Psychosis psychotic episodes

Brief Psychotic Disorder. This diagnosis also differs from schizophrenia by virtue of the duration of symptoms. The symptoms mnst last less than 1 month, and the patient must return to his/her previous level of social functioning when the illness subsides. Formerly called brief reactive psychosis, an episode of this illness usually arises in reaction to some markedly stressfnl event, thongh this is not always the case. 

All psychostimulants can cause jitteriness, palpitations, and psychic dependence. Depression may arise after their discontinuance, and high doses can produce a florid psychosis. On occasion, even small doses of amphetamine can precipitate psychotic episodes in those with an underlying predisposition (e.g., schizophrenic disorder). 

Two studies have directly addressed the question of lithium s specificity for mania or affective psychosis, as it is sometimes called. In one of these studies a group of 78 patients admitted with an acute psychotic episode diagnosed as mania, schizophrenia or schizoaffective disorder were randomised to receive lithium or chlorpromazine. The authors hypothesised that patients diagnosed as manic would respond better to lithium and those diagnosed with schizophrenia would respond better to chlorpromazine. In contrast they found that there was no difference in the effects of the different drugs on people with different diagnostic labels and that the only discernible effect was the inferiority of lithium in severely disturbed patients (Braden et al. 1982). A similar study published in 1988 claimed to show that lithium had specificity for... 

Two adult patients with refractory partial seizures without a previous history of psychosis had an acute psychotic episode with hallucinations and psychomotor agitation after taking topiramate 200-300 mg/day (626). 

Of 74 epileptic patients who had taken zonisamide 14 had psychotic episodes, diagnosed retrospectively (690). The authors estimated that the incidence of psychotic episodes during zonisamide treatment was several times higher than the previously reported prevalence of epileptic psychosis, and that the risk was higher in young patients. In 13 patients, psychotic episodes occurred within a few years of starting zonisamide. In children, obsessive-compulsive symptoms were related to psychotic episodes. 

Several reports of persistent psychosis following the administration of interferon-alpha (Tamam et al., 2003 Thome and Knopf, 2003 Teho et al., 2006) or high doses of IL-2 (Denicoff et al., 1987) demonstrate that cytokines could conceivably mediate some aspects of cognitive impairment observed in schizophrenic patients. These studies are interesting in light of the fact that evidence for abnormal levels of cytokines in schizophrenic patients is accumulating (Malek-Ahmadi, 1996 Prolo and Licinio, 1999). However, further studies are needed to show a causative relationship between cytokine levels in patients and the precipitation of psychotic episodes. 

Taken together, most studies confirm the vulnerability hypothesis for cannabis use and schizophrenia. Thus, schizophrenia patients should probably not use cannabis because a psychotic episode can be induced in someone with a preexisting disorder and, indeed, increased hospitalization rates and symptom exacerbation have been demonstrated (Caspari, 1999). Increased rates of psychosis are also observed in those meeting the criteria for caimabis dependence (Fergusson, Horwood, and Swain-Campbell, 2003). Hollister, (1986) summarized in his review (p. 6-7) It would seem reasonable to assume that caimabis might unmask latent psychiatric disorders. ... 

People often ask if psychosis gets better. Ejq)lain that a psychotic episode may occur just once in a lifetime, but further episodes can happen. Emphasise that support and treatment now offers the best chance of getting and staying well. 

Optimize the dose of mood stabilizing medication(s) before adding on lithium, lamotrigine, or antidepressant (e.g., bupropion or an SSRI) if psychotic features are present, add on an antipsychotic ECT used for severe or treatment-resistant depressive episodes or for psychosis or catatonia... 

The key to distinguishing schizophrenia from a psychotic mood disorder is to obtain a history of the patient prior to the acute episode of psychosis. This includes both the past history from medical and psychiatric records and collateral history... 

Psychosis for demented patients usually takes the form of paranoid delusions. Demented patients may believe family members have turned against them, or they may misidentify their loved ones as intruders in their home. Although hallucinations are not listed in the DSM-IV criteria, they may also occur. When psychosis occurs in a demented patient, it is a serious problem. It is very distressful to the patient, makes it difficult (if not impossible) for family members to provide care, may lead to episodes of violence, and commonly leads patients to be hospitalized or placed in nursing homes. Fortunately, most patients with dementia do not develop delusions or other psychotic symptoms. 

Erard et al.25a,43 believe that the psychosis Is a special form of an acute schizophrenic episode activated by the drug In some susceptible persons. Luisada estimated that 1-5% of the population may be susceptible (Luisada, P.V. personal comunicatlon). Although the Army volunteers were psychologically screened, preschizophrenic test subjects may have been Included. As noted, the psychotic reactions associated with SNA typically occur Immediately or soon after consumption of the drug. If serious mental consequences were not observed during the Immediate followup period or during the later Army tour of duty, It seems unlikely that a delayed SNA psychosis occurred. 

It is well established that monotherapy with various antidepressants or mood stabilizers is relatively ineffective (i.e., they are necessary but not sufficient) for treating mood disorders with associated psychosis. Thus, psychotically depressed patients are best managed with a combination of antipsychotic-antidepressant or with electroconvulsive therapy. Although antipsychotics have a more rapid onset of action than lithium in an acute manic episode, we are unaware of clinical trials that examine the differential effect of antipsychotics or lithium for nonpsychotic versus psychotic mania. This topic is discussed further in... 

As noted above, large doses of amphetamine, cocaine, and other sympathomimetics can cause acute paranoid reactions, either spontaneously in abusers or experimentally in normal volunteers. An injection of a large amphetamine dose, for example, often produces a paranoid psychosis within hours. Frequent smaller doses over several days can also produce a paranoid psychotic reaction. An episode s duration usually parallels the length of time the drug remains in the body. 

Additional evidence comes from studies of increasing dopaminergic activity in patients with active psychosis. Small i.v. doses of methylphenidate (e.g., 0.5 mg/kg) can result in a marked exacerbation of an acute schizophrenic episode (18). By contrast, such doses usually do not produce psychotic symptoms in normal control... 

Before the discovery of the neuroleptics, episodes of psychotic excitement were usually managed with i.v. amobarbital in doses sufficient to heavily sedate or actually put patients to sleep. Upon awakening, they were often much less excited. The role that sleep deprivation plays in the onset of psychotic symptoms may be a partial explanation for this beneficial effect. Although sedatives have no specific effect on the underlying psychosis, they can calm psychotic excitement. Because the extreme excitement, rage, and explosivity often associated with a psychotic exacerbation are amenable to intervention with sedatives, this raises the possibility that these symptoms may have a different underlying mechanism than that subserving the psychosis itself. 

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