The document discusses various types of psychotic disorders including schizophrenia, schizoaffective disorder, brief psychotic disorder, drug induced psychosis, and reactive psychosis. It provides diagnostic criteria and descriptions for each disorder, including typical presentations, durations, treatments, and prognoses. It also discusses the relationship between substance use and psychosis, distinguishing between intoxication, withdrawal, and genuine comorbidity.

1. Psychotic Spectrum Disorder
Drug induced psychosis
Abdullah MahmoudAbu Dannoun
Juniordoctor of psychiatry

2. Schizophrenia :it’s enduring mental illness CCC by
• Diagnostic Criteria:
• A. Two (or more) of the following, each present for a significant portion of time during a 1 -month period (or less if successfully
treated). 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. 5. Negative symptoms (i.e., diminished emotional expression or avolition).
• B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as
work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in
childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
• C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of
symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of
prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by
only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs,
unusual perceptual experiences).
• D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1 ) no
major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have
occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual
periods of the illness.
• E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another
medical condition.
• F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of
schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of
schizophrenia,are also present for at least 1 month (or less if successfully treated).

3. labeling theory
the sociological hypothesis that describing an individual in terms
of particular behavioral characteristics may have a significant
effect on his or her behavior, as a form of self-fulfilling
prophecy. For example, describing an individual as deviant
and then treating him or her as such may result in mental
disorder or delinquency. Also called societal-reaction theory

4. Brief or acute/transient psychotic disorder
ICD-10 (F20.)
• F23 Acute and transient psychotic disorder: symptoms
not exceeding 2 weeks, with or without associated acute
stress. This disorder accounts for around 10% of all
psychotic disorder. 30% of patients can remain in
remission without medication (Philmann and Marneros,
2005)
• F23.0 Acute polymorphic psychotic disorder without
symptoms of schizophrenia: duration < 3 months
• F23.1 Acute polymorphic psychotic disorder with
symptoms of schizophrenia: duration < 1 month
• F23.2 Acute schizophrenia-like psychotic disorder:
duration < 1 month
• F23.3 Other acute predominantly delusional psychotic
disorders: duration < 3 months
• F23.8 Other acute and transient psychotic disorders
• F23.9 Acute and transient psychotic disorder, unspecified
Proposed DSM-5
• 298.8 Brief psychotic disorder: presence of one (or
more) of the following: delusions, hallucinations,
disorganized speech (e.g. frequent derailment or
incoherence), and grossly disorganized or catatonic
behaviour. Duration is between 1 day and 1 month
• Specifier includes with stressful event, without
stressful event, and with postpartum onset
• Substance-induced psychotic disorder: Psychotic
symptoms develop within 1 month of substance
intoxication or withdrawal
• Psychotic disorder associated with another medical
condition: hallucination subtype, delusion subtype,
and disorganized speech subtype
• The number of subtypes of brief psychotic disorder
proposed by DSM-5 is less than ICD-10

5. cont
• The essential feature of brief psychotic disorder is a disturbance that
involves the sudden onset of at least one of the following positive
psychotic symptoms: delusions, hallucinations, disorganized speech (e.g.,
frequent derailment or incoherence), or grossly abnormal psychomotor
behavior, including catatonia (Criterion A).
• Sudden onset is defined as change from a nonpsychotic state to a clearly
psychotic state within 2 weeks, usually without a prodrome. An episode of
the disturbance lasts at least 1 day but less than 1 month,and the
individual eventually has a full return to the premorbid level of
functioning

6. cont
• Acute psychotic disorders: There are disorders which have symptoms (e.g.
delusions, hallucinations and disorganisation symptoms) similar to
schizophrenia, however do not meet the duration criterion. These
disorders have been classified separately in DSM-5 and ICD-10. These
disorders frequently are preceded by a stressor (stressful life event), have
an acute onset and often resolve completely. These disorders may also be
precipitated by feverQ.
• In ICD-10, if the symptoms (delusions, hallucinations, disorganization) are
present for less than one month, a diagnosis of acute and transient
psychotic disorder is made.
• In DSM-5, if symptoms (delusions, hallucinations, disorganisation) are
present for less than one month, a diagnosis of brief psychotic disorder is
made

7. cont
• Epidemiology:
• Age of Onset Gender
• 20-30 years. More common in women.
• Aetiology:
• 1) Acute stressful life event e.g. disaster, bereavement or severe
psychological trauma.
• 2) Underlying personality disorders: borderline, histrionic, paranoid
and schizotypal.
• 3) Family history of mood disorders or schizophrenia

8. cont
• Treatment:
• 1) Short-term use of low dose antipsychotic e.g. risperidone 1 to 2mg
daily to control psychotic symptoms.
• 2) Short-term use of low dose benzodiazepine e.g. lorazepam 0.5mg
for sleep.
• 3) Problem solving or supportive psychotherapy.
• Prognosis:
• Complete recovery usually occurs within 2-3 months. Relapse is
common. The more acute/abrupt the onset, The better the long term
outcome.

9. REACTIVE PSYCHOSIS
• Reactive psychosis is characterised by following features:
• 1. A sudden onset of symptoms.
• 2. Presence of a major stress before the onset (the quantum of stress
should be severe enough to be stressful to a majority of people).
• 3. A clear temporal relation between stress and the onset of psychotic
symptoms.
• 4. No organic cause underlying the psychosis.
• The usual duration of illness is less than one month and recovery is usually
complete.
• Currently a majority of cases of reactive psychosis would be classified
under acute and transient psychotic disorder with associated stress (in ICD-
10) or brief reactive psychosis (in DSM-IV-TR).

10. Schizophreniform Disorder
• This is a diagnostic category in DSM-V with features of schizophrenia
as diagnostic criteria.
• The only difference is that the duration is less than 6 months and
prognosis is usually better than that of schizophrenia. This term was
originally introduced by
• Langfeldt (1961) to designate good prognosis cases, distinct from
“true” schizophrenia. A similar condition in ICD-10 is called acute
schizophrenia-like psychotic disorder
• Treatment same

11. SCHIZOAFFECTIVE DISORDER
• The term ‘schizoaffective psychosis’ was introduced by Kasanin in
1933 to describe a condition with both affective and schizophrenic
symptoms, with sudden acute onset after good premorbid
functioning, and usually with complete recovery.
• This is a disorder which lies on the borderline between schizophrenia
and mood disorders. In this disorder, the symptoms of schizophrenia
and mood disorders are prominently present within the same
episode. The symptoms of both disorders may be present
simultaneously or may follow within few days of each other.

12. cont
• It distinguishes various types:
• Manic type—the person usually makes a full recovery.
• Depressive type—prognosis not as good as that of the manic subtype,
with a greater chance of developing ‘negative’ symptoms.
• Mixed type.
• The course is usually episodic (particularly in manic subtype),
although a chronic course in some patients has been described
(particularly in the depressed subtype). The prognosis is better than
that in schizophrenia but is worse than that in mood disorders.

13. cont
ICD-10
• F20.0 Schizoaffective disorder—manic
type: duration at least 2 weeks
• F25.1 Schizoaffective disorder—
depressive type: duration at least 2
weeks
• F25.2 Schizoaffective disorder—mixed
type: Schizophrenia and affective
symptoms are prominent
• F25.8 Other schizoaffective disorders
• F25.9 Schizoaffective disorder,
unspecified
DSM 5
• 295.70 Schizoaffective disorder—
bipolar type and depressive type
• The psychosis is present for at least
2 weeks in the absence of mood
symptoms
• The mood symptoms account for at
least 50% in the course of illness
• Specify the number of episodes
and remission status (e.g. partial or
full)

14. Treatment and Prognosis for Schizoaffective
Disorders :
• Psychotic symptoms: antipsychotics (e.g. olanzapine and quetiapine
and Aripiprazole because it has good mood stabilising effects).
• • Manic subtype: Mood stabiliser e.g. lithium or Na- valproate
carbamazepine.
• • Depressive subtype: Antidepressant, usually a SSRI.
• • Poor response to pharmacological treatments: ECT.
• • Psychosocial treatments: similar to schizophrenia.
• The prognosis of schizoaffective disorders lies between that of mood
disorders and schizophrenia.

15. Drug induced psychosis
• The association of substance misuse and psychotic features is a
common and problematic one in clinical practice. The key to
management is accurate diagnosis. Psychotic symptoms represent
underlying psychiatric abnormality in this group of patients as in any
other. There is not a general finding of ‘low-grade’ psychotic features
in substance users and apparent psychotic features should not be
attributed to effects of substance use without further inquiry.

16. Psychotic features during drug intoxication
• Substances with hallucinogenic or stimulant activity can produce
psychotic features during acute intoxication. This is not consistent and
varies by drug dose and setting. These are characterized by a rapidly
changing pattern of symptom type and severity and include visual and
other hallucinations, sensory distortions/illusions, and persecutory
and referential thinking. They are characteristically rapidly fluctuating
hour by hour and show resolution as the drug level falls.

17. Psychotic features during withdrawal
• In patients with physiological dependency on alcohol, BDZs, or
cocaine, withdrawals may be complicated by delirium in which
variable psychotic features may be prominent. These will occur in the
context of the general features of delirium ,There may be fluctuating
visual or tactile hallucinations and poorly formed persecutory
delusional ideas.

18. Residual psychotic illness (drug-induced
psychosis)
• In some individuals, psychotic features continue after the period of
acute intoxication and withdrawals has passed. These may be
symptomatically more typical of primary psychotic illness and, once
established, should be treated as for acute episodes of schizophrenia.

19. Genuine comorbidity
• Many individuals with primary psychotic illnesses will misuse substances. In
addition to the intrinsic risks of substance misuse, this carries risks in this
group of diminished treatment compliance, risk of disinhibition leading to
violence, and exacerbation of the primary illness. In view of the sometimes
obvious (to others) causal link between drug use and relapse it is worth
asking why patients persist in substance use. Reasons include:
• • Endemic drug use within patient’s environment (e.g. home or social
• setting) or within other individuals with mental health problems.
• • As means of self-medicating distressing positive and negative symptoms
• (which may be improved by addressing these symptoms directly).