Functional psychoses

2017 ◽  
pp. 1057-1064
Author(s):  
Luis Agüera-Ortiz
Keyword(s):  
Adverse Effects ◽  
Older People ◽  
Atypical Antipsychotics ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Psychotic Symptoms ◽  
Younger Adults ◽  
Psychological Management ◽  
Concomitant Medications

Psychotic symptoms are more common in older people than in any other age. The most frequent psychotic disorders in older people are juvenile-onset schizophrenia in ageing patients, psychosis in Alzheimer’s disease, and the late- and very late-onset schizophrenia-like psychosis. Drug treatment of all types of psychosis is essential and often achieves similar levels of efficacy than in younger adults. The treatment of choice for any psychotic condition is atypical antipsychotics. Rather than being based on specific diagnosis, the choice of drug must be highly personalized, depending on the efficacy for the particular patient, drug’s profile of adverse effects, medical comorbidities, and concomitant medications. Attention should be paid to the emergence of adverse effects that are in general more frequently found with conventional than with atypical antipsychotics. Clinical and psychological management includes the need to establish a therapeutic alliance with the patient and ensure adherence to treatment in the long term.

What Diagnoses Are Associated with Psychosis?

2021 ◽  
pp. 35-48
Author(s):  
Beth Broussard ◽  
Michael T. Compton
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Healthcare Provider ◽  
Psychotic Disorders ◽  
Definitive Diagnosis ◽  
Psychotic Symptoms ◽  
Specific Diagnosis ◽  
Substance Related Disorders

In this chapter we discuss the different diagnoses associated with psychosis. Schizophrenia is one of several primary psychotic disorders, a group of psychiatric disorders that primarily cause psychosis. Other disorders can cause psychotic symptoms—or symptoms similar to these—but are not considered psychotic disorders. A few examples of such disorders are major depressive disorder, bipolar disorder, and some substance-related disorders. It is often difficult to make a specific diagnosis when long-term information is not available at first. In instances in which a definitive diagnosis is uncertain, a working diagnosis allows the healthcare provider to begin effective treatments for psychosis even before a more certain diagnosis is made.

scholarly journals Antipsychotic-induced hyperprolactinemia in Tourette syndrome

2017 ◽  
Vol 7 (6-7) ◽  
pp. 201-205 ◽  
Author(s):  
Judith J. G. Rath ◽  
Marlies E. J. Deen ◽  
Hessel van Houten ◽  
Sebastiaan F. T. M. de Bruijn ◽  
Joop van Gerven ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Tourette Syndrome ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
Psychotic Disorders ◽  
Treatment Options ◽  
Therapeutic Interventions ◽  
Childhood Onset ◽  
Choice Of Treatment ◽  
Age And Sex

For many years, Tourette syndrome (TS) was considered to be a rare disorder, but tics and TS are now recognized as fairly common childhood-onset conditions. Children and adolescents with TS are frequently treated with antipsychotics, either as monotherapy or in combination with psychostimulants, melatonin and selective serotonin reuptake inhibitors (SSRIs). Antipsychotics are most often used in schizophrenia and related psychotic disorders, and in these conditions hyperprolactinemia is one of the most common adverse effects associated with antipsychotics, occurring in 40–50% of patients. We describe two patients with TS who experienced antipsychotic-induced hyperprolactinemia. Treatment options generally consist of dose reduction or switching from typical to atypical antipsychotics. However, diminishing dosages can lead to exacerbations of tics. Also, not all atypical antipsychotics have the same pharmacologic properties required to normalize prolactin levels. The choice of treatment may also be affected by the patient’s age and sex. These factors are discussed in relation to these cases, and illustrated by the results of therapeutic interventions over the years.

Psychosis and dementia: risk factor, prodrome, or cause?

2017 ◽  
Vol 30 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Corinne E. Fischer ◽  
Luis Agüera-Ortiz
Keyword(s):  
Psychotic Disorders ◽  
Clinical Course ◽  
Late Onset ◽  
Early Recognition ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Functional Psychosis ◽  
Dementia Risk ◽  
Treatment Considerations ◽  
The Impact

ABSTRACTBackground:Progression of dementia is often associated with the emergence of neuropsychiatric symptoms (NPS), though there is recent evidence that NPS may occur in prodromal dementia (PrD) and impact clinical course. Mood and anxiety symptoms are the NPS that tend to occur most frequently in PrD and thus have been most extensively studied. Comparatively, there has been little focus on psychotic symptoms in PrD.Methods:The authors review the existing literature on psychosis in PrD, including the functional psychosis of early and late onset, with a focus on epidemiology, phenomenology, and clinical course and treatment considerations.Results:Patients with psychotic disorders at baseline such as schizophrenia may be more at risk for developing dementia over time, although this is not completely clear. Psychotic symptoms are likely more common in PrD than previously understood based on factor analysis studies, although they are much more common in established dementia. Variability in findings may reflect the heterogeneous nature of PrD studies to date and the lack of inclusion of patients with late onset psychosis in most clinical studies. The presence of psychosis in patients with PrD may be associated with a worse prognosis in terms of mortality and conversion to dementia.Conclusions:Research to date suggests that psychosis in PrD may be more common than previously thought and impact clinical course negatively. Future studies incorporating patients with late onset psychotic disorders, and focusing on the impact of early recognition and treatment, are required to more fully understand the role of psychosis in PrD.

scholarly journals Steroid induced psychiatric adverse effects: an overview of risk factors, clinical features and management

2020 ◽  
Vol 8 (6) ◽  
pp. 2365
Author(s):  
Anant Parasher ◽  
Jeplin Bez
Keyword(s):  
Adverse Effects ◽  
Steroid Therapy ◽  
Wound Repair ◽  
Glucocorticoid Receptors ◽  
Psychiatric Symptoms ◽  
Immunosuppressive Drugs ◽  
Psychotic Symptoms ◽  
Metabolic Disturbances ◽  
Duration Of Treatment

Corticosteroids have been in use since the past five decades as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Adverse effects include growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. The psychiatric effects of steroids are due to the wide expression of Glucocorticoid Receptors in the brain, and their long-term modulation can lead to functional and anatomical alterations along with hippocampal dysfunction. In most cases, the psychiatric symptoms disappear on cessation of steroid therapy; others may require some form of therapeutic management. A search was conducted for clinically relevant articles from 1971 to 2016 by including the terms corticosteroids, mania, depression, psychosis and cognitive defects. About one-fifth of patients receiving high doses of corticosteroids develop psychiatric symptoms. These symptoms are observed to be dose-dependent and generally occur during the first few weeks of therapy. Lithium has a preventive as well as therapeutic role, while antipsychotics are reserved for high risk cases with predominant psychotic symptoms. Psychiatric effects of long term steroid therapy have become increasingly common nowadays due to long duration of treatment of many chronic respiratory and orthopedic illnesses. Reduction in the dose or complete discontinuation of steroid therapy has been proven beneficial in many patients. Among the therapeutic options, lithium has a definitive role, both in the prevention as well as treatment of psychiatric symptoms. Better co-ordination between the physician and psychiatrist can go a long way to improve the quality of life in these patients. 

Electroconvulsive therapy (ECT) treatments in late-onset schizophrenia: Report of a case

2016 ◽  
Vol 33 (S1) ◽  
pp. S556-S556
Author(s):  
M. Valverde Barea ◽  
F. Cartas Moreno ◽  
M.E. Ortigosa Luque
Keyword(s):  
Behavioral Disorders ◽  
Electroconvulsive Therapy ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Personal History ◽  
Psychotic Symptoms ◽  
Sexual Content ◽  
History Of ◽  
Competing Interest ◽  
Effective Result

Female patient, 66 years old, who goes to the doctor because of behavioral disorders and delusional injury 8 months of evolution. She showed no personal history of psychiatric disorders. In the psychopathological examination some relevant symptoms are seen delusions of prejudice with their immediate surroundings, self-referential regarding neighbors and walls. Delusional interpretations of sexual content. Punitive pseudo hallucinations hearing which are identifies with her daughters and sex with her son-in-law. Behavioral disorders consisting of going out naked into the street overnight and rebuking pedestrians; furthermore, she showed heteroaggressivity towards objects. Logical psychotropic treatment is initiated as indicated by the guidelines having no effect. Electroconvulsive therapy being tested an effective result. The late-onset schizophrenia symptoms should be taken into account in people with psychotic symptoms start at an advanced age, but is most prevalent at younger ages. Electroconvulsive therapy (ECT) may be used as an adjunct to drug therapy or as second-line treatment in patients with affective or psychotic disorders resistant to treatment with psychotropic drugs. It is essential a differential diagnosis with dementia symptoms previously established, given that part of the late-onset schizophrenia evolves to dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Resolution of Risperidone-Induced Hyperprolactinemia with Substitution of Quetiapine

2003 ◽  
Vol 37 (2) ◽  
pp. 206-208 ◽  
Author(s):  
Arun Raj Kunwar ◽  
James L Megna
Keyword(s):  
Adverse Effects ◽  
Prolactin Level ◽  
Atypical Antipsychotics ◽  
Significant Degree ◽  
Psychotic Symptoms ◽  
Therapeutic Effects ◽  
The Past ◽  
Case Summary ◽  
Level Elevation

OBJECTIVE: To report a case of risperidone-induced hyperprolactinemia that was successfully managed with quetiapine. CASE SUMMARY: A 30-year-old white woman with schizoaffective disorder, depressive type, and comorbid alcohol and cocaine abuse was treated successfully for her psychotic symptoms with risperidone until she developed adverse effects consistent with hyperprolactinemia. This was confirmed by laboratory blood tests, as her prolactin level was 186.9 ng/mL (normal for nonpregnant women 2.8–29.2). The woman had experienced similar effects in the past, which had led to noncompliance and subsequent psychotic relapse. Normalization of prolactin levels and associated adverse effects were achieved upon switching to quetiapine. No psychotic symptoms reoccurred. DISCUSSION: Dopamine type 2 (D2) receptor blockade in the mesolimbic tract is thought to mediate the therapeutic effects of antipsychotics. This action in the tuberoinfundibular system produces prolactin level elevation. Risperidone has a relatively higher affinity for the D2 receptor in comparison with other atypical antipsychotics, which may explain why it is associated with a higher incidence of hyperprolactinemia. Quetiapine, which has one of the lowest D2 receptor affinities, is not known to increase prolactin levels to any significant degree. This pharmacologic property allows quetiapine to be a reasonable treatment option for patients who develop risperidone-induced hyperprolactinemia. CONCLUSIONS: Quetiapine may be a suitable substitute when a patient taking risperidone develops hyperprolactinemia.

Duration of untreated psychosis: a critical examination of the concept and its importance

2001 ◽  
Vol 31 (3) ◽  
pp. 381-400 ◽  
Author(s):  
ROSS M. G. NORMAN ◽  
ASHOK K. MALLA
Keyword(s):  
Treatment Outcome ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Critical Examination ◽  
Duration Of Untreated Psychosis ◽  
Relationship Of ◽  
The Relationship

Background. The concept of duration of untreated psychosis (DUP) has recently attracted much interest because of its possible relationship to treatment outcome and implications for preventive efforts with reference to psychotic disorders, especially schizophrenia. In this paper we review critically the literature concerning the concept and its importance.Methods. Articles concerned with measuring DUP and those that have been suggested to provide indirect or direct evidence of the effect of DUP on treatment outcome are reviewed.Results. Evidence thus far suggests that DUP may be related to ease of reducing psychotic symptoms once treatment begins for first episode patients, but there is no evidence of a relationship to likelihood of relapse. There has been little investigation of the relationship of DUP to other long-term outcomes such as negative symptoms and cognitive functioning neither have the possible confounds of DUP been widely investigated or controlled.Conclusions. It is important that there should be more thorough investigations of DUP, its correlates, and the extent to which it does mediate any advantages of earlier intervention.

scholarly journals Psychotic Symptoms after Long Term Using Diazepam and Alprazolam Medication; Depend Syndrome of Alprazolam

2019 ◽  
Vol 4 (10) ◽  
Keyword(s):  
Adverse Effects ◽  
Brain Tissue ◽  
Half Life ◽  
Withdrawal Syndrome ◽  
Psychotic Symptoms ◽  
Negative Consequences ◽  
Experimental Conditions ◽  
Alprazolam Withdrawal ◽  
The Brain

Alprazolam and Diazepam two most prescribed benzodiazepine in the Kosovo have been potential for addictive use. Both drugs are rapidly absorbed and enter the brain tissue rapidly, leading to reinforcement. Alprazolam has a short half – life that may lead to more withdrawal symptoms than Diazepam. In experimental conditions, they are among the most reinforcing benzodiazepines. Each causes a withdrawal syndrome, but Alprazolam withdrawal may be more severe and may occur after a shorter period of use. Adverse effects from their use are rare, yet negative consequences may be seen with some regularly. Alprazolam deserves special caution, because of its relative newness great popularity-reinforcing capabilities relatively sense withdrawal syndrome, and reports of addiction and negative consequences of use.

Assessing Diagnosis and Symptoms Profiles of Late-Life Psychosis

GeroPsych ◽  
2013 ◽  
Vol 26 (4) ◽  
pp. 205-209 ◽  
Author(s):  
Ali Javadpour ◽  
Maryam Sehatpour ◽  
Arash Mani ◽  
Ali Sahraian
Keyword(s):  
Differential Diagnosis ◽  
Mood Disorders ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Late Life ◽  
Psychotic Symptoms ◽  
Elderly Persons ◽  
Visual Hallucinations ◽  
Symptom Profiles ◽  
Symptom Profile

Background: There are many controversies with regard to the nosology and conditions causing psychosis in old age people. This study defines a symptom profile and differential diagnosis of late-onset psychosis. Method: 201 elderly persons with psychotic symptoms were recruited. All patients were interviewed based on SCID-1 to confirm the possible diagnosis. Results: The most delusional symptom reported by the subjects was persecutory delusion, and visual hallucinations were the most common hallucination. The most repeated diagnosis was dementia, followed by psychosis due to mood disorders, primary psychotic disorders, delirium, and psychosis due to medical conditions. Conclusions: Results from the current study indicate that late-life psychoses form a heterogeneous group of disorders with varying symptom profiles and etiologies.

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