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Psychotic disorders

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a short talk about psychotic disorders,, best wishes

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Psychotic disorders

  1. 1. Psychotic Disorders Al-Momtan
  2. 2. Definitions <ul><ul><li>Psychotic behavior – Cluster of disorders characterized by hallucinations and/or loss of contact with reality. </li></ul></ul><ul><li>Psychotic Symptoms </li></ul><ul><li>Presence of Delusions and Hallucinations </li></ul><ul><li>Severely disorganized behavior, speech and thought </li></ul><ul><li>Also occurs in Mood Disorders </li></ul><ul><li>May be associated with substance use </li></ul><ul><li>May be due to medication side effects </li></ul><ul><li>May be due to Delirium, GMC </li></ul><ul><li>DSM-IV </li></ul>
  3. 3. Schizophrenia <ul><li>Schizophrenia vs. Psychosis </li></ul><ul><ul><li>Psychosis – Broad term (e.g., hallucinations, delusions) </li></ul></ul><ul><ul><li>Schizophrenia – A type of psychosis </li></ul></ul><ul><ul><li>Psychosis and Schizophrenia are heterogeneous </li></ul></ul><ul><ul><li>Disturbed thought, emotion, behavior </li></ul></ul>
  4. 4. Schizophrenia <ul><li>Neurological disease that affects a person’s perception, thinking, language, emotion, and social behavior. </li></ul>
  5. 5. Facts and How common? <ul><li>Onset and Prevalence of Schizophrenia worldwide </li></ul><ul><ul><li>About 1% of the population </li></ul></ul><ul><ul><li>Usually develops in early adulthood, but can emerge at any time </li></ul></ul><ul><li>Schizophrenia Is Generally Chronic </li></ul><ul><ul><li>Most suffer with moderate-to-severe impairment throughout their lives </li></ul></ul><ul><ul><li>Life expectancy in persons with schizophrenia is slightly less than average </li></ul></ul><ul><li>Schizophrenia Affects Males and Females About Equally </li></ul><ul><ul><li>Females tend to have a better long-term prognosis </li></ul></ul><ul><ul><li>Onset of schizophrenia differs between males (earlier) and females (later) </li></ul></ul><ul><li>Schizophrenia Appears to Have a Strong Genetic Component </li></ul>
  6. 6. DSM-IV-TR Criteria for Schizophrenia <ul><li>Characteristic symptoms – </li></ul><ul><li>Two or more of the following, one month, less if treated: </li></ul><ul><ul><li>Delusions. </li></ul></ul><ul><ul><li>Hallucinations. </li></ul></ul><ul><ul><li>Disorganized Speech. </li></ul></ul><ul><ul><li>Disorganized or Catatonic Behavior. </li></ul></ul><ul><ul><li>Negative symptoms.(flat affect) </li></ul></ul>
  7. 7. Assessment of Symptoms <ul><li>Symptoms may be classified as </li></ul><ul><ul><li>Positive – “attention getter” symptoms i.e. hallucinations, delusions, bizarre behavior, disorganized speech </li></ul></ul><ul><ul><li>Negative – “crippling” symptoms i.e. apathy, lack of motivation, anhedonia </li></ul></ul><ul><ul><li>Cognitive - i.e. difficulty with attention, memory, and problem solving </li></ul></ul><ul><ul><li>Disorganized – i.e. disorganized speech, inappropriate affect </li></ul></ul>
  8. 8. Alterations in Thinking <ul><li>Delusions </li></ul><ul><ul><ul><li>Ideas of Reference </li></ul></ul></ul><ul><ul><ul><li>Persecution </li></ul></ul></ul><ul><ul><ul><li>Grandiosity </li></ul></ul></ul><ul><ul><ul><li>Bodily Functions </li></ul></ul></ul><ul><ul><ul><li>Jealousy </li></ul></ul></ul><ul><ul><ul><li>Control </li></ul></ul></ul>
  9. 9. Also observed! <ul><ul><li>Thought broadcasting </li></ul></ul><ul><ul><li>Thought insertion </li></ul></ul><ul><ul><li>Thought withdrawal </li></ul></ul><ul><ul><li>Being controlled </li></ul></ul><ul><ul><li>Loose Association </li></ul></ul><ul><ul><li>Neologisms </li></ul></ul><ul><ul><li>Concrete Thinking </li></ul></ul><ul><ul><li>Echolalia </li></ul></ul><ul><ul><li>Clang Association </li></ul></ul><ul><ul><li>Word Salad </li></ul></ul>
  10. 10. Alterations in Perception <ul><li>Hallucinations - auditory, visual, olfactory, gustatory, and tactile </li></ul><ul><ul><li>90% of schizophrenics experience hallucinations - auditory most common </li></ul></ul><ul><ul><li>Difference between Illusions and Hallucinations </li></ul></ul><ul><ul><li>Depersonalization and Derealization (loss of ego boundaries) </li></ul></ul><ul><li>Bizarre Behavior </li></ul>
  11. 11. Negative Symptoms <ul><li>Develop over time </li></ul><ul><li>May not be detected (masked by positive symptoms </li></ul><ul><li>Negative symptoms include: poverty of speech content, thought blocking, anergia, anhedonia, affective blunting, and lack of avolition. </li></ul>
  12. 12. Associated symptoms <ul><li>Depression and Suicide </li></ul><ul><li>Water Intoxication </li></ul><ul><li>Substance Abuse </li></ul><ul><li>Violent Behavior </li></ul>
  13. 13. Management <ul><ul><li>Phases of presentation: </li></ul></ul><ul><ul><li>Acute. </li></ul></ul><ul><ul><li>Maintenance. </li></ul></ul><ul><ul><li>Stable. </li></ul></ul><ul><ul><li>Psychopharmacology : </li></ul></ul><ul><li>- Typical (Traditional) Antipsychotics – target the positive symptoms </li></ul><ul><ul><ul><li>Older drugs – Watch for signs of EPS </li></ul></ul></ul><ul><li>- Atypical (Novel) Antipsychotics – diminish the positive and negative symptoms </li></ul>
  14. 14. Pharmacology <ul><li>Typical ones!! </li></ul><ul><ul><li>Thorazine (chlorpromazine) </li></ul></ul><ul><ul><li>Mellaril (thioredazine) </li></ul></ul><ul><ul><li>Stelazine ( Trifluoperazine) </li></ul></ul><ul><ul><li>Trilafon (perphenazine) </li></ul></ul><ul><ul><li>Serentil ( Mesoridazine) </li></ul></ul><ul><ul><li>Prolixin ( Fluphenazine) </li></ul></ul><ul><ul><li>Navane ( Thiothixene) </li></ul></ul><ul><ul><li>Haldol (Haloperidol and Haloperidol deconate) </li></ul></ul><ul><ul><li>Loxapine </li></ul></ul><ul><ul><li>Moban (molindon) </li></ul></ul><ul><li>A typicals !! </li></ul><ul><li>Clozapine (Clozaril) agranulocytosis and seizures </li></ul><ul><li>LOWER SIDE EFFECTS: </li></ul><ul><ul><li>Risperidone (Risperdal). </li></ul></ul><ul><ul><li>Olanzapine (Zyprexa). </li></ul></ul><ul><ul><li>Quetiapine (Seroquel) </li></ul></ul><ul><ul><li>Ziprasidone (Geodon) </li></ul></ul>
  15. 15. Side Effects of antipsychotics <ul><li>Anticholinergic Symptoms </li></ul><ul><li>Extrapyramidal Symptoms (EPS): </li></ul><ul><ul><li>Pseudoparkinsonism. </li></ul></ul><ul><ul><li>Acute dystonic reactions </li></ul></ul><ul><ul><ul><li>Opisthotonos </li></ul></ul></ul><ul><ul><ul><li>Oculogyric Crisis. </li></ul></ul></ul><ul><ul><li>Akathisia. </li></ul></ul><ul><ul><li>Tardive Dyskinesia </li></ul></ul>
  16. 16. Adjuncts to Antipsychotic Therapy <ul><li>Antidepressants </li></ul><ul><li>Antimanic Agents </li></ul><ul><li>Benzodiazepines </li></ul><ul><li>ECT </li></ul>
  17. 17. Sub-types of Schizophrenia <ul><li>Paranoid Type </li></ul><ul><li>Disorganized Type </li></ul><ul><li>Catatonic Type </li></ul>
  18. 18. Paranoid type <ul><li>Any intense and strongly defended irrational suspicion </li></ul><ul><li>Most common symptoms - hallucination and delusions </li></ul><ul><li>Defense Mechanism - Projection </li></ul>
  19. 19. Disorganised type <ul><li>Most regressed and socially impaired </li></ul><ul><li>Symptoms - loose association, inappropriate affect, bizarre mannerisms, incoherent speech and withdrawn </li></ul><ul><li>Onset? </li></ul><ul><li>Prognosis </li></ul>
  20. 20. Catatonia type <ul><li>Abnormal motor behavior </li></ul><ul><li>Be familiar with other symptoms </li></ul><ul><li>Prognosis? </li></ul><ul><li>Physical Needs are a Priority </li></ul>
  21. 21. Help and Support <ul><li>Educate patient and family about illness </li></ul><ul><li>Assist patient in improving his or her ability to solve problems related to environmental stress </li></ul><ul><li>Teach the patient coping strategies </li></ul><ul><li>Assist family and patient to identify sources for ongoing support </li></ul>
  22. 22. Better Prognosis <ul><li>Acute onset </li></ul><ul><li>Marked confusion while psychotic </li></ul><ul><li>Good premorbid functioning </li></ul><ul><li>No affective blunting or flattening </li></ul><ul><li>No family history of psychosis </li></ul><ul><li>Clear precipitant/stressor </li></ul><ul><li>Later onset. </li></ul><ul><li>Insight preserved </li></ul><ul><li>Female </li></ul><ul><li>Minimal residual symptoms </li></ul><ul><li>Normal neurological functioning </li></ul><ul><li>Family history of a mood disorder </li></ul><ul><li>Early treatment and good compliance </li></ul>
  23. 23. To be familiar with!! <ul><li>Loose association. </li></ul><ul><li>Neolgism </li></ul><ul><li>Echolalia </li></ul><ul><li>Clang association </li></ul><ul><li>Word salad </li></ul><ul><li>Concrete thinking </li></ul><ul><li>Thought broadcasting. </li></ul><ul><li>Thought insertion, withdrawal. </li></ul><ul><li>Delusion of being controlled! </li></ul>
  24. 24. Gross and Imaging changes! <ul><ul><li>Increased size of lateral ventricles </li></ul></ul><ul><ul><li>Decreased brain volume </li></ul></ul><ul><ul><li>Smaller Prefrontal Cortex? </li></ul></ul><ul><ul><li>Loss of asymmetry between left and right brain. </li></ul></ul>
  25. 25. Schizophreniform Disorder vs Breif psychotic disorder <ul><li>Same criteria as Schizophrenia except for duration: </li></ul><ul><ul><li>Lasts at least 1 month but less than 6 months </li></ul></ul><ul><li>Diagnosis is “Provisional” if made without waiting for recovery (ie. Before 6 months) </li></ul>
  26. 26. Schizoaffective disorder <ul><li>Mixture of Schizophrenic and Affective symptoms </li></ul><ul><ul><li>I.e. alterations in mood as well as disturbances in thought </li></ul></ul><ul><li>Thought by some to be a severe form of Bipolar (Varcarolis, 1998) </li></ul><ul><li>Treatment: Lithium used with antipsychotic therapy for treatment of manic symptoms </li></ul>
  27. 27. Other Disorders with Psychotic Features (cont.) <ul><li>Delusional Disorder </li></ul><ul><ul><li>Delusions that are contrary to reality </li></ul></ul><ul><ul><li>Lack other positive and negative symptoms </li></ul></ul><ul><ul><li>Types of delusions include </li></ul></ul><ul><ul><ul><li>Erotomanic </li></ul></ul></ul><ul><ul><ul><li>Grandiose </li></ul></ul></ul><ul><ul><ul><li>Jealous </li></ul></ul></ul><ul><ul><ul><li>Persecutory </li></ul></ul></ul><ul><ul><ul><li>Somatic </li></ul></ul></ul><ul><ul><li>Extremely rare </li></ul></ul><ul><ul><li>Better prognosis than schizophrenia </li></ul></ul>
  28. 28. Psychosis due to GMC <ul><li>R/O them 1 st . </li></ul><ul><li>PD?, tumours?, strokes? Aura of migraine? </li></ul><ul><li>DLB, MS, alzehimer? Sarcoidosis? </li></ul><ul><li>Vitamins dif.?, endocrinopathies? </li></ul><ul><li>RF?, Liver failure? </li></ul><ul><li>Infxns: syphilis, AIDS, Leprosy? Malaria? </li></ul><ul><li>Electrolyte disturbance? </li></ul>
  29. 29. Substance induced Psychosis <ul><li>toxins? </li></ul><ul><li>Drugs? </li></ul><ul><li>hormons </li></ul><ul><li>Withdrawal of sedatives/hypnotics. </li></ul><ul><li>Hormons? Bromocriptine? </li></ul><ul><li>Cannabis? </li></ul>
  30. 30. Associated mental disorders <ul><li>MR </li></ul><ul><li>OCD </li></ul><ul><li>Autism </li></ul><ul><li>Post-traumatic stress disorders. </li></ul>
  31. 31. Thank you! Best of Wishes,,
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a short talk about psychotic disorders,, best wishes


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