Psychotic disorders

These disorders involve cognitive and perceptual dysfunction - most notably delusions and hallucinations - leading to an altered perception of reality. Psychosis is associated with an imbalance of neurotransmitters (dopamine, glutamate, and GABA) in the hippocampus, midbrain, corpus striatum, and prefrontal cortex. In general, increased dopamine and glutamate and decreased GABA are seen.

In schizophrenia specifically, dopamine levels are increased in the ventral striatum and decreased in the frontal cortex. Glutamate levels are increased in the prefrontal and medial temporal lobes. Imaging findings in schizophrenia, schizoaffective disorder, and bipolar disorder include decreased volume in the frontal, temporal, and parietal lobes, along with decreased cortical thickness.

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

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.
Delusions: A clearly false belief that can’t be explained by a person’s cultural or religious background, or by their intelligence level. A person with a delusion holds firmly to the belief despite evidence to the contrary. e.g., “Russians are trying to poison me with radioactive particles delivered through my tap water”
Hallucinations: Sensory perception in the absence of an actual external stimulus, e.g., hearing noises when nobody is talking. Hallucinations can be visual, auditory, olfactory, tactile (e.g., bugs crawling), gustatory, etc.
Schizophreniform disorder: Symptoms of schizophrenia but lasting from 1-6 months.
Brief psychotic disorder: Symptoms of schizophrenia but lasting < 1 month.
Schizoaffective disorder: Psychotic and mood symptoms occurring concurrently or independently.
Bipolar disorder with psychotic features: Psychotic symptoms like delusions and hallucinations during manic episodes.
Major depressive disorder with psychotic features: Psychotic symptoms like delusions and hallucinations only during depressive episodes.
Delusional disorder: Suffer from delusions but socialize and function quite normally and do not have psychosis.
Postpartum psychosis: Psychotic symptoms within 6 weeks after delivery.
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.
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.

Psychotic disorders

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

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.
Delusions: A clearly false belief that can’t be explained by a person’s cultural or religious background, or by their intelligence level. A person with a delusion holds firmly to the belief despite evidence to the contrary. e.g., “Russians are trying to poison me with radioactive particles delivered through my tap water”
Hallucinations: Sensory perception in the absence of an actual external stimulus, e.g., hearing noises when nobody is talking. Hallucinations can be visual, auditory, olfactory, tactile (e.g., bugs crawling), gustatory, etc.
Schizophreniform disorder: Symptoms of schizophrenia but lasting from 1-6 months.
Brief psychotic disorder: Symptoms of schizophrenia but lasting < 1 month.
Schizoaffective disorder: Psychotic and mood symptoms occurring concurrently or independently.
Bipolar disorder with psychotic features: Psychotic symptoms like delusions and hallucinations during manic episodes.
Major depressive disorder with psychotic features: Psychotic symptoms like delusions and hallucinations only during depressive episodes.
Delusional disorder: Suffer from delusions but socialize and function quite normally and do not have psychosis.
Postpartum psychosis: Psychotic symptoms within 6 weeks after delivery.
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.
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.