Psychosis Intervention

1
Psychosis
Intervention

• Family Practice Academic 1/2 day
• Dr. Jillian Parsons
• September 16th, 2003

2
Psychotic Disorders

• Definition break from reality
• Disorganized emotional processes
• difficulty with interpersonal relationships and
  day to day functioning
• features of hallucinations and delusions

3
Psychotic symptoms

• Abnormal form and content of thought
• perceptual disturbances
• alteration in emotions and behavior
• A Formal Thought Disorder
• Speech affected by Derailment,
  
• tangentially
• incoherence

4
Psychosis can be

• Part of an underlying disease or disease in
  itself
• Must rule out a host of differentials including
• affective disorder with psychotic features
• personality disorders
• general medical conditions
• substance abuse disorders

5
Prototype Schizophreniabut other psychotic
disorders to consider

• Brief Psychotic disorder
• Schizophreniform disorder
• Schizoaffective disorder
• Delusional disorder
• Shared Psychotic disorder

6
Schizophrenia- a constellation of symptoms

• Abnormalities in thinking, emotions, and behavior
• 1-2 population risk 1st degree relative risk
  4-9
• peak age of onset 15-54 years
• male peak 15-25yrs female peak 25-35yrs
• Genetic predisposition and environmental trigger
• Possible links to major life stressor, small
  social circle, decreased family intimacy and
  decreased intimate contacts

7
Diagnosis

• DSM - IV diagnosis criteria
• requires 1 month duration with deteriorating
  course
• prodrome often seen retrospectively
• Prodromal symptoms includedecreased attention,
  exaggeration of normal idiosyncrasies, decreased
  emotional and social responsiveness, decrease in
  general upkeep and appearance, speech changes and
  increased incoherence

8
Often Seen Behaviors

• Decreased personal upkeep/appearance
• Echolalia
• Verbigeration and stilted language
• Mannerisms
• Stuporous
• Echopraxia
• Negativism
• Stereotypy
• decrease emotional response increased
  sensitivity
• Anhedonia/ Disinhibiton

9
Subtypes of Schizophrenia

• Catatonic - rigidity, posturing, motor
  abnormalities
• Paranoid - mainly paranoia
• disorganized - flat affect, disorganized speech
  and behavior
• undifferentiated type

10
Subtypes of symptoms

• Positive symptoms those added to base
  personality - hallucinations, delusions, bizarre
  behaviour.
• More dramatic in presentation
• Negative symptoms things less than most normal
  personalities. Emotional blunting, flat affect,
  apathy, avolution.
• Each person may have 1 or the other
  predominantly, or a combination particular to them

11
Key Features

• Hallucinations experiencing of a stimuli with no
  external stimulus
• visual hallucinations - rare, only in
  schizophrenia
• auditory hallucinations - more common
• Delusions False beliefs
• Mood congruent or incongruent delusions
• Many types of common delusions

12
Types of Delusions

• Paranoia
• Delusions of reference
• Being controlled
• Thought broadcasting
• Thought insertion/withdrawal
• Jealousy
• Guilt
• Grandiosity
• Religious
• Somatic beliefs

13
Poor Prognostic Factors

• Male
• 15-25 years at onset
• Relapsing course
• Associated major life stressors
• ?lower socioeconomic status

14
Good Prognostic Factors

• Female
• Older age at onset
• Acute onset
• High premorbid functioning
• Absence of flat affect

15
Treatment Options

• Acutely hospitalization
• chronically frequent follow-up
• Both low rate of return to premorbid status
• Neuroleptics - Typical and Atypical
• Psychosocial counseling/therapy

16
Typical Antipsychotic Drugs

• Neuroleptics haloperidol, chlorpromazine,
  thioridazine
• Extrapyramidal side effects
• Bradykinesia
• Acute dystonia- ocular gyric crises
• Akathasia restlessness
• Tardive Dyskinesia gt late onset chorea

17
Other Medication Options

• Atypical Antipsychotics
• Lower extrapyramidal side effects
• Clozapine - Zyprexa
• Zidus form is quick acting for acute situations