Psychosis (PowerPoint) by mikesanye

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									                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
         Causes of psychosis
• Mental illness (e.g. schizophrenia)
• Drug use (e.g. LSD, PCP)
• High fever
• Anoxia
• Vitamin deficiencies (B vitamins)
• Neurological impairment (syphilis, Alzheimer’s
  etc.)
• Dehydration
• <1% lifetime prevalence
                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
                Hallucinations
• Perceptual experiences out of contact with
  reality
• Common types:
  – Auditory
  – Visual
  – Somatic
  – Olfactory
     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”
   Schizophreniform Disorder
• Repeated fluctuations of psychotic
  symptoms (up to 6 months) broken by
  significant periods of “normalcy”
• Psychotic breaks often accompany stress
          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 < 0.1% of population
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
              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
          Prodromal Period
• Person’s 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
        Types of Schizophrenia
•   Paranoid
•   Disorganized
•   Catatonic
•   Undifferentiated (NOS)
•   Residual
    – Positive symptoms removed, persistent
      negative symptoms, typical for treatment
• Symptoms persist at least 6 months
     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
                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
                  Etiology
• Generally unknown
• Large heritability index
• Associated with neurological decline
  – Enlarged ventricles
  – Decreased neural density in frontal lobe
• Dopaminergic systems
                 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
      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
   anticholinergic medications
• given to treat the extrapyramidal effects of
  the antipsychotics
• Cogentin, Artane
• Benadryl (an antihistamine) also effective
  in reducing EPS

								
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