Psychosis

Nota:

• Gross Impairment of reality testing accompanied with hallucinations, delusions, and loss of ego boundaries. 

1. Schizophrenia

   Nota:

   • It cannot be considered as a single illness.
   • Maintained intellectual abilities. Cognitive deficits may evolve with time.
   • 1 % of every population 16-25 years old Continuation signs of disturbance for at least 6 months
   1. Psychopathology (7)

      Nota:

      • Thought echo Thought insertion/withdrawal Thought broadcasting Thought disorders and negative symptoms Delusional perceptions and delusions of control Influence or passivity  Hallucinatory voices commenting or discussing the patient in third person.
      • Multifactorial
   2. Kraepalin, Bleuler, Schneider
      1. Four As

         Nota:

         • Primary Symptoms Affective blunting Disturbance of association Autism Ambivalence 
         • Secondary Symptoms Hallucinations and Delusions
   3. Course

      Nota:

      • Continuous without temporary improvement. Episodic with progressive or stable deficit. Episodic with complete or incomplete remission
   4. Typical Stages

      Nota:

      • Prodromal: No symptoms/Deterioration Active: Symptoms triggered by stress Residual: Leftovers/prodromal-like phase of functioning and symptoms/ -ve not +ve
   5. Positive and Negative Symptoms

      Nota:

      • Negative Symptoms:  Cognitive Disorders Association of thoughts Disorder Emotional Blunting Small or MISSING Hallucinations and delusions
      • Positive Symptoms: Hallucinations and Delusions Bizarre Behavior Positive formal thought Disorder (loose associations-Neologisms-Perseverations-Clang- Derailment-Tangentiality-Incoherence-Illogicality-Circumstantiality-Pressure of speech-Distractible speech ) 
      • Negative Symptoms:  Cognitive Disorders Association of thoughts Disorder Emotional Blunting Small or MISSING Hallucinations and delusions Alogia(Poverty of speech) Affective flattening Avolition (lack of performing self-directed activities) Apathy(lack of concern) Anhedonia  Asociality Attentional Impairment Catatonia(cerebral folate deficiency- autoimmune-paraneoplastic)
      1. Types

         Nota:

         • Type 1: positive symptoms Biochemical abnormalities Type 2:Negative Symptoms Brain Structures abnormalities
   6. Hallucinations and Delusions

      Nota:

      • Both affect reality testing Hallucinations:  Altered perceptions Types: Auditory 70%: Voices commenting-conversing-arguing-own thoughts spoken by another voice Visual 20%-Olfactory-Gustatory- Somatic/Tactile
      • Delusions: Altered thoughts Persecutory-Jealousy-Guilt(Sin-based)-Grandiose-Religious-Somatic-Reference(Center of Attention)-Mind Reading-Control(Thoughts/Behavior/Feelings BIW)
      1. Levels of Intensity of Hallucinations

         Nota:

         • Stage 1: Comforting moderate level of anxiety Non-psychotic Stage 2: Condemning severe level of anxiety Mildly Psychotic Stage 3: Controlling severe level of anxiety Psychotic Stage 4: Conquering panic level of anxiety Severely Psychotic
   7. Diagnostic Criteria

      Nota:

      • Two or more-6 months 123 must be like schizophrniform
   8. Demographics

      Nota:

      • 1% worldwide 2.5 billion people in US 100 billion dollars annually 15% suicide 50% attempt suicide25% recover
      • Relative Risk: 1% people 5.6 parents 10.1 siblings 12.8 children
   9. Etiology
      1. Dopamine Hypothesis

         Nota:

         • Increased sensitivity and density of dopamine D2 receptors in different parts of the brain leading to its hyperactivity.
      2. Contemporary Models

         Nota:

         • Norepinephrin-Serotonine-Glutamate-Peptidergic Systems NCDNancy: Arises from Cognitive DysmetriaDaniel: Neurodevelopmental Disorder
      3. Neurodevelopmental Model

         Nota:

         • Silent lesion in Frontal, Parietal, Temporal
2. Schizoaffective Disorder
   1. Diagnostic Criteria

      Nota:

      • Major Depression or manic attack - 1 month less than 6 months Like schizophrenia for 2 or more weeks without mood disorder
3. Not specified
4. Mood Induced Psychosis
5. Substance Induced Psychosis
   1. Diagnostic Criteria

      Nota:

      • Delusions and Hallucinations after taking a specific substance that can be known upon verbal or physical examination
      • 1 month after withdrawal
      • Not during delirium
6. Brief Psychotic Disorder
   1. Diagnostic Criteria

      Nota:

      • One or more of the following symptoms (first 3 must be): Hallucinations-Delusions-Disorganized speech(Derailment/Incoherence)-Catatonia)
      • At least 1 day but less than 1 month
   2. Stressors

      Nota:

      • With marked stressors Without marked stressors With postpartum onset With catatonia
7. Psychotic Disorder due to a medical condition
   1. Diagnostic Criteria

      Nota:

      • Delusions or hallucinations and which one is prominent
      • Not during Delirium
8. Schizophreniform
   1. Diagnostic Criteria

      Nota:

      • Two or more-1 months but less than 6 months 1,2,3 must be Hallucinations Delusions Disorganized speech Catatonia Negative Symptoms
9. Delusional Disorder
   1. Diagnostic Criteria

      Nota:

      • The presence of one or more delusions in a period of one month or longer.
   2. Types

      Nota:

      • Erotomatic-Grandiose-Jealousy-Persecutory-Somatic
10. Clinical Picture (12)

    Nota:

    • Stupor-Catalepsy-Waxy Flexibility-Mutism-Negativism-Mannerism-posturing-Stereotypy-Agitation-Grimacing-Echolalia-Echopraxia)
11. Nursing Process
    1. Assessment

       Nota:

       • Neuropsychological Testing
12. Treatment

    Nota:

    • Antipsychotics Adjunctive Pharmacotherapies ECT Psychological/Family Interventions Vocational Rehabilitation Cognitive Behavioral Therapy Milieu Therapy Token Economy System Assertive Community Treatment