Delusions schizophrenia

As well as hallucinations and delusions, schizophrenia is characterized by deficits in information processing. Schizophrenics have difficulty suppressing irrelevant environmental stimuli. This is referred to as sensory gating or prepulse inhibition, and commonly measured with auditory evoked potentials. When two stimuli, such as sounds, are presented within 30-500 msec, the response to the second stimulus rapidly decreases upon repeated presentations in healthy people, but not in persons with schizophrenia (Braff et al., 2001). This deficit is found in family members of patients with schizophrenia, and has been linked to the alpha-7 nicotinic receptor gene. The deficit is reversed by nicotine on an acute basis, and by some antipsychotic drugs. Alpha-7 nicotinic agonists are under development as treatment for schizophrenia (Martin et al., 2004). 

D. Antiparkinson drugp help to decrease hallucinations and delusions in patients witii schizophrenia... 

Psychiatric signs euphoria, dysphoria, agitation, hallucinations, delusions, aggression, violence, bizarre behavior, schizophrenia-like body trip ... 

Pervasive developmental disorder If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated). 

Paranoia A delusion of persecution or grandeur, one of the positive clinical symptoms of schizophrenia. 

Schizophrenia is a chronic, complex psychiatric disorder affecting approximately 1% of the population worldwide. The chronic nature of the illness, in addition to the early age of onset, results in direct and indirect health care expenditures in the U.S., which amount to approximately 30 to 64 billion dollars per year [4]. It is perhaps the most devastating of psychiatric disorders, with approximately 10% of patients committing suicide. The dopamine hypothesis of schizophrenia postulates that overactivity at dopaminergic synapses in the central nervous system (CNS), particularly the mesolimbic system, causes the psychotic symptoms (hallucinations and delusions) of schizophrenia. Roth and Meltzer [5] have provided a review of the literature and have concluded a role for serotonin as well in the pathophysiology and treatment of schizophrenia. The basic premise of their work stems from the known interaction between the serotonergic and dopaminergic systems. 

The positive symptoms are the most responsive to antipsychotic medications, such as chlorpromazine or halo-peridol. Initially, these drugs were thought to be specific for schizophrenia. However, psychosis is not unique to schizophrenia, and frequently occurs in bipolar disorder and in severe major depressive disorder in which paranoid delusions and auditory hallucinations are not uncommon (see Ch. 55). Furthermore, in spite of early hopes based on the efficacy of antipsychotic drugs in treating the positive symptoms, few patients are restored to their previous level of function with the typical antipsychotic medications [2]. 

The typical antipsychotic drugs, which for 50 years have been the mainstay of treatment of schizophrenia, as well as of psychosis that occurs secondary to bipolar disorder and major depressive disorder, affect primarily the positive symptoms[10]. The behavioral symptoms, such as agitation or profound withdrawal, that accompany psychosis, respond to the antipsychotic drugs within a period of hours to days after the initiation of treatment. The cognitive aspects of psychosis, such as the delusions and hallucinations, however, tend to resolve more slowly. In fact, for many patients the hallucinations and delusions may persist but lose their emotional salience and intrusiveness. The positive symptoms tend to wax and wane over time, are exacerbated by stress, and generally become less prominent as the patient becomes older. 

Schizophrenia is a chronic heterogeneous syndrome of disorganized and bizarre thoughts, delusions, hallucinations, inappropriate affect, cognitive deficits, and impaired psychosocial functioning. 

Although hallucinations and delusions are common symptoms of schizophrenia, psychotic mood disorders (depressive or bipolar), and a few other disorders,... 

The symptoms of schizophrenia are so foreign to most of us that it is difficult to appreciate their horror. Patients feel that they have lost control of their minds with thoughts being inserted into their brains. Their delusions are usually terrifying. The common auditory hallucinations are horrifically accusatory. Many psychiatrists characterize the entire adult lives of schizophrenics as a living death. The behavior of schizophrenics is so disruptive that fives of their parents and siblings are often devastated. Thus, whether calculated in terms of dollars lost to a country s economy or human suffering, schizophrenia may well rank as the number one mental illness. 

Despite their importance in psychiatry, the neuroleptics are by no means cure-alls. Even patients that respond extremely well to neuroleptics remain disturbed. Specifically, though their florid hallucinations and delusions, the positive symptoms of schizophrenia, are alleviated, patients remain emotionally detached from the environment. This wallflower syndrome and related symptoms are commonly designated the negative symptoms of schizophrenia and often are the most disabling ones. The first glimmer of effective treatment of such negative symptoms came with the drug clozapine. 

Chronic cocaine use can cause a syndrome of insomnia, hallucinations, delusions, and apathy. This syndrome develops around the time when the euphoria turns to a paranoid psychosis, which resembles paranoid schizophrenia. Further, after cessation of cocaine use, the hallucinations may stop, but the delusions can persist. Still, the incidence of a persistent cocaine-induced psychosis appears to be rare. One study found only 4 out of 298 chronic cocaine users receiving a diagnosis of psychotic disorder (Rounsaville et al. 1991). This incidence is approximately the... 

BZ is undeniably psychotomimetic, but only in the broad sense that it causes a true loss of contact with reality. It also lacks most of the distinguishing features of the natural psychoses. Schizophrenia, for example, rarely produces visual hallucinations. BZ, on the other hand, seldom produces well-organized delusions (as may occur with LSD). BZ does not produce persistent social withdrawal, as seen in chronic schizophrenia, nor does it create the annoying overfriendliness of the manic phase of bipolar disorder. 

There are two general classes of clinical characteristics of schizophrenia. First, there are the positive symptoms that include auditory hallucinations (voices) and delusions, often paranoid. Second, there are the negative symptoms these include disorganization, loss of will, inability to pay attention, social withdrawal, and flattening of affect. The relative roles of positive and negative symptoms for a particular victim vary over time. The positive symptoms may predominate for a period to be followed by one in which the negative symptoms are more prominent. About 10% of people with schizophrenia commit suicide. 

Again, the character of the patient s prior episodes, premorbid functioning, and family history all are helpful. By definition, schizophrenia is marked by a 6-month decline in social and occupational functioning that is seldom seen in bipolar illness. In addition, the delusions and hallucinations of schizophrenia are present during periods of normal mood, whereas bipolar patients only experience psychotic symptoms in the context of severe mood disturbance (i.e., mania or depression). 

E. Not autism. Delusions or hallucinations must be present to diagnose schizophrenia in an autistic child or adult. 

Finally, hallucinations (usually auditory) and delusions are a common feature of schizophrenia. But please remember, not everyone who hears voices has schizophrenia. 

Deiusionai Disorder. Patients with delnsional disorder share the presence of delusions with schizophrenia patients. However, the delnsions are not bizarre as they often are in schizophrenia. Patients with delnsional disorder often fnnction fairly well in society. They can nsnally hold employment and typically remain active members of their families. Delnsional disorder patients do not have the negative symptoms of schizophrenia, do not experience hallncinations, and do not suffer from the gross social impairment of schizophrenia. They may, however, have circumscribed social problems that are directly related to the content of their delusions. The delusions often are believable or at least somewhat plausible. 

Mood Disorder with Psychotic Features. One subtype of major depression and many episodes of mania are associated with psychotic symptoms. Like schizophrenia, the most prominent psychotic symptoms of psychotic depression or mania are delusions and auditory hallucinations. Unless a longitudinal history is available, it is often difficult to distinguish schizophrenia from a psychotic mood disorder. 

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