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