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Psychotic disorders

Psychotic disorders

A psychotic disorder is a pathological mental health state where people lose their intact sense of reality due to their disturbed judgment of their own selves and the surroundings. People with psychosis are described as psychotic. People experiencing psychosis may exhibit some personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities.

There are different types of psychotic disorders, such as:

  • Schizophrenia: Patients with this condition show deviation in their behaviors and other symptoms- delusional ideation and hallucinations-lasting more than six months, usually followed with decline in their function in job, school, and other social settings.
  • Schizoaffective Disorder: Patients with this condition show symptoms of both Schizophrenia and other affective disorder such as Depression or Mania.
  • Brief Psychotic Disorder: Patients with this condition show unexpected, brief in duration psychotic behavior, often related to an intense life stressor such as death in family. The recovery is often short-usually less than a month-and complete.
  • Delusional Disorder: People with this condition show delusional thoughts related to everyday instances that could resemble reality such as being followed, or that others plot conspiration against them or having a somatic condition. These ideas usually last for more than a month.
  • Shared Psychotic Disorder: This condition takes place when someone develops delusional ideas in the context of a relation with another person that already holds his own delusions.
  • Psychotic Disorder due to drugs: This condition appears in relation to the use or the abrupt discontinuation of drugs in a person already dependent on them. Usually these drugs can be alchool, cannabis, opiods, cocaine etc.
  • Psychotic Disorder due to medical condition: Hallucinations, delusional ideas or other symptoms can relate to other medical conditions affecting brain function such as traumatic brain injury, brain cancer etc.

People with psychosis normally have one or more of the following: hallucinations, delusions, catatonia, or a volition disorder. Impairments in social cognition also occur.

A hallucination is defined as a sensory perception in the absence of external stimuli. Hallucinations are different from illusions, or perceptual distortions, which are the misperception of external stimuli. Hallucinations may occur in any of the senses and take on almost any form, which may include simple sensations (such as lights, colors, tastes, and smells) to experiences such as seeing and interacting with fully formed animals and people, hearing voices, and having complex tactile sensations.

The exact cause of psychotic disorders is not known, but researchers believe that many factors may play a role. Some psychotic disorders can occur due to hereditary causes. Environmental factors may also play a role in their development, including stress, substance abuse and major changes in person’s life. In addition, people with psychotic disorders may have incomplete balance of certain chemicals in the brain. The most commonly affected are dopamine and glutamatergic acid.

Approximately 1% of the population worldwide suffer from psychotic disorders. These disorders most often first appear when the person is in his late teens, 20 ‘s or 30 ‘s. They affect both sexes roughly the same with light greater prevalence in men.

Most of the psychotic disorders are treated with the combination of medication and psychotherapy.

Medication

The main medications used in the treatment of psychotic disorders are the antipsychotics. These drugs do not cure the disorder but help to control the symptoms such as delusions, hallucinations and the exaggerated behavior. Generally speaking, the antipsychotics are divided into 2 categories depending on their pharmacological mechanism; the typical (aloperidol,thioridazine) which are the older but equally efficient and the atypical (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole) thought to cause less side effects and to be more efficient in improving symptoms such as avolition, social alienation, flattening of affect. The controversy is that the atypical ones are blamed to cause metabolic side effects (weight increase, diabetes, high cholesterol levels).

Typical antipsychotics help to control symptoms such as:

  • Hallucinations
  • Delusions
  • Confusion
  • Disorganised thought and speech

Moderate adverse effects can include:

  • Dry mouth
  • Blurred vision
  • Constipation
  • Somnolence
  • Dizziness

More serious side effects are:

  • Difficulty in controlling muscles with involuntary contractions
  • Stiffness
  • Tremor
  • Restlessness
  • Erectile dysfunction

But there are new medications, often called atypical or new generation antipsychotics, such as Risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), Ziprasidone (Geodon), Clozapine (Leponex), Sertindol (Serdolect), Aripiprazole (Abilify), paliperidone (Invega). The later drugs are now used at the forefront of pharmacotherapy because they are considered to have fewer and more tolerable side effects. Plus, they target to symptoms such as:

  • Social isolation
  • Avolition
  • Blunted affect

These medications can cause weight gain and raise the risk for diabetes and high cholesterol.

Psychotherapy

In psychotic disorders some types of psychotherapies can be used. The most common of them are the individual, the group and even the family therapy. The individual therapy has a supportive and counseling character and can be implemented with psychoeducation and cultivation of social skills. The majority of the psychotic patients are treated on outpatients basis. But patients with severe symptoms, those who are in danger of harming themselves or others, may need to be admitted in a clinic up until their state stabilize.

The response of the treatment varies. Some psychotic patients will show instant response and full recovery. Others may need a substantial period up until months so as to gain recovery and relief from their symptoms. Finally there is a portion of nearly a third of the total patients who would not fully recover from the psychotic state. Generally speaking even if the patient fully recovers from a full blown psychotic episode, a long term prophylactic treatment is recommended. A last issue is that not all therapies work for each patient. So a sincere and close relationship with the psychiatrist is of critical importance.

Generally, there is no known way to predict most of the psychotic disorders but many of the related symptoms can be prevented by early detection and treatment. The search for treatment once symptoms appear, can help to reduce the negative effects on patient’s life, family and relations.

“Για την ψυχή που νοσεί φάρμακο είναι ο λόγος”

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