Psychosis refers to psychiatric disorders characterized by thought disorders, behavioral disorders, impaired perception (hallucinations) and delusions. The disorders include acute and chronic brain syndromes such as delirium and dementia, functional disorders such as schizophrenia and affective disorders such as bipolar disorder. Schizophrenia is a condition characterized by disorganized thoughts and behavior, mood disorder and altered perception. Symptoms that accompany psychosis include delusions, hallucinations, apathy, and lack of interest in the surrounding.
Psychosis-related symptoms include hallucinations, delusions, depression, and disorganized speech, difficulty in concentrating, social withdrawal, and neglect of personal hygiene. Psychosis-related symptoms are not always indicative of a diagnosis of schizophrenia. There are many other psychotic disorders and each has its diagnostic criteria. However, the symptoms may overlap among disorders thus making a diagnosis challenging ( Abraham and Kulhara, 2010) .
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According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders) for one to make a diagnosis of schizophrenia the patient should meet a criteria. The patient should have signs and symptoms of schizophrenia for not less than six months, during which there should be one month of active symptoms. The patient should also have at least two of these symptoms: hallucinations, delusions, behavioral, speech disorders, and negative symptoms such as lack of motivation. Other causes of a similar presentation should also be ruled out. There should be a decline in patient’s functioning in terms of occupational performance from the beginning of the illness (Jack and William, 2012).
Some auditory hallucinations are specific to schizophrenia such as hearing two voices discussing the patient in third person, or hearing a voice giving a running commentary about the patient’s activities. The positive symptoms (delusions, hallucinations, thought, and behavioral disorders) usually occur in the acute episodes. They usually respond to antipsychotic medications. If a patient progresses to chronic state the negative symptoms are experienced (Edward, 2012). These include social withdrawal, poverty of speech, loss of motivation apathy and anhedonia. These do not respond well to antipsychotics. Two peaks characterize schizophrenia. The first peak occurs in early childhood or adolescent stage while the second peak occurs in midlife.
Possible alternative diagnoses for psychosis- related symptoms include: psychosis secondary to a medical condition such as delirium, schizoaffective disorder, substance-induced psychosis, delusional disorder, personality disorders (paranoid), brief psychotic disorder, mood disorder with psychotic features, schizophreniform disorder.
In schizoaffective disorder, a patient has both symptoms of hallucinations, delusions, and mood disorders including mania and depression. Usually the mood disorder (mania or depression) is present independently or concurrently with psychotic symptoms. The mood disorder should be present for most of the period during the course of the illness. The psychotic symptoms should be present for not less than two weeks. Other causes of a similar presentation should be ruled out ( Van Putten, May, Marder & Wittmann, 2011) .
In schizophreniform disorder, the presentation (positive and negative) symptoms is similar to schizophrenia. The difference is the duration of the symptoms, in that for schizophreniform disorder it is between one to six months. There may be no impairment in occupational and social functioning. It may also have a good prognosis such that there may exist no blunted affect.
A brief psychotic disorder is characterized by psychotic symptoms (hallucinations, delusions, speech, and behavioral disorders) that last for less than one month. The patient may also have attention deficits and unstable mood. It can occur after a stressful event such as the death of a relative or after delivery (postpartum). Other causes of a similar presentation e.g substance-induced psychosis should be ruled out.
In conclusion, organic brain syndromes include delirium and dementia. Delirium also refers to an acute confused state. Patients present with visual hallucinations, disorientation, impaired consciousness, delusions (persecutory), irritability, and impaired memory. Mood disorders can also present with psychotic symptoms. Major depression can present with delusions or hallucinations, which can be appropriate to the mood (congruent) or not. A clinician should therefore have these conditions in mind and rule them out before making a diagnosis of schizophrenia.
References
Abraham R. & Kulhara P. (2010). The efficacy of electroconvulsive therapy in the treatment of schizophrenia. A comparative study. The British Journal of Psychiatry , 151 (2) 152-155
Edward, S. (2012). Commentary on Treatment of Gender Variant and Gender Dysphoric Children and Adolescents: Common themes and Ethical Reflections. Journal of Homosexuality . 59:3, 480-500
Jack, D. and William, B. (2012). Introduction to the Special Issue on “Treatment of Gender Dysphoric/ Gender Variant Children and Adolescents” Journal of Homosexuality . 59:3, 295-300, 2012
Van Putten, T., May, P. R., Marder, S. R., & Wittmann, L. A. (2011). Subjective response to antipsychotic drugs. Archives of General Psychiatry, 38(2) , 187-190.
