Psychosis- Adolescent-onset psychosis typically occurs between ages 13 and 18 and significantly

impacts thought, perception, emotions, and behaviours. It includes hallucinations, delusions,

disorganized thinking, and cognitive issues, disrupting daily functioning. Early onset is concerning due
to its effects on brain development and long-term emotional, social, and academic growth.

Positive Symptoms
These symptoms represent an excess or distortion of normal functioning and are often the most
disruptive.

1. Hallucinations

o Auditory: Hearing voices or sounds that aren’t real. These can be distressing and
lead to harmful behaviours.

o Visual: Seeing things or people that aren’t there, often causing confusion or fear.

o Other Types: Less common, but can include smelling, tasting, or feeling things that
aren't real.

2. Delusions
False beliefs that persist despite evidence to the contrary:

o Paranoid: Belief that others are plotting against them.

o Grandiose: Believing they have special powers or importance.

o Delusions of Control: Feeling controlled by external forces.

o Delusions of Reference: Believing random events are directly related to them.

3. Disorganized Thinking
Disruptions in thought patterns making it hard to communicate coherently:

o Incoherent Speech: Jumbled or disconnected speech.

o Tangential Thinking: Jumping from one unrelated topic to another.

o Thought Blocking: Sudden stops in speech due to interruptions in thought.

4. Disorganized or Catatonic Behavior

o Disorganized Behavior: Odd or purposeless actions, like neglecting hygiene or

engaging in strange routines.

o Catatonia: Lack of movement or extreme agitation.

Negative Symptoms
These represent a reduction in normal functioning, particularly emotional expression, and social
engagement.

1. Blunted or Flat Affect

Reduced emotional expression; may seem indifferent or detached.
 2. Avolition
Lack of motivation to start or complete tasks, including self-care and social responsibilities.

3. Anhedonia
Inability to experience pleasure from activities that once brought joy.

4. Alogia
Reduced speech output, with minimal or vague responses.

5. Social Withdrawal
Withdrawal from friends, family, and social activities, leading to isolation.

Prodromal Symptoms
Early warning signs that may indicate the onset of psychosis. Recognizing these can help in early
intervention.

1. Social Withdrawal
Gradual isolation from social activities, friends, and family.

2. Subtle Changes in Perception

Heightened sensitivity to stimuli, mild misinterpretations, and increased awareness of
internal sensations.

3. Decreased Motivation
Decline in daily activities and neglect of responsibilities.

4. Unusual Thoughts or Magical Thinking

Irrational or fantastical beliefs, such as thinking they can control events.

5. Mood Swings
Intense and sudden changes in mood, including irritability, depression, and anxiety.

1. First-Rank Symptoms (FRS) of Schizophrenia

These are hallmark symptoms identified by Kurt Schneider, which include:

• Auditory Hallucinations: Hearing voices or sounds that don't exist in reality. Examples
include voices commenting on actions, talking about the person, or commanding them to
perform actions.

• Thought Insertion: The belief that thoughts are being placed in the mind by an external
force.

• Thought Withdrawal: The belief that one's thoughts are being taken away by an external
entity.

• Thought Broadcasting: The belief that others can hear or access one’s thoughts.

• Delusions of Control: The belief that one’s actions, feelings, or thoughts are being controlled
by an external force.
 • Somatic Passivity: The sensation that bodily sensations or functions are being manipulated
by an outside force.

2. ICD-10 Criteria for Schizophrenia

The ICD-10 sets clear guidelines for diagnosing schizophrenia:

• Core Symptoms: At least one of the following must be present: delusions, hallucinations,
disorganized speech, or disorganized/catatonic behavior.

• Duration: Symptoms must persist for at least one month.

• Functional Impairment: Significant impairment in social, occupational, or personal

functioning.

• Exclusion Criteria: Schizophrenia cannot be diagnosed if symptoms are caused by substance

use, mood disorders, or other psychotic disorders.

3. Subtypes of Schizophrenia

Schizophrenia can present in various forms, each with distinct symptoms:

• Paranoid Schizophrenia: Characterized by delusions (persecution, grandeur) and auditory

hallucinations.

• Hebephrenic (Disorganized) Schizophrenia: Features disorganized behavior and speech, with

emotional disruption.

• Catatonic Schizophrenia: Marked by psychomotor disturbances like stupor, mutism,

posturing, or excessive movement.

• Undifferentiated Schizophrenia: A mix of symptoms that don’t fit neatly into other
categories.

• Residual Schizophrenia: Involves negative symptoms after an acute psychotic episode.

• Simple Schizophrenia: Gradual development of negative symptoms with no acute psychotic

episodes.

• Schizophrenia, Unspecified: When the clinical presentation does not fit into any specific
subtype.

4. Causes of Schizophrenia

The text outlines various factors contributing to schizophrenia:

• Genetic Factors: Family history, twin studies, and specific gene mutations contribute to the
risk.

• Neurobiological and Neurochemical Factors: Dopamine dysregulation is a key contributor,

along with other neurotransmitter imbalances and brain structural abnormalities.

• Environmental and Prenatal Factors: Exposure to infections, malnutrition, and birth

complications increases the risk of schizophrenia.

• Psychosocial Stressors: Stressful life events, trauma, and social isolation can trigger or
worsen symptoms in predisposed individuals.
 • Neurodevelopmental Model: Schizophrenia is viewed as a neurodevelopmental disorder,
with early brain development issues triggering symptoms in adolescence or early adulthood.

• Inflammatory and Immune System Factors: Abnormalities in the immune system and
inflammation may also play a role.

The treatment for schizophrenia involves a combination of pharmacotherapy, psychotherapy, and

supportive interventions. Here's a detailed overview of the treatment modalities:

1. Pharmacotherapy (Medications)

Antipsychotic medications are the cornerstone of treatment for schizophrenia, primarily targeting
positive symptoms like delusions and hallucinations. The medications can be classified into two
categories:

1.1. First-Generation (Typical) Antipsychotics

These primarily block dopamine D2 receptors in the brain.

• Examples:

o Haloperidol (Haldol)

o Chlorpromazine (Thorazine)

o Fluphenazine (Prolixin)

• Advantages:

o Effective at reducing positive symptoms.

• Disadvantages:

o Higher risk of extrapyramidal side effects (EPS), such as tremors, rigidity,

bradykinesia, and tardive dyskinesia.

o Sedation and cognitive dulling are also common.

1.2. Second-Generation (Atypical) Antipsychotics

These medications affect both dopamine and serotonin receptors, offering better side-effect profiles.

• Examples:

o Risperidone (Risperdal)

o Olanzapine (Zyprexa)

o Clozapine (Clozaril) – used for treatment-resistant schizophrenia

o Quetiapine (Seroquel)

o Aripiprazole (Abilify)

• Advantages:

o Fewer motor side effects compared to typical antipsychotics.

o Some benefit in treating negative symptoms (e.g., social withdrawal, flat affect).
 o Clozapine is particularly effective in reducing suicide risk.

• Disadvantages:

o Risk of metabolic side effects like weight gain, diabetes, and increased cholesterol.

o Clozapine requires regular blood monitoring for agranulocytosis.

1.3. Long-Acting Injectable Antipsychotics

Used for patients who have trouble adhering to oral medications. These are administered every 2-4
weeks.

• Examples:

o Paliperidone (Invega Sustenna)

o Aripiprazole (Abilify Maintena)

o Risperidone (Risperdal Consta)

Side Effect Management:

• Anticholinergic medications (e.g., benztropine or diphenhydramine) may be used for

managing EPS.

• Regular monitoring for metabolic syndrome is essential, particularly with atypical

antipsychotics.

2. Psychotherapy

Psychotherapy supports patients in managing symptoms, understanding their illness, and improving
functioning. While medications address biological symptoms, psychotherapy helps in coping with
challenges and improving social, occupational, and personal life.

2.1. Cognitive Behavioral Therapy (CBT)

CBT is effective in treating schizophrenia by addressing delusions and hallucinations, restructuring

irrational thoughts, and teaching coping strategies.

• How It Works:

o Helps patients question the validity of delusions and reinterpret hallucinations.

o Assists in recognizing and correcting cognitive distortions, such as paranoia.

o Teaches practical coping skills for managing stress and psychotic symptoms.

2.2. Family Therapy

Family therapy involves the individual with schizophrenia and their family members, improving
communication, reducing conflict, and providing a supportive environment.

• Goals:

o Educating family members about schizophrenia.

 o Teaching effective communication strategies.

o Encouraging medication adherence and crisis management.

2.3. Social Skills Training (SST)

SST focuses on improving social and communication skills, which are often impaired in individuals
with schizophrenia.

• Goals:

o Teaching communication strategies, such as initiating conversations and maintaining

eye contact.

o Helping patients handle interpersonal conflicts and practice assertiveness.

2.4. Cognitive Remediation Therapy (CRT)

CRT aims to improve cognitive deficits such as memory and attention.

• How It Works:

o Exercises designed to enhance cognitive abilities and generalize these skills to real-
life situations.

2.5. Acceptance and Commitment Therapy (ACT)

ACT helps patients accept distressing thoughts and symptoms, focusing on values-based living.

• Goals:

o Encourage acceptance of symptoms like hallucinations.

o Help individuals live meaningful lives despite symptoms.

2.6. Psychoeducation

Psychoeducation involves educating the patient and their family about schizophrenia, treatments,
and coping strategies to improve medication adherence and prevent relapse.

3. Electroconvulsive Therapy (ECT)

ECT is recommended for individuals with treatment-resistant schizophrenia or severe catatonic

symptoms. It is also considered for those experiencing severe depression or acute psychosis.

• Process:

o Electrical currents are passed through the brain to induce a controlled seizure under
general anaesthesia.

o Typically administered several times a week over a course of several weeks.

• Effectiveness:

o Particularly useful for treating catatonia and severe depressive symptoms.

4. Hospitalization

Hospitalization is needed during acute episodes when the individual poses a risk to themselves or
others, or cannot care for their basic needs.

• Goals:

o Stabilizing acute symptoms.

o Providing structured treatment, including medication management, individual and

group therapy.

5. Lifestyle and Self-Care

5.1. Physical Exercise

Regular exercise can improve mood, reduce stress, and combat negative symptoms like lethargy.

5.2. Healthy Diet

A balanced diet helps manage metabolic side effects from antipsychotic medications.

5.3. Sleep Hygiene

Maintaining a regular sleep schedule and reducing screen time before bed can help improve sleep
and mental health.

5.4. Avoiding Substance Abuse

Avoiding substances like cannabis or alcohol, which can worsen psychotic symptoms and interfere
with medication adherence, is crucial.

6. Relapse Prevention

6.1. Early Signs of Relapse

Recognizing early signs of relapse, such as social withdrawal or sleep disturbances, can help prevent
full-blown psychotic episodes.

6.2. Medication Adherence

Ongoing adherence to prescribed medications is essential for relapse prevention. Long-acting

injectable antipsychotics may be considered for patients struggling with adherence.

6.3. Psychoeducation

Providing ongoing education about the illness and treatment helps patients and families recognize
early signs of relapse and take preventive actions.

6.4. Stress Management

Teaching stress management techniques, such as relaxation exercises and mindfulness, is vital since
stress can trigger or worsen symptoms.