Psychosis

1
Psychosis

• Involves break with reality
• positive symptoms delusions, hallucinations,
  thought disorder (disorganization)
• negative symptoms speech disturbances, hygiene
  neglect, flat affect, avolition, anhedonia,
  impaired social skills

2
Causes of psychosis

• Mental illness (e.g. schizophrenia)
• Drug use (e.g. LSD, PCP)
• High fever
• Anoxia
• Vitamin deficiencies (B vitamins)
• Neurological impairment (syphilis, Alzheimers
  etc.)
• Dehydration
• lt1 lifetime prevalence

3
Delusions

• Non-bizarre vs. bizarre
• Common types Persecutory, Grandiose, Erotomanic,
  Formication
• Can lead to self-harm
• Autocastration
• Minority of serial murderers are delusional
• e.g. Danny Rolling

4
Hallucinations

• Perceptual experiences out of contact with
  reality
• Common types
• Auditory
• Visual
• Somatic
• Olfactory

5
Brief Reactive Psychosis

• Nervous Breakdown
• Clear (often acute) stressor
• Sudden onset of dramatic symptoms
• More likely to include visual hallucinations
• Labile mood
• Quick reduction in symptoms after stressor
  relieved (less than 1 month)
• Battlefield fatigue

6
Schizophreniform Disorder

• Repeated fluctuations of psychotic symptoms (up
  to 6 months) broken by significant periods of
  normalcy
• Psychotic breaks often accompany stress

7
Delusional Disorder

• Positive symptoms only
• Communication skills intact
• 1 or more non-bizarre delusions
• Hallucinations rare, if present always match
  delusions
• Subtypes Erotomanic, Grandiose, Jealous,
  Persecutory, Somatic
• Onset middle to late adulthood
• Prevalence lt 0.1 of population

8
Erotomanic Delusional disorder

• Focus on high status person
• Focus on romance rather than sex
• Believe relationship is ongoing
• Make efforts to contact
• More common among women, although males
  increased violence risk
• Sarah McLaughlin

9
Schizophrenia

• Dementia Praecox described by Emil Kraeplin
• Onset late teens, early 20s
• Believed due to organic decomposition in brain
• Believed it to be incurable
• But small percentage (16 of 127) of his patients
  recovered

10
Prodromal Period

• Persons behavior normal prior to onset of
  prodromal period
• Period of slipping
• Onset of negative symptoms
• Hygiene problems
• Social skills decline
• Confusion begins to set in
• Usually 6 month period prior to onset of full
  schizophrenia

11
Types of Schizophrenia

• Paranoid
• Disorganized
• Catatonic
• Undifferentiated (NOS)
• Residual
• Positive symptoms removed, persistent negative
  symptoms, typical for treatment
• Symptoms persist at least 6 months

12
Schizoaffective Disorder

• Person meets criteria for both psychosis and mood
  disorder
• Must have at least 2 week period of psychotic
  symptoms w/o mood symptoms. Why?
• Difficult to distinguish both from schizophrenia
  and Major depression with psychotic features

13
Prognosis

• Generally poor.
• Factors age of 1st onset, subtype, social
  support, female gender
• Suicide common (10)
• Medications generally fail to treat negative
  symptoms
• Can be stabilized with meds
• If untreated can worsen to catatonia

14
Etiology

• Generally unknown
• Large heritability index
• Associated with neurological decline
• Enlarged ventricles
• Decreased neural density in frontal lobe
• Dopaminergic systems

15
Antipsychotics

• Common typical antipsychotics Thorazine,
  Haldol, Stelazine, Prolixin, Mellaril, (drugs
  that end in zine)
• Remove positive symptoms
• Sedating effect
• Many side effects dry mouth, vision problems,
  gastrointestinal problems, depression,
  concentration problems, drooling, muscle cramps
• Extrapyramidal effects involuntary movements or
  tremors of head, neck, throat and hands
• Tardive dyskinesia

16
Atypical Antipsychotics

• As effective, on average, as typicals
• Fewer extrapyramidal and tardive dyskinesia side
  effects
• Common Seroquel, Risperdal, Zyprexa, Geodon,
  Abilify
• Anticonvulsants also given at times

17
anticholinergic medications

• given to treat the extrapyramidal effects of the
  antipsychotics
• Cogentin, Artane
• Benadryl (an antihistamine) also effective in
  reducing EPS