Psychosis, Acute Transient Psychotic Disorder

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1. Unit 3 Psychosis and Schizophrenia related Disorder Nabina Paneru

2. Psychosis Psychosis is the severe type of mental illness in which personality of the person is affected and is characterized by alteration in thought process, emotion, loss of insight, impairment in attention, concentration, memory and orientation.

3. Acute Transient Psychotic Disorder B rief psychotic disorder (DSM – IV) or ATPD (ICD – 10) is a psychotic condition that involves abrupt (less than 48 hrs ) or acute (less than 2 weeks) onset of psychotic symptoms, which lasts 1 day or more but less than one month. The onset if often abrupt and complete recovery within 2-3 months

4. Contd . Often associated with easily identifiable acute stress such as bereavement, unexpected loss of partner or job, marriage, or the psychological trauma of combat, terrorism, and torture. Long-lasting difficulties or problems are not included as stressful.

5. Types Acute polymorphic psychotic disorder without symptoms of schizophrenia Acute polymorphic psychotic disorder with symptoms of schizophrenia Acute schizophrenia like psychotic disorder Other acute predominantly delusional psychotic disorders

6. Acute polymorphic psychotic disorder without symptoms of schizophrenia According to ICD – 10, this disorder is characterized by an acute onset (from a non psychotic state to a clearly psychotic state within 2 weeks) and polymorphic picture (unstable and markedly variable clinical picture that changes from day to day or even hour to hour).

7. Contd. There are several types of hallucinations and/or delusions changing in both type and intensity from day to day or within the same day. Emotional instability is also frequently present. This disorder is particularly likely to have an abrupt onset (within 48 hours) and rapid resolution of symptoms.

8. Acute polymorphic psychotic disorder with symptoms of schizophrenia The disorder that meets the descriptive criteria for acute polymorphic psychotic disorder but in which typically schizophrenic symptoms are constantly present. If the schizophrenic symptoms persist for more than 1 month, the diagnosis should be changed to schizophrenia

9. Acute schizophrenia like psychotic disorder This disorder is characterized by an acute onset of psychotic disorder in which the psychotic symptoms are comparatively stable and fulfill the criteria for schizophrenia but have lasted for less than 1 month. Emotional variability and instability may be present but not to the extent of acute polymorphic psychotic disorder. If symptoms persist >1 months  schizophrenia

10. Other acute predominantly delusional psychotic disorders This disorder is characterized by an acute onset of psychotic disorder in which comparatively stable delusions or hallucinations are the main clinical features, but do not fulfill the criteria for schizophrenia. Delusion of persecution or reference are common, and hallucination are usually auditory. The criteria for acute polymorphic psychotic disorder or schizophrenia should not be fulfilled.

11. Contd. If delusion persists for more than 3 months, the diagnosis should be changed to persistent delusional disorder. If only hallucinations persists for more than 3 months, the diagnosis should then be changed to other non organic psychotic disorder.

12. Epidemiology Young adults, with the average age at onset being in the late 20s or early 30s Double in women than men and person in developing countries

13. Pathophysiology Some data suggest increased incidence of mood disorders in families of patient with brief psychotic disorder. Psychodynamic theories suggest that the psychotic symptoms occur because of inadequate coping mechanisms.

14. Etiology Idiopathic Patients who have a personality disorder particularly those with borderline, schizoid, schizotypal, or paranoid qualities. Family history of schizophrenia or mood disorders

15. Contd . Inadequate coping mechanism (according to psychodynamic theory) Precipitating stressors ( major life events that would cause significant emotional upset e.g., the loss of close family member, marriage etc.

16. Clinical Features (Diagnostic Criteria) Presence of at least one or more of the following symptoms: Delusions Hallucinations Disorganized speech (e.g., frequent derailment or incoherence) Grossly disorganized or catatonic behavior

17. Contd. At least one major symptom of psychosis, usually with an abrupt onset. Labile mood, confusion, and impaired attention Characteristic symptoms include emotional volatility, strange or bizarre behavior, streaming or muteness, and impaired memory for recent events.

18. Contd. Perplexity, misidentification or impairment of attention, concentration are present Paranoia is often the predominant symptoms.

19. Management Pharmacotherapy Antipsychotic drugs: olanzapine can achieve symptom relief in acute psychosis, haloperidol, ziprasidone Benzodiazepines: can be used in the short term treatment of psychosis Anxiolytic medications: useful during the first 2 to 3 weeks after the resolution of the psychotic episode

20. Contd. Psychotherapy Psychotherapy is of use in providing an opportunity to discuss the stressors and the psychotic episode. Exploration and development of coping strategies. Helping patient deal with the loss of self – esteem An individual treatment strategy: increasing problem – solving skills while strengthening the ego structure. Family involvement in the treatment process

21. Nursing Management