Psychotic disorders

Psychotic disorders

Psychosis • Psychosis is a disruptive mental state • Individual has difficulty distinguishing external reality from his or her own internal experiences and perceptions

PsychosisPresenting complaints • Hearing voices when no one is around, seeing visions • Strange beliefs or fears • Confusion • Apprehension • Abnormal behaviour

PsychosisPresenting complaints • Fear • Apprehension • Inappropriate smile/laughter • Talking to self • Agitation • Aggressive behavior • Aggression

Causes of psychosis • Alcoholic hallucinosis / Alcohol induced psychosis • Psychosis induced by amphetamines or other substances • Acute psychotic disorder • Schizophrenia • Bipolar disorder, mania • Delusional disorder • Depression with psychotic features • Delirium • Dementia • Head injury

Epidemiology and burden Schizophrenia • The lifetime prevalence rate is 1% • Onset in late teens to early 20s, equally affecting men and women • Devastating disease for both the patient and the family • Affects thoughts and emotions to the point that social and occupational functioning is impaired • About one in a ten with schizophrenia commit suicide

Positive and negative symptoms of Schizophrenia Positive symptoms • Delusions • Hallucinations • Hostility • Disorganised thinking/behaviours Negative symptoms • Alogia • Affective blunting • Anhedonia • Asociality • Avolition • Apathy

Treatment of Schizophrenia • Acute phase treatment with anti-psychotics • Haloperidol, chlorpromazine • Risperidone, Olanzapine • Maintenance treatment with antipsychotics • Depot preparations (Fluphenazine) • Risperidone, Olanzapine, Haloperidol • Family / community support • Rehabilitation

Bipolar disorderManic episode • Persistent elevated, irritable mood ≥ 1 week • Three or four (irritable mood) of the following: • Increased self esteem • Reduced sleep • Increased talk / pressured speech • Racing thoughts / flight of ideas • Distractibility • Extreme goal directed activity • Excessive buying/sex/business investments

Treatment of manic episode • Acute phase treatment with mood stabilisers (Lithium, Divalproate), antipsychotics (Olanzapine) • Maintenance treatment with Mood stabilisers (Lithium, Divalproate, Lamotrigine, Carbamazepine)

Alcoholic hallucinosis • Usually occurs during alcohol withdrawal • Can also occur during prolonged, steady drinking • A hallucinatory or delusional state with clear or relatively clear consciousness • Auditory hallucinations with sexual or derogatory content • Delusions are paranoid • The condition lasts for months rather than days or week

Alcoholic Hallucinosis Alcoholic Hallucinosis Age of onset • 40-50 years Type of onset • Usually acute Duration of illness • 3 months Premorbid personality • A Variety Alcohol dependence • Over many years Paranoid Schizophrenia Age of onset • before 40 Type of onset • Insidious Duration of illness • Chronic Premorbid personality • shy, aloof, withdrawn Alcohol dependence • Not stated

Alcoholic Hallucinosis Alcoholic Hallucinosis Family history of alcoholism • Increased Family history of schizophrenia • No evidence Hallucinations & delusions • auditory but visual and tactile Paranoid Schizophrenia Family history of alcoholism • Not stated Family history of schizophrenia • Increased prevalence Hallucinations & delusions • auditory

Alcoholic Hallucinosis Alcoholic Hallucinosis Thought processes • Coherent Affect • Anxious, depressed, perplexed but appropriate Intellectual function • Fleeting memory disturbance Orientation • At times not oriented to time Paranoid Schizophrenia Thought processes • Incoherent Affect • Inappropriate Intellectual function • Not compromised Orientation • Not compromised

Psychotic disorders