2. The definition of Psychosis.
Term psychosis is used to describe conditions that affect the mind,
where there has been some loss of contact with reality.
During a period of psychosis, a person’s thoughts and perceptions are
disturbed and the individual may have difficulty understanding what
is real and what is not.
Symptoms of psychosis include:
1. Delusions (false beliefs)
2. Hallucinations (seeing or hearing things that others do not see or
hear).
3. Also usually present incoherent or nonsense speech, and behavior
that is inappropriate for the situation.
3. Psychosis vs. neurosis
Neurosis is a class of functional mental disorders involving chronic
distress but neither delusions nor hallucinations.
• Neurosis refers to a group of a mental and emotional disorders that
affects only part of the personality
• In these cases there are less distorted perception of reality than in a
psychosis
• Neurosis does not result in disturbance of the use of language
• Neurosis is accompanied by various physical, physiological, and
mental disturbances (such as visceral symptoms, anxieties, or
phobias)
4. Brief psychotic disorder
• Delusions, hallucinations, or disorganized speech last
for more than 1 day but resolve within 1 month.
• Characteristically, people experiencing a brief
psychotic disorder will change from a nonpsychotic
state to a psychotic state suddenly (e.g., within 2
weeks) without a prodrome.
• A full return to the premorbid level of functioning is
required.
5. DSM-5 Criteria for Brief Psychotic Disorder.
A. Presence of one (or more) of the following symptoms.
At least one of these must be (1) (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or
incoherence).
4. Grossly disorganized or catatonic behavior.
Note: Do not include a symptom if it is a culturally
sanctioned response.
6. DSM-5 Criteria for Brief Psychotic Disorder.
B. Duration of an episode of the disturbance is at
least 1 day but less than 1 month, with eventual full
return to premorbid level of functioning.
C. The disturbance is not better explained by major
depressive or bipolar disorder with psychotic features
or another psychotic disorder such as schizophrenia or
catatonia, and is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition.
7. DSM-5 Criteria for Brief Psychotic Disorder.
Specify if:
With marked stressor(s) (brief reactive psychosis)
Without marked stressor(s)
With postpartum onset
Specify if:
With catatonia
8. Delusional disorder
• One or more delusions that are present for longer than 1
month. If hallucinations are present, they are not prominent
and are related to the content of the delusions.
• For a diagnosis of delusional disorder, functioning should
not be markedly impaired and behavior not obviously odd
(apart from the impact of the delusions). Individuals with
delusional disorder tend to behave and appear appropriately
when their delusions are not being discussed or acted upon.
• Social, marital, work, or legal problems can result from
delusional beliefs or actions taken in response to delusions.
9. DSM-5 Criteria for Delusional Disorder
• A. The presence of one (or more) delusions with a duration of 1
month or longer.
• B. Criterion A for schizophrenia has never been met.
Note: Hallucinations, if present, are not prominent and are related to
the delusional theme (e.g., the sensation of being infested with insects
associated with delusions of infestation).
( in schizophrenia criterion A two (or more) of the following must present at
least one of these must be (1), (2), or (3): they are 1 – Delusions, 2 –
Hallucinations, 3 - Disorganized speech (e.g., frequent derailment or
incoherence), 4 - Grossly disorganized or catatonic behavior, 5- Negative
symptoms (i.e., diminished emotional expression or avolition).
10. DSM-5 Criteria for Delusional Disorder
C. Apart from the impact of the delusion(s) or its ramifications,
functioning is not markedly impaired, and behavior is not obviously
bizarre or odd.
D. If manic or major depressive episodes have occurred, these have
been brief relative to the duration of the delusional periods.
E. The disturbance is not attributable to the physiological effects of a
substance or another medical condition and is not better explained by
another mental disorder, such as body dysmorphic disorder or obsessive-
compulsive disorder.
11. DSM-5 Criteria for Delusional Disorder
Types of delusional disorder
• Erotomanic type (The patient is convinced that some person is
in love with them although the alleged lover may never have
spoken to them. )
• Grandiose type
• Jealous type (A jealous husband, for example, may interpret
common phenomena as ‘evidence’ of infidelity)
• Persecutory type (Patient knows that people are talking about
him, slandering him or spying on him.)
12. Types of delusional disorder
• Somatic type (Individuals with delusions of ill health in the context
of depression may believe that they have a serious disease)
• Mixed type
• Unspecified type
Psychosis can also occur during the manic phase of bipolar I disorder
or during major depressive disorder with psychotic features. If
delusions or other psychotic symptoms occur exclusively during
manic or depressive episodes, then the diagnosis is bipolar or major
depressive disorder with psychotic features.
13. Schizoaffective disorder
• Сore symptom: criteria for schizophrenia co-occur with a manic or
major depressive episode but are preceded or followed by at least 2
weeks of delusions or hallucinations without a major mood episode.
• Major mood episodes must be present for at least half the total
duration of the illness.
• Some individuals who initially receive a diagnosis of schizoaffective
disorder may no longer fulfill this condition if mood symptoms
become less prominent over time.
• Impaired social or occupational functioning is not a diagnostic
criterion, reflecting a belief that schizoaffective disorder has a
somewhat better prognosis than schizophrenia.
14. DSM-5 Criteria for Schizoaffective Disorder
• A. An uninterrupted period of illness during which there is a
major mood episode (major depressive or manic) concurrent with
Criterion A of schizophrenia.
• Note: The major depressive episode must include Criterion A1:
Depressed mood.
• B. Delusions or hallucinations for 2 or more weeks in the
absence of a major mood episode (depressive or manic) during the
lifetime duration of the illness.
15. DSM-5 Criteria for Schizoaffective Disorder
• C. Symptoms that meet criteria for a major mood episode are
present for the majority of the total duration of the active and
residual portions of the illness.
• D. The disturbance is not attributable to the effects of a
substance (e.g., a drug of abuse, a medication) or another medical
condition.
Schizoaffective Disorder subtypes:
A) Bipolar type B) Depressive type
16. Psychotic disorder due to another medical
condition.
• If psychosis is the direct physiological consequence of a
general medical condition, then the diagnosis is psychotic
disorder due to another medical condition.
• If there are evidences of physiological changings (from the
history, physical examination, or laboratory findings)
• The symptoms are not present only in the context of
delirium
(in delirium electrolyte disturbances and poor oxygenation
associated with many illnesses may cause psychosis. Steroids,
opiates, benzodiazepines, and any polypharmacy frequently
cause delirium)
17. Psychotic disorder due to another medical
condition. Examples
• Neoplasms Mental status changes are common in primary and
metastatic brain tumors.
• Neurovascular events Hemi-neglect and seizures can resemble
delusions.
• Seizures Temporal lobe seizures can be associated with olfactory
and religious delusions.
• Endocrine disorders Hypo- and hyperthyroidism, Addison's and
Cushing's diseases, and hyper- and hypoparathyroidism may cause
psychosis.
18. Psychotic disorder due to another medical
condition.
• Neurodegenerative disordersDementia, Huntington's disease, and
Creutzfeldt-Jakob disease are all associated with psychosis.
• White matter diseases
Metachromatic leukodystrophy, X-linked adrenoleukodystrophy,
Pelizaeus-Merzbacher disease, cerebrotendinous xanthomatosis, adult-
onset Niemann- Pick type C, and multiple sclerosis may be associated
with symptoms of psychosis.
• Systemic lupus erythematosus
Psychosis occurs in 5%-15% of patients.
19. Substance/medication-induced
psychotic disorder.
When hallucinations or delusions develop in the context of exposure
to or intoxication or withdrawal from a drug, medication, or toxin and
do not occur exclusively during the course of a delirium, then the
diagnosis is substance/medication-induced psychotic disorder.
1. Amphetamines, cocaine, phencyclidine (PCP, angel dust),
methylenedioxypyrovalerone (bath salts),
2. Hallucinogens (e.g., lysergic acid diethylamide or LSD, mescaline,
psilocybin),
3. Dextromethorphan at high doses
4. Cannabis are among die drugs that can trigger psychotic symptoms.
