Download Session 2 Psychotic disorders

PSYCHOTIC DISORDERS
PSYCHOSIS

Psychosis is a disruptive mental state

Individual has difficulty distinguishing external reality
from his or her own internal experiences and perceptions
PSYCHOSIS
PRESENTING COMPLAINTS
 Hearing
voices when no one is around, seeing
 Strange
beliefs or fears
visions
 Confusion
 Apprehension
 Abnormal
behaviour
PSYCHOSIS
PRESENTING COMPLAINTS

Fear

Apprehension

Inappropriate smile/laughter

Talking to self

Agitation

Aggressive behavior

Aggression
CAUSES OF PSYCHOSIS
Alcoholic hallucinosis / Alcohol induced psychosis
 Psychosis induced by amphetamines or other substances
 Acute psychotic disorder
 Schizophrenia
 Bipolar disorder, mania
 Delusional disorder
 Depression with psychotic features


Delirium

Dementia

Head injury
EPIDEMIOLOGY AND BURDEN
SCHIZOPHRENIA

The lifetime prevalence rate is 1%

Onset in late teens to early 20s, equally affecting men and
women

Devastating disease for both the patient and the family

Affects thoughts and emotions to the point that social and
occupational functioning is impaired

About one in a ten with schizophrenia commit suicide
POSITIVE AND NEGATIVE SYMPTOMS
OF SCHIZOPHRENIA
Positive symptoms
 Delusions
 Hallucinations
 Hostility
 Disorganised
thinking/behaviours
Negative symptoms
 Alogia
 Affective blunting
 Anhedonia
 Asociality
 Avolition
 Apathy
TREATMENT OF
SCHIZOPHRENIA

Acute phase treatment with anti-psychotics
Haloperidol, chlorpromazine
 Risperidone, Olanzapine


Maintenance treatment with antipsychotics
Depot preparations (Fluphenazine)
 Risperidone, Olanzapine, Haloperidol


Family / community support

Rehabilitation
BIPOLAR DISORDER
MANIC EPISODE
 Persistent
 Three
elevated, irritable mood ≥ 1 week
or four (irritable mood) of the following:
Increased self esteem
 Reduced sleep
 Increased talk / pressured speech
 Racing thoughts / flight of ideas
 Distractibility
 Extreme goal directed activity
 Excessive buying/sex/business investments

TREATMENT OF MANIC
EPISODE

Acute phase treatment with mood stabilisers (Lithium,
Divalproate), antipsychotics (Olanzapine)

Maintenance treatment with Mood stabilisers (Lithium,
Divalproate, Lamotrigine, Carbamazepine)
ALCOHOLIC HALLUCINOSIS

Usually occurs during alcohol withdrawal

Can also occur during prolonged, steady drinking

A hallucinatory or delusional state with clear or relatively clear
consciousness

Auditory hallucinations with sexual or derogatory content

Delusions are paranoid

The condition lasts for months rather than days or week
ALCOHOLIC HALLUCINOSIS
Alcoholic Hallucinosis
Paranoid Schizophrenia
Age of onset
 40-50 years
Age of onset
 before 40
Type of onset
 Usually acute
Type of onset
 Insidious
Duration of illness
 3 months
Duration of illness
 Chronic
Premorbid personality
 A Variety
Premorbid personality
 shy, aloof, withdrawn
Alcohol dependence
 Over many years
Alcohol dependence
 Not stated
ALCOHOLIC HALLUCINOSIS
Alcoholic Hallucinosis
Paranoid Schizophrenia
Family history of alcoholism
Family history of alcoholism

Increased
Family history of schizophrenia

Not stated
Family history of schizophrenia
 Increased prevalence
No evidence
Hallucinations & delusions


auditory but visual and tactile
Hallucinations & delusions

auditory
ALCOHOLIC HALLUCINOSIS
Alcoholic Hallucinosis
Paranoid Schizophrenia
Thought processes
 Coherent
Thought processes
 Incoherent
Affect
 Anxious, depressed, perplexed but
appropriate
Affect
 Inappropriate
Intellectual function
 Fleeting memory disturbance
Intellectual function
 Not compromised
Orientation
 At times not oriented to time
Orientation
 Not compromised