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Watch the whole lesson at https://onlinemeded.org/spa/psychiatry/psychotic-disorders! A delusion is a fixed false belief. To the patient it’s a glaring universal truth – one that can’t be denied. To the rest of the world there’s no sound basis whatsoever. Delusions often can’t be confronted, so it’s best not to try. Put another way, the patients have no insight. In dealing with delusion disorders it’s critical to identify the duration of symptoms, and how bizarre the delusion / illogical the thought process. Study schizophrenia carefully and learn how other delusional disorders are simply spin-offs of this one disease.
Schizophrenia is a thought process disorder with an unknown etiology. There’s definitely a genetic component, while overload of dopamine (confirmed) and serotonin (likely) contribute to a constellation of thought symptoms culminating in the final diagnosis. Schizophrenia typically presents in young adults (20s) following a major life stressor (college) with a psychotic break. A normal healthy person suddenly snaps, acts bizarrely, and hopefully gets on meds. Rule out drugs (illicit). Once diagnosed, schizophrenia is a lifetime of relapses with continually declining mental functioning each break. We’ll talk more about treatment in the psych-pharm lesson; here, focus on diagnosis and differentiation of schizophrenia and schizophrenia-like disorders (listed to the right).
Treatment is with anti-psychotics. They come in two forms. The first-to-be-made aka the first-generation, but second-line treatments are typical antipsychotics focused primarily on the positive symptoms, targeting dopamine-receptor antagonism. Typical antipsychotics are stratified by potency, but often have a larger side effect profile. High-potency typicals (haloperidol, fluphenazine) have a stronger effect, but higher incidence of extrapyramidal symptoms, while low-potency typicals (chlorpromazine) have high rates of anticholinergic side effects.
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