Psychosis
Psychosis, NOS
(Atypical psychotic disorders)
- Schizophreniform disorder episodee less than 6 months; often a tentative diagnosis; identical to schizophrenia in Tx and Sx; duration 1-6 mo
- Good Prognosis – short prodrome, confusion is predominent during the active phase, good morbid functioning, intact affect
- Schizoaffective disorder Mood d/o + Schizophrenia; must have 2 wks of symptoms of schizophrenia but no symptoms of mood d/o; then symptoms of depression, mania, or hypomania w/o manifestations of schizo
- Intermittent affective symptoms punctuating an Active Psychotic Phase
- Psychosis is the backdrop NO affective symptoms without psychosis
- DDx: Major Depression with psychotic features; mania with psychotic symptoms
- Prognosis is better than for schizo
- Delusional Disorder
- Delusion- fixed belief w/ inability to entertain the possibility that it is wrong
- Bizarre delusions are not possible: thought insertion, thought control, referential thinking- e.g. seen in schizophrenia
- Non-bizarre delusions are possible- being followed, poisoned, infected, distant love, disease, deception\
- Symptoms
Erotomaniac – delusion that a high status person is in love with you
Grandiose – delusion of inflated worth, power, knowledge, identity, deification
Jealous- delusion of sexual infidelity of a partner
Paranoid/Persecutory- delusion of being malevolently treated; legal complaints
Somatic – physical defect, disorder, disease
- Brief Reactive Psychosis – same symptoms as schizophrenia; duration (1day – 1 month); disappear spontaneously; not supposed to wait….treat immediately
There is no prodrome, mood change or related organic factor identified.
Precipitants:
- emotional
- incoherance/LOA
Fortunately a full recovery is expected.
Symptoms:
- perplexity hallucinations
- turmoil delusions
- catatonia
- disorganized behavior
- affective shifts for few hours to one month
Shared Psychiatric Disorder (folie a deux) – psychosis develops during a long-term relationship with another person who has a similar psychotic syndrome before the onset of symptoms in the patient with the shared psychotic disorder. (i.e. 2 people who live (isolated) together for a long time and one develops delusions and the other accepts the delusions as fact)
- Folie imposee – imposing delusions on others
- Folie simultanee – 2 people have delusions at the same time but they do not exchange delusions
- Folie communiquee – 2 people who live together have different types of delusions and they exchange delusions
- i.e. Pinell believes he is the president of the US and his wife believes that she is the queen of England and they believe each other
- Folie induite – same as above but she believes him and he does not believe her so one person is getting the delusion from the other
Autoscopic Psychosis – visual hallucinations of all or part of the persons own body; you see yourself in black and white and the image makes the same gestures that you are making (associated with migraines)
Cotards syndrome – or “delire de negation” characterized by nihilistic delusions; illusions of negations; ie, “I have no brain” or “I don’t exist”
Amok- preoccupation, brooding, mild depression followed by wild rage, running about madly, attacking people or animals. After the attack the person feels exhausted, does not remember the attack, and often commits suicide
Koro- TQ – Occurs among people of southeast Asia and in some areas of China. Characterized by the delusion that the penis is shrinking and may disappear into the pelvis/abdomen and that the person will die
Piblokto – occurs among Eskimos. Pts are usually women. The attack is characterized by screaming, tearing off and detroying their clothing; imitating the cry of some animals or birds; the pt may throw themselves on the snow or run wildly; after the attack, the person may appear to be normal and usually has no memory of the episode
Wihtigo or Windigo – confined to the Cree, Ojibwa, and Salteaux Indians of North America. The person who suffers this problem believes that he is going to be transformed into a Wihtigo, a giant monster that eats human flesh
- Post-Partum Psychosis (mood d/o + delerium)
- Epidemiology
- Incidence 1 or 2 per 1,000 childbirths
- 50-60% have had their 1st child
- 50% have a family history of mood disorders
- Rare cases affect the father (Couvade syndrome)
- Etiology
Apparently they are essentially an episode of mood disorder
Perhaps they are associated with hormonal changes (↑ esrogen upregulates dopamine receptors metabolites from estrogen occupy the dopamine receptor when levels of estrogens go ↓ they are hypersensitive to dopamine stimulation
A few instances are associated with perinatal events such as infections, drug intoxication, sudden fall in hormones concentration
- Psychological Causes
Stressful events; some mothers don’t want to become pregnant, feel unhappy in marriage by motherhood; marital discord
The less stress in the life of the pt, the less potential problems faced
- Clinical Features
Mean time to onset is 2 or 3 weeks but the psychosis may start a few days after the delivery
Patient begins complaining of fatigue, insomnia, and restlessness; pt appears to be tearful or labile. Later the pt may be suspicious, confused, incoherant, irrational with obsessive concern about the baby. Delusions in 50% and hallucinations in 25%. Complains about the inability to move, to stand, or walk. Delusions that the baby is dead; not loving the baby; wanting to harm the baby of to kill herself. 5% of pts commit suicide, 4% kill the baby. Cause of the episode is similar to that seen in patients with mood disorder
- Treatment
More synthetic estrogen
anti-maniac
anti-depressant
ECT
TQ: Anti-psychotic blocks the dopamine receptor upregulation of dopamine receptors (↑ in #) release of dopamine ↑ quantity, ↓ dopamine activity eliminate anti-psychotic exacerbation of condition b/c rec no longer is blocked and are increased in #
TQ: Clozapine eliminates tarditive dyskinesia; BZ’s, Clozapine, and Vitamin E (Parkinson-like syndrome)
Tags: Delusional Disorder, Delusions, Erotomaniac, Grandiose, Paranoid, Reactive Psychosis, Schizoaffective, Schizophreniform, Somatic
