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 esteemReduced sleep Increased talk / pressured speechRacing thoughts / flight of ideasDistractibilityExtreme goal directed activityExcessive 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