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Anita S. Kablinger MD
Associate Professor Departments of Psychiatry of Pharmacology
LSUHSC-Shreveport
What is Psychosis?
Generic term Break with Reality Symptom, not an illness Caused by a variety of conditions that affect the functioning of the brain. Includes hallucinations, delusions and thought disorder
Differential Diagnosis
Medical/surgical/ substance-induced
Psychotic d/o due to GMC Dementias Delirium Medications Substance induced Amphetamines Cocaine Withdrawal states Hallucinogens Alcohol
Mood disorders
Bipolar disorder Major depression with psychotic features
Mood disorders
Functional disorders
Schizophrenia spectrum disorders
P S Y C H O S I S
Substance induced
Personality disorders
Schizoid Schizotypal Paranoid Borderline Antisocial
Miscellaneous
PTSD Dissociative disorders Malingering Culturally specific phenomena: Religious experiences Meditative states Belief in UFOs, etc
Metabolic panel CBC with diff B12, Folate RPR, VDRL Serum Alcohol Urinalysis Thyroid profile
URINE DRUG SCREEN!!!
Talking Points
Schizophrenia is not an excess of dopamine. The differentiation between functional and organic is artificial. Schizophrenia and other psychiatric illnesses are syndromes. Schizophrenia is a diagnosis of exclusion.
Talking Points
1% prevalence Early onset, M>F Early, aggressive treatment decreases long-term problems Multiple subtypes- catatonic, disorganized, paranoid, undifferentiated, residual
Schizophrenia
Diagnostic features
Diagnosis (cont.)
Impairment in social or occupational functioning Duration of illness at least 6 mo. Symptoms not due to mood disorder or schizoaffective disorder Symptoms not due to medical, neurological, or substance-induced disorder
Paranoid/persecutory Ideas of reference External locus of control Thought broadcasting Thought insertion, withdrawal Jealousy Guilt Grandiosity
Psychotic Disorders
Onset
Symptoms
Many
Course
Chronic
Duration
>6 months
Usually insidious
Chronic
>1 mo.
Limited
<1 mo.
Psychosocial Factors
Expressed emotion Stressful life events Low socioeconomic class Limited social network
Anatomical abnormalities
Enlargement of lateral ventricles Smaller than normal total brain volume Cortical atrophy Widening of third ventricle Smaller hippocampus
Dopamine systems
Cell bodies Projections Functions Clinical implications
Substantia Nigra
Movement
Emotions, affect, memory
Positive symptoms
Prefrontal Cortex
Typical Neuroleptics
Low potency:
High potency:
Atypical Antipsychotics:
Risperidone Olanzapine Quetiapine Clozapine Ziprasidone Aripiprazole (new-partial DA agonist)
Atypical antipsychotics:
Broader spectrum of receptor activity (Serotonin, dopamine, GABA) May be better at alleviating negative symptoms and cognitive dysfunction Clozaril (clozapine) associated with agranulocytosis, seizures
Psychosocial Treatment
Education, compliance #1 Hospitalize for acute loss of functioning Outpatient treatment is rehabilitative Psychoanalysis, exploratory therapies have limited value Families should be involved