Psychoses

Psychoses-

-Delusional Disorder-

-Delusional disorder is characterized by the presence of one or more delusions for a month or longer in the absence of meeting the criteria for schizophrenia

-There is also a lack of being attributed to a manic or depressive episodes, and other medical conditions other than a medical disorder

-Delusions are classified as erotomaniac type, grandiose type, jealous type, persecutory type, somatic type, mixed type or unspecified type

-They are also classified by rather than have bizarre content

-Treatment of choice for delusions is antipsychotic medication

-Needs a medical evaluation especially with initial episode to exclude this as being attributed to medical disorder


-Schizophrenia-
-The DSM 5 Criteria for Schizophrenia is as follows:

A.  Characterized by two or more of the following:
1.  Delusions
2.  Hallucinations
3.  Disorganized speech
4.  Gross disorganized or catatonic behavior
5.  Negative symptoms (affective flattening, alogia, or avolition)

B.  For a significant portion of the time since the onset of the disturbance, one or more of the major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset.  When onset is in childhood or adolescence:  failure to achieve expected level of interpersonal, academic, or occupational achievement

C.  Continuous signs of disturbance persist for at least 6 months.  The six months of symptoms must include one mont of symptoms that meet criterion A

D.  Schizoaffective disorder and mood disorder with psychotic features have been ruled out

E.  The disturbance is not due the direct physiologic effects of a substance such as drug abuse or medication or due to a general medical condition

F.  If the patient has a history of autistic disorder or other pervasive developmental disorder, the diagnosis of schizophrenia is is made only if prominent delusions or hallucinations are also present for at least one month

-People with schizophrenia present with several areas of symptoms such as:
1.  Positive symptoms (exaggeration of normal processes, distortion of symptoms, hallucinations, and delusions)
2.  Negative symptoms (conceptualized as an absence or diminution of normal processes, decreased expressiveness, apathy, flat affect, and lack of energy)
3.  Cognitive impairment
4.  Mood symptoms
5.  Anxiety

-Anti-psychotic medications are first line treatment for schizophrenia and have been shown to reduce positive symptoms

-Patients should be observed on a stable dose of antipsychotic medications for 2-6 weeks before concluding the medication is ineffective

-Antipsychotic medication should be continued indefinitely after the acute phase is passed at the lowest effective dose