pathophysiology of psychosis

1. Mental disorder: Psychosis
Pharmacotherapeutic I

2. Introduction
• Definition:
• Psychosis refers to an abnormal condition of the
mind described as involving a "loss of contact
with reality ".
• It is a severe form of mental disorder
characterized by delusion, hallucination,
detached with reality testing and marked
impairment of mental functioning.
• Hallucination: False sensation
• Delusion: False belief.

3. Classification
A) Acute and chronic organic psychosis: In this some toxic
or pathological basis can often be defined. Eg: Dementia.
Prominent features are confusion, disorientation, defective
memory and disorganized behaviour.
B) Functional Psychosis:
In this no underlying cause can be defined.
• Memory and orientation are mostly retained but emotion,
thought, reasoning and behaviour are seriously altered.
– i) Schizophrenia (split mind): Inablity to interpret from reality-
hallucinations, inability to think coherently.
– ii) Paranoid states: There are marked delusions ( false beliefs)
and loss of insight into the abnormality.

4. c) Affective disorder: There is change in mood state
recurrently.
i) Mania: There is elavationor irritable mood, reduced sleep,
• hyperactivity, uncontrollable thought and speech, may
• be associated with reckless or violent behaviour, or
ii) Depression: There is sadness, loss of interest and pleasure,
• worthlessness, guilt, physical and mental slowing,
• melancholia, self-destructive ideation.
iii) Bipolar (manic-depressive) : There is cyclically alternating
manic and depressive phases.
D) Drug induced: Certain drugs like, amphetamine, cocaine.

5. Etiology
• The exact causes are not well understood.
• Biological Causes
– Genetics
– Trauma /Lesion on brain/Reduced grey matter in brain
– Disease condition: Dementia Alzheimer's disease, parkinson disease, epilepsy.
– Neurotransmitter disturbances
– Hormonal disturbances
– Toxic effect of drugs, heavy metals: Alcohol, cocaine etcc
• Psychological Causes
– Stress
– Lack of sleep
– Sociocultural factors: Family problem, financial loss, loss of loved one.
• Lack of nutrition

6. Risk Factors
• Social isolation
• Migration
• Sensory impairment (Blindness, deafness)
• Drugs abuser (alcohol,cocaine, amphetamine)

7. Clinical features and phases
• Prodormal/initial phase:
– This phase occurs before the development of psychotic
symptoms.
– Clear psychotic symptoms have usually not yet started.
– Symptom are:
• Cognitive decline (the brain is not functioning as well as usual) Ì
Spending much less time with family and friends
• Receiving poor grades when grades used to be better
• Performing poorly at work when performance used to be better .
• Avoiding doing activities that were once enjoyed.
• Avoiding bathing, grooming, and other personal care,
• Seeming anxious, irritable.
• Changing sleep patterns

8. Stage cont..
• Second phase: Acute phase.
• The person has clear psychotic symptoms such as hallucinations, delusions,
and confused thinking in this stage.
– Reduced emotional expression
– Problems handling everyday stress
– Increased sensitivity to sights and sounds
– Mistaking noises for voices
– Unusual or overly intense new ideas or beliefs
– Strange new emotions or seeming to have no emotions at all
– Speech that does not make sense
• Third phase: Recovery/residual phase:
• Recovery takes time and doesn’t happen all at once.
• Most of symptoms are treatable but recovery does not always mean the
illness is gone or that the symptoms all go away.
• Some symptoms often remain and the person learns to deal with them .

9. Overall clinical features
• Delusion,
• hallucination,
• disorganized speech,
• bizarre behaviour and posture,
• screaming or muteness,
• impaired memory,
• emotional volatilty, disorientation.

10. Pathophysiology
• Pathophysiology of psychosis is not clearly understood.
• The below mentioned three hypothesis are well
accepted.
i) Dopamine hypothesis:
Psychosis may results from hyper or hypoactivity of
dopamine in specific brain region.
ii) Glutamate hypothesis: Psychosis may result due to
deficiency of glutamate
iii) Serotonin hypothesis: Abnormal brain scar have higher
serotonin concentration which might result into
psychosis.

11. Diagnosis
• Laboratory;
• CT Scan, MRI, hormonal test, EEG, routine blood test.
• Psychosocial:
– Personality questionnaire
– Rating scales
– Sentence completion test
– Mental State examination:- Appearance, speech,
mood, thought, perception, orientation, memory
judgement etc.

12. Treatment
• Non pharmacological
• Psychoterapy/counseling
• Rehalbitation
• Cognitive behavioural therapy
• ECT (Electroconvulsive therapy)
• Stress managment

13. Pharmacological:
• Anti-psychotics medicines
– Phenothiazines: Chlorpromazine Triflupromazine,
Thioridazine ,Trifluoperazine ,Fluphenazine.
– Butyrophenones: Haloperidol (Trifluperidol
– Atypical antipsychotics :Clozapine, Risperidone 2mg
initially up to 8 mg) Olanzapine (5-10 mg daily),
Quetiapine
• Benzodiazepine: Diazepam(2-10 mg),
lorazepam(2-3 mg ), H.S
• Anti cholinergic: Trihexyphenydyl, benzhexol

14. Thank you.