Psychotic disorders 

Psychotic disorders are often accompanied by psychosis which is a is a thought disorder and can show up predominantly as delusions or hallucinations.

• Delusions
  • fixed false beliefs that are not consistent with the patient's cultural or religious beliefs. 

Schizophrenia 

A thought disorder with a large genetic component. Even though the genes have not yet been identified, twin studies have shown a significantly increased risk of schizophrenia.

 

• Symptoms
  • Positive symptoms 
    • Are thought to be caused by dopamine excess (typical antipsychotics target this pathway better) 
    • Parkinson's disorder patients treated with dopamine can get delusions or hallucinations 
    • Types
      • Delusions 
      • Hallucinations 
  • Negative symptoms 
    • Are thought to be caused by excess serotonin (atypical antipsychotics target this pathway better) 
• Diagnosis 
  • 2 or more of the following with at least 1 of 1-3
    • Positive symptoms 
      • 1. Delusions - Persecution and grandiosity 
      • 2. Hallucinations - mostly auditory (drug-induced usually visual) 
      • 3. Disorganization of speech
      • 4. Disorganization of behaviour 
    • Negative symptoms 
      • 5. Flat affect 
        • 
        • Limited speech or movement 
        • Anhedonia 
        • Cognitive delay with later onset 
  • Duration 
    • 6 months or longer 
• Presentation 
  • Usually, these patients present with a psychotic break:
    • When medications are stopped
    • When the disease presents for the first time 
    • When the dose of medications need to be increased or the patient needs new medications 
  • Psychotic breaks reduce cognitive function 
    • Increased risk of dementia and earlier onset 
  • Age of onset for a first psychotic break 
    • In late teens or early 20s 
    • After a major stressor = growing up, moving out
      • 
    • Initial symptoms may not be overt 
    • Rule out drugs in this age group 
      • Cocaine common 
      • Urine tox 
  • Duration and mood changes 
• Treatment 
  • Lifelong treatment with antipsychotics 

Brief psychotic disorder 

• Symptoms 
  • Identical to schizophrenia after a major stressor (including giving birth to a baby) 
• Diagnosis
  • These usually last for at least 1 day but less than 1 month
• Treatment 
  • Treatment for 1 month 
  • If psychosis does not stop = more likely to be schizophrenia 

Schizophreniform disorder

• Symptoms 
  • Identical to schizophrenia 
• Diagnosis 
  • Symptoms for more than 1 and less than 6 months 
• Treatment
  • Treatment 3-6 months in duration 
  • If symptoms persist beyond 6 months, will require lifelong treatment = schizophrenia 

Schizoaffective disorder 

• Symptoms 
  • Predominantly psychotic symptoms with mood symptoms secondary 
• Treatment 
  • Treat the mood disorder first 

Mood disorder with psychotic features 

• Symptoms 
  • Mostly mood disorder with some psychosis 
• Treatment 
  • Treat the mood disorder first 

Delusional disorder

• Symptoms 
  • Non-bizarre(but unrealistic) delusion with no impairment 
  • E.g. falling in love with celebrities and thinking that they love you too 
• Treatment
  • Gentle confrontation 
  • Show them that the delusion if wrong 
  • No medical treatment