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Block 4 Unit 3 Psychotic Disorder Due to General Medical Condition

1. Describe seizure disorder in terms of producing psychotic symptoms.

Seizure disorders can be associated with a psychiatric presentation. The postictal state, following a seizure, is characterised by a gradual clearing of delirium, which can last from a few minutes to many hours.

2. What are the various types of psychotic disorders?

There are several types of psychotic disorders:

• Schizophrenia: Characterised by significant social or occupational dysfunction, and a combination of symptoms of the disorder.
• Schizoaffective disorder: Characterised by a mood episode and the active phase symptoms of schizophrenia occurring at the same time. There must have been at least 2 weeks of delusions or hallucinations (without mood symptoms) before or after the occurrence of them together.
• Delusional disorder: Characterised by at least 1 month of non-bizarre symptoms without any other active phase symptoms.
• Brief psychotic disorder: Lasts more than 1 day and goes away by 1 month.
• Shared psychotic disorder: Involves delusions that have been influenced by someone else who has similar delusions.
• Psychotic disorder due to a general medical condition: Due to a direct relation from a physiological condition.
• Substance-induced psychotic disorder: Due to a direct physiological condition from medication, drug abuse, or toxin exposure.
• Psychotic disorder not otherwise specified: This category includes all psychotic disorders that do not fit into any of the above criteria or when there is not enough information or contradictory information provided.

3. What are the various symptoms of psychotic disorders due to medical conditions?

Symptoms of psychotic disorders due to medical conditions can include delusions, hallucinations, confusion, disorganised speech, and altered emotions.

4. What are the various types of hallucinations?

Hallucinations can occur in any sensory modality, including visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, thermoceptive and chronoceptive.

5. What are the causes of psychosis in general medical conditions?

Psychosis due to medical conditions can be caused by various factors, including:

• Neurological disorders, such as multiple sclerosis, meningitis, and seizure disorders.
• Metabolic disorders, such as parathyroid disorders.
• Heavy metal poisoning.
• Substance abuse.
• Adverse reactions to medication.
• Stress response.
• Postpartum psychosis.

6. What are the symptoms of psychotic disorders due to general medical conditions?

Psychotic disorders due to medical conditions are characterised by impaired perception and understanding of reality. Specific symptoms may include delusions (fixed but untrue beliefs), hallucinations (seeing visions or hearing voices), confusion, disorganised speech, exaggerated or diminished emotions, and bizarre behaviour. The level of functioning can be severely impaired, leading to social withdrawal and inability to attend to work, relationships, or basic personal care.

7. What are the causes of psychotic disorders due to medical conditions?

Psychotic disorders due to medical conditions can arise from several sources:

• Neurological disorders: Such as Parkinson's disease, multiple sclerosis, Huntington’s disease, epilepsy, and meningitis.
• Metabolic disorders: Including dysfunction of the parathyroid glands and resultant hypercalcemia.
• Heavy metal poisoning: Exposure to lead, mercury, manganese, arsenic and organophosphorus compounds can lead to psychiatric symptoms.
• General Medical Conditions: Medical illnesses such as thyroid disorders, heart disease, HIV/AIDS and cancer can induce psychosis.
• Psychoactive drugs: Both prescription and recreational drugs can induce psychotic symptoms.
• A stress response: Severe or prolonged stress may trigger psychotic symptoms.
• Postpartum psychosis: Dramatic hormonal changes after childbirth can result in a form of brief psychotic disorder.

8. What role brain tumors play in producing psychotic symptoms?

Brain Tumours and Psychotic Symptoms

• Brain tumours can cause a range of psychiatric symptoms, including cognitive impairment, personality changes, and motor and language dysfunction.
• Limbic and hypothalamic tumours can cause affective symptoms such as rage, mania, emotional lability and altered sexual behaviour. They can also produce delusions involving complex plots.
• Hallucinations, often considered a hallmark of psychiatric illness, can be caused by focal neurological pathology.

9. How does multiple sclerosis affect the medical condition and produce psychotic symptoms?

Multiple Sclerosis (MS) and Psychotic Symptoms

• MS is a demyelinating disorder characterised by multiple episodes of neuropsychiatric symptoms related to lesions in the white matter of the central nervous system.
• Symptoms can be categorised as cognitive and psychiatric. Cognitive symptoms include difficulties with abstract reasoning, planning, and organisational skills. Dementia may eventually develop.

10. Discuss thyroid disorder and the production of psychotic symptoms.

Thyroid Disorders and Psychotic Symptoms

• Hyperthyroidism can present with symptoms of anxiety, confusion, and agitated depression. Patients can also present with hypomania and frank psychosis. In most cases, psychiatric symptoms resolve with treatment of the hyperthyroidism, provided there is no other psychiatric history.
• Hypothyroidism can also present with depression and anxiety.

11. How does sodium imbalance contribute to psychiatric disorders. Describe the stages?

Sodium Imbalance and Psychiatric Disorders

12. Which are the vitamin deficiencies cause psychiatric disorders? Explain.

Vitamin Deficiencies and Psychiatric Disorders

13. How do amphetamines, solvents and hallucinogens produce psychotic symptoms?

Amphetamines, Solvents, and Hallucinogens and Psychotic Symptoms

• Amphetamines trigger the release of dopamine, and excessive dopamine function is believed to be responsible for many symptoms of schizophrenia. Amphetamines can worsen existing schizophrenia symptoms and cause stimulant psychosis in otherwise healthy individuals.
• The sources don't specifically describe the effects of solvents on psychosis.
• Hallucinogens, such as ketamine and PCP, can mimic symptoms of schizophrenia. These drugs are considered better models for research than stimulants because they produce both positive and negative symptoms.

14. What are the positive and negative symptoms of psychotic disorders?

Positive and Negative Symptoms of Psychotic Disorders

• Positive symptoms include:
  • Delusions (fixed but untrue beliefs)
  • Hallucinations (seeing visions or hearing voices)
  • Disorganised speech
  • Exaggerated or diminished emotions
  • Bizarre behaviour
• Negative symptoms in the context of psychotic disorders: a severe impairment in functioning may lead to social withdrawal and an inability to attend to work, relationships or personal care.

15. Describe hallucinations and delusions.

Hallucinations and Delusions

• Hallucinations are sensory perceptions that no one else can detect and can involve the sense of sight, touch, hearing, smell, or taste. Hearing voices is the most frequent hallucination in psychosis. Hallucinations occur when the individual is awake.
• Delusions are unshakable and irrational beliefs in something untrue. Delusions defy normal reasoning and remain firm even when overwhelming proof is presented to disprove them.

16. What are the causes of psychotic disorders? Explain.

Causes of Psychotic Disorders

Psychotic disorders can be caused by a combination of biological, psychological and social factors. These include:

• Neurological conditions such as epilepsy, migraines, Parkinson's disease, cerebrovascular disease, and dementia.
• Metabolic imbalances such as hypoglycaemia.
• Endocrine disorders such as hyper- or hypothyroidism.
• Renal failure, electrolyte imbalance, or autoimmune disorders.
• Substance abuse including hallucinogenics, PCP, amphetamines, cocaine, marijuana, and alcohol.
• Certain prescription medications such as anesthetics, anticonvulsants, chemotherapeutic agents and antiparkinsonian medications.
• Toxic substances such as carbon dioxide and carbon monoxide.
• Trauma and stress.

17. Describe the symptoms of this disorder.

Symptoms of Psychotic Disorders

Symptoms include:

• Delusions (fixed but untrue beliefs).
• Hallucinations (seeing or hearing things that are not there).
• Disorganised speech.
• Altered or diminished emotions.
• Bizarre behaviour.
• Impaired reality testing.
• Inability to distinguish personal, subjective experiences from the reality of the external world.

18. What are the various types of delusions?

Types of Delusions

19. Define hallucinations.

Hallucinations are false or distorted sensory experiences that appear to be real. Psychotic patients may see, hear, smell, taste, or feel things that aren’t there.

20. What are psychoactive drugs? How are they involved in producing psychotic symptoms?

Psychoactive Drugs and Psychotic Symptoms

• Psychoactive substances can cause, exacerbate, and/or precipitate psychotic states and/or disorders in users.
• Drugs of abuse that can cause psychosis include alcohol, amphetamines, marijuana, cocaine, hallucinogens, inhalants, opioids, and sedative-hypnotics.
• Common over-the-counter and prescription medications that can cause psychosis include anesthetics, analgesics, anticholinergic agents, anticonvulsants, antihistamines, cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications, and antidepressants.

21. Describe a stress response in the context psychotic symptoms

Stress Response and Psychotic Symptoms

• Stress can contribute to and trigger psychotic states. A history of psychologically traumatic events and recent stressful experiences can both contribute to the development of psychosis.
• Short-lived psychosis triggered by stress is known as brief reactive psychosis, and patients may spontaneously recover normal functioning within two weeks.

22. What is meant by defense mechanisms in psychotic disorders?

Defense Mechanisms in Psychotic Disorders

23. What do we understand by culturally defined disorders?

Culturally Defined Disorders

The types of behaviour that occur during brief psychotic disorder are shaped by cultural expectations and traditions. Many cultures have unique mental disorders that meet criteria for brief psychotic disorder, with similar behaviours attributed to causes specific to that community. The DSM-IV-TR calls disorders unique to certain societies or groups "culture-bound".

24. Describe the early intervention as part of treatment of these disorders.

Early Intervention in Psychotic Disorders

• Early intervention in psychosis involves identifying and treating someone in the early stages of a psychosis, which can significantly improve their long-term outcome. This involves an intensive multi-disciplinary approach during a critical period when intervention is most effective.
• Cognitive behavioural therapy during the early pre-cursory stages of psychosis may prevent or delay the onset of psychosis.

25. When are these patients hospitalised and what are the main reasons for the same?

Hospitalisation for Psychotic Disorders

• Hospitalisation is preferred when dealing with patients who exhibit severe symptoms of Schizophrenia. The aim of hospitalisation is to prevent them from hurting or injuring themselves and gain stability as they take medication.
• Psychiatric hospitalisation may be needed to observe individuals and protect them from their own loss of reality, judgment, and impulse control.

26. Discuss the psychosocial therapy for psychotic disorders due to general medical condition.

Psychosocial Therapy for Psychotic Disorders due to General Medical Conditions