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1. Unit 3
Psychosis and Schizophrenia
related Disorder
NABINA PANERU

2. Psychosis
 Psychosis is the severe type of mental illness in
which personality of the person is affected and is
characterized by alteration in thought process,
emotion, loss of insight, impairment in attention,
concentration, memory and orientation.

3. Acute Transient Psychotic Disorder
Brief psychotic disorder (DSM – IV) or ATPD (ICD – 10) is
a psychotic condition that involves abrupt (less than 48 hrs)
or acute (less than 2 weeks) onset of psychotic symptoms,
which lasts 1 day or more but less than one month.
The onset if often abrupt and complete recovery within 2-3
months

4. Contd.
Often associated with easily identifiable acute
stress such as bereavement, unexpected loss of
partner or job, marriage, or the psychological
trauma of combat, terrorism, and torture.
Long-lasting difficulties or problems are not
included as stressful.

5. Types
1. Acute polymorphic psychotic disorder without symptoms
of schizophrenia
2. Acute polymorphic psychotic disorder with symptoms of
schizophrenia
3. Acute schizophrenia like psychotic disorder
4. Other acute predominantly delusional psychotic disorders

6. Acute polymorphic psychotic disorder
without symptoms of schizophrenia
According to ICD – 10, this disorder is
characterized by an acute onset (from a non
psychotic state to a clearly psychotic state within 2
weeks) and polymorphic picture (unstable and
markedly variable clinical picture that changes from
day to day or even hour to hour).

7. Contd.
 There are several types of hallucinations and/or delusions
changing in both type and intensity from day to day or
within the same day. Emotional instability is also frequently
present.
 This disorder is particularly likely to have an abrupt onset
(within 48 hours) and rapid resolution of symptoms.

8. Acute polymorphic psychotic disorder
with symptoms of schizophrenia
The disorder that meets the descriptive criteria for
acute polymorphic psychotic disorder but in which
typically schizophrenic symptoms are constantly
present.
If the schizophrenic symptoms persist for more than
1 month, the diagnosis should be changed to
schizophrenia

9. Acute schizophrenia like psychotic disorder
 This disorder is characterized by an acute onset of psychotic
disorder in which the psychotic symptoms are comparatively
stable and fulfill the criteria for schizophrenia but have lasted
for less than 1 month.
 Emotional variability and instability may be present but not
to the extent of acute polymorphic psychotic disorder.
 If symptoms persist >1 months  schizophrenia

10. Other acute predominantly delusional
psychotic disorders
 This disorder is characterized by an acute onset of psychotic
disorder in which comparatively stable delusions or
hallucinations are the main clinical features, but do not fulfill
the criteria for schizophrenia.
 Delusion of persecution or reference are common, and
hallucination are usually auditory. The criteria for acute
polymorphic psychotic disorder or schizophrenia should not be
fulfilled.

11. Contd.
 If delusion persists for more than 3 months, the diagnosis
should be changed to persistent delusional disorder. If only
hallucinations persists for more than 3 months, the diagnosis
should then be changed to other non organic psychotic
disorder.

12. Epidemiology
 Young adults, with the average age at onset being
in the late 20s or early 30s
 Double in women than men and person in
developing countries

13. Pathophysiology
 Some data suggest increased incidence of mood disorders
in families of patient with brief psychotic disorder.
 Psychodynamic theories suggest that the psychotic
symptoms occur because of inadequate coping
mechanisms.

14. Etiology
 Idiopathic
 Patients who have a personality disorder particularly those with
borderline, schizoid, schizotypal, or paranoid qualities.
 Family history of schizophrenia or mood disorders

15. Contd.
 Inadequate coping mechanism (according to
psychodynamic theory)
 Precipitating stressors ( major life events that would
cause significant emotional upset e.g., the loss of close
family member, marriage etc.

16. Clinical Features (Diagnostic Criteria)
 Presence of at least one or more of the following symptoms:
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or
incoherence)
- Grossly disorganized or catatonic behavior

17. Contd.
 At least one major symptom of psychosis, usually with an
abrupt onset.
 Labile mood, confusion, and impaired attention
 Characteristic symptoms include emotional volatility, strange
or bizarre behavior, streaming or muteness, and impaired
memory for recent events.

18. Contd.
 Perplexity, misidentification or impairment of attention,
concentration are present
 Paranoia is often the predominant symptoms.

19. Management
 Pharmacotherapy
1. Antipsychotic drugs: olanzapine can achieve symptom relief in
acute psychosis, haloperidol, ziprasidone
2. Benzodiazepines: can be used in the short term treatment of
psychosis
3. Anxiolytic medications: useful during the first 2 to 3 weeks
after the resolution of the psychotic episode

20. Contd.
 Psychotherapy
- Psychotherapy is of use in providing an opportunity to discuss
the stressors and the psychotic episode.
- Exploration and development of coping strategies.
- Helping patient deal with the loss of self – esteem
- An individual treatment strategy: increasing problem – solving
skills while strengthening the ego structure.
- Family involvement in the treatment process

21. Nursing Management