Psychoses: Nature.

Causes, symptoms and treatment

Nature of psychoses:
 Absence of insight
 Disoriented to time, place and person
 Cannot maintain personal care
 Disorganized behavior
 Presence of delusion and hallucination
 Abnormal thoughts and feelings

Psychotic disorders are a group of serious illnesses that affect the mind. They make it hard for
someone to think clearly, make good judgments, respond emotionally, communicate effectively,
understand reality, and behave appropriately.
When symptoms are severe, people with psychotic disorders have trouble staying in touch with
reality and often are unable to handle daily life.

Types:
There are different types of psychotic disorders, including:
 Schizophrenia
 Schizoaffective disorder
 Schizophreniform disorder
 Delusional disorder
 Substance-induces psychotic disorder
 Psychotic disorder due to another medical condition
 Paraphrenia

Schizophrenia
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and
behaves. People with schizophrenia may seem like they have lost touch with reality.

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Symptoms
Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have
schizophrenia too.
The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.

Positive symptoms:
“Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with
positive symptoms may “lose touch” with some aspects of reality. Symptoms include:
 Hallucinations
Hearing voices is much more common than seeing, feeling, tasting, or smelling
things which are not there, however, people with schizophrenia may experience a
wide range of hallucinations.
 Delusions
The patient has false beliefs which can take many forms, such as delusions of
persecution, or delusions of grandeur. They may feel others are attempting to
control them through remote control. Or, they may think they have extraordinary
powers and gifts.
 Thought disorders (unusual or dysfunctional ways of thinking)
 Movement disorders (agitated body movements)

Negative symptoms:
“Negative” symptoms are associated with disruptions to normal emotions and behaviors. These
refer to elements that are taken away from the individual. Symptoms include:
 “Flat affect” (reduced expression of emotions via facial expression or voice tone)
 Reduced feelings of pleasure in everyday life
 Difficulty beginning and sustaining activities
 Reduced speaking

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Cognitive symptoms:
For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are
more severe and patients may notice changes in their memory or other aspects of thinking.
Symptoms include:
 Poor “executive functioning” (the ability to understand information and use it to make
decisions)
 Trouble focusing or paying attention
 Problems with “working memory” (the ability to use information immediately after
learning it)

Other symptoms may include:

 Lack of motivation (avolition) - the patient loses their drive. Everyday actions, such as
washing and cooking, are abandoned.
 Social withdrawal - when a patient with schizophrenia withdraws socially, it is often
because they believe somebody is going to harm them.
 Unaware of illness - as the hallucinations and delusions seem so real for patients, many of
them may not believe they are ill. They may refuse to take medication for fear of side-
effects, or for fear that the medication may be poison, for example.

Criteria for the diagnosis of Schizophrenia (DSM-IV-TR)

A. Two or more of the following symptoms, present for a significant portion of time during a 1
month period (less if successfully treated)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized behavior
5. Negative symptoms
(Only one symptom is required if the delusions are bizarre or if the hallucinations consists of a
voice.
B. Dysfunctions in work, self-care, interpersonal relations
C. Signs of disturbances for at least 6 months, with at least 1 month of symptoms listed above.

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Sub-types of Schizophrenia
1. Paranoid type
2. Disorganized type
3. Catatonic type
4. Undifferentiated type
5. Residual type

1. Paranoid Schizophrenia:
It is characterized by delusions that have been themes of suspiciousness, persecution or
grandeur. For example, the individual may become extremely suspicious that everyone at work is
trying to kill him or her. Or that he/she possess some profound or even divine powers.
Hallucination will often accompany with these delusion often reinforcing the false beliefs.

Criteria for Paranoid schizophrenia (DSM-IV-TR)

 Preoccupation with delusions or frequent auditory hallucinations
 No evidence of marked disorganized speech, disorganized or catatonic behavior,
flat or inappropriate affect

2. Disorganized Schizophrenia:
It was previously known as hebephrenia. A particularly severe (although also less
common) type of schizophrenia characterized by incoherent behaviors, thoughts and affects.
There is extreme loosening of association. The individual seems to become increasingly
indifferent and infantile. Giggling, silliness, weeping, anger amd other reactions inappropriate to
the situations are common. In some cases, the incoherence progress to the point where the person
“makes no sense at all”

Criteria for Disorganized schizophrenia (DSM-IV-TR)

 Disorganized speech
 Disorganized behavior
 Flat or inappropriate affect
 No evidence of catatonic schizophrenia

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3. Catatonic Schizophrenia:
The essential feature is serious motor behavior disturbance. Such disturbance can take
various forms.
o Stupor - Marked decrease in responsiveness to environment, reduction in
spontaneous movement, mutism
o Negativism - Resistance to all instructions or attempts to be moved
o Rigidity – Maintaining a rigid posture against all efforts to be moved
o Excitement – Purposeful and excited activity and movements in which the patient
may mimic sounds (echolalia) or movements (echopraxia) around them.

Criteria for catatonic schizophrenia (DSM-IV-TR)

 Immobile body or stupor
 Excessive motor activity that is purposeless and unrelated to outside stimuli
 Extreme negativism (resistance to being moved, or to follow instructions) or
mutism
 Echolalia or echopraxia

4. Undifferentiated Schizophrenia
It is a waste basket category. Those individuals who do not fit neatly into the other
categories but who do show prominent psychotic symptoms (delusion, hallucination,
incoherence, grossly disorganized)

Criteria for undifferentiated according to DSM-IV-TR

 Symptoms of schizophrenia that do not meet criteria for the paranoid,
disorganized or catatonic types.

5. Residual Schizophrenia
A category reserved for those individuals who have at least one episode of schizophrenia,
but where there are no prominent symptoms. The individual exhibits following signs of disorder.
 Marked social isolation or withdrawal
 Inappropriate affects

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  Illogical thinking
 Mild loosening of association

Criteria for Residual (DSM-IV-TR)

 Absence of prominent delusions, hallucinations, disorganized speech, and grossly
disorganized or catatonic behavior
 Continued evidence of schizophrenia (example: negative symptoms) or mild
psychotic symptoms (example: odd beliefs, unusual perceptual experiences)

Other Psychotic Disorders

1. Schizoaffective disorder:
This diagnosis is conceptually something of a hybrid in that it is used to describe people
who have features of schizophrenia and severe mood disorder. It is a mental disorder in which a
person experiences a combination of schizophrenia symptoms, such as hallucinations or
delusions, and mood disorder symptoms such as depression or mania.
Symptoms:
 Delusion
 Hallucination
 Symptoms of depression such as feeling empty, sad or worthless
 Periods of manic mood or a sudden behavior that is out of character
 Impaired occupational, academic and social functioning

2. Schizophreniform disorder:
The characteristic symptoms of schizophrenia disorder are identical to those of
schizophrenia, but schizophreniform disorder is distinguished by its duration. The symptoms
lasts less than 6 months.
Symptoms same as schizophrenia.

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3. Delusional disorder
Delusional disorder is characterized by the presence of delusions which have persisted for
at least one month. Themes of delusions may fall into the following types:
 Erotomanic type: Patient believes that a person, usually of higher social standing,
is in love with the individual
 Grandiose type: patient believes that he/she has some great but unrecognized
talent, power or special relationship with God.
 Jealous type: Patient believes his/her partner has been unfaithful
 Persecutory type: Patient believes he/she is being spied, followed.

4. Substance-induced psychotic disorder:

This condition is caused by the use of or withdrawal from drugs, such as hallucinogens
and crack cocaine that cause hallucinations, delusions, or confused speech.

5. Psychotic disorder due to another medical condition:

Hallucinations, delusions, or other symptoms may happen because of another illness that
affects brain function, such as a head injury or brain tumor.

6. Paraphrenia: This condition has symptoms similar to schizophrenia. It starts late in life,
when people are elderly.

Causes of Schizophrenia/Psychotic disorder

The cause of schizophrenia is still unclear. Some theories about the cause of this disease include:
genetics (heredity), biology (abnormalities in the brain’s chemistry or structure); and/or possible
viral infections and immune disorders along with some drugs.

 Genetics (Heredity)
Scientists recognize that the disorder tends to run in families and that a person inherits a
tendency to develop the disease. Similar to some other genetically-related illnesses,
schizophrenia may appear when the body undergoes hormonal and physical changes (like those

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that occur during puberty in the teen and young adult years) or after dealing with highly stressful
situations.

 Biology
Chemistry - Scientists believe that people with schizophrenia have an imbalance of the brain
chemicals or neurotransmitters: dopamine, glutamate and serotonin. These neurotransmitters
allow nerve cells in the brain to send messages to each other. The imbalance of these chemicals
affects the way a person’s brain reacts to stimuli--which explains why a person with
schizophrenia may be overwhelmed by sensory information (loud music or bright lights) which
other people can easily handle. This problem in processing different sounds, sights, smells and
tastes can also lead to hallucinations or delusions.
Structure - Some research suggests that problems with the development of connections and
pathways in the brain while in the womb may later lead to schizophrenia.

 Viral Infections and Immune Disorders

Schizophrenia may also be triggered by environmental events, such as viral infections or immune
disorders. For instance, babies whose mothers get the flu while they are pregnant are at higher
risk of developing schizophrenia later in life. People who are hospitalized for severe infections
are also at higher risk.

 Some drugs
Cannabis and LSD are known to cause schizophrenia relapses. For people with a predisposition
to a psychotic illness such as schizophrenia, usage of cannabis may trigger the first episode.
Some researchers believe that certain prescription drugs, such as steroids and stimulants, can
cause psychosis.

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Treatment
Because the causes of schizophrenia are still unknown, treatments focus on eliminating the
symptoms of the disease. Treatments include:

 Medication: The main type of drug that doctors prescribe to treat psychotic disorders are
“antipsychotics.” Although these medicines aren’t a cure, they are effective in managing
the most troubling symptoms of psychotic disorders, such as delusions, hallucinations,
and thinking problems.

 Psychotherapy: There are different types of counseling -- including individual, group,

and family therapy – that can help someone who has a psychotic disorder.

Most people with psychotic disorders are treated as outpatients, meaning they don’t live in
institutions. But sometimes people need to be hospitalized, such as if they have severe
symptoms, are in danger of hurting themselves or others, or can’t care for themselves because of
their illness.

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