• Yousef Etlouba, Abdullah Laher, Feroza Motara, Muhammed Moolla, and Nazeema Ariefdien.
• Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Emergency Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
• J Emerg Med. 2018 Jul 1; 55 (1): 78-86.

BackgroundMental health conditions account for 52.8 million (4.9-6.3%) emergency department (ED) visits in the United States. Psychotic conditions are responsible for approximately 10% of all mental health presentations.ObjectiveWe aimed to determine the underlying etiology and characteristics of patients presenting to the ED with a first episode of psychotic symptoms.MethodsMedical records of 159 African, Asian, white, and mixed-race patients were prospectively reviewed. Subjects were classified into one of three groups; psychosis due to an underlying medical condition (UMC), substance-induced psychotic disorders (SIPDs), and psychosis due to other primary psychiatric disorders (OPD). Demographic details and presenting features were described and compared.ResultsOverall mean (standard deviation [SD]) age of all study subjects was 34.3 (13.4) years. A UMC was responsible for a first presentation with psychotic features in more than half of the study subjects (n = 87 [54.7%]), while SIPD (n = 37 [23.3%]) and OPD (n = 35 [22.0%]) were responsible for the remainder of cases. The majority of subjects were male (n = 95 [59.7%]), unemployed (n = 105 [66.0%]), and had not completed secondary school (n = 109 [68.6%]). More than one-third of subjects tested positive for human immunodeficiency virus infection (n = 63 [39.6%]). Mean (SD) duration of psychotic symptoms before ED presentation was 16.6 (26.3) days.ConclusionsUMC is a common etiology in patients presenting to the ED with a first episode of psychotic symptoms.Copyright © 2018 Elsevier Inc. All rights reserved.

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