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Psychotic Disorder

Psychotic disorder is a term where there is a altered mental state where there is dissociation with reality. The clinical term psychosis is used in the more complicated presentations, with distortions of perception like delusions, hallucinations, aggression and judgment impairment.

Psychotic disorder occurs because of a multifactorial background. The most common cause of psychotic disorder is the aggravation of a pre-existing genetic predisposition, in persons who have a family history of mental illness or frank psychotic disorder, by super-added environmental, social and psychological factors. Risk is amplified with parents or siblings with psychosis. While there is no straight liner cause and effect sequence, triggers have been identified. Risk factors for psychotic disorder types like Schizophrenia and Bipolar disorder often overlap.

A history of drug abuse and organic illness can also be implicated in psychotic disorder. Both milder drugs like marijuana and ‘harder’ drugs like Ketamine have been linked to psychotic disorder. About 25% percent of women who suffer from post-partum depression develop features of psychosis in later life. While there is usually a history of domestic abuse or substance abuse, sporadic occurrence is also documented.

Types of Psychotic Disorder

The most common type of psychotic disorder is Schizophrenia. Other variants that are observed are Brief Psychotic Disorder, Substance induced psychotic disorder, schizoaffective disorder, psychosis secondary to organic illness, and frank delusional disorder. Sometimes, psychotic disorder can develop from worsening of Bipolar disorder or Major depression as well.

Signs and Symptoms of Psychotic Disorder

Symptoms and signs may sometimes not be clinically apparent at all. The most common features are divided into two major clusters, positive symptoms and negative symptoms.

Positive symptoms include delusions of persecution, paranoia, delusions of spousal infidelity, delusions of grandeur or thought amplification, hallucinations which can be auditory or visual or both, incessant talking which is often nonsensical.

Negative symptoms include features of depression, social anxiety and withdrawal, reclusiveness, distorted reactions to emotional stimuli, apathy and unresponsiveness.

Other symptoms include mood disturbances like depression, suicidal tendencies, difficulty in interacting with people and processing social situations, confusion, inappropriate responses, etc.

Treatment of psychotic disorder

Treatment is carried out firstly with the management of the Acute phase with high dose Antipsychotic medication, followed by a lower maintenance dose once a stable state is achieved. While some patients have relapses, most patients are normal with antipsychotic drugs. These include Chlorpromazine, Haloperidol, Fluphenazine, Perphenazine, etc.

Nowadays newer drugs are used with lesser side effects, but in refractory cases the older drugs can be used. Newer commonly used drugs include Clozapine, Risperidone, Olanzipine, Seroquel, Abilify, Asenapine, Iloperidone, etc. Antidepressants are also prescribed simultaneously in most cases.

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