PSYCHOTIC DISORDERS

What is psychosis? It is impairment in reality testing .A person that has psychosis is unable to recognize illness related distortions in perception and thinking.

The characteristic symptoms of schizophrenia are
- Delusions (fixed, false belief)
- Hallucinations (hear or see things that other people cannot)
- Disorganized speech
- Disorganized behavior
- No affect or volition


The symptoms of the disorder should be present for at least a month and it should affect one or more major areas of functioning such as work, interpersonal relations or self care. Suicide is a problem as 50% of patients with psychosis will attempt suicide and 10% do complete suicide .If a person has suicidal thoughts due to their psychosis it is imperative to call for help, call 911 or take the person to the nearest emergency room. Violence is also associated with mental disorders, while in an uncomplicated patient it is no more than the general population; it is definitely 3-4 times if mental illness is also associated with illicit substance /drug use.

Schizophrenia is present in approximately 0.5-1.5% of adults and is equally present in men and women. It is also one of the disorders which has equal prevalence around the world .It is one of the more disabling conditions in psychiatry .The good news is diagnosed early on and treated appropriately it does not have to be associated with this degree of dysfunction.

Researches are working on biological markers to diagnose people at risk so they can be initiated into treatment early on before the dysfunction sets in. It's not known what causes schizophrenia. However, researchers believe that an interaction of genetics and environment may cause schizophrenia. Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't fully certain about the significance of these changes, they support evidence that schizophrenia is a brain disease. It has a genetic predisposition, the first degree relatives have a 10 fold risk of developing schizophrenia than the general population.. Monozygotic twins having a 50-50 chance of having the disorder and if both parents have schizophrenia, the risk to their offspring is as high as 75%.Some relatives of individuals with schizophrenia have an increased risk for a group of mental disorders termed the schizophrenia spectrum.

Schizophrenia onset is usually at an early age –early to mid twenties in men and about a decade later in women. The onset of the disorder maybe sudden ,for example if a child goes to boot camp or to school –the stress of that might be enough to bring about a psychotic episode in one who is predisposed to it .The onset maybe more gradual for others –slow deterioration in functioning ,etc. The precipitating event might be separation, use of drugs or other emotional trauma e.g. death of a loved one. Majority of the patient with schizophrenia have a prodromal phase in which they might present with symptoms of anxiety, perplexity, terror or even depression.

It is important to recognize and treat schizophrenia because left untreated it only gets worse. Unfortunately most patients with schizophrenia do not recognize that they are sick or that they need help .In that case a trusted and loved family member might be the one who will bring patient to treatment.

The mainstay of the treatment of schizophrenia is medications that I will talk about next week, however therapy, case management, family involvement are all equally important to stabilize and maintain the patient in health.

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