Hallucinations psychotic

Affective (mood) disorders are characterized by changes in mood. The most common manifestation is depression, arranging from mild to severe forms. Psychotic depression is accompanied by hallucinations and illusions. Mania is less common than depression. In bipolar affective disorder, depression alternates with mania. 

Some patients with parkinsonism communicate poorly and do not tell the primary health care provider or nurse that problems are occurring. The nurse observes the patient with parkinsonism for outward changes that may indicate one or more adverse reactions. For example a sudden change in the facial expression or changes in posture may indicate abdominal pain or discomfort, which may be caused by urinary retention, paralytic ileus, or constipation. Sudden changes in behavior may indicate hallucinations, depression, or other psychotic episodes. 

Most of the motor effects of amphetamine, especially stereotypy, are due to the release of DA as are its psychotic effects such as hallucinations. Its ability to mimic the action of DA in reward and reinforcement behaviour may contribute to its abuse potential (see Chapter 22) but its arousal (stimulant) properties also involve NA release. 

Sensorium. Patients with PCP intoxication can have a clear sensorium, or they can be disoriented, confused, stuporous, lethargic, or comatose. Signs of cerebral stimulation, such as pressured speech, verbigerations, and echolalia, may also occur. Frank psychotic symptoms, including hallucinations, delusions, and paranoid ideation, are not unusual. 

First, two-drug combinations lithium3 or valproate3 plus an atypical antipsychotic (e.g., olanzapine, quetiapine, risperidone) for shortterm adjunctive treatment of psychotic features (e.g., delusions or hallucinations)... 

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. 

Long-term amphetamine abuse results in many damaging effects, not least of which is addiction. Chronic abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin). The paranoia can result in homicidal as well as suicidal thoughts. 

Emotional symptoms may include diminished ability to experience pleasure, loss of interest in usual activities, sadness, pessimistic outlook, crying spells, hopelessness, anxiety (present in almost 90% of depressed outpatients), feelings of guilt, and psychotic features (e.g., auditory hallucinations, delusions). 

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

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... 

The term psychotomimetic was coined to compare the effects of hallucinogens to the symptoms of schizophrenia and other psychotic conditions. However, the effects produced by hallucinogens and mental illness are qualitatively different. While drug-induced hallucinations tend to be more visual, auditory hallucinations are most common in schizophrenia. The hallucinogenic drugs discussed here may induce positive symptoms (e.g., hallucinations), but do not induce the negative symptoms (e.g., cognitive deficits, social withdrawal) of schizophrenia. 

Neurological Effects. Neurological effects in hrnnans after acute inhalation exposure to chloroform are well documented because chloroform has been used as an anesthetic for surgery. Inhaled chloroform acts as a depressant on the central nervous system. Chronic inhalation exposure to chloroform resulted in exhaustion, lack of concentration, depression, and irritability in occupationally exposed people (Challen et al. 1958). In a case study, chloroform inhalation for 12 years resulted in psychotic episodes, hallucinations, and convulsions (Heilbmnn et al. 1945). Central nervous system toxicity was observed in humans after oral exposure to chloroform, which suggests that the effects of inhalation and oral exposure are similar. In case reports of patients who intentionally or accidentally ingested several ounces of chloroform, deep coma with abolished reflexes occurred within a few minutes (Piersol et al. 1933 Schroeder 1965 Storms 1973). 

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). 

Brief Psychotic Disorder. This disorder occurs in the immediate aftermath of a markedly stressful event (or series of events). It is marked by emotional turmoil in conjunction with one or more psychotic symptoms such as delusions, hallucinations, disorganization, or catatonia. On presentation, a brief psychotic disorder can be difficult to distinguish from psychotic depression or mania. The presence of a precipitating stressor is not always helpful, because episodes of psychotic mood disorders (especially early in the course of illness) are also commonly triggered by stressful life events. Careful evaluation for symptoms of emerging depression or... 

In addition to this partial listing, a wide assortment of medical illnesses can produce a state of delirium, which though distinct from psychotic illnesses often does manifest certain psychotic symptoms like hallucinations and paranoia. 

Psychotic Disorder Due to Generai Medical Condition. Certain medical illnesses occasionally present with symptoms of paranoid delnsions or hallucinations that resemble schizophrenia (Table 4.4). When these illnesses are snccessfully treated, fnll resolntion of the psychotic symptoms invariably occnrs. All patients presenting with new-onset psychosis shonld nndergo a thorongh medical evaluation including a physical exam, family and personal medical history, and laboratory stndies inclnding electrolytes, thyroid function tests, syphilis screen, vitamin B12 and folate levels, and a CT or MRI brain scan. A lumbar puncture (spinal tap) and electroencephalogram are sometimes also warranted. 

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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