Trauma and stress can cause a short term psychosis known as a brief psychotic disorder. Major life changing events, such as the death of a family member or a natural disaster, have been known to stimulate a brief psychotic disorder in patients with no prior history of mental illness.
Shared psychotic disorder, also known as psychosis by association, is a delusional disorder involving two or more people with close emotional ties. In the West, shared psychosis most commonly develops between two sisters/brothers or between a husband and a wife. In Japan, the most common form of psychosis by association involves a parent and a son or daughter. Shared psychosis can involve an entire nuclear family.
Psychosis is characterized by the following symptoms:
 Delusions. Those delusions that occur in schizophrenia and its related forms are typically bizarre (ie. they couldn’t not occur in real life). Delusions occurring in delusional disorder are more plausible, but still patently untrue. In some cases, delusions may be accompanied by feelings of paranoia.
 Hallucinations. Psychotic patients see, hear, smell, taste, or feel things that aren’t there. Schizophrenic hallucinations are typically auditory or, less commonly, visual, but psychotic hallucinations can involve any of the five senses.
 Disorganized speech. Psychotic patients, especially those with schizophrenia, often ramble on in incoherent, nonsensical speech patterns.
 Disorganized or catatonic behavior. The catatonic patient reacts inappropriately to his/her environment by either remaining rigid and immobile or by engaging in excessive motor activity. Disorganized behavior is behavior or activity that is inappropriate for the situation or unpredictable.
Diagnosis:
Patients with psychotic symptoms should undergo a thorough physical examination and history to rule out such possible organic causes such as seizures, delirium, or alcohol withdrawal, and such other psychiatric conditions as dissociation or panic attacks. If a psychiatric cause such as schizophrenia is suspected, a mental health professional will typically conduct an interview with the patient and administer one of several clinical inventories or tests to evaluate mental status. This assessment takes place in either an outpatient or hospital setting. Psychotic symptoms and behaviors are considered psychiatric emergencies, and persons showing signs of psychosis are frequently taken by family, friends, or the police to a hospital emergency room. A person diagnosed as psychotic can be legally hospitalized against his or her will, particularly if he or she is violent, threatening to commit suicide, or threatening to harm another person. A psychotic person may also be hospitalized if he or she has become malnourished or ill as a result of failure to feed, dress appropriately for the climate, or otherwise take care of themselves.
Treatment:
Psychosis that is symptomatic of schizophrenia or another psychiatric disorder should be treated by a psychologist and/or psychiatrist. An appropriate course of medication and/or psychosocial therapy is employed to treat the underlying primary disorder. If the patient is considered to be at risk for harming himself or others, inpatient treatment is usually recommended.
Treatment of shared psychotic disorder involves separating the affected persons from one another as well as using antipsychotic medications and psychotherapy. Antipsychotic medication such as thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), sertindole (Serlect), olanzapine (Zyprexa), or risperidone (Risperdal) is usually prescribed to bring psychotic symptoms under control and into remission.
After an acute psychotic episode has subsided, anti-psychotic drug maintenance treatment is typically employed and psycho-social therapy and living and vocational skills training may be attempted.
Prognosis:
Prognosis for brief psychotic disorder is quite good; for schizophrenia, less so. Generally, the longer and more severe a psychotic episode, the poorer the prognosis is for the patient. Early diagnosis and treatment are critical to improving outcomes for the patient across all psychotic disorders.
Approximately 10% of America’s permanently disabled population is comprised of schizophrenic individuals. The mortality rate of schizophrenic individuals is also high; approximately 10% of schizophrenics commit suicide and 20% attempt it. However, early diagnosis and long-term follow-up care can improve the outlook for these patients considerably. Roughly 60% of patients with schizophrenia will show substantial improvement with appropriate treatment.
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