Psychotic Disorders – Symptoms and Causes

The first main type of psychotic disorders is schizophrenia.  Positive symptom schizophrenia may be brief or a recurring disorder.  It is characterized by its active delusions and hallucinations, and is linked to the hyperactive dopamine system (Preston, 2009, p. 40).  Negative symptom schizophrenia does not contain active delusions and hallucinations, and is marked by anhedonia, flat affect, and social withdrawal.  An earlier onset of negative symptom schizophrenia is normally seen.

The second type of psychotic disorders is from psychotic mood disorders.  These psychotic symptoms can be seen in conjunction with poor reality testing.  Depressed and excited states are seen in psychotic mood disorders.

Neurological conditions can also account for psychotic disorders, which makes up the third main group of psychotic disorders.  For instance, head injury can result in certain diseases and produce psychotic behavior.  A number of metabolic and toxic states result in delirium, according to Preston (2009, p. 41).

According to Preston (2009), there are several diseases and disorders that may cause psychosis.  Addison’s disease, delirium, dementias, Huntington’s chorea, multiple sclerosis, pancreatitis, pellagra, porphyria, and temporal lobe epilepsy are among others that can be found in this category (p. 41).  Additionally, the following classes of drugs may cause psychosis: sympathomimetics, anti-inflammatory drugs, anticholinergic drugs, hallucinogenic drugs, and L-dopa (p. 42).

Interventions

Medical treatments are numerous in terms of drugs for psychotic disorders.  Preston (2009) notes that the correct drug is chosen almost exclusively in regards to the listed side effects (p. 43).  These side effects often rest on how well the patient is able to deal with the initial side effects, which is the most common reason for relapse (p. 43).  The five primary side effects are sedation, anticholinergic (ACH) effects, extrapyramidal (EPS) effects, weight gain, and metabolic effects (p. 43).

The first class of EPS side effects is Parkinson-like side effects.  Consisting of those similar to Parkinson’s disease, this class is characterized by those such as flat affect, tremor, and muscular rigidity.  However, these must be contrasted from the primary forms of schizophrenia.  Anticholinergic agents are useful in eliminating Parkinson-like effects.

The second class of EPS side effects is akathisia.  Contrasted from anxiety, akathisia is characterized by inner restlessness.  It is partially alleviated through the use of anticholinergic agents.  Preston (2009) notes that diphenhydramine, propranolol, and minor tranquilizers can be more successful (p. 44).

The third class of EPS side effects is acute dystonias.  These are characterized by muscle spasms and contractions normally along the head and neck.  Intramuscular anticholinergic agents quickly treat these effects.  Otherwise oral anticholinergics can treat the side effect prophylactically.

The fourth and final class of EPS side effects is tardive dyskinesia (TD).  Often irreversible, TD is seen as late in onset for EPS.  According to Preston (2009), it affects one in four after seven years of continuous treatment, or one in twenty-five after one year (p. 44-45).  Chorea in the trunk and extremities, combined with sucking and smacking of the mouth and lips involuntarily characterize TD.  While baclofen, sodium valproate, lecithin, and benzodiazepines can reduce TD symptoms, there is no cure (p. 45).