1. Psychotic disorders

2. Psychosis Psychosis is a disruptive mental state
Individual has difficulty distinguishing external reality from his or her own internal experiences and perceptions

3. Psychosis Presenting complaints
Hearing voices when no one is around, seeing visions
Strange beliefs or fears
Confusion
Apprehension
Abnormal behaviour

4. Psychosis Presenting complaints
Fear
Apprehension
Inappropriate smile/laughter
Talking to self
Agitation
Aggressive behavior
Aggression

5. Causes of psychosis Alcoholic hallucinosis / Alcohol induced psychosis
Psychosis induced by amphetamines or other substances
Acute psychotic disorder
Schizophrenia
Bipolar disorder, mania
Delusional disorder
Depression with psychotic features
Delirium
Dementia
Head injury

6. Epidemiology and burden Schizophrenia
The lifetime prevalence rate is 1%
Onset in late teens to early 20s, equally affecting men and women
Devastating disease for both the patient and the family
Affects thoughts and emotions to the point that social and occupational functioning is impaired
About one in a ten with schizophrenia commit suicide

7. Positive and negative symptoms of Schizophrenia
Positive symptoms
Delusions
Hallucinations
Hostility
Disorganised thinking/behaviours
Negative symptoms
Alogia
Affective blunting
Anhedonia
Asociality
Avolition
Apathy

8. Treatment of Schizophrenia
Acute phase treatment with anti-psychotics
Haloperidol, chlorpromazine
Risperidone, Olanzapine
Maintenance treatment with antipsychotics
Depot preparations (Fluphenazine)
Risperidone, Olanzapine, Haloperidol
Family / community support
Rehabilitation

9. Bipolar disorder Manic episode
Persistent elevated, irritable mood ≥ 1 week
Three or four (irritable mood) of the following:
Increased self esteem
Reduced sleep
Increased talk / pressured speech
Racing thoughts / flight of ideas
Distractibility
Extreme goal directed activity
Excessive buying/sex/business investments

10. Treatment of manic episode
Acute phase treatment with mood stabilisers (Lithium, Divalproate), antipsychotics (Olanzapine)
Maintenance treatment with Mood stabilisers (Lithium, Divalproate, Lamotrigine, Carbamazepine)

11. Alcoholic hallucinosis
Usually occurs during alcohol withdrawal
Can also occur during prolonged, steady drinking
A hallucinatory or delusional state with clear or relatively clear consciousness
Auditory hallucinations with sexual or derogatory content
Delusions are paranoid
The condition lasts for months rather than days or week

12. Alcoholic Hallucinosis
Age of onset
40-50 years
Type of onset
Usually acute
Duration of illness
3 months
Premorbid personality
A Variety
Alcohol dependence
Over many years
Paranoid Schizophrenia
Age of onset
before 40
Type of onset
Insidious
Duration of illness
Chronic
Premorbid personality
shy, aloof, withdrawn
Alcohol dependence
Not stated

13. Alcoholic Hallucinosis
Family history of alcoholism
Increased
Family history of schizophrenia
No evidence
Hallucinations & delusions
auditory but visual and tactile
Paranoid Schizophrenia
Family history of alcoholism
Not stated
Family history of schizophrenia
Increased prevalence
Hallucinations & delusions
auditory

14. Alcoholic Hallucinosis
Thought processes
Coherent
Affect
Anxious, depressed, perplexed but appropriate
Intellectual function
Fleeting memory disturbance
Orientation
At times not oriented to time
Paranoid Schizophrenia
Thought processes
Incoherent
Affect
Inappropriate
Intellectual function
Not compromised
Orientation