Disease: Psychotic Disorders

    Psychotic disorder facts

    • Psychotic disorders include schizophrenia and a number of lesser-known disorders.
    • The number of people who develop a psychotic disorder tends to vary depending on the country, age, and gender of the sufferer, as well as on the specific kind of disorder.
    • There are genetic, biological, environmental, and psychological risk factors for developing a psychotic disorder.
    • Usually with any psychotic disorder, the person's inner world and behavior have notably changed.
    • When assessing a person suffering from psychotic symptoms, health-care professionals will take a careful history of the symptoms from the person and loved ones as well as conduct a medical evaluation, including necessary laboratory tests and a mental-health assessment.
    • Most effective treatments for psychotic disorders are comprehensive, involving appropriate medications, mental-health education, and psychotherapy for the sufferer of psychosis and his or her loved ones. It will also include the involvement of community supportive services when needed.
    • Prevention of psychosis primarily involves preventing or decreasing the impact of factors that put the person at risk for developing a psychotic disorder.

    What are the different types of psychotic disorders?

    Psychotic disorders are now referred to as schizophrenia spectrum and other psychotic disorders. In addition to the more commonly known mental disorders like schizophrenia, other mental disorders in this group include brief psychotic disorder, schizotypal personality disorder, delusional disorder, schizophreniform disorder, schizoaffective disorder, catatonia, substance/medication-induced psychotic disorder, psychosis due to a medical condition, other specified schizophrenia spectrum, unspecified schizophrenia spectrum, and other psychotic disorder. Besides catatonia, other catatonia-related disorders include catatonic disorder due to another medical condition, as well as unspecified catatonia. Women who recently had a baby (are in the postpartum state) may uncommonly develop postpartum psychosis. Also, mood disorders like major depressive disorder and bipolar disorder can become severe enough to result in psychotic symptoms like hallucinating or having delusions, also called psychotic features.

    How common are psychotic disorders?

    The percentage of people who suffer from any psychotic symptom at any one time (prevalence) varies greatly from country to country, from as little as 0.66% in Vietnam to 45.84% in Nepal. While the figure of one out of 100 people who qualify for the diagnosis of schizophrenia may sound low, that translates into about 3 million people in the United States alone who have schizophrenia. The first time a person has psychotic symptoms is usually between the ages of 18 and 24 years; related but less severe (prodromal) symptoms often start during the teenage years. Statistics for postpartum psychosis include that it occurs in one or two out of 1,000 births but increases greatly, up to one in seven mothers, in women who had postpartum psychosis in the past. Men are thought to develop psychotic disorders more often and at younger ages than women.

    What are causes and risk factors for psychotic disorders in children, teenagers, and adults?

    Except for those psychotic disorders that result from the use of a substance or a medical condition, specific causes for most psychotic disorders are not known. However, the interplay of genetic (familial), biological, environmental, and psychological factors is thought to be involved. We do not yet understand all of the causes and other issues involved, but current research is making steady progress toward elucidating and defining causes of psychosis. For example, schizophrenia and bipolar disorder are thought to have many risk factors in common.

    In biological models of psychotic disorders, genetic predisposition, infectious agents, toxins, allergies, and disturbances in metabolism have all been investigated. Psychotic disorders are known to run in families. For example, the risk of the illness in an identical twin of a person with schizophrenia is 40%-50%. A child of a parent suffering from schizophrenia has a 10% chance of developing the illness, in contrast to the risk of schizophrenia in the general population being about 1%. Toxins like ketamine or marijuana increase the risk of developing psychosis.

    The current concept is that multiple genes are involved in the development of schizophrenia and that risk factors such as prenatal (intrauterine), perinatal (around the time of birth), and nonspecific stressors are involved in creating a disposition or vulnerability to develop the illness. Neurotransmitters (chemicals allowing the communication among nerve cells) have also been implicated in the development of psychotic disorders. The list of neurotransmitters under scrutiny is long, but special attention has been given to dopamine, serotonin, and glutamate.

    Also, recent research studies have identified subtle changes in brain structure and function, indicating that, at least in part, schizophrenia could be a disorder of the development of the brain. The fact that autism is a risk factor for developing psychosis during childhood seems to support that theory. Psychosis is more likely to occur in people who have poor medical health in a general sense or who suffer from another mental illness.

    Environmental risk factors, like a history of problematic drinking, using tobacco, marijuana, or other drugs, have been associated with the development of a psychotic disorder.

    There are a number of genetic, medical, psychological, and social risk factors for psychotic disorders. Women who have recently delivered a baby (in the postpartum state) are at risk for a number of mental-health problems, including postpartum psychosis. More than 25% of mothers with bipolar disorder may develop postpartum psychosis, and more than half of those who have both a personal history of bipolar disorder and a family history of postpartum psychosis may develop the condition. Children of mothers with a psychotic disorder may experience more than the genetic risk of developing a psychotic disorder if their birth or mother's pregnancy with them had problems like infections, high blood pressure, or problems with the placenta.

    Psychological risks for developing a psychotic disorder include a history of mood problems, like an anxiety disorder, major depression, or bipolar disorder and trouble functioning socially or generally. Individuals who tend to be suspicious of others or to have unusual thoughts are also more likely to develop a psychotic disorder. Studies show that women with postpartum psychosis are often victims of domestic violence or abusive childhoods and often have histories of abandonment or substance abuse. Children, teens, or adults who have endured more negative life events, have poor housing, are more ethnically isolated where they live, or otherwise have little in terms of a support group are at higher risk for developing a psychotic disorder.

    What are psychotic disorder symptoms and signs?

    Usually with any psychotic disorder, the person's inner world and behavior notably change.

    Behavior changes might include the following:

    • Social withdrawal
    • Agitation or anxiety
    • Depersonalization (intense anxiety and a feeling of being unreal)
    • Loss of appetite
    • Worsened hygiene
    • Disorganized speech and behaviors
    • Catatonic behavior, in which the affected person's body may be rigid and the person may be unresponsive

    Changes/problems with thinking that may occur in a psychotic disorder include

    • delusions (beliefs with no basis in reality),
    • hallucinations (for example, hearing, seeing, or perceiving things not actually present),
    • the sense of being controlled by outside forces,
    • disorganized thoughts.

    A person with a psychotic disorder may not have any outward characteristics of being ill. In other cases, the illness may be more apparent, causing bizarre behaviors. For example, a person suffering from psychosis may wear aluminum foil in the belief that it will stop one's thoughts from being broadcasted and protect against malicious waves entering the brain.

    People with psychosis vary widely in their behavior as they struggle with an illness beyond their control. Some may ramble in illogical sentences or react with uncontrolled anger or violence to a perceived threat. Characteristics of a psychotic disorder may also include phases in which the affected individuals seem to lack personality, movement, and emotion (also called a flat affect). People with a psychotic disorder may alternate between these extremes. Their behavior may or may not be predictable.

    In order to better understand psychotic disorders, the concept of clusters of symptoms is often used. Thus, people with psychosis can experience symptoms that may be grouped under the following categories:

    • Positive symptoms: hearing voices or otherwise hallucinating, suspiciousness, feeling under frequent or constant surveillance, delusions, or making up words without a meaning (neologisms)
    • Negative (or deficit) symptoms: social withdrawal, difficulty in expressing emotions (in extreme cases called blunted affect), difficulty in taking care of themselves, inability to feel pleasure (These symptoms cause severe impairment.)
    • Cognitive symptoms: difficulties attending to and processing information, in understanding the environment, and in remembering simple tasks
    • Affective (or mood) symptoms: often manifested by depression, accounting for a very high rate of attempted suicide in people suffering from schizophrenia and other psychotic disorders

    Postpartum psychosis usually develops within the first three months after childbirth, often within three to 14 days. Symptoms may include auditory or visual hallucinations, delusions, or rapid mood swings. The hallucinations may have themes of violence toward herself or her baby. This condition may be associated with significant problems in thinking, ranging from mental confusion and indecision to intrusive and bizarre thoughts. Also, symptoms can arise and disappear suddenly, with the mother appearing lucid one moment and psychotic the next.

    How are psychotic disorders diagnosed?

    In order to determine whether the diagnosis of a psychotic disorder is warranted, the health-care professional has to first consider if a medical illness may be the cause of the behavioral changes. If a medical cause is identified or the psychosis is found to be the result of exposure to a medication or drug, the sufferer is assessed as having psychotic disorder due to a medical condition or psychotic disorder due to toxin exposure or withdrawal, respectively. On the other hand, if a medical cause and toxin exposure have been looked for and not found, a psychotic illness such as schizophrenia could be considered. The diagnosis will best be made by a licensed mental-health professional (like a psychiatrist) who can evaluate the patient and carefully sort through the diagnostic criteria for a variety of mental illnesses that might look alike at the initial examination, like schizotypal or schizoid personality disorder, severe depression, or the manic phase of bipolar disorder.

    • The physician will examine someone in whom psychosis is suspected either in an office, in an emergency department, or a hospital. The physician's role is to ensure that the psychosis sufferer doesn't have any medical problems, including active drug use, since these conditions can mimic the symptoms of a psychotic disorder. The doctor takes the patient's history and performs a physical examination. Laboratory and other tests, sometimes including a computerized tomography (CT) scan of the brain, are performed. Physical findings can relate to the symptoms associated with psychosis or to the medications the person may be taking.
      • People with a psychotic disorder can exhibit signs of mild confusion or clumsiness.
      • Subtle physical features, such as highly arched palate or wide or narrow set eyes, have been described in psychotic disorders, but none of these findings alone allow the physician to make the diagnosis.
    • Generally, results are normal for most psychotic disorders for the lab tests and imaging studies available to most doctors. If the person has a particular behavior as part of their mental disorder, such as drinking too much water, then this might show as a metabolic abnormality in the person's laboratory results.

    Family members or friends of the person with psychosis can help by giving the doctor a detailed history and information about the patient, including recent life stressors, behavioral changes, previous level of social functioning, history of mental illness in the family, past medical and psychiatric problems, medications, and allergies (to foods and medications), as well as the person's previous physicians and psychiatrists. A history of hospitalizations is also helpful so that prior records at these facilities might be obtained and reviewed.

    The diagnosis of another psychotic disorder may be distinguished from schizophrenia based on the duration of symptoms (as with brief psychotic disorder), the specific kind of psychotic symptoms that occur with delusional disorder, the type of nonpsychotic symptoms that occur with it as with schizoaffective disorder, or what causes it, as with substance/medication-induced psychotic disorder and psychosis due to a medical condition. The diagnosis of other specified schizophrenia spectrum and other psychotic disorder is reserved for those individuals who have some psychotic symptoms but do not qualify for a specific psychotic diagnosis. Women who recently had a baby (are in the postpartum state) may uncommonly develop postpartum psychosis. Also, a neurosis like major depressive disorder or bipolar disorder can become severe enough to result in psychosis symptoms, also called psychotic features.

    What are the treatments for psychotic disorders?

    Antipsychotic medications are proven effective in treating acute psychosis and reducing the risk of future psychotic episodes. For example, the treatment of schizophrenia or bipolar disorder with psychotic features thus has two main phases: an acute phase, when higher doses of medication might be necessary in order to treat psychotic symptoms, followed by a maintenance phase, which could be lifelong. During the maintenance phase, the medication dosage is gradually reduced to the minimum required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in dosage may help prevent a relapse.

    Even with continued treatment of the more chronic or recurring psychotic disorders, some patients experience relapses. By far, though, the highest relapse rates for such disorders are seen when medication is discontinued. The large majority of patients experience substantial improvement when treated with antipsychotic agents. Some patients, however, do not respond to medications, and a few may seem not to need them.

    Antipsychotic medications are the cornerstone in the management of psychosis. They have been available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a physician who is well trained and experienced in treating severe mental illness.

    The first antipsychotic was discovered by accident and then used for schizophrenia. This was chlorpromazine (Thorazine), which was soon followed by medications such as haloperidol (Haldol), fluphenazine (Prolixin), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). These medications have become known as "neuroleptics" because, although effective in treating positive symptoms (for example, acute symptoms such as hallucinations, delusions, thought disorders, loose associations, ambivalence, or mood swings/emotional lability), they cause side effects, many of which affect the neurologic (nervous) system. Examples of such neurologic side effects include muscle stiffness or rigidity, painful spasms, restlessness, tremors, and muscle twitches. These older medications are thought to be not as effective against so-called negative symptoms such as decreased motivation and lack of emotional expressiveness.

    Since 1989, a new class of antipsychotics (atypical antipsychotics) has been used. At clinically effective doses, none (or very few) of these neurological side effects of traditional antipsychotics, which often affect the extrapyramidal nerve tracts, are observed.

    Clozapine (Clozaril), the first of the new class, is the only agent that has been shown to be effective in situations where other antipsychotics have failed. Its use is not associated with extrapyramidal side effects, but it does produce other side effects, including a possible decrease in the number of white blood cells. Therefore, blood cell counts need to be monitored every week during the first six months of treatment and then every two weeks to detect this side effect early if it occurs.

    Other atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt), and lurasidone (Latuda). The use of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizophrenia.

    Although more effective and better tolerated, the use of these agents is also associated with side effects, and current medical practice is developing better ways of understanding these effects, identifying people at risk, and monitoring for the emergence of complications.

    Most of these medications take two to four weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, or another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least six to eight weeks (or even longer with clozapine).

    Since people with a psychotic disorder are at increased risk of also developing depression, medications that address that symptom may be of great benefit as well. Serotonergic medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) are often prescribed because of their effectiveness and low incidence of side effects. Other often-prescribed antidepressant medications for the depression that can be associated with psychotic disorders include venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and buproprion (Wellbutrin).

    Because the risk of relapse of illness is higher when antipsychotic medications are taken irregularly or discontinued, it is important that people with a psychotic disorder follow a treatment plan developed in collaboration with their doctors and with their families. The treatment plan will involve taking the prescribed medication in the correct amount and at the times recommended, attending follow-up appointments, and following other treatment recommendations.

    People with psychosis often do not believe that they are ill or that they need treatment. Other possible things that may interfere with the treatment plan include side effects from medications, substance abuse, negative attitudes toward treatment from families and friends, or even unrealistic expectations. When present, these issues need to be acknowledged and addressed for the treatment to be successful.

    What are potential complications of medications used to treat psychotic disorders?

    Many symptoms found in psychotic individuals are related to movement (motor symptoms). Some of these can be side effects of prescribed medications. Medication side effects may, for example, include dry mouth, constipation, drowsiness, stiffness on one side of the neck or jaw, restlessness, tremors of the hands and feet, and slurred speech.

    Tardive dyskinesia is one of the most serious, although quite uncommon, side effects of medications used to treat schizophrenia and other psychotic disorders. It is usually seen in older people and involves facial twitching, jerking, and twisting of the limbs or trunk of the body, or both. It is a less common side effect with the newer generation of medications used to treat schizophrenia. It does not always go away, even when the medicine that caused it is discontinued.

    A rare but life-threatening complication resulting from the use of neuroleptic (antipsychotic, tranquilizing) medications is neuroleptic malignant syndrome (NMS). It involves extreme muscle rigidity, sweatiness, salivation, and fever. If this complication is suspected, it should be treated as an emergency.

    Other potential complications of antipsychotic medications include significant weight gain and sleepiness, depending on the medication. To address weight gain, prescribing physicians often counsel their patients with a psychotic disorder on nutrition and exercise. Dose and timing adjustments may alleviate sleepiness. For pregnant women, the potential risks of the medication to a developing fetus must be balanced with the potential benefit to the mother and fetus of treating the illness.

    Is it possible to treat psychotic disorders without medication?

    In spite of successful antipsychotic treatment, many patients with psychosis have difficulty with motivation, activities of daily living, relationships, and communication skills. Also, since an illness like schizophrenia typically begins during the years critical to education and professional training, these patients lack social and work skills and experience. In these cases, the psychosocial treatments help most, and many useful treatment approaches have been developed to assist people suffering from a psychotic disorder.

    • Individual psychotherapy: This involves regular sessions between just the patient and a therapist focused on past or current problems, thoughts, feelings, or relationships. Thus, via contact with a trained professional, people with psychosis become able to understand more about the illness, to learn about themselves, and to better handle the problems of their daily lives. They can become better able to differentiate between what is real and, by contrast, what is not and can acquire beneficial problem-solving skills.
    • Rehabilitation: Rehabilitation may include job and vocational counseling, problem solving, social skills training, and education in money management. Thus, patients learn skills required for successful reintegration into their community following discharge from the hospital.
    • Family education: Research has consistently shown that people with a psychotic disorder who have involved families have a better prognosis than those who battle the condition alone. Insofar as possible, all family members should be involved in the care of their loved one.
    • Self-help groups: Outside support for family members of those with any psychotic disorder is necessary and desirable. The National Alliance for the Mentally Ill (NAMI) is an in-depth resource. This outreach organization offers information on all treatments for psychosis, including home care.

    What are causes and risk factors for psychotic disorders in children, teenagers, and adults?

    Except for those psychotic disorders that result from the use of a substance or a medical condition, specific causes for most psychotic disorders are not known. However, the interplay of genetic (familial), biological, environmental, and psychological factors is thought to be involved. We do not yet understand all of the causes and other issues involved, but current research is making steady progress toward elucidating and defining causes of psychosis. For example, schizophrenia and bipolar disorder are thought to have many risk factors in common.

    In biological models of psychotic disorders, genetic predisposition, infectious agents, toxins, allergies, and disturbances in metabolism have all been investigated. Psychotic disorders are known to run in families. For example, the risk of the illness in an identical twin of a person with schizophrenia is 40%-50%. A child of a parent suffering from schizophrenia has a 10% chance of developing the illness, in contrast to the risk of schizophrenia in the general population being about 1%. Toxins like ketamine or marijuana increase the risk of developing psychosis.

    The current concept is that multiple genes are involved in the development of schizophrenia and that risk factors such as prenatal (intrauterine), perinatal (around the time of birth), and nonspecific stressors are involved in creating a disposition or vulnerability to develop the illness. Neurotransmitters (chemicals allowing the communication among nerve cells) have also been implicated in the development of psychotic disorders. The list of neurotransmitters under scrutiny is long, but special attention has been given to dopamine, serotonin, and glutamate.

    Also, recent research studies have identified subtle changes in brain structure and function, indicating that, at least in part, schizophrenia could be a disorder of the development of the brain. The fact that autism is a risk factor for developing psychosis during childhood seems to support that theory. Psychosis is more likely to occur in people who have poor medical health in a general sense or who suffer from another mental illness.

    Environmental risk factors, like a history of problematic drinking, using tobacco, marijuana, or other drugs, have been associated with the development of a psychotic disorder.

    There are a number of genetic, medical, psychological, and social risk factors for psychotic disorders. Women who have recently delivered a baby (in the postpartum state) are at risk for a number of mental-health problems, including postpartum psychosis. More than 25% of mothers with bipolar disorder may develop postpartum psychosis, and more than half of those who have both a personal history of bipolar disorder and a family history of postpartum psychosis may develop the condition. Children of mothers with a psychotic disorder may experience more than the genetic risk of developing a psychotic disorder if their birth or mother's pregnancy with them had problems like infections, high blood pressure, or problems with the placenta.

    Psychological risks for developing a psychotic disorder include a history of mood problems, like an anxiety disorder, major depression, or bipolar disorder and trouble functioning socially or generally. Individuals who tend to be suspicious of others or to have unusual thoughts are also more likely to develop a psychotic disorder. Studies show that women with postpartum psychosis are often victims of domestic violence or abusive childhoods and often have histories of abandonment or substance abuse. Children, teens, or adults who have endured more negative life events, have poor housing, are more ethnically isolated where they live, or otherwise have little in terms of a support group are at higher risk for developing a psychotic disorder.

    What are psychotic disorder symptoms and signs?

    Usually with any psychotic disorder, the person's inner world and behavior notably change.

    Behavior changes might include the following:

    • Social withdrawal
    • Agitation or anxiety
    • Depersonalization (intense anxiety and a feeling of being unreal)
    • Loss of appetite
    • Worsened hygiene
    • Disorganized speech and behaviors
    • Catatonic behavior, in which the affected person's body may be rigid and the person may be unresponsive

    Changes/problems with thinking that may occur in a psychotic disorder include

    • delusions (beliefs with no basis in reality),
    • hallucinations (for example, hearing, seeing, or perceiving things not actually present),
    • the sense of being controlled by outside forces,
    • disorganized thoughts.

    A person with a psychotic disorder may not have any outward characteristics of being ill. In other cases, the illness may be more apparent, causing bizarre behaviors. For example, a person suffering from psychosis may wear aluminum foil in the belief that it will stop one's thoughts from being broadcasted and protect against malicious waves entering the brain.

    People with psychosis vary widely in their behavior as they struggle with an illness beyond their control. Some may ramble in illogical sentences or react with uncontrolled anger or violence to a perceived threat. Characteristics of a psychotic disorder may also include phases in which the affected individuals seem to lack personality, movement, and emotion (also called a flat affect). People with a psychotic disorder may alternate between these extremes. Their behavior may or may not be predictable.

    In order to better understand psychotic disorders, the concept of clusters of symptoms is often used. Thus, people with psychosis can experience symptoms that may be grouped under the following categories:

    • Positive symptoms: hearing voices or otherwise hallucinating, suspiciousness, feeling under frequent or constant surveillance, delusions, or making up words without a meaning (neologisms)
    • Negative (or deficit) symptoms: social withdrawal, difficulty in expressing emotions (in extreme cases called blunted affect), difficulty in taking care of themselves, inability to feel pleasure (These symptoms cause severe impairment.)
    • Cognitive symptoms: difficulties attending to and processing information, in understanding the environment, and in remembering simple tasks
    • Affective (or mood) symptoms: often manifested by depression, accounting for a very high rate of attempted suicide in people suffering from schizophrenia and other psychotic disorders

    Postpartum psychosis usually develops within the first three months after childbirth, often within three to 14 days. Symptoms may include auditory or visual hallucinations, delusions, or rapid mood swings. The hallucinations may have themes of violence toward herself or her baby. This condition may be associated with significant problems in thinking, ranging from mental confusion and indecision to intrusive and bizarre thoughts. Also, symptoms can arise and disappear suddenly, with the mother appearing lucid one moment and psychotic the next.

    How are psychotic disorders diagnosed?

    In order to determine whether the diagnosis of a psychotic disorder is warranted, the health-care professional has to first consider if a medical illness may be the cause of the behavioral changes. If a medical cause is identified or the psychosis is found to be the result of exposure to a medication or drug, the sufferer is assessed as having psychotic disorder due to a medical condition or psychotic disorder due to toxin exposure or withdrawal, respectively. On the other hand, if a medical cause and toxin exposure have been looked for and not found, a psychotic illness such as schizophrenia could be considered. The diagnosis will best be made by a licensed mental-health professional (like a psychiatrist) who can evaluate the patient and carefully sort through the diagnostic criteria for a variety of mental illnesses that might look alike at the initial examination, like schizotypal or schizoid personality disorder, severe depression, or the manic phase of bipolar disorder.

    • The physician will examine someone in whom psychosis is suspected either in an office, in an emergency department, or a hospital. The physician's role is to ensure that the psychosis sufferer doesn't have any medical problems, including active drug use, since these conditions can mimic the symptoms of a psychotic disorder. The doctor takes the patient's history and performs a physical examination. Laboratory and other tests, sometimes including a computerized tomography (CT) scan of the brain, are performed. Physical findings can relate to the symptoms associated with psychosis or to the medications the person may be taking.
      • People with a psychotic disorder can exhibit signs of mild confusion or clumsiness.
      • Subtle physical features, such as highly arched palate or wide or narrow set eyes, have been described in psychotic disorders, but none of these findings alone allow the physician to make the diagnosis.
    • Generally, results are normal for most psychotic disorders for the lab tests and imaging studies available to most doctors. If the person has a particular behavior as part of their mental disorder, such as drinking too much water, then this might show as a metabolic abnormality in the person's laboratory results.

    Family members or friends of the person with psychosis can help by giving the doctor a detailed history and information about the patient, including recent life stressors, behavioral changes, previous level of social functioning, history of mental illness in the family, past medical and psychiatric problems, medications, and allergies (to foods and medications), as well as the person's previous physicians and psychiatrists. A history of hospitalizations is also helpful so that prior records at these facilities might be obtained and reviewed.

    The diagnosis of another psychotic disorder may be distinguished from schizophrenia based on the duration of symptoms (as with brief psychotic disorder), the specific kind of psychotic symptoms that occur with delusional disorder, the type of nonpsychotic symptoms that occur with it as with schizoaffective disorder, or what causes it, as with substance/medication-induced psychotic disorder and psychosis due to a medical condition. The diagnosis of other specified schizophrenia spectrum and other psychotic disorder is reserved for those individuals who have some psychotic symptoms but do not qualify for a specific psychotic diagnosis. Women who recently had a baby (are in the postpartum state) may uncommonly develop postpartum psychosis. Also, a neurosis like major depressive disorder or bipolar disorder can become severe enough to result in psychosis symptoms, also called psychotic features.

    What are the treatments for psychotic disorders?

    Antipsychotic medications are proven effective in treating acute psychosis and reducing the risk of future psychotic episodes. For example, the treatment of schizophrenia or bipolar disorder with psychotic features thus has two main phases: an acute phase, when higher doses of medication might be necessary in order to treat psychotic symptoms, followed by a maintenance phase, which could be lifelong. During the maintenance phase, the medication dosage is gradually reduced to the minimum required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in dosage may help prevent a relapse.

    Even with continued treatment of the more chronic or recurring psychotic disorders, some patients experience relapses. By far, though, the highest relapse rates for such disorders are seen when medication is discontinued. The large majority of patients experience substantial improvement when treated with antipsychotic agents. Some patients, however, do not respond to medications, and a few may seem not to need them.

    Antipsychotic medications are the cornerstone in the management of psychosis. They have been available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a physician who is well trained and experienced in treating severe mental illness.

    The first antipsychotic was discovered by accident and then used for schizophrenia. This was chlorpromazine (Thorazine), which was soon followed by medications such as haloperidol (Haldol), fluphenazine (Prolixin), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). These medications have become known as "neuroleptics" because, although effective in treating positive symptoms (for example, acute symptoms such as hallucinations, delusions, thought disorders, loose associations, ambivalence, or mood swings/emotional lability), they cause side effects, many of which affect the neurologic (nervous) system. Examples of such neurologic side effects include muscle stiffness or rigidity, painful spasms, restlessness, tremors, and muscle twitches. These older medications are thought to be not as effective against so-called negative symptoms such as decreased motivation and lack of emotional expressiveness.

    Since 1989, a new class of antipsychotics (atypical antipsychotics) has been used. At clinically effective doses, none (or very few) of these neurological side effects of traditional antipsychotics, which often affect the extrapyramidal nerve tracts, are observed.

    Clozapine (Clozaril), the first of the new class, is the only agent that has been shown to be effective in situations where other antipsychotics have failed. Its use is not associated with extrapyramidal side effects, but it does produce other side effects, including a possible decrease in the number of white blood cells. Therefore, blood cell counts need to be monitored every week during the first six months of treatment and then every two weeks to detect this side effect early if it occurs.

    Other atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt), and lurasidone (Latuda). The use of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizophrenia.

    Although more effective and better tolerated, the use of these agents is also associated with side effects, and current medical practice is developing better ways of understanding these effects, identifying people at risk, and monitoring for the emergence of complications.

    Most of these medications take two to four weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, or another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least six to eight weeks (or even longer with clozapine).

    Since people with a psychotic disorder are at increased risk of also developing depression, medications that address that symptom may be of great benefit as well. Serotonergic medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) are often prescribed because of their effectiveness and low incidence of side effects. Other often-prescribed antidepressant medications for the depression that can be associated with psychotic disorders include venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and buproprion (Wellbutrin).

    Because the risk of relapse of illness is higher when antipsychotic medications are taken irregularly or discontinued, it is important that people with a psychotic disorder follow a treatment plan developed in collaboration with their doctors and with their families. The treatment plan will involve taking the prescribed medication in the correct amount and at the times recommended, attending follow-up appointments, and following other treatment recommendations.

    People with psychosis often do not believe that they are ill or that they need treatment. Other possible things that may interfere with the treatment plan include side effects from medications, substance abuse, negative attitudes toward treatment from families and friends, or even unrealistic expectations. When present, these issues need to be acknowledged and addressed for the treatment to be successful.

    What are potential complications of medications used to treat psychotic disorders?

    Many symptoms found in psychotic individuals are related to movement (motor symptoms). Some of these can be side effects of prescribed medications. Medication side effects may, for example, include dry mouth, constipation, drowsiness, stiffness on one side of the neck or jaw, restlessness, tremors of the hands and feet, and slurred speech.

    Tardive dyskinesia is one of the most serious, although quite uncommon, side effects of medications used to treat schizophrenia and other psychotic disorders. It is usually seen in older people and involves facial twitching, jerking, and twisting of the limbs or trunk of the body, or both. It is a less common side effect with the newer generation of medications used to treat schizophrenia. It does not always go away, even when the medicine that caused it is discontinued.

    A rare but life-threatening complication resulting from the use of neuroleptic (antipsychotic, tranquilizing) medications is neuroleptic malignant syndrome (NMS). It involves extreme muscle rigidity, sweatiness, salivation, and fever. If this complication is suspected, it should be treated as an emergency.

    Other potential complications of antipsychotic medications include significant weight gain and sleepiness, depending on the medication. To address weight gain, prescribing physicians often counsel their patients with a psychotic disorder on nutrition and exercise. Dose and timing adjustments may alleviate sleepiness. For pregnant women, the potential risks of the medication to a developing fetus must be balanced with the potential benefit to the mother and fetus of treating the illness.

    Is it possible to treat psychotic disorders without medication?

    In spite of successful antipsychotic treatment, many patients with psychosis have difficulty with motivation, activities of daily living, relationships, and communication skills. Also, since an illness like schizophrenia typically begins during the years critical to education and professional training, these patients lack social and work skills and experience. In these cases, the psychosocial treatments help most, and many useful treatment approaches have been developed to assist people suffering from a psychotic disorder.

    • Individual psychotherapy: This involves regular sessions between just the patient and a therapist focused on past or current problems, thoughts, feelings, or relationships. Thus, via contact with a trained professional, people with psychosis become able to understand more about the illness, to learn about themselves, and to better handle the problems of their daily lives. They can become better able to differentiate between what is real and, by contrast, what is not and can acquire beneficial problem-solving skills.
    • Rehabilitation: Rehabilitation may include job and vocational counseling, problem solving, social skills training, and education in money management. Thus, patients learn skills required for successful reintegration into their community following discharge from the hospital.
    • Family education: Research has consistently shown that people with a psychotic disorder who have involved families have a better prognosis than those who battle the condition alone. Insofar as possible, all family members should be involved in the care of their loved one.
    • Self-help groups: Outside support for family members of those with any psychotic disorder is necessary and desirable. The National Alliance for the Mentally Ill (NAMI) is an in-depth resource. This outreach organization offers information on all treatments for psychosis, including home care.

    Source: http://www.rxlist.com

    Antipsychotic medications are proven effective in treating acute psychosis and reducing the risk of future psychotic episodes. For example, the treatment of schizophrenia or bipolar disorder with psychotic features thus has two main phases: an acute phase, when higher doses of medication might be necessary in order to treat psychotic symptoms, followed by a maintenance phase, which could be lifelong. During the maintenance phase, the medication dosage is gradually reduced to the minimum required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in dosage may help prevent a relapse.

    Even with continued treatment of the more chronic or recurring psychotic disorders, some patients experience relapses. By far, though, the highest relapse rates for such disorders are seen when medication is discontinued. The large majority of patients experience substantial improvement when treated with antipsychotic agents. Some patients, however, do not respond to medications, and a few may seem not to need them.

    Antipsychotic medications are the cornerstone in the management of psychosis. They have been available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a physician who is well trained and experienced in treating severe mental illness.

    The first antipsychotic was discovered by accident and then used for schizophrenia. This was chlorpromazine (Thorazine), which was soon followed by medications such as haloperidol (Haldol), fluphenazine (Prolixin), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). These medications have become known as "neuroleptics" because, although effective in treating positive symptoms (for example, acute symptoms such as hallucinations, delusions, thought disorders, loose associations, ambivalence, or mood swings/emotional lability), they cause side effects, many of which affect the neurologic (nervous) system. Examples of such neurologic side effects include muscle stiffness or rigidity, painful spasms, restlessness, tremors, and muscle twitches. These older medications are thought to be not as effective against so-called negative symptoms such as decreased motivation and lack of emotional expressiveness.

    Since 1989, a new class of antipsychotics (atypical antipsychotics) has been used. At clinically effective doses, none (or very few) of these neurological side effects of traditional antipsychotics, which often affect the extrapyramidal nerve tracts, are observed.

    Clozapine (Clozaril), the first of the new class, is the only agent that has been shown to be effective in situations where other antipsychotics have failed. Its use is not associated with extrapyramidal side effects, but it does produce other side effects, including a possible decrease in the number of white blood cells. Therefore, blood cell counts need to be monitored every week during the first six months of treatment and then every two weeks to detect this side effect early if it occurs.

    Other atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), iloperidone (Fanapt), and lurasidone (Latuda). The use of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizophrenia.

    Although more effective and better tolerated, the use of these agents is also associated with side effects, and current medical practice is developing better ways of understanding these effects, identifying people at risk, and monitoring for the emergence of complications.

    Most of these medications take two to four weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, or another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least six to eight weeks (or even longer with clozapine).

    Since people with a psychotic disorder are at increased risk of also developing depression, medications that address that symptom may be of great benefit as well. Serotonergic medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) are often prescribed because of their effectiveness and low incidence of side effects. Other often-prescribed antidepressant medications for the depression that can be associated with psychotic disorders include venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), and buproprion (Wellbutrin).

    Because the risk of relapse of illness is higher when antipsychotic medications are taken irregularly or discontinued, it is important that people with a psychotic disorder follow a treatment plan developed in collaboration with their doctors and with their families. The treatment plan will involve taking the prescribed medication in the correct amount and at the times recommended, attending follow-up appointments, and following other treatment recommendations.

    People with psychosis often do not believe that they are ill or that they need treatment. Other possible things that may interfere with the treatment plan include side effects from medications, substance abuse, negative attitudes toward treatment from families and friends, or even unrealistic expectations. When present, these issues need to be acknowledged and addressed for the treatment to be successful.

    Source: http://www.rxlist.com

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