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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, Alzheimers 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
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

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