Download Psyche means mind/soul, "osis“ means abnormal condition or

WHAT IS PSYCHOSIS?
Psyche means mind/soul, "osis“ means abnormal condition or derangement
A cluster of symptoms which results in “one’s mind playing tricks on that person” constitutes psychosis
It is a mental condition where a person’s contact with reality is distorted or lost
So a person with psychosis will have 1. Altered thinking and 2.Altered emotions
This can lead to Impaired functioning.
Psychosis affects both men and women of all age groups.
Symptoms of psychosis:
The symptoms of psychosis do not appear suddenly. They creep in stealthily and may be present for
weeks to months before they progress to a full blown state.
The symptoms exhibited at different stages are also different.
In the very beginning there are some “Behavioral changes” which can pass for normal variations in daily
life. It is very difficult to state that at this stage they clearly indicate a disorder. These changes are not
just a set of particular symptoms but a definite variation in the routine behavior of the individual.
This stage is called the prodrome. In this stage, “Things are not quite right” or “ he/she is not the same
person”.
The symptoms that appear in this stage are nonspecific and vague. They are:
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Reduced attention and concentration ( difficulty in filtering out distracting information and
sensations)
Reduced interest and motivation
Confusion ( about what is real and what is not real)
Depressed mood
Sleep disturbances
Anxiety/Fear
Social withdrawal ( feel more disconnected and prefer being alone)
Suspiciousness
Deterioration in role functioning
Irritability
This is followed by the acute phase when clear psychotic symptoms appear.
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Delusions
Hallucinations
Disorganized speech
Emotional outbursts
Suicidal attempts
Difficulty in functioning
Disorganized behaviour
Psychotic disorders can be broadly classified into organic type and functional type Delirium and
dementia are examples of organic psychosis
Functional psychotic disorders include
• Schizophrenia
• Schizoaffective disorder
• Acute and transient psychotic disorders
• Delusional disorder
• Schizotypal disorder
Schizophrenia is a chronic, severe multifaceted and complex disorder of the mind, now being
increasingly considered a brain disorder
It affects approximately 1% of the world population and has a ubiquitous distribution
It is considered as the “greatest disabler of youth” as it most commonly affects persons in the
productive period of their life between15 and 35 years of age
Schizophrenia cuts across boundaries of gender, socioeconomic class, race, caste, creed and geographic
location.
This implies that anybody can be affected by schizophrenia.
The World Health Organization (WHO) has identified schizophrenia as one of the ten most disabling
disorders affecting all human beings.
What causes schizophrenia?
No single cause has been identified. A combination of genetic predisposition, inherent vulnerability and
the presence of environmental factors such as prolonged stress seem to lead to schizophrenia.
Other environmental factors could be :
• pregnancy and delivery complications
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childhood and prenatal virus infection
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urban birth and residence
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psychosocial factors (dysfunctional family environment)
The disorder is triggered by an interplay of genetic and environmental factors which leads to alterations
in the biochemical amines especially dopamine in the brain.
There is an excess of dopamine activity which is directly responsible for the signs and symptoms of
schizophrenia. Other amines like serotonin, GABA etc are also implicated in schizophrenia.
There is no single diagnostic test to confirm this illness The information provided by an observant family
member combined with the doctor’s clinical acumen go a long way in arriving at a diagnosis.
Besides, there are scientifically laid down guidelines and diagnostic criteria for arriving at a diagnosis,
like the International Classification of Diseases and the Diagnostic and Statistical Manual of mental
disorders ( V) which help a psychiatrist in making the right diagnosis.
The early symptoms ( prodrome) have already been listed.
The signs and symptoms of schizophrenia are broadly grouped into two: Positive symptoms and
Negative symptoms.
Positive symptoms of schizophrenia are behaviors and experiences that the ill person has, that healthy
people do not.
1. Delusions: These are false beliefs that are firmly held with conviction by the patient however untrue it
may be to others. These include feelings of:
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being watched by others all the time ( hidden cameras, walls being bugged).
their food being poisoned.
their partners/spouses being unfaithful to them.
their thoughts being known to others
people plotting against them and their dear ones
being controlled by external forces sometimes through electric/electronic devices secretly
implanted in some part of their body
that everybody around them is talking about them /teasing them
things said or happening on television or radio having a special meaning or significance to them.
thoughts being removed, inserted in their brains and also that their thoughts are being read by
others.
Being extremely powerful , very wealthy , or being gods or kings etc.
2.Hallucinations: These are false perceptions i.e., they are imaginations involving all the five sense
organs namely eyes, ears, nose, tongue and skin. They see imaginary figures, hear imaginary voices and
smell, taste and feel sensations that are not real.
The imaginary voices (auditory hallucinations) are most common in schizophrenia. Visual hallucinations
can also occur. The other modalities of sensation can also be involved though not very common in
schizophrenia.
The voices in schizophrenia which form the hallmark of the disease are of many types.
 They may comment on the person’s behavior continuously (mostly derogatory).
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There may be more than one voice and they can discuss the person in question among themselves.
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The voices can threaten the person of harm befalling him or his family
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Voices can command the person to perform certain acts and control the person completely.
The hallucinations can be very strong and overpowering driving the person to do things which he would
not otherwise do. This can result in violent behavior, causing harm to self and others.
3.Disorganised speech: Schizophrenia is primarily a disorder of thinking which is reflected in the spoken
words which can be difficult to understand. It can be incoherent and irrelevant to the context of a
conversation. There may be jumps from one topic to another which are unrelated. Sometimes the ill
person says that he/she feels confused or muddled.
4.Disorganized Behavior: There can be problems in performing directed daily activities leading
neglected personal hygiene and appearance and disinterest in the surroundings.
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5.Catatonic Behavior: The individual remains unaware and does not respond to things happening
around him, has a rigid posture, resists movement or instructions and sometimes maintains odd
postures for prolonged periods of time. We are seeing less of catatonia nowadays.
Negative symptoms of schizophrenia refer to the absence or reduction of certain behaviours that are
normally present in people.
The range and intensity of emotional expression, communication, body language and interest in normal
activities are restricted.
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Blunted (or flat) Affect: Decreased emotional expressiveness, unresponsive immobile facial
appearance, reduced eye contact and body language.
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Alogia: Reduced speech. Responses are detached and speech is not fluid.
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Avolition: Lacking motivation, spontaneity, initiative. Sitting for lengthy periods or ceasing to
participate in work or daily activities.
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Anhedonia: Lacking Pleasure or interest in activities that were once enjoyable.
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Attention Deficit: Difficulty in concentrating
In addition, persons with schizophreni a can also feel depressed and anxious.
MANAGEMENT
Effective management of schizophrenia always involves a multidisciplinary team of psychiatrists, social
workers, psychologists, occupational therapists and families.
Medication is the mainstay of treatment in schizophrenia.
There is a wide range of medication to choose from depending on the person’s age, nature of illness,
affordability, side effect profile etc.
Treatment in schizophrenia does not stop with symptom control. It extends to include rehabilitation and
reintegration back into the society.
Rehabilitation involves helping those affected with schizophrenia to return to the roles they were
performing before they became sick.
Schizophrenia is a treatable neurobiological disorder. Like in medical disorders, good improvement is
seen if treatment is initiated early in the course of illness.
Acute and transient psychotic disorders
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Abrupt onset (<48 hours)
Presence of acute stressful event common
The person has predominant confusion and perplexity
Quick and complete recovery in 2-3 months
Do not resemble schizophrenia or mood disorders in clinical picture or course.
Commonly seen in India and other developing countries
Persistent delusional disorders
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Non bizarre delusions-most prominent feature
At least 3 months duration
Delusions of persecution, grandeur, jealousy, erotomania and somatic commonly seen
Absence of hallucinations/organic conditions/schizophrenia/mood disorders
Stable and chronic course.
Near normal social and occupational functioning
Schizoaffective disorder
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Borders between schizophrenia and mood disorders.
Features of both can be prominent within the same episode
Present simultaneously or follow within few days of each other
3 types : Manic, depressive and mixed
Usually episodic, can be chronic.
Prognosis better than schizophrenia
Dr. R. Thara,
Director, SCARF, India
Dr. R. Mangala
Psychiatrist, SCARF, India