Psychotic disorders

a short talk about psychotic disorders,, best wishes

1. Psychotic Disorders
Al-Momtan
1

2. Definitions
•Psychotic behavior – Cluster of disorders
characterized by hallucinations and/or loss of
contact with reality.
Psychotic Symptoms
-Presence of Delusions and Hallucinations
-Severely disorganized behavior, speech and thought
-Also occurs in Mood Disorders
-May be associated with substance use
-May be due to medication side effects
-May be due to Delirium, GMC
DSM-IV
2

3. Schizophrenia
•Schizophrenia vs. Psychosis
–Psychosis – Broad term (e.g.,
hallucinations, delusions)
–Schizophrenia – A type of psychosis
–Psychosis and Schizophrenia are
heterogeneous
–Disturbed thought, emotion, behavior
3

4. Schizophrenia
•Neurological disease that
affects a person’s perception,
thinking, language, emotion,
and social behavior.
4

5. Facts and How common?
•Onset and Prevalence of Schizophrenia worldwide
–About 1% of the population
–Usually develops in early adulthood, but can emerge at any time
•Schizophrenia Is Generally Chronic
–Most suffer with moderate-to-severe impairment throughout their lives
–Life expectancy in persons with schizophrenia is slightly less than average
•Schizophrenia Affects Males and Females About Equally
–Females tend to have a better long-term prognosis
–Onset of schizophrenia differs between males (earlier) and females (later)
•Schizophrenia Appears to Have a Strong Genetic Component
5

6. DSM-IV-TR Criteria for Schizophrenia
Characteristic symptoms –
•Two or more of the following, one month, less
if treated:
–Delusions.
–Hallucinations.
–Disorganized Speech.
–Disorganized or Catatonic Behavior.
–Negative symptoms.(flat affect)
6

7. Assessment of Symptoms
•Symptoms may be classified as
–Positive – “attention getter” symptoms i.e.
hallucinations, delusions, bizarre behavior,
disorganized speech
–Negative – “crippling” symptoms i.e.
apathy, lack of motivation, anhedonia
–Cognitive - i.e. difficulty with attention,
memory, and problem solving
–Disorganized – i.e. disorganized speech,
inappropriate affect
7

8. Alterations in Thinking
•Delusions
•Ideas of Reference
•Persecution
•Grandiosity
•Bodily Functions
•Jealousy
•Control
8

9. Also observed!
–Thought broadcasting
–Thought insertion
–Thought withdrawal
–Being controlled
–Loose Association
–Neologisms
–Concrete Thinking
–Echolalia
–Clang Association
–Word Salad
9

10. Alterations in Perception
•Hallucinations- auditory, visual, olfactory,
gustatory, and tactile
–90% of schizophrenics experience
hallucinations - auditory most common
–Difference between Illusions and Hallucinations
–Depersonalization and Derealization (loss of
ego boundaries)
•Bizarre Behavior
10

11. Negative Symptoms
•Develop over time
•May not be detected (masked by positive symptoms
Negative symptoms include: poverty of speech content,
thought blocking, anergia, anhedonia, affective blunting,
and lack of avolition.
11

12. Associated symptoms
•Depression and Suicide
•Water Intoxication
•Substance Abuse
•Violent Behavior
12

13. Management
•Phases of presentation:
-Acute.
-Maintenance.
-Stable.
•Psychopharmacology:
- Typical (Traditional) Antipsychotics – target the positive
symptoms
•Older drugs – Watch for signs of EPS
- Atypical (Novel) Antipsychotics – diminish the positive and
negative symptoms 13

14. Pharmacology
Typical ones!!
–Thorazine
(chlorpromazine)
–Mellaril (thioredazine)
–Stelazine (Trifluoperazine)
–Trilafon (perphenazine)
–Serentil (Mesoridazine)
–Prolixin (Fluphenazine)
–Navane (Thiothixene)
–Haldol (Haloperidol and
Haloperidol deconate)
–Loxapine
–Moban (molindon)
14
Atypicals !!
- Clozapine (Clozaril)
agranulocytosis and
seizures
LOWER SIDE
EFFECTS:
-Risperidone
(Risperdal).
-Olanzapine
(Zyprexa).
-Quetiapine
(Seroquel)
-Ziprasidone
(Geodon)

15. Side Effects of antipsychotics
15
•Anticholinergic Symptoms
•Extrapyramidal Symptoms (EPS):
1.Pseudoparkinsonism.
2.Acute dystonic reactions
Opisthotonos
 Oculogyric Crisis.
3.Akathisia.
4.Tardive Dyskinesia

16. Adjuncts to Antipsychotic
Therapy
•Antidepressants
•Antimanic Agents
•Benzodiazepines
•ECT
16

17. Sub-types of Schizophrenia
•Paranoid Type
•Disorganized Type
•Catatonic Type
17

18. Paranoid type
•Any intense and strongly defended
irrational suspicion
•Most common symptoms -
hallucination and delusions
•Defense Mechanism - Projection
18

19. Disorganised type
•Most regressed and socially impaired
•Symptoms - loose association,
inappropriate affect, bizarre mannerisms,
incoherent speech and withdrawn
•Onset?
•Prognosis
19

20. Catatonia type
•Abnormal motor behavior
•Be familiar with other symptoms
•Prognosis?
•Physical Needs are a Priority
20

21. Help and Support
•Educate patient and family about illness
•Assist patient in improving his or her ability to solve
problems related to environmental stress
•Teach the patient coping strategies
•Assist family and patient to identify sources for
ongoing support
21

22. Better Prognosis
•Acute onset
•Marked confusion while psychotic
•Good premorbid functioning
•No affective blunting or flattening
•No family history of psychosis
•Clear precipitant/stressor
•Later onset.
•Insight preserved
•Female
•Minimal residual symptoms
•Normal neurological functioning
•Family history of a mood disorder
•Early treatment and good compliance
22

23. To be familiar with!!
•Loose association.
•Neolgism
•Echolalia
•Clang association
•Word salad
•Concrete thinking
•Thought broadcasting.
•Thought insertion, withdrawal.
•Delusion of being controlled!
23

24. Gross and Imaging changes!
–Increased size of lateral ventricles
–Decreased brain volume
–Smaller Prefrontal Cortex?
–Loss of asymmetry between left and
right brain.
24

25. Schizophreniform Disorder
vs Breif psychotic disorder
•Same criteria as Schizophrenia
except for duration:
–Lasts at least 1 month but less than 6
months
•Diagnosis is “Provisional” if made
without waiting for recovery (ie.
Before 6 months)
25

26. Schizoaffective disorder
•Mixture of Schizophrenic and Affective
symptoms
–I.e. alterations in mood as well as disturbances in
thought
•Thought by some to be a severe form of Bipolar
(Varcarolis, 1998)
•Treatment: Lithium used with antipsychotic
therapy for treatment of manic symptoms
26

27. Other Disorders with
Psychotic Features (cont.)
•Delusional Disorder
–Delusions that are contrary to reality
–Lack other positive and negative symptoms
–Types of delusions include
•Erotomanic
•Grandiose
•Jealous
•Persecutory
•Somatic
–Extremely rare
–Better prognosis than schizophrenia

28. Psychosis due to GMC
-R/O them 1
st
.
-PD?, tumours?, strokes? Aura of migraine?
-DLB, MS, alzehimer? Sarcoidosis?
-Vitamins dif.?, endocrinopathies?
-RF?, Liver failure?
-Infxns: syphilis, AIDS, Leprosy? Malaria?
-Electrolyte disturbance?
28

29. Substance induced
Psychosis
-toxins?
-Drugs?
-hormons
-Withdrawal of sedatives/hypnotics.
-Hormons? Bromocriptine?
-Cannabis?
29

30. Associated mental disorders
•MR
•OCD
•Autism
•Post-traumatic stress disorders.
30

31. Thank you!
Best of Wishes,,
31