"Psychosis in Youth"
Portland, Maine; March 30, 2004
Psychiatry Grand Rounds at Maine Medical Center
*Learn clinical assessment of psychosis in youth
*Learn neurobiology of psychosis
*Learn course and prognosis of psychosis
*Learn treatment of psychosis in youth
Hypertension, or high blood pressure, refers to blood pressure above 140/90 mmHg. It puts stress on blood vessels and vital organs like the heart, brain, and kidneys over time if not controlled. The document discusses what causes hypertension, risk factors, potential health effects, diagnosis through blood pressure monitoring, treatment through lifestyle modifications and medications, and treatment goals of lowering blood pressure to reduce risks of heart disease, stroke, and other complications. Treatment involves lifestyle changes like losing weight, reducing salt, exercising, and quitting smoking, as well as medications like diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and ARBs.
This document discusses screening and treatment for alcohol withdrawal. It recommends using the CAGE assessment tool to screen for alcohol dependency and risk of withdrawal symptoms. For patients who screen positive, it suggests making referrals to social services and informing physicians. It also describes the CIWA-Ar scale for assessing withdrawal symptoms and guiding medication administration to safely manage alcohol withdrawal syndrome.
Anxiety Disorders based on the DSM 4 and 5SMR Grey
So this is actually my report in one of my class(abnormal psychology) I wanted to upload it here so it wont go to waste. all of these photos here is not mine, i got it from pinterest :)
This document summarizes the syndrome of inappropriate antidiuretic hormone (SIADH). It describes SIADH as a disorder caused by inappropriate secretion of antidiuretic hormone (ADH), leading to water retention and hyponatremia. The key symptoms of SIADH include hyponatremia, concentrated urine, and euvolemia. Treatment involves fluid restriction, salt administration, and vasopressin receptor antagonists to increase water excretion. Care must be taken to correct hyponatremia slowly to avoid central pontine myelinolysis.
This document provides an overview of alcohol withdrawal syndromes. It defines alcohol withdrawal, describes the pathophysiology and timeline of symptoms. Minor withdrawal can occur within 6-12 hours and includes autonomic hyperactivity and insomnia. Alcoholic hallucinosis may occur in the first 24-48 hours. Withdrawal seizures typically occur within 8-48 hours. Delirium tremens occurs 2-14 days later and has a mortality rate of 5% with treatment. Benzodiazepines are the main treatment, with fixed dose or symptom-triggered regimens using medications like diazepam or lorazepam. Delirium tremens requires ICU care and treatment until the patient is alert and
This document provides an overview of psychosis (psychotic disorder). It defines psychosis as an abnormal condition of the mind involving a loss of contact with reality. Some key signs and symptoms include hallucinations, delusions, disorganized thinking, emotional changes, and personality changes. Psychosis can be caused by factors such as genetics, trauma, other psychiatric disorders, medical conditions, drugs, and medications. The main types of psychotic disorders discussed are schizophrenia, bipolar disorder, psychotic depression, and schizoaffective disorder. Diagnosis involves interviews and exams to evaluate symptoms, while treatment primarily uses antipsychotic medications along with psychotherapy.
Acute dystonia is defined as involuntary muscle contractions causing abnormal movements or postures. It is often caused by drugs that block dopamine receptors or disrupt dopamine-cholinergic balance in the basal ganglia. Symptoms vary but include trismus, risus sardonicus, torticollis, and opisthotonus. Treatment involves diphenhydramine, benztropine, or lorazepam to relieve symptoms, with diphenhydramine as first line. Differential diagnoses include conversion disorder, seizures, meningitis, and other conditions involving muscle spasms or contractions.
This document discusses the management of complicated alcohol withdrawal. It begins with an introduction and overview of key topics including alcohol withdrawal seizures, alcoholic hallucinosis, delirium tremens, and Wernicke's encephalopathy. It then provides more detailed information on the pathogenesis, risk factors, clinical features, investigations, and management approaches for each of these complicated alcohol withdrawal conditions. Benzodiazepines are emphasized as the primary treatment for managing withdrawal symptoms, seizures, and delirium, while thiamine supplementation is stressed for preventing and treating Wernicke's encephalopathy.
Hypertension, or high blood pressure, refers to blood pressure above 140/90 mmHg. It puts stress on blood vessels and vital organs like the heart, brain, and kidneys over time if not controlled. The document discusses what causes hypertension, risk factors, potential health effects, diagnosis through blood pressure monitoring, treatment through lifestyle modifications and medications, and treatment goals of lowering blood pressure to reduce risks of heart disease, stroke, and other complications. Treatment involves lifestyle changes like losing weight, reducing salt, exercising, and quitting smoking, as well as medications like diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and ARBs.
This document discusses screening and treatment for alcohol withdrawal. It recommends using the CAGE assessment tool to screen for alcohol dependency and risk of withdrawal symptoms. For patients who screen positive, it suggests making referrals to social services and informing physicians. It also describes the CIWA-Ar scale for assessing withdrawal symptoms and guiding medication administration to safely manage alcohol withdrawal syndrome.
Anxiety Disorders based on the DSM 4 and 5SMR Grey
So this is actually my report in one of my class(abnormal psychology) I wanted to upload it here so it wont go to waste. all of these photos here is not mine, i got it from pinterest :)
This document summarizes the syndrome of inappropriate antidiuretic hormone (SIADH). It describes SIADH as a disorder caused by inappropriate secretion of antidiuretic hormone (ADH), leading to water retention and hyponatremia. The key symptoms of SIADH include hyponatremia, concentrated urine, and euvolemia. Treatment involves fluid restriction, salt administration, and vasopressin receptor antagonists to increase water excretion. Care must be taken to correct hyponatremia slowly to avoid central pontine myelinolysis.
This document provides an overview of alcohol withdrawal syndromes. It defines alcohol withdrawal, describes the pathophysiology and timeline of symptoms. Minor withdrawal can occur within 6-12 hours and includes autonomic hyperactivity and insomnia. Alcoholic hallucinosis may occur in the first 24-48 hours. Withdrawal seizures typically occur within 8-48 hours. Delirium tremens occurs 2-14 days later and has a mortality rate of 5% with treatment. Benzodiazepines are the main treatment, with fixed dose or symptom-triggered regimens using medications like diazepam or lorazepam. Delirium tremens requires ICU care and treatment until the patient is alert and
This document provides an overview of psychosis (psychotic disorder). It defines psychosis as an abnormal condition of the mind involving a loss of contact with reality. Some key signs and symptoms include hallucinations, delusions, disorganized thinking, emotional changes, and personality changes. Psychosis can be caused by factors such as genetics, trauma, other psychiatric disorders, medical conditions, drugs, and medications. The main types of psychotic disorders discussed are schizophrenia, bipolar disorder, psychotic depression, and schizoaffective disorder. Diagnosis involves interviews and exams to evaluate symptoms, while treatment primarily uses antipsychotic medications along with psychotherapy.
Acute dystonia is defined as involuntary muscle contractions causing abnormal movements or postures. It is often caused by drugs that block dopamine receptors or disrupt dopamine-cholinergic balance in the basal ganglia. Symptoms vary but include trismus, risus sardonicus, torticollis, and opisthotonus. Treatment involves diphenhydramine, benztropine, or lorazepam to relieve symptoms, with diphenhydramine as first line. Differential diagnoses include conversion disorder, seizures, meningitis, and other conditions involving muscle spasms or contractions.
This document discusses the management of complicated alcohol withdrawal. It begins with an introduction and overview of key topics including alcohol withdrawal seizures, alcoholic hallucinosis, delirium tremens, and Wernicke's encephalopathy. It then provides more detailed information on the pathogenesis, risk factors, clinical features, investigations, and management approaches for each of these complicated alcohol withdrawal conditions. Benzodiazepines are emphasized as the primary treatment for managing withdrawal symptoms, seizures, and delirium, while thiamine supplementation is stressed for preventing and treating Wernicke's encephalopathy.
THERE ARE LOTS OF DISORDERS IN MENTAL HEALTH ASPECT.THIS PRESENTATION'S FOCUS IS ON PANIC DISORDER AND ITS MANAGEMENT.THIS CLASS IS IN ASPECT OF PSYCHIATRIC NURSING STUDENTS.
Bipolar disorder causes extreme shifts in mood from mania to depression. It is a chronic illness often diagnosed in adolescence that has high rates of suicide. While the causes are unknown, genetic and environmental factors likely contribute. Diagnosis involves meeting DSM-5 criteria for manic or hypomanic episodes. Treatment includes medication, psychotherapy, and lifestyle changes. Lithium and anticonvulsants are commonly used to stabilize moods, while antidepressants may be used for depression but carry risk for inducing mania. Long-term management focuses on preventing recurrences through medication adherence and monitoring for risky behaviors.
The patient is a 63-year-old male with a history of alcohol abuse presenting with symptoms of acute alcohol withdrawal including tremors, anxiety, tachycardia and hypokalemia. Initial treatment involves monitoring, managing withdrawal symptoms, addressing nutritional deficits and providing counseling and referrals to support ongoing sobriety and prevent relapse.
Presentation delivered by Dr. Carol Manning at the live webinar hosted by AlzPossible at www.alzpossible.org on the 17th of March, 2014.
www.alzpossible.org
Schizophrenia is a mental disorder characterized by splitting of psychic functions and disturbed harmony between thought, emotions, and behavior. It has a prevalence of 0.5% and typically onset is in late adolescence or early adulthood. Etiology involves genetic, biological, and environmental factors. Symptoms include positive symptoms like delusions and hallucinations, negative symptoms such as social withdrawal, and cognitive impairment. Diagnosis involves meeting criteria for symptoms lasting at least 6 months from scales like PANSS. Treatment involves atypical antipsychotic medication which can have side effects as well as psychosocial therapies and hospitalization if risks are present.
Mr. XYZ, age 39, presented with tremors, vomiting blood, seizures, and confusion. He has a history of alcohol dependence and multiple relapses. On examination, he was confused, tachycardic, and jaundiced. Lab tests showed elevated liver enzymes. He was diagnosed with delirium tremens during acute alcohol withdrawal. He was treated with benzodiazepines, thiamine, and other supportive care. Benzodiazepines are the primary treatment for alcohol withdrawal to prevent progression to severe withdrawal states like delirium tremens and seizures.
This document discusses bipolar disorder, including its genetic and environmental influences, symptoms, and treatments. It notes that bipolar disorder often emerges during adolescence and young adulthood and is influenced by both hereditary genetic factors and environmental triggers. Symptoms can include changes in mood, sleep, behavior, and cognitive functioning. The document outlines different types of bipolar disorder and compares incidences internationally. It concludes by describing various treatment approaches, including medications, psychotherapy, lifestyle management techniques, and emerging therapies and technologies.
Bipolar disorder is characterized by recurrent episodes of mania and depression. It is classified into Bipolar I and II based on the severity of manic episodes. The exact causes are unknown but genetic and biochemical factors are thought to play a role. Clinical features include changes in mood, energy, sleep patterns, and risk-taking behavior. Treatment involves mood stabilizers like lithium, antipsychotics, and antidepressants to control symptoms and prevent future episodes. Prognosis depends on factors like comorbidities, stress levels, and medication compliance.
Participants will explore the prevalence of psychotic experiences among kids with mental health concerns and kids in the general population, discuss the differential diagnosis of psychotic symptoms in children and youth, examine the relationship between hallucinations and suicidal behavior in youth and review the appropriate psychiatric and medical workup for youth with psychotic experiences
The document discusses trauma in childhood and its effects. It notes that PTSD in children is often underdiagnosed, and children may receive multiple incorrect diagnoses before an accurate one of PTSD. Trauma in childhood can impact brain development and lead to issues with attention, hyperactivity, aggression, and oppositional behavior. The document outlines symptoms of PTSD in early childhood, school age children, and teenagers. It discusses the two main types of dysregulation—hyperactivation and hypoactivation—that can result from trauma. Building resilience and social support are important factors in recovering from childhood trauma.
This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.
Schizophrenia and other psychotic disorders involve positive, negative, and disorganized symptoms that distort thinking, perception, and behavior. Schizophrenia is a chronic condition defined by fundamental distortions in thought, perception, emotion, and behavior. It affects about 1% of the population and typically emerges in early adulthood. Treatment involves antipsychotic medications to reduce positive symptoms as well as psychosocial support. The causes are complex and involve genetic, neurological, developmental, and environmental factors.
This document discusses personality disorders and their classification. It defines personality disorders as enduring patterns of inner experience and behavior that deviate from a person's culture and cause impairment. Personality disorders are divided into three clusters - A, B, and C - based on similar characteristics. Cluster A disorders include paranoid, schizoid, and schizotypal personalities. Cluster B includes antisocial, borderline, histrionic, and narcissistic personalities. Cluster C comprises avoidant, dependent, and obsessive-compulsive personalities. The document provides descriptions of each disorder's traits and symptoms. Treatment involves long-term psychotherapy as personality disorders develop gradually over time.
This document discusses alcohol withdrawal delirium (AWD), also known as delirium tremens or DTs. It defines delirium and describes different types. AWD is a serious form of alcohol withdrawal that causes sudden brain and nervous system problems. It only affects heavy drinkers who stop drinking abruptly. Symptoms include hallucinations, agitation, and disorientation. Diagnosis involves various medical tests. AWD is treated in hospitals with intravenous fluids, medications to prevent seizures and reduce symptoms, and rehabilitation. With treatment, AWD has a low death rate but some withdrawal symptoms may persist long-term.
SISCOM may help differentiate PNES from epileptic seizures by showing changes in brain perfusion during seizures in epileptic seizures but not PNES. However, its diagnostic accuracy is limited and normal findings do not rule out epileptic seizures. Overall, EEG monitoring remains the gold standard for differentiating the two.
Impulse-control disorders (ICDs) are psychological disorders characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or others.
The individual fails to resist performing a potentially harmful act and it is usually accompanied by a sense of tension or arousal before committing the act and a sense of relief or pleasure when it is committed.
The hallmark in describing any of the ICDs is a tendency to gratify an immediate desire or impulse regardless of the consequences to one's self or to others.
The document provides an overview of psychiatry and mental health topics. It defines mental health according to the WHO as a state of complete physical, mental, social and spiritual well-being. More than two-fifths of total disabilities worldwide are due to mental illnesses such as schizophrenia, depression, and substance abuse disorders. It discusses classification systems for psychiatric disorders, biological, psychological and social factors in mental illnesses, and specific conditions such as mood disorders, psychotic disorders, personality disorders, and more.
The document provides clinical practice guidelines for the management of dementia. It outlines recommendations for assessment, management, and treatment of dementia. Some key points:
- A multidisciplinary panel of experts in geriatrics, neurology, and psychiatry developed the guidelines.
- Non-pharmacological interventions like behavior-, stimulation-, and emotion-oriented treatments should always be considered before drug options.
- Neuroleptic drugs have limited efficacy evidence but may be used for serious behavioral issues like psychosis if other options are insufficient. Low doses for short terms are recommended.
- Acetylcholinesterase inhibitors can modestly improve cognition in mild to moderate Alzheimer's but risks must be discussed prior to
Schizophrenia is a group of biological disorders that produce impairments in thinking, learning, and relationships. It affects around 1% of the population and often begins in late adolescence or early adulthood. While there is no known cure, treatments can help manage symptoms and improve quality of life. Biological factors like genetics and brain abnormalities are involved in schizophrenia, as are psychological and social factors. Medications are effective in reducing positive symptoms like hallucinations and delusions, while psychosocial therapies also play an important role in treatment and recovery.
Schizophrenia is a psychotic disorder characterized by disturbances in thought, perception, emotions, language, sense of self and behavior. Symptoms include delusions, hallucinations, disorganized speech and behavior, and negative symptoms such as lack of motivation and flat affect. It is thought to involve genetic vulnerabilities interacting with environmental stressors and imbalances in neurotransmitters like dopamine. Treatment involves antipsychotic medication combined with therapy and social skills training, though long-term outcomes vary significantly.
THERE ARE LOTS OF DISORDERS IN MENTAL HEALTH ASPECT.THIS PRESENTATION'S FOCUS IS ON PANIC DISORDER AND ITS MANAGEMENT.THIS CLASS IS IN ASPECT OF PSYCHIATRIC NURSING STUDENTS.
Bipolar disorder causes extreme shifts in mood from mania to depression. It is a chronic illness often diagnosed in adolescence that has high rates of suicide. While the causes are unknown, genetic and environmental factors likely contribute. Diagnosis involves meeting DSM-5 criteria for manic or hypomanic episodes. Treatment includes medication, psychotherapy, and lifestyle changes. Lithium and anticonvulsants are commonly used to stabilize moods, while antidepressants may be used for depression but carry risk for inducing mania. Long-term management focuses on preventing recurrences through medication adherence and monitoring for risky behaviors.
The patient is a 63-year-old male with a history of alcohol abuse presenting with symptoms of acute alcohol withdrawal including tremors, anxiety, tachycardia and hypokalemia. Initial treatment involves monitoring, managing withdrawal symptoms, addressing nutritional deficits and providing counseling and referrals to support ongoing sobriety and prevent relapse.
Presentation delivered by Dr. Carol Manning at the live webinar hosted by AlzPossible at www.alzpossible.org on the 17th of March, 2014.
www.alzpossible.org
Schizophrenia is a mental disorder characterized by splitting of psychic functions and disturbed harmony between thought, emotions, and behavior. It has a prevalence of 0.5% and typically onset is in late adolescence or early adulthood. Etiology involves genetic, biological, and environmental factors. Symptoms include positive symptoms like delusions and hallucinations, negative symptoms such as social withdrawal, and cognitive impairment. Diagnosis involves meeting criteria for symptoms lasting at least 6 months from scales like PANSS. Treatment involves atypical antipsychotic medication which can have side effects as well as psychosocial therapies and hospitalization if risks are present.
Mr. XYZ, age 39, presented with tremors, vomiting blood, seizures, and confusion. He has a history of alcohol dependence and multiple relapses. On examination, he was confused, tachycardic, and jaundiced. Lab tests showed elevated liver enzymes. He was diagnosed with delirium tremens during acute alcohol withdrawal. He was treated with benzodiazepines, thiamine, and other supportive care. Benzodiazepines are the primary treatment for alcohol withdrawal to prevent progression to severe withdrawal states like delirium tremens and seizures.
This document discusses bipolar disorder, including its genetic and environmental influences, symptoms, and treatments. It notes that bipolar disorder often emerges during adolescence and young adulthood and is influenced by both hereditary genetic factors and environmental triggers. Symptoms can include changes in mood, sleep, behavior, and cognitive functioning. The document outlines different types of bipolar disorder and compares incidences internationally. It concludes by describing various treatment approaches, including medications, psychotherapy, lifestyle management techniques, and emerging therapies and technologies.
Bipolar disorder is characterized by recurrent episodes of mania and depression. It is classified into Bipolar I and II based on the severity of manic episodes. The exact causes are unknown but genetic and biochemical factors are thought to play a role. Clinical features include changes in mood, energy, sleep patterns, and risk-taking behavior. Treatment involves mood stabilizers like lithium, antipsychotics, and antidepressants to control symptoms and prevent future episodes. Prognosis depends on factors like comorbidities, stress levels, and medication compliance.
Participants will explore the prevalence of psychotic experiences among kids with mental health concerns and kids in the general population, discuss the differential diagnosis of psychotic symptoms in children and youth, examine the relationship between hallucinations and suicidal behavior in youth and review the appropriate psychiatric and medical workup for youth with psychotic experiences
The document discusses trauma in childhood and its effects. It notes that PTSD in children is often underdiagnosed, and children may receive multiple incorrect diagnoses before an accurate one of PTSD. Trauma in childhood can impact brain development and lead to issues with attention, hyperactivity, aggression, and oppositional behavior. The document outlines symptoms of PTSD in early childhood, school age children, and teenagers. It discusses the two main types of dysregulation—hyperactivation and hypoactivation—that can result from trauma. Building resilience and social support are important factors in recovering from childhood trauma.
This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.
Schizophrenia and other psychotic disorders involve positive, negative, and disorganized symptoms that distort thinking, perception, and behavior. Schizophrenia is a chronic condition defined by fundamental distortions in thought, perception, emotion, and behavior. It affects about 1% of the population and typically emerges in early adulthood. Treatment involves antipsychotic medications to reduce positive symptoms as well as psychosocial support. The causes are complex and involve genetic, neurological, developmental, and environmental factors.
This document discusses personality disorders and their classification. It defines personality disorders as enduring patterns of inner experience and behavior that deviate from a person's culture and cause impairment. Personality disorders are divided into three clusters - A, B, and C - based on similar characteristics. Cluster A disorders include paranoid, schizoid, and schizotypal personalities. Cluster B includes antisocial, borderline, histrionic, and narcissistic personalities. Cluster C comprises avoidant, dependent, and obsessive-compulsive personalities. The document provides descriptions of each disorder's traits and symptoms. Treatment involves long-term psychotherapy as personality disorders develop gradually over time.
This document discusses alcohol withdrawal delirium (AWD), also known as delirium tremens or DTs. It defines delirium and describes different types. AWD is a serious form of alcohol withdrawal that causes sudden brain and nervous system problems. It only affects heavy drinkers who stop drinking abruptly. Symptoms include hallucinations, agitation, and disorientation. Diagnosis involves various medical tests. AWD is treated in hospitals with intravenous fluids, medications to prevent seizures and reduce symptoms, and rehabilitation. With treatment, AWD has a low death rate but some withdrawal symptoms may persist long-term.
SISCOM may help differentiate PNES from epileptic seizures by showing changes in brain perfusion during seizures in epileptic seizures but not PNES. However, its diagnostic accuracy is limited and normal findings do not rule out epileptic seizures. Overall, EEG monitoring remains the gold standard for differentiating the two.
Impulse-control disorders (ICDs) are psychological disorders characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or others.
The individual fails to resist performing a potentially harmful act and it is usually accompanied by a sense of tension or arousal before committing the act and a sense of relief or pleasure when it is committed.
The hallmark in describing any of the ICDs is a tendency to gratify an immediate desire or impulse regardless of the consequences to one's self or to others.
The document provides an overview of psychiatry and mental health topics. It defines mental health according to the WHO as a state of complete physical, mental, social and spiritual well-being. More than two-fifths of total disabilities worldwide are due to mental illnesses such as schizophrenia, depression, and substance abuse disorders. It discusses classification systems for psychiatric disorders, biological, psychological and social factors in mental illnesses, and specific conditions such as mood disorders, psychotic disorders, personality disorders, and more.
The document provides clinical practice guidelines for the management of dementia. It outlines recommendations for assessment, management, and treatment of dementia. Some key points:
- A multidisciplinary panel of experts in geriatrics, neurology, and psychiatry developed the guidelines.
- Non-pharmacological interventions like behavior-, stimulation-, and emotion-oriented treatments should always be considered before drug options.
- Neuroleptic drugs have limited efficacy evidence but may be used for serious behavioral issues like psychosis if other options are insufficient. Low doses for short terms are recommended.
- Acetylcholinesterase inhibitors can modestly improve cognition in mild to moderate Alzheimer's but risks must be discussed prior to
Schizophrenia is a group of biological disorders that produce impairments in thinking, learning, and relationships. It affects around 1% of the population and often begins in late adolescence or early adulthood. While there is no known cure, treatments can help manage symptoms and improve quality of life. Biological factors like genetics and brain abnormalities are involved in schizophrenia, as are psychological and social factors. Medications are effective in reducing positive symptoms like hallucinations and delusions, while psychosocial therapies also play an important role in treatment and recovery.
Schizophrenia is a psychotic disorder characterized by disturbances in thought, perception, emotions, language, sense of self and behavior. Symptoms include delusions, hallucinations, disorganized speech and behavior, and negative symptoms such as lack of motivation and flat affect. It is thought to involve genetic vulnerabilities interacting with environmental stressors and imbalances in neurotransmitters like dopamine. Treatment involves antipsychotic medication combined with therapy and social skills training, though long-term outcomes vary significantly.
Schizophrenia is a psychotic disorder characterized by a disintegration of normal thought processes and poor contact with reality. The document discusses the epidemiology, aetiology, clinical features, diagnosis and differentiation from other psychoses of schizophrenia. Key points include that it has a lifetime risk of around 10/1000, genetic and environmental risk factors are implicated in its development, and symptoms can be positive (e.g. hallucinations, delusions) or negative (social withdrawal, lack of emotion). Diagnosis involves clinical assessment and meeting criteria such as Schneider's first-rank symptoms for over 1 month.
Psychotic disorders involve hallucinations and/or delusions where the person loses contact with reality. Schizophrenia is a type of psychosis characterized by disturbances in thought, emotion and behavior. It affects about 1% of the population and usually develops in early adulthood. Symptoms include delusions, hallucinations, disorganized speech and behavior. Treatment involves antipsychotic medications and psychosocial support. Prognosis depends on several factors but schizophrenia generally involves long-term impairment.
This document discusses psychosis and psychotic disorders in youth. It begins with an overview of psychosis, defining it as a serious disturbance in reality testing that affects thinking, perception and behavior. It then reviews the prevalence of psychiatric disorders in adolescence compared to childhood, noting increases in conditions like depression, bipolar disorder and psychosis during the teen years. The rest of the document outlines various psychotic symptoms like hallucinations, delusions, and cognitive and mood changes. It also discusses the importance of early identification and treatment of psychosis in youth given the disabilities and poor long-term outcomes if untreated.
Schizophrenia is a psychotic disorder characterized by disturbances in thought, perception, emotions, language, sense of self and behavior. Common symptoms include delusions, hallucinations, disorganized speech and behavior, lack of motivation and flat affect. It typically emerges in late teens to early twenties. Theories suggest both genetic and environmental factors contribute to vulnerability. Treatments include medications to reduce positive symptoms, and therapy, social skills training, and family support to improve functioning. Recovery rates vary but many experience ongoing challenges.
Schizophrenia is a psychotic disorder characterized by disturbances in thought, perception, emotions, language, sense of self and behavior. Common symptoms include delusions, hallucinations, disorganized speech and behavior, lack of motivation and flat affect. It typically emerges in late teens to early twenties. Theories suggest both genetic and environmental factors contribute to vulnerability. Treatments include medications to reduce positive symptoms, and therapy, social skills training, and family support to improve functioning. Recovery rates vary but many experience ongoing challenges.
Schizophrenia is a psychotic disorder characterized by disturbances in thought, perception, emotions, language, sense of self and behavior. Common symptoms include delusions, hallucinations, disorganized speech and behavior, and negative symptoms such as lack of motivation and flat affect. It typically emerges in late teens to early twenties. Theories suggest both genetic and environmental factors contribute to the development of schizophrenia. Treatments include medications to reduce positive symptoms, as well as therapy, social skills training, and support for patients and families. Recovery rates are low, with only 10-20% achieving full recovery.
Schizophrenia is a chronic mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self and behavior. It is defined by symptoms such as delusions, hallucinations, disorganized speech and behavior, and negative symptoms. The disorder has been recognized since the late 19th century and was termed "dementia praecox" and later "schizophrenia". It affects about 1% of the population and has varying levels of severity and outcomes depending on factors like symptom type, treatment adherence and social support. Treatment involves antipsychotic medications and psychosocial therapies.
The document provides a historical overview of schizophrenia, from its early descriptions by various scientists to its modern conceptualization and diagnosis. It notes that Emil Kraepelin initiated the scientific study of schizophrenia by describing dementia praecox. Eugen Bleuler renamed it schizophrenia and described its fundamental symptoms. Kurt Schneider later described first-rank symptoms that are important for diagnosis. The text then covers epidemiology, etiology, phases, clinical features, diagnosis, and treatment of schizophrenia.
Schizophrenia is a psychotic disorder characterized by disturbances in thinking, emotions, perceptions and behavior. It is a chronic condition with possible remissions and exacerbations. Symptoms include hallucinations, delusions, disorganized speech and behavior, negative symptoms like flat affect, alogia and avolition. It is classified based on symptom presentation into subtypes like paranoid, disorganized, catatonic and undifferentiated schizophrenia. Treatment involves antipsychotic medications and psychosocial interventions with the goal of managing symptoms and improving functioning. Prognosis depends on factors like age of onset, symptom profile, course of illness and adherence to treatment.
This document provides an overview of the management of pervasive developmental disorder (autism). It begins with a brief history and description of autism. It then discusses clinical presentation including deficits in social behavior, communication problems, and unusual behaviors. It covers assessment, diagnosis, treatment including educational, behavioral and medical interventions, and prognosis. Treatment is multidisciplinary and individualized, aiming to minimize core deficits and maximize independence. Speech/language therapy, developmental therapies, and behaviorally-based treatments are commonly used. Medications may help target specific symptoms but do not impact core deficits. The prognosis is variable, with early diagnosis/treatment and no cognitive impairment predicting better outcomes.
This document discusses the management of pervasive developmental disorder (autism). It begins with a brief history of autism from Kanner's initial description in 1943. It then describes the core characteristics and clinical presentation of autism including deficits in social behavior, communication problems, and unusual behaviors. It discusses the rising rates of autism as well as common comorbid conditions. Etiology is unknown but believed to have a biological basis. Prognosis varies but symptoms typically persist throughout life.
Prof. Dr. Vladimir Trajkovski - Mental Health Issues in ASD-10.05.2019Vladimir Trajkovski
President of MSSA Prof. Dr. Vladimir Trajkovski presented this topic "Mental Health Issues in Autism Spectrum Disorders" at the mini simposyum in Voerandaal, Holland, organized by ReAttach Academy at May 10th 2019.
The document discusses a training program provided by the Alzheimer Society of Calgary to educate direct care providers and families about dementia, depression, and delirium. The program consisted of workshops that helped participants understand the relationship between these conditions, recognize their signs and symptoms, and appreciate a person-centered approach to care. An evaluation found the training increased participants' knowledge and understanding. Lessons learned include the need for continued education on these topics and recognizing the Alzheimer Society's role in supporting staff and families.
The document discusses the concepts of psychosis and schizophrenia, debating whether they should be considered categorical diagnoses or dimensional constructs. It notes that Kraepelin originally proposed a dichotomy between schizophrenia and bipolar disorder, but that the boundaries between these conditions are blurred. Modern studies question Kraepelin's nosology and whether conditions like psychosis and schizophrenia actually measure distinct entities. The work advocates for a hybrid categorical-dimensional model that better captures clinical characteristics while maintaining traditional diagnostic distinctions when needed for treatment decisions. It raises questions about the concept of "early psychosis" and whether early intervention targets a specific disorder, dimension, or symptom domain.
Behaviourial manifestation in neurologic disease assam1
Dr. Saurav Deka is an experienced clinical pharmacologist and medical advisor who has compiled information on neurological disorders with behavioral manifestations. The document discusses several key points, including that behaviors generated by the brain may manifest from neurological diseases and be misattributed to psychiatric disorders. It also provides an overview of several neurological diseases, their associated clinical manifestations such as emotional and motor disturbances, and challenges in distinguishing neurological behavioral signs from psychiatric conditions.
This document provides an overview of mental illness, including definitions, types of mental illnesses, symptoms, causes, diagnosis criteria, treatments, and interventions. It defines mental disorder and distinguishes between serious mental illnesses like schizophrenia, major depression and bipolar disorder from other conditions. It describes biological and environmental causes and interactions. It outlines approaches to treatment including medications for different conditions and side effects, as well as psychosocial interventions like illness self-management, therapy, rehabilitation, and case management.
Psychological disorders can be understood from biological, psychological, and socio-cultural perspectives. They are classified in the DSM and include anxiety disorders like generalized anxiety disorder, panic disorder, and PTSD. Mood disorders involve disturbances in mood like depression and bipolar disorder. Schizophrenia impacts thinking, perception, communication and behavior with symptoms like delusions and hallucinations. Personality disorders are chronic maladaptive patterns grouped into odd/eccentric, dramatic/emotionally problematic, and chronic fearfulness clusters which include paranoid, antisocial, avoidant, and obsessive-compulsive types.
Metyrosine has shown promise in treating psychosis associated with Velocardiofacial Syndrome (VCFS). A case report described a 15-year-old male with VCFS and treatment-resistant psychosis. He was unresponsive to multiple antipsychotics. Treatment with metyrosine led to a reduction in neuropsychiatric symptoms. Metyrosine inhibits the enzyme tyrosine hydroxylase, reducing dopamine levels and psychotic symptoms. This case provides preliminary evidence that metyrosine may effectively treat psychosis in VCFS patients where other treatments have failed.
Lamotrigine for Treatment Refractory Mood Disorders in Adolescents: A Case Se...Carlo Carandang
“Lamotrigine for Treatment Refractory Mood Disorders in Adolescents: A Case Series,”
Halifax, Nova Scotia, Canada; September 14, 2005
Psychiatry Clinical Case Conference at IWK Health Centre
*Learn about prevalence and treatment interventions for refractory depression in adolescents
*Summarize the intervention studies in refractory mood disorders in adolescents
*Dissect the 9 cases of lamotrigine for treatment refractory mood disorders in adolescents
*Learn pharmacokinetics and pharmacodynamics of lamotrigine
*Learn safe titration schedule to minimize rash
“Anxiety Disorders,”
Scarborough, Maine; May 7, 2003
Community presentation, Scarborough Campus of Maine Medical Center.
*Anxiety disorders and how to cope
Metyrosine in Adolescent Psychosis Associated with 22q11.2 Deletion SyndromeCarlo Carandang
"Metyrosine in Adolescent Psychosis Associated with 22q11.2 Deletion Syndrome,"
Halifax, Nova Scotia, Canada; June 7, 2006
Dalhousie University, Department of Psychiatry, Clinical Conference
*Learn clinical features of velocardiofacial syndrome (VCFS)
*Learn association of psychosis with VCFS
*Learn genetic and biochemical abnormalities leading to psychosis in VCFS
*Discuss case report of metyrosine in psychosis associated with VCFS
*What can we learn from the association between VCFS and schizophrenia to design candidate gene studies for polygenic syndromes?
Velocardiofacial Syndrome Associated with Adolescent PsychosisCarlo Carandang
"Velocardiofacial Syndrome Associated with Adolescent Psychosis,"
Halifax, Nova Scotia, Canada; October 4, 2006
Psychiatry Clinical Case Conference at IWK Health Centre
*Learn clinical features of velocardiofacial syndrome (VCFS)
*Learn association of VCFS with psychosis and other psychiatric disorders
*Learn genetic and biochemical abnormalities leading to psychosis in VCFS
*Discuss case report of metyrosine in psychosis associated with VCFS
*Discuss case reports of VCFS in childhood-onset schizophrenia
Clinical Assessment of Children and Adolescents with DepressionCarlo Carandang
“Clinical Assessment of Children and Adolescents with Depression,”
Halifax, Nova Scotia, Canada; October 1, 2008
Pediatric Grand Rounds, IWK Health Centre
*Although the core symptoms of depression are similar across the life span, developmental differences exist and should be taken into account in the assessment
*With increasing age, there generally is an increase in melancholic symptoms, delusions, substance abuse, and suicidal ideation/attempts.
*In contrast, younger children tend to have more somatic sxs, separation anxiety, behavior problems, temper tantrums, and hallucinations
*Direct interviews with children and adolescents are critical because parents and teachers may not be aware of the youth’s depressive symptoms
*Discrepant information between parents and their children should be solve in a cordial and non judgmental way
*Assessment of suicidal and homicidal ideation and behaviors is mandatory
*The interview process and screening questions utilized by research interviews such as the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version (KSADS-PL) can be useful
*Detection and diagnosis can be enhanced by available parent and child self-report measures
Data Safety Monitoring Boards in Pediatric Clinical TrialsCarlo Carandang
“Data Safety Monitoring Boards and Safety in High Risk Trials in Youths,”
Halifax, Nova Scotia, Canada; June 6, 2007
Dalhousie University, Department of Psychiatry, Clinical Conference
*Safety in high risk randomized controlled trials (RCTs) in young persons
*Data Safety Monitoring Boards (DSMBs)
*Defining the concept of “high risk”
*Capturing Adverse Events
*Recommendations for improvement of safety in pediatric psychiatry trials
*Case Study: Evaluating safety in a clinical trial
“Teen Depression and Suicide,”
South Portland, Maine; April 26, 2005
Suicide Conference, Maine Suicide Prevention Program.
*Learn clinical presentation of adolescent depression
*Learn course and prognosis of pediatric depression
*Learn treatment of pediatric depression
*Discuss controversy of antidepressant medications in youth and suicidality
“Bipolar Disorder in Youth: Does it Exist?” Halifax, Nova Scotia, Canada; March 22, 2006, Community presentation at IWK Health Centre
*Learn clinical presentation of pediatric bipolar disorder
*Differentiate pediatric bipolar disorder from other psychiatric disorders
*Learn genetics of bipolar disorder
*Learn treatment of pediatric bipolar disorder
“Antidepressants and Suicidality in Youth,” Halifax, Nova Scotia, Canada; May 15, 2006, IWK Research Celebration, IWK Health Centre
*Discuss suicide risk associated with antidepressants in youth
*Discuss FDA post-hoc analysis of SSRI (Selective Serotonin Reuptake Inhibitor) youth studies
*Future Research Directions
“The Neurobiology of Adolescent Development,” Austin, Texas; May 6, 2008. Psychiatry resident didactics, Austin Medical Education Programs (AMEP) Psychiatry program, Seton Hospital. Learn about adolescent development. Correlate adolescent development with brain changes. Learn about the two distinct processes of behavioral maturation (adolescence) and gonadal maturation (puberty), and how both interact, with resulting mature, reproductively active adult
Canadian Psychiatry: The Case for Universal Health Care and How Psychiatry Be...Carlo Carandang
Presentation on universal healthcare in Canada and how psychiatry benefits. Portland, Maine, October 20, 2009, Psychiatry Grand Rounds at Maine Medical Center
Clinical assessment of child and adolescent psychiatric emergenciesCarlo Carandang
This document provides guidance on clinically assessing child and adolescent psychiatric emergencies. It discusses goals of acute assessment including determining risk of harm, ruling out acute medical issues, and determining need for inpatient care. It also covers distinguishing between psychiatric diagnoses and mental health problems. Common acute mental health problems presented in the emergency department that are discussed include suicide, aggression, adjustment issues, borderline traits, abuse/homelessness, and acute psychiatric disorders like psychosis, mania, depression, and anxiety disorders. The document provides assessment approaches and case examples for managing these various psychiatric emergencies.
This presentation was given to students and staff of the University of the Philippines (Manila) College of Medicine, May 30, 2015. Computer anxiety is an intense fear of using computers. Computers are avoided at all cost, and exposure to computers induces a panic attack. This presentation goes into detail about what it is, how it evolves, and how to treat it.
In this presentation, we approach a two-class classification problem. We try to find a plane that separates the class in the feature space, also called a hyperplane. If we can't find a hyperplane, then we can be creative in two ways: 1) We soften what we mean by separate, and 2) We enrich and enlarge the featured space so that separation is possible.
AI and Big Data in Psychiatry: An Introduction and OverviewCarlo Carandang
Dr. Carlo Carandang, a psychiatrist and data scientist, talks about how Big Data can be implemented into clinical psychiatric practice to improve patient care and reduce costs. Dr. Carandang introduces Big Data topics, Big Data systems, machine learning algorithms, and AI psychiatry applications. Dr. Carandang presented this talk at the 2019 Presidential Symposium in Washington, DC, sponsored by the Washington Psychiatric Society.
Air Pollution in Nova Scotia: Analysis and PredictionsCarlo Carandang
This document analyzes air pollution data from Nova Scotia to predict future pollution levels. It discusses how air pollution harms health and the economy. The authors cleaned and analyzed air particulate pollution datasets from Nova Scotia's open data portal to build a data warehouse and fact table in Oracle Database for business intelligence. They loaded dimension tables and connected the fact table to Tableau for interactive visualization.
Workplace Disability from Stress, Anxiety, and Depression: Solutions and Prev...Carlo Carandang
Stress, anxiety, and depression in the workplace are common causes of disability that result in large economic costs. While mental distress is a normal experience, prolonged stress can lead to mental health problems like burnout or adjustment disorder, or develop into mental disorders like anxiety and depression if not properly addressed. Employers can implement preventative measures like psychoeducation workshops on stress management to prevent mental health issues from worsening. For employees experiencing mental health problems, a multidisciplinary approach including counseling and lifestyle assessments is recommended, while those with disorders may require additional therapies and medical treatment to support recovery and reduce disability.
Analysis of Air Pollution in Nova Scotia PresentationCarlo Carandang
This presentation is an analysis of air pollution in Nova Scotia. We detail how we obtain the dataset, how we clean it, how we process and analyze it, and then we visualize the results of the analysis.
Paxil Study 329 Retracted: A Critical Statistical AnalysisCarlo Carandang
I give a lecture regarding the statistical methodology employed in the 2001 Paxil (paroxetine) Study 329: Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP, Birmaher B, Hagino OR, Koplewicz H, Carlson GA, Clarke GN, Emslie GJ, Feinberg D, Geller B, Kusumakar V, Papatheodorou G, Sack WH, Sweeney M, Wagner KD, Weller EB, Winters NC, Oakes R, McCafferty JP. J Am Acad Child Adolesc Psychiatry. 2001 Jul;40(7):762-72.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
Psychosis in Youth
1. Psychosis in YouthPsychosis in Youth
Carlo G. Carandang, M.D.Carlo G. Carandang, M.D.
Pediatric Affective Disorder ServicesPediatric Affective Disorder Services
Maine Medical CenterMaine Medical Center
Clinical Assistant Professor of PsychiatryClinical Assistant Professor of Psychiatry
University of Vermont College of MedicineUniversity of Vermont College of Medicine
2. ObjectivesObjectives
Learn clinical assessment of psychosis inLearn clinical assessment of psychosis in
youthyouth
Learn neurobiology of psychosisLearn neurobiology of psychosis
Learn course and prognosis of psychosisLearn course and prognosis of psychosis
Learn treatment of psychosis in youthLearn treatment of psychosis in youth
3. What is psychosis?What is psychosis?
Thought Disorder/Disorganized ThinkingThought Disorder/Disorganized Thinking
(core deficit)(core deficit)
Hallucinations (accessory symptom)Hallucinations (accessory symptom)
Delusions (accessory symptom)Delusions (accessory symptom)
Disorganized/Bizarre BehaviorDisorganized/Bizarre Behavior
Impaired reality testingImpaired reality testing
4. Thought DisorderThought Disorder
Disturbance in the form or manner that one presentsDisturbance in the form or manner that one presents
their thoughts to otherstheir thoughts to others
No consensus definition: includes loosening ofNo consensus definition: includes loosening of
associations, illogical thinking, incoherence, tangentiality,associations, illogical thinking, incoherence, tangentiality,
circumstantiality, poverty of speechcircumstantiality, poverty of speech
Must account for developmental level (normal youth <Must account for developmental level (normal youth <
age 7 exhibit illogical thinking and loosening ofage 7 exhibit illogical thinking and loosening of
associations)associations)
R/O language d/o’s, PDDR/O language d/o’s, PDD
Usually more bizarre or marked in youth withUsually more bizarre or marked in youth with
schizophrenia vs. youth with affective psychosisschizophrenia vs. youth with affective psychosis
Mild forms can present in youth with ADHDMild forms can present in youth with ADHD
5. HallucinationsHallucinations
Perceptions in the absence of external stimuliPerceptions in the absence of external stimuli
Any sensory modality (auditory most often)Any sensory modality (auditory most often)
Distinguish from hypnogogic (falling asleep) andDistinguish from hypnogogic (falling asleep) and
hypnopompic (awakening) hallucinationshypnopompic (awakening) hallucinations
Differentiate from illusions (misperceptions ofDifferentiate from illusions (misperceptions of
external stimuli) and elaborate fantasyexternal stimuli) and elaborate fantasy
Hearing a voice calling name once or twice notHearing a voice calling name once or twice not
likely to be pathologic hallucinationlikely to be pathologic hallucination
6. DelusionsDelusions
Fixed false belief that is not consistentFixed false belief that is not consistent
with person’s subculture and cannot bewith person’s subculture and cannot be
changed by evidence against itchanged by evidence against it
Distinguish from magical thinking, fantasyDistinguish from magical thinking, fantasy
Can be somatic, grandiose, guilt,Can be somatic, grandiose, guilt,
persecutory, referentialpersecutory, referential
Less systematized in younger agesLess systematized in younger ages
Anxiety (excessive worry) sometimesAnxiety (excessive worry) sometimes
mistaken for paranoid delusionmistaken for paranoid delusion
7.
8. Psychotic-like phenomenaPsychotic-like phenomena
Developmental delays causing idiosyncraticDevelopmental delays causing idiosyncratic
thinking and perceptionsthinking and perceptions
Speech and language disordersSpeech and language disorders
Exposure to traumatic eventsExposure to traumatic events
– Dissociation/DerealizationDissociation/Derealization
– FlashbacksFlashbacks
Obsessions in OCD (ego dystonic)Obsessions in OCD (ego dystonic)
Hypnogogic and hypnopompic hallucinationsHypnogogic and hypnopompic hallucinations
Overactive imagination (intact reality testing)Overactive imagination (intact reality testing)
9. Screening psychosis in youthScreening psychosis in youth
Use age-appropriate language (does yourUse age-appropriate language (does your
mind ever play tricks on you?)mind ever play tricks on you?)
Normalize the experience to make lessNormalize the experience to make less
threatening (some children tell me…)threatening (some children tell me…)
How pervasive are the experiencesHow pervasive are the experiences
(transient vs. frequent)(transient vs. frequent)
Make sure symptoms occur while awakeMake sure symptoms occur while awake
11. Organic PsychosisOrganic Psychosis
Delirium/encephalopathyDelirium/encephalopathy
Seizure disorders (complex partial seizures)Seizure disorders (complex partial seizures)
CNS lesions (***always get brain imaging forCNS lesions (***always get brain imaging for
new onset psychosis***)new onset psychosis***)
Neurodegenerative diseasesNeurodegenerative diseases
Metabolic DisordersMetabolic Disorders
Infectious diseases (i.e. HIV)Infectious diseases (i.e. HIV)
***Rule-out organic etiology before diagnosing***Rule-out organic etiology before diagnosing
psychosis***psychosis***
12. Workup for New-Onset PsychosisWorkup for New-Onset Psychosis
MRI-brainMRI-brain
CBCCBC
Electrolytes, BUN, Creatinine, Ca, MgElectrolytes, BUN, Creatinine, Ca, Mg
Hepatic panelHepatic panel
Sed RateSed Rate
RPRRPR
Vit B12, RBC and serum FolateVit B12, RBC and serum Folate
Urine PorphyrinsUrine Porphyrins
CeruloplasminCeruloplasmin
TSH, free T4TSH, free T4
Heavy metalsHeavy metals
13. Schizophrenia DSM-IV criteriaSchizophrenia DSM-IV criteria
Two or more of: 1) delusions; 2)Two or more of: 1) delusions; 2)
hallucinations; 3) disorganized speech; 4)hallucinations; 3) disorganized speech; 4)
grossly disorganized behavior; or 5)grossly disorganized behavior; or 5)
negative symptoms (four A’s: flat Affect,negative symptoms (four A’s: flat Affect,
Alogia, Avolition, Autism-like social W/D)Alogia, Avolition, Autism-like social W/D)
Impairment of functioningImpairment of functioning
At least 6 months continuous disturbanceAt least 6 months continuous disturbance
< 6 months but > 1 month =< 6 months but > 1 month =
Schizophreniform d/oSchizophreniform d/o
14. Schizophrenia in YouthSchizophrenia in Youth
Early-Onset Schizophrenia (EOS): OnsetEarly-Onset Schizophrenia (EOS): Onset
before age 18before age 18
Very Early-Onset Schizophrenia (VEOS):Very Early-Onset Schizophrenia (VEOS):
Onset before age 13Onset before age 13
Usually family history of schizophreniaUsually family history of schizophrenia
Prevalence:Prevalence:
– VEOS: 1/5000 (NIMH est. 1/40,000)VEOS: 1/5000 (NIMH est. 1/40,000)
– EOS: 4/5000EOS: 4/5000
– Adult-onset Schizophrenia: 1/100Adult-onset Schizophrenia: 1/100
15.
16. Clinical PresentationClinical Presentation
VEOS: insidious onsetVEOS: insidious onset
EOS: insidious or acute onsetEOS: insidious or acute onset
Pre-morbid abnormalities occur in 90% ofPre-morbid abnormalities occur in 90% of
youth with schizophrenia (especiallyyouth with schizophrenia (especially
VEOS)VEOS)
17. Premorbid AbnormalitiesPremorbid Abnormalities
Disruptive Behavior Disorders (ADHD,Disruptive Behavior Disorders (ADHD,
Conduct D/O)Conduct D/O)
Autistic features (social withdrawal,Autistic features (social withdrawal,
unusual peer relationships, developmentalunusual peer relationships, developmental
delays)delays)
Speech and language problemsSpeech and language problems
Academic difficultyAcademic difficulty
18. SymptomatologySymptomatology
Most common: Thought Disorder,Most common: Thought Disorder,
Hallucinations, Flattened AffectHallucinations, Flattened Affect
Less common: Delusions, CatatoniaLess common: Delusions, Catatonia
Types of Thought Disorder:Types of Thought Disorder:
– More common: loosening of associations,More common: loosening of associations,
illogical thinking, impaired executive skillsillogical thinking, impaired executive skills
– Less common: incoherence, poverty ofLess common: incoherence, poverty of
speechspeech
19.
20. Neurobiological AbnormalitiesNeurobiological Abnormalities
None are diagnosticNone are diagnostic
Neuroimaging findings:Neuroimaging findings:
– Progressive increase in lateral ventricular sizeProgressive increase in lateral ventricular size
– VEOS:VEOS: ↓↓ brain volume,brain volume, ↓↓ total grey matter,total grey matter,
andand ↓↓ frontal grey matter compared to ADHDfrontal grey matter compared to ADHD
controls and normal controls (longitudinalcontrols and normal controls (longitudinal
NIMH study following schizophrenic childrenNIMH study following schizophrenic children
into adolescence)into adolescence)
27. Longitudinal CourseLongitudinal Course
Rarely complete remission (<20%)Rarely complete remission (<20%)
80-90% had more than one psychotic episode80-90% had more than one psychotic episode
over 5-year follow-upover 5-year follow-up
Long term follow-up into adulthoodLong term follow-up into adulthood
– 50-75% had moderate or severe impairment50-75% had moderate or severe impairment
– Good prognosis: later age of onset, good premorbidGood prognosis: later age of onset, good premorbid
functioning, acute onsetfunctioning, acute onset
– Poor prognosis: early age of onset, poor premorbidPoor prognosis: early age of onset, poor premorbid
functioning, insidious onset (VEOS has worstfunctioning, insidious onset (VEOS has worst
outcome)outcome)
– Prognosis for affective psychosis much betterPrognosis for affective psychosis much better
28.
29.
30. Complications of SchizophreniaComplications of Schizophrenia
Functional DisabilityFunctional Disability
Family Distress and DisruptionFamily Distress and Disruption
Increased MortalityIncreased Mortality
SuicideSuicide
Substance AbuseSubstance Abuse
ViolenceViolence
Criminal BehaviorCriminal Behavior
31. Differentiating from Psychosis dueDifferentiating from Psychosis due
to Substance Useto Substance Use
Substance-induced psychosis not likely ifSubstance-induced psychosis not likely if
symptoms persist 1 week beyondsymptoms persist 1 week beyond
discontinuationdiscontinuation
Substance use often occurs duringSubstance use often occurs during
prodromal phaseprodromal phase
Substance use may trigger active phase ofSubstance use may trigger active phase of
schizophreniaschizophrenia
32. Differentiating Psychosis from PDDDifferentiating Psychosis from PDD
Psychotic symptoms more transient andPsychotic symptoms more transient and
less prominent in PDDless prominent in PDD
Language, social deficits,Language, social deficits,
restricted/bizzare interests morerestricted/bizzare interests more
prominent in PDDprominent in PDD
PDD has earlier onset (usually before agePDD has earlier onset (usually before age
3) and more severe developmental delays3) and more severe developmental delays
33. Treatment for SchizophreniaTreatment for Schizophrenia
Antipsychotic medications (cornerstone ofAntipsychotic medications (cornerstone of
treatment)treatment)
Psychoeducation (patient and family)Psychoeducation (patient and family)
Educational/Vocational Support ProgramsEducational/Vocational Support Programs
PsychotherapyPsychotherapy
– SupportiveSupportive
– Social Skills trainingSocial Skills training
– Family Therapy (reduce expressed emotions)Family Therapy (reduce expressed emotions)
34. AntipsychoticsAntipsychotics
All exert blockade of post-synaptic dopamineAll exert blockade of post-synaptic dopamine
receptors (Dreceptors (D22))
Relative overactivity of dopaminergic mesolimbicRelative overactivity of dopaminergic mesolimbic
circuits (axonal projections from midbrain tocircuits (axonal projections from midbrain to
limbic area) produces positive symptomslimbic area) produces positive symptoms
(thought d/o, hallucinations, delusions)(thought d/o, hallucinations, delusions)
Relative hypoactivity of mesocortical circuitsRelative hypoactivity of mesocortical circuits
(esp. prefrontal) leads to negative symptoms(esp. prefrontal) leads to negative symptoms
(four A’s: flat Affect, Alogia, Avolition, Autism-like(four A’s: flat Affect, Alogia, Avolition, Autism-like
social withdrawal)social withdrawal)
35.
36.
37. Randomized Controlled TrialsRandomized Controlled Trials
Psychosis in YouthPsychosis in Youth
Loxapine = Haldol > placeboLoxapine = Haldol > placebo (Pool et al., 1976)(Pool et al., 1976)
Thiothixene = thioridazine (50% showedThiothixene = thioridazine (50% showed
improvementimprovement (Realmuto et al., 1984)(Realmuto et al., 1984)
Haldol > placeboHaldol > placebo (Spencer et al., 1992)(Spencer et al., 1992)
Clozapine > Haldol in treatment-resistantClozapine > Haldol in treatment-resistant
schizophreniaschizophrenia (Kumra et al., 1996)(Kumra et al., 1996)
44. ConclusionConclusion
Consider broad differential diagnosis ofConsider broad differential diagnosis of
psychosis in youth: most youth will notpsychosis in youth: most youth will not
have schizophrenia (very rare)have schizophrenia (very rare)
Evaluate potential psychotic symptoms inEvaluate potential psychotic symptoms in
developmental contextdevelopmental context
Treatment with atypical antipsychoticsTreatment with atypical antipsychotics
first-line, given less adverse effectsfirst-line, given less adverse effects
Editor's Notes
Symptoms of schizophrenia develop gradually into the hallmark mentally disruptive features.
In almost all cases, patients are symptomatic for approximately 50 weeks before they seek--or are brought into--treatment.
These are MRI scans of identical twins. The twin on the right has schizophrenia; the twin on the left is healthy. Even to the unprofessional eye, there are obvious differences, a systematic and consistent variation between the affected and the unaffected twin in the gross anatomy of the brain.
PET scans of five normal individuals (left), each row is one person, and each image is a slice from five different levels of the person&apos;s brain. The red areas show regions of the brain that are activated when a person performs a memory task.
PET scans of five individuals with schizophrenia (right), each row representing a different person, with comparable slices. Clearly, the patients with schizophrenia do not generate the dramatic brain activity in the circuits of the brain critical to the memory task.
On this slide, each white dot represents cells in a particular part of the brain.
A patient with schizophrenia is compared to an individual with another psychiatric illness, bipolar disorder, and to a normal subject. The white dots show the turning-on of a gene that is the blueprint for a protein related to the process by which cells adapt themselves to a changing environment.
This illustrates so-called &quot;linkage studies,&quot; showing a number of places in the human genome where pieces of DNA are inherited along with risk for the illness.
It shows one of each of the 23 pairs of chromosomes, and the red dots indicate regions where a piece of DNA has been shown to be inherited along with the risk for schizophrenia in certain families and certain studies.
The slide shows brain scans of normal brains versus brains of young children with childhood onset schizophrenia. The scans reveal significant gray matter loss. Brain volume (gray matter) decreases and lateral ventricular volume increases. Their most intriguing avenue of inquiry is the examination of siblings, which could lead to the finding of a trait marker because this back to front wave of gray matter loss could be diagnostically specific. The loss stops in early adulthood.