This document defines psychosis and describes its classification, causes, risk factors, clinical features, diagnosis, and treatment. Psychosis refers to a loss of contact with reality and is characterized by delusions and hallucinations. It can be organic or functional, acute or chronic. Causes include genetics, trauma, disease, neurotransmitter imbalances, and drugs. Symptoms progress from a prodromal phase to an acute phase with clear psychotic symptoms, to a recovery phase where some symptoms may remain. Treatment involves antipsychotic medications, psychotherapy, and rehabilitation.

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.