Psychotic disorders functional

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. 

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. 

Administration of bromocriptine necessitates monitoring pituitary gland function, especially during pregnancy, whereas in psychotic disorders, including schizophrenia, bromocriptine must be administered with caution. There is no need to reduce the dose or administer bromocriptine with caution in patients with renal impairment. 

The specific etiology of psychotic disorders has not currently been sufficiently investigated. It is believed, however, that the initial cause of psychotic behavior may originate from an imbalance of dopaminergic functions in the CNS. Many researchers adhere to the opinion that a large increase of dopamine activity in specific regions of the CNS is the cause of abnormal behavior. 

Schizophreniform disorder in DSM-FV is somewhat different from schizotypal disorder in ICD-10. The diagnosis of schizophreniform disorder requires the identical criteria of schizophrenia (criterion A), except for two differences the total duration of the illness is at least 1 month, but less than 6 months (criterion B), and impaired social or occupational functioning during some part of the illness is not required. The delusional disorder in DSM-IV corresponds more or less to the category persistent delusional disorder of ICD-10, and brief psychotic disorder (DSM-IV) is similar to the ICD-10 category acute and transient psychotic disorder, whereas the shared psychotic disorder of DSM-IV corresponds to induced delusional disorder of ICD-10. 

Reserpine, used as a folk medicine in India, was found to have antipsychotic properties at about the same time as CPZ. Both agents affected the dopaminergic system, albeit in different ways, but the functional results were similar (i.e., lowering dopamine activity). This phenomenon has continued to be an important factor in hypotheses about the mechanism of action of these drugs and for biological theories about the pathophysiology of psychotic disorders. 

An important implication of this observation is the suggestion that early intervention in schizophrenia could substantially alter the natural course of the illness. To investigate this idea, early-intervention projects have been developed. In one, primary physicians were trained to recognize the early symptoms of a mental disorder and to arrange consultation with an intervention team who assessed and treated the disorder. If early symptoms were present, the functional psychotic disorder was treated with low doses of the appropriate medication, often for a relatively short period of time (i.e., several weeks), and then tapered when symptoms abated while psychosocial intervention was continued. In some patients, symptoms returned and medication was reinstituted. The psychosocial program, social skills training, and social casework were continued for some time, and all patients were monitored for at least 2 years. Epidemiological data established that over the lifetime of this project, 7.5 new cases would be expected for 100,000 patients (227, 228). 

Schizophrenia is a complex psychotic disorder affecting multiple functional modalities and is one of the two most common psychotic emotional disturbances (the other... 

Many social workers are challenged by the task of how to best help the client with schizophrenia. Most agree, however, that medication treatment for the active symptomology of schizophrenia and the other psychotic disorders is an absolute necessity. Any type of verbal therapy by social workers or other mental health professionals is not productive until the client is stabilized, the psychosis is reduced, and some semblance of reality is restored. Once the client is stabilized, social work interventions that emphasize problem-solving methods may be used to address the significant problems that affect the daily lives of clients with schizophrenia. Strict behavioral intervention strategies may be employed that help clients become aware of their actions and the consequences on their levels of daily functioning (Sensky et al., 2000). 

Functions include regulation of affect, reinforcement, cognitive functions, and sensory perception. Psychotic disorders and addiction are partly explained by T DA in these pathways. 

Psychosis is divided into major categories, once of which is schizophrenia. Schizophrenia is a chronic psychotic disorder where patients exhibit either positive or negative symptoms. Positive symptoms are exaggeration of normal function such as agitation, incoherent speech, hallucination, delusion, and paranoia. Negative symptoms are characterized by a decrease or loss of motivation or function such as social withdrawal, poor selfcare, and a decrease in the content of speech. Negative symptoms are more chronic and persistent than positive symptoms. 

Sexual function A study of 100 men with psychotic disorders found that the rate of sexual dysfunction was highest for risperidone, followed by trifluoperazine and olanzapine, measured on three different scales [73 ]. Rates of sexual function varied according to the scale used decreased libido was the most prevalent except for orgasmic disorders for risperidone on the ASEX scale. 

I and depressive symptoms. Hypomanic symptoms include inflated self-esteem or grandiosity (non-delusional), decreased need for sleep, pressure of speech, flight of ideas, distractibility, and increased involvement in goal-directed activities, not causing severe impairment in social or occupational functioning or requiring hospitalization. Psychotic features are not found in cyclothymic disorder.1... 

Frontotemporal dementias are characterized by gross structural changes in the frontal and anterior temporal lobes, metabolic disturbances, and involvement of certain subcortical structures as well (Ishii et al. 1998). Whereas in Alzheimer s disease the early cognitive disturbances are in memory, in frontotemporal dementias the early manifestations are in executive and behavioral function (Pfeffer et al. 1999 Varma et al. 1999). This relative cognitive distinction persists throughout the course of the two disorders (Pachana et al. 1996). Disinhibition and disorganization are common, and psychotic symptoms may be prominent in frontotemporal dementia. 

Surely a 480 percent increase in the number of psychiatric abnormalities over fifty years cannot result solely from dispassionate scientific discovery. The transition from disorder to disease and the proliferation of such diseases are more a function of cultural, economic, and political processes than scientific advances. In fact, the sharpest critics of psychiatry s current stance maintain that, except for a few major psychotic illnesses, there is no evidence that the multiplication of conditions listed as brain diseases in the DSM warrant that designation. 

Abnormalities of the glutamate system have also been documented in neuropsychiatric disorders. For example, compounds such as PCP and ketamine, which block the NMDA receptor, can induce psychotic symptoms. By contrast, compounds such as d-cycloserine or glycine, which increase NMDA receptor function via the glycine binding site, can decrease psychotic and/or negative symptoms in schizophrenia (Farber et ah, 1999 Goff et ah, 1999, Fleresco-Levy et ah, 1999). 

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