Psychosis

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Basics

Description

A disorder where thoughts and emotions are significantly impaired (i.e., a loss of contact with reality). Seen in schizophrenia, affective disorders, bipolar disorder, depression, substance use, medical problems, delirium, and dementia; symptoms include the following:

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

Epidemiology

Incidence
The incidence of schizophrenia is about 1.5 per 10,000 people.

Prevalence
  • Schizophrenia: peak onset 18 to 25 years in males; 25 to 35 years in females
  • 1% of the U.S. population; similar percentage worldwide
  • Delusional disorder: 0.3% of population, bipolar: 1–3% of population, unipolar depression: up to 20% prevalence

Etiology and Pathophysiology

  • Many causes, including psychiatric, medical, and/or substance use
  • Positive symptoms relate to excessive dopaminergic activity in the mesolimbic pathway.
  • Negative symptoms relate to diminished dopaminergic activity in mesocortical pathway.

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

Risk Factors

Substance abuse (particularly THC-containing substances), family history of psychosis, lower socioeconomic status

General Prevention

Community interventions for early detection and treatment of prodromal symptoms show promise.

Commonly Associated Conditions

  • 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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Basics

Description

A disorder where thoughts and emotions are significantly impaired (i.e., a loss of contact with reality). Seen in schizophrenia, affective disorders, bipolar disorder, depression, substance use, medical problems, delirium, and dementia; symptoms include the following:

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

Epidemiology

Incidence
The incidence of schizophrenia is about 1.5 per 10,000 people.

Prevalence
  • Schizophrenia: peak onset 18 to 25 years in males; 25 to 35 years in females
  • 1% of the U.S. population; similar percentage worldwide
  • Delusional disorder: 0.3% of population, bipolar: 1–3% of population, unipolar depression: up to 20% prevalence

Etiology and Pathophysiology

  • Many causes, including psychiatric, medical, and/or substance use
  • Positive symptoms relate to excessive dopaminergic activity in the mesolimbic pathway.
  • Negative symptoms relate to diminished dopaminergic activity in mesocortical pathway.

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

Risk Factors

Substance abuse (particularly THC-containing substances), family history of psychosis, lower socioeconomic status

General Prevention

Community interventions for early detection and treatment of prodromal symptoms show promise.

Commonly Associated Conditions

  • 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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