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Psychosis

Psychosis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

A mental disorder in which thoughts and emotions are significantly impaired. Seen in schizophrenia, schizoaffective, bipolar, depression, substance use, medical problems, delirium, and dementia; symptoms include the following:

  • Positive symptoms: hallucinations and delusions (fixed false beliefs not typical of patient’s cultural background)
  • Negative symptoms: anhedonia, poverty of speech, lack of motivation, social withdrawal, affective blunting
  • Cognition: decreased working memory, difficulty with attention, poor and slow information processing; disorganized speech and/or behavior

Epidemiology

Prevalence
  • Schizophrenia: peak onset 18 to 25 years in males; peak onset 25 to 35 years in females
  • 1% of the U.S. population; similar percentage worldwide; 1:1 male–female ratio
  • Delusional disorder: 0.3% of population
  • Bipolar: 1–3% of population
  • Up to 20% prevalence in unipolar major depression

Etiology and Pathophysiology

  • Neurodevelopmental predisposition plus 1st/3rd trimester in utero insult (e.g., infections, birth hypoxia) leads to exaggerated neuronal apoptosis in late adolescence with subsequent thalamic sensory overload. Increased dopaminergic mesolimbic transmission may contribute to delusions and hallucinations in schizophrenia. Dopamine deficiency in mesocortical pathways may contribute to frontal lobe hypoactivity often associated with negative symptoms including apathy and social withdrawal in schizophrenia. Glutamate, neurosteroids, inflammation, and neurodevelopmental abnormalities are active areas of research.
  • Postulated stress-diathesis model: Those biologically at risk develop psychosis when under stress.

Genetics
Schizophrenia: 50% concordance for monozygotic twins, little or no shared environmental effect; multiple candidate genes involved

Risk Factors

Substance abuse (particularly cannabis or synthetic cannabinoids), family history of psychosis, lower socioeconomic status

General Prevention

Community interventions for early detection and treatment of prodromal symptoms show promise; research currently exploring use of omega-3 fatty acids/fish oil and anti-inflammatories drugs which may prevent prodromal progression to schizophrenia

Commonly Associated Conditions

  • Serious mental illness is associated with metabolic syndrome, autonomic dysfunction, sudden cardiac death, and cancer mortality: particularly breast and lung cancer
  • Substance abuse disorders, including nicotine dependence

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Citation

Stephens, Mark B., et al., editors. "Psychosis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116502/all/Psychosis.
Psychosis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116502/all/Psychosis. Accessed April 18, 2019.
Psychosis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116502/all/Psychosis
Psychosis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116502/all/Psychosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Psychosis ID - 116502 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116502/all/Psychosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -