Psychotic disorders types

Manic-depressive illness connotes a psychotic disorder of affect that occurs episodically without external cause. In endogenous depression (melancholia), mood is persistently low. Mania refers to the opposite condition (p. 234). Patients may oscillate between these two extremes with interludes of normal mood. Depending on the type of disorder, mood swings may alternate between the two directions (bipolar depression, cyclothymia) or occur in only one direction (unipolar depression). 

Rapid control of acutely disruptive behavior, often associated with an exacerbation of various types of psychotic disorders, is desirable to achieve the following ... 

This discussion of clusters of psychotic symptoms does not constitute diagnostic criteria for any psychotic disorder. It is given merely as a description of several types of symptoms in psychosis to give the reader an overview of the nature of behavioral disturbances associated with the various psychotic illnesses. 

Of all the psychotic disorders, schizophrenia is often considered the most devastating (Breier, 1996) and to date no known prevention or cure exists (Carpenter, 1996). At a conference to update professionals on the newer antipsychotic medications several speakers who were psychiatrists stated that because of managed care and its handling of those clients few professionals would compete to serve psychotic disordered clients. The authors sadly concur with the truth of these statements, as there is indeed little interest in building practices that primarily assist clients who suffer from this type of mental illness. 

TABLE 7.1 Schizophrenia and Primary Psychotic Disorders Five types of schizophrenia ... 

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). 

Extrapyramidal symptoms (EPS) Numerous negative side effects experienced by clients as a result of taking several types of medications, especially the typical antipsychotic medications used to treat psychotic disorders. 

Since the cannabinoid agonists are not first-line drugs in the treatment of any of the various types of pain or pain syndromes, any potential risk of serious consequences from their use should be considered an absolute contraindication. Preexisting or genetic predisposition to serious psychiatric disorders such as schizophrenia or psychotic disorders, in general, would be an example. Precipitation or worsening of these and less serious psychiatric disorders has been reported. Caution and close monitoring of patients with less serious illnesses such as bipolar disorder, anxiety, or depression is necessary since the symptoms of these disorders could become manifest. 

Delusions are false beliefs that the patient maintains in the face of incontrovertible, contradictory evidence. The schizophrenic patient usually has no insight that these beliefs are not real, but rather maintains a firm conviction in them. Schizophrenia is characterized by a variety of delusions, of which the persecutory type predominates. Other delusions often involve bizarre bodily changes. In contrast to delusional disorder, these delusions are not as well formed and occur in the context of other psychotic symptoms (e.g., hallucinations, negative symptoms). 

Certain disorders may require combined therapy. For example, SA-bipolar type may best respond to the addition of mood stabilizers, and BZDs may be useful adjuncts for agitated psychoses. Conversely, some mood disorders may require augmentation with antipsychotics (e.g., delusional depression). Unfortunately, except for schizophrenia, most other psychotic conditions have not been systematically studied to determine the optimal use of these agents. 

Investigators have attempted to assess the impact of antipsychotics on the cognitive and the behavioral disturbances characteristic of schizophrenia. The antipsychotics decrease typical, but nonspecific, positive symptoms such as hallucinations and delusions ( Table 5-4). Thus, labeling them as antischizophrenic agents is too restrictive inasmuch as they also benefit such disparate disorders as psychotic depression or mania, iate-onset paraphrenia, and organic-induced psychosis. As the symptoms reduced by neuroleptics are typical of psychosis in general, these agents are best conceptualized as a type of antipsychotic. 

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