Psychotic disorders

These disorders are characterized by cognitive and perceptual dysfunction like delusions and hallucinations, with an altered perception of reality. An imbalance of dopamine and glutamate in the hippocampus, midbrain, corpus striatum, and prefrontal cortex is associated with psychosis. An increase in dopamine and glutamate and a decrease in GABA are seen. Patients with schizophrenia show increased dopamine in the ventral striatum and decreased levels in the frontal cortex, while increased glutamate is seen in the prefrontal and medial temporal lobes. Patients with schizophrenia, schizoaffective disorder, and bipolar disorder show decreased volume in the frontal, temporal, and parietal lobes and decreased cortical thickness.

According to DSM V, the following types of psychotic disorders are seen:

1. Schizophrenia: Symptoms lasting for = or > 6 months. Includes delusions, hallucinations (auditory most common), disorganized thought, and abnormal psychomotor behavior. Positive symptoms include hallucinations, delusions, and thought disorders. Negative symptoms include loss of motivation, disinterest or lack of enjoyment in daily activities, social withdrawal, difficulty showing emotions, difficulty functioning normally, difficulty in planning tasks, “flat affect,” and reduced speaking. Cognitive symptoms include problems in attention, concentration, and memory. Schizophrenia sometimes runs in families.

2. Delusions: A clearly false belief, which cannot be accounted for by a person’s cultural, religious background or intelligence level. A person with a delusion will hold firmly to the belief regardless of evidence to the contrary. e.g., “Russians are trying to poison me with radioactive particles delivered through my tap water”

3. Hallucinations: Sensory perception in the absence of an actual external stimulus, e.g., hearing noises when nobody is talking. It can be visual, auditory, olfactory, tactile (e.g., bugs crawling), gustatory, etc.

4. Schizophreniform disorder: Symptoms of schizophrenia but lasting from 1-6 months.

5. Brief psychotic disorder: Symptoms of schizophrenia but lasting < 1 month.

6. Schizoaffective disorder: Psychotic and mood symptoms occurring concurrently or independently.

7. Bipolar disorder with psychotic features: Psychotic symptoms like delusions and hallucinations during manic episodes.

8. Major depressive disorder with psychotic features: Psychotic symptoms like delusions and hallucinations only during depressive episodes.

9. Delusional disorder: Suffer from delusions but socialize and function quite normally and do not have psychosis.

10. Postpartum psychosis: Psychotic symptoms within 6 weeks after delivery.

11. Psychosis induced by toxins, recreational substances, or iatrogenic (medications): May be seen with organophosphate poisoning, sarin gas, carbon monoxide poisoning, anticholinesterases, paint thinners, glucocorticoids, anticholinergics, antihistamines, cannabis, alcohol, PCP, etc.

12. Psychosis secondary to medical conditions: May be seen in CNS tumors, SLE, electrolyte imbalances, endocrinopathies like thyroid and parathyroid disorders, cerebrovascular disorders, multiple sclerosis, epilepsy, migraine, hypoglycemia, hypoxia, etc.