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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 <1% lifetime prevalence
Delusions
Non-bizarre vs. bizarre Common types: Persecutory, Grandiose, Erotomanic, Formication Can lead to self-harm
Autocastration
Hallucinations
Perceptual experiences out of contact with reality Common types:
Auditory Visual Somatic Olfactory
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
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
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
Types of Schizophrenia
Paranoid Disorganized Catatonic Undifferentiated (NOS) Residual
Positive symptoms removed, persistent negative symptoms, typical for treatment
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