Psychotic Disorders

Psychosis

Distorted perception of reality, which may be accompanied by delusions, perceptual disturbances, and disorganized thinking/behavior

Delusions

Fixed, false beliefs that persist despite evidence to the contrary and that do not make sense within the context of an individual’s cultural background

Bizarre

False and impossible delusions

“Aliens are spying on me through a WIFI connection in my brain”

Nonbizarre

False and plausible, but still not true delusions

“The neighbors are spying on me by reading my email”

Persecution

Irrational belief that one is being persecuted

“The CIA is monitoring me and tapped my cell phone”

Ideas of Reference

Beliefs that cues in external environment are uniquely related to the individual

“The TV characters are speaking directly to me”

Control

Includes thought broadcasting, which is the belief that one’s thoughts can be heard by others, and thought insertion, which is the belief that outside thoughts are being placed in one’s head

Grandeur

Belief that one has special powers beyond those of a normal person

“I am the all powerful son of God”

Guilt

Belief that one is guilty or responsible for something

“I am responsible for all the world’s wars”

Somatic

Belief that one has a certain illness or health condition

i.e. a patient believing she is pregnant despite negative pregnancy tests and US

Illusion

Misinterpretation of an existing sensory stimulus, such as mistaking a shadow for an evil spirit

Hallucination

Sensory perception without an external stimulus

Delusional Disorder

A condition defined by 1+ delusion lasting > 1 month, where functioning in life is not significantly impaired and behavior is not obviously bizarre

-Does not meet the criteria for schizophrenia

Erotomanic

Delusions another person is in love with them

Grandiose

Delusions of having great talent

Somatic

Physical delusions

Persecutory

Delusions of being persecuted

Jealous

Delusions of unfaithfulness

Antipsychotics

What class of medications are indication in delusional disorder?

Mesolimbic

What pathway is being described?

-Projections from ventral tegmental area to nucleus accumbens in the limbic system

-Functions in pleasure and reward

-Dopamine hyperactivity in the mesolimbic pathway, leading to + symptoms

Mesocortical

What pathway is being described?

-Projections from the ventral tegmental area to tegmentum prefrontal cortex

-Functions in cognition, executive function, emotions, and affect

-Dopamine hypoactivity in mesocortical pathway leads to negative symptoms

Nigrostriatal

What pathway is being described?

-Projections from substantia nigra to dorsal striatum

-Functions in coordination of voluntary movement

-Dopamine hyperactive in nigrostriatal pathway leads to hyperkinetic movement

-Dopamine hypoactivity leads to EPS/TD

Tuberoinfundibular

What pathway is being described?

-Projections from hypothalamus to median eminence

-Functions to release dopamine into portal circulation, connecting median eminence with anterior pituitary, inhibiting prolactin release

-Causes menstrual irregularities, infertility, galactorrhea, decreased libido, sexual dysfunction (hyperprolactinemia)

Schizophreniform Disorder

A disorder that meets criterion (A) of schizophrenia lasting > 1 mo but < 6 mo

-Treat with hospitalization, 6mo course of antipsychotics, supportive psychotherapy

Schizoaffective Disorder

A disorder classified by MDE or manic episode concurrent with Criterion (A) of schizophrenia

• > 2 weeks of delusions/hallucinations without concurrent depression/mania

• Tx is hospitalization, supportive psychotherapy, medications

Brief Psychotic Disorder

A disorder, usually caused by severe psychological stress, characterized by 1 sx lasting > 1 day but < 1 month. One symptom must be 1/2/3:

• (1) Delusions

• (2) Hallucinations

• (3) Disorganized speech

• (4) Disorganized or catatonic behavior

-Treatment is brief hospitalization, supportive therapy, course of APs for psychosis, or benzos for agitation

Schizophrenia

A condition characterized by 3 phases- prodromal, psychotic, and residual. Classified by 2+ sx lasting > 1 month (A):

• Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative sx

-(B) Significant functional deterioration in 1+ major area

-(C) Continuous signs of disturbance > 6 months with >1 month of symptoms meeting criteria A