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 visions Strange beliefs or fears 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 elevated, irritable mood ≥ 1 week Three 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 Age of onset 40-50 years Type of onset Usually acute Duration of illness 3 months Premorbid personality A Variety Alcohol dependence Over many years Paranoid Schizophrenia Age of onset before 40 Type of onset Insidious Duration of illness Chronic Premorbid personality shy, aloof, withdrawn Alcohol dependence Not stated

Alcoholic Hallucinosis Family history of alcoholism Increased Family history of schizophrenia No evidence Hallucinations & delusions auditory but visual and tactile Paranoid Schizophrenia Family history of alcoholism Not stated Family history of schizophrenia Increased prevalence Hallucinations & delusions auditory

Alcoholic Hallucinosis Thought processes Coherent Affect Anxious, depressed, perplexed but appropriate Intellectual function Fleeting memory disturbance Orientation At times not oriented to time Paranoid Schizophrenia Thought processes Incoherent Affect Inappropriate Intellectual function Not compromised Orientation