YOUR ILLNESS ARE UNPREDICTABLE, WE WILL GIVE YOU THESE OBJECTS BACK AS SOON AS POSSIBLE AND, IN THE MEAN TIME, WE ARE GOING TO GET A DOCTOR TO LOOK AFTER YOU".
• Clear and simple limits should be put in place. Avoid long conversations(they could lapse back into a delirium and hallucination). Explain everything you are going to do as clearly and simply as is possible and offering the possibility that they themselves can speak to the doctor or can be present at the radio consultation.
• If the patient becomes excited and agitated, or becomes dangerous, physical restraint should be applied (see VIOLENT PATIENTS, norms of action).