Schizophrenia and Related Psychoses

suicide.

-Tardive dyskinesia: continuous slow writhing movements and sudden involuntary movements, typically of the oral region. Symptoms tend to be irreversible (the older the patient the more likely). Treatment is difficult, procyclidine worsen the condition or reduction of the antipsychotic can make it worse. Vit E may prevent deterioration.

Anticholinergic side-effects: Dry mouth, blurred vision, difficulty passing urine, urinary retention, constipation, glaucoma, confusion, cognitive impairment. Antiadrenergic side-effect: Postural hypotension, tachycardia, sexual dysfunction. Antihistaminic side-effect: Sedation, weight gain Hyperprolactinemia. Cardiovascular risk: prolongation of QTc interval, sudden death (Pimozide)  Idiosyncratic: Cholestatic jaundice, altered glucose tolerance, hypersensitivity reaction, skin photosensitivity, yellow pigmentation of the skin, Neuroleptic Malignant Syndrome (rigidity, fluctuating consciousness, and pyrexia. May be fatal , requires ICU admission).

 2.Newer antipsychotic (so called atypical):

 e.g. Olanzapine, Quetiapine, Resperidone, Ziprasidone and many others.

 Safer than the ‘older generation’. Very expensive. Not devoted of serious side effect, depends on the agent. Recently linked to causing DM and hypercholesterolemia. In high doses (and some times within normal dose, could have similar side effect as typical antipsychotic). Other side effect depends on the drug e.g. Olanzapineà weight gain.

All antipsychotics (typical or atypical) have similar clinical effect. None is superior clinically. The exception is Clozapine (only agent licensed for resistant schizophrenia).

Need continuous blood monitoring, weekly for 18 w and then regularly (depends on which guidelines). Risk of agranulocytosis and neutropenia. 

 Psychosocial approach:

Effective psychosocial interventions include:

Family Therapy Cognitive behavioural therapy Social skills training Social support Illness management skills Assertive community treatment.

Delusional Disorder:

The patient present with circumscribed symptoms of non-bizarre delusions, but with absence of prominent hallucinations and no thought disorder or mood disorder. Symptoms should have been present for at least 1 month in The DSM-IV and 3 months in The ICD-10.

Relatively uncommon (0.03% ), but account for up to 2% of hospital admission

Sub-types:

Erotomania (Delusion of Love/ de Clérambault Syndrome)

Patient present with the belief that some important person is secretly in love with them. Clinical samples are often females and forensic samples often males. Patient may make efforts to contact the person, and some cases are associated with dangerous or assaultive behaviour. Stalking.

Grandiose

Patient believes they fill some special role, have some special relationship, or possess some special ability. They may be involved with social or religious organisations.

Jealous (morbid jealousy/ Othello syndrome)

Patient possesses the fixed belief that their spouse or partner has been unfaithful. Often patient try to collect evidence or attempt to restrict their partner’s activities. This type of delusional disorder has been associated with forensic cases involving murder.

Persecutory

This is the most common type. Patient are convinced that others are attempting to do them harm. Often they obtain legal recourse, and they sometimes may resort to violence.

Somatic

Varying presentation, from those who have repeat contact with physicians requesting various forms of medical or surgical treatment to patients who are concerned with bodily infestation, or deformity (dysmorphophobia), or odour

Induced or shared delusional disorders (Folie a deux/ Communicated insanity)

A paranoid delusional system which appears to have developed in a person as a result of a close relationship with another person who already has an established delusions. Could be more than one person (e.g. a family, ‘cult’). 90% of cases are members of same family, dominant partner and isolated. F>M. usually separation improve the recipient but not the inducer. Subtypes:

Folie imposée: primary psychotic illness in one adopted by another Folie simultanée: primary psychotic illness in both with identical delusions Folie communiqué: primary psychotic illness in both at different times with delusions shared or passed on. Folie induite: pre-existing primary psychosis in one patient, adopts fellow patient’s delusions.

Delusional misidentifications syndromes:

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