Anthropometric Measurements as Predictors of Low Birth Weight Among Tanzanian Neonates: A Hospital-Based Study
November 7, 2025
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Background
Psychosis basically presents as a psychotic disorder and is marked by hallucinations, delusions, disorganized or bizarre thinking, and a lack of appreciation of personal illness. The definition of psychosis, over the course of historical development, has emerged from the first notions of madness in ancient societies, including Ancient Greece and Rome, where the primitives of mental pathology was linked with supernatural influence and an excess or deficiency of bodily fluids.
Contemporary meaning of psychosis is believed to have emerged from Germany in late nineteenth century, primarily through the works of Emil Kraepelin who made the initial split between mood and psychotic disorders; although in his categorization schizophrenia was termed as “dementia praecox.” This framework was expanded by Eugen Bleuler who also introduced the term “schizophrenia and distinguished psychosis from cognitive and emotional as well as volitional.” Schizophrenia mind loss is now known no longer as one disease but as the perspective which may be encountered in several psychiatric, neurological, and medical affections.
Psychosis is characteristic of schizophrenia spectrum disorders, but its presentation can also be part of mood disorders like bipolar disorder or major depression with psychotic features, substance use and induced conditions, and neurodegenerative disorder like Parkinson’s or Alzheimer’s disease.
Epidemiology
In a first-time psychosis, the rate is approximately 50 per 100,000 populations, whereas schizophrenia is roughly 15 per 100,000 individuals. The greatest vulnerability to psychosis is during the late teenage and mid-20s for men and from teenage years to late 20s for women. Early onset of psychosis is usually considered to correlate with poor prognosis, while early intervention is believed to be beneficial. Schizophrenia and related psychosis are particularly uncommon in children below the age of 12 years.
Anatomy
Pathophysiology
The neurotransmitter which is closely associated with the development of psychotic disorders is dopamine. It is thought that an excess of dopamine in the mesolimbic pathway contributes to the positive symptoms of psychosis. Also, a decrease in activity of the N-methyl-D-aspartate (NMDA) glutamate receptor is involved in the excitatory neurotransmitter glutamate. Role of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter has also been postulated; however, these sources indicate that GABA might be dysregulated in schizophrenia. In addition, there is a discrepancy in the levels of acetylcholine; this inference can be made based on the patients’ smoking habits that involve schizophrenia subtype. Cholinergic activity was enhanced by nicotine; it raised some aspects of cognition in these people and research has indicated improvements in cognitive function due to this effect of the substance.
Etiology
Psychosis is caused either by a primary psychotic illness or by substance abuse, or even a neurological or medical condition. The current literature suggests that first episode psychotic disorders are linked to brain structural changes including decreased gray matter in the prefrontal, superior, and medial temporal lobes. First episode psychosis is considered neurodevelopmental disorders that started during fetal development; however, symptom onset mainly occurs with epigenetic or environmental factors including substance use, stress, immigration, infections, post-partum period or medical related events. Research findings suggest that there is clear genetic predisposition to involve in the occurrence of psychotic disorders.
Genetics
Prognostic Factors
Aside from episodic psychotic disorders like schizophrenia, it used to be generally believed that the prognosis is always poor but this is is no longer necessarily the case. The availability of newer medications of antipsychotics, including long acting injectables, have increased the number of treatments presents and solutions to problems with adherence to therapy. Earlier referral and delivery of higher doses of speech therapy were also established as important in determining the long-term prognosis. When schizophrenia with a single psychotic episode that could be attributed to a non-psychotic medical or neurological condition is considered, renewed data on prognosis is scarce and future outcomes tend to depend on the presence of the condition. The approach would be to probably manage the psychotic episode and the condition leading to the psychotic episode.
Clinical History
Age group
Adolescence to Early Adulthood (Teens to 30s): Â Psychosis nearly always develops in late adolescence to early mid-thirties. Psychosis occurring during the adolescent age has a lower prognosis than cases that occur at other ages.
Late Adulthood (40s and beyond): Psychosis may be a symptom of neurodegenerative conditions in elderly people including dementia (such as Alzheimer’s or Parkinson’s disease, etc.) Schizophrenia that develops after the patient is 40 years is not common though it is possible.
Physical Examination
The general survey assessment of psychosis entails the appearance and behavior of the client; for instance, he or she may be agitated or in a state of catalepsy. It involves examination of clinical parameters such as pulse rate, blood pressure among others to exclude medical etiology including infections or use of substances. Neurological examination assesses for any neurological deficit in motor power, coordination, reflexes or sensation that might point towards brain pathology or neuropathies. A mental status exam (MSE) is used to evaluate progressive disturbances in speech, mood, thought, and ideas as well as insight into the disease. The exam may also involve screening for intoxication, thyrotoxicosis, other medical causes for psychosis or encephalopathy.
Age group
Associated comorbidity
Substance induced psychosis
Dementia
Parkinson’s Disease
Lewy Body Dementia
Epilepsy
Traumatic brain injury
Associated activity
Acuity of presentation
Acute Psychosis: Usually acute, occurring after the administration of psychostimulants or other drugs, under conditions of acute stress or withdrawal. Patient may have serious side effects such as, hallucination, agitation or even confusion and requires medical help.
Subacute or Chronic Psychosis: May develop more gradually, as seen in some other disorders where one may have symptoms of schizophrenia for some time before the development of full-blown psychotic symptoms: prodromal state includes withdrawal from people, strange beliefs, or suspicions.
Differential Diagnoses
Primary Psychiatric Disorders
Neurological Conditions
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Pharmacological Interventions:
Antipsychotic Medications: Typically used to treat symptoms are first generation or typical antipsychotics and second generation or atypical antipsychotics. Long-acting injectable formulations may be deployment in contributing to adherence.
Psychosocial Interventions: CBT and psychoeducation enable the patients to be informed about the disease and the ways on how to counter them.
Crisis Intervention: Severe cases may call for hospitalization on the reasons of safety with crisis teams for community-based interventions. Addressing Underlying Causes: It is crucial to address any substance use disorders and medical conditions that may lead to psychosis. Rehabilitation and Support Services: Rehabilitation activities such as occupational therapy, social skills training, and case management help in the reintegration and daily living.
Long-Term Management: Such more often sessions are necessary to evaluate the results of therapy and avoid repetition of the same problem occur.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
use-of-modification-of-environment-in-the-treatment-of-psychosis
Safe Spaces: Lowering stimuli and ensuring personal safety or elimination of things that cause the child to hurt themselves or become anxious.
Structured Routine: Implementing schedules for the day to afford predictability and alleviate anxiety.
Therapeutic Areas: Designing special rooms for therapy and rest to enhance the clients’ ability to speak and reduce stress levels.
Social Integration: Promoting community dwelling and peer support services to improve social participation and social inclusion.
Environmental Enhancements: Exploiting colours that have been known to reduce tension, adequate lighting from natural sources and possibility to get a close touch with nature.
Role of First-Generation (Typical) Antipsychotics
Haloperidol: Utilized in schizophrenia treatment for psychotic symptoms and in cases of emergent agitation; marketed in tablet and injectable preparations.
Chlorpromazine: An early second-generation antipsychotic whose uses include a variety of psychotic disorders; more side effects include sedation and weight gain.
Fluphenazine: Predominantly used in chronic psychosis; comes in a long-acting injectable type to enhance compliance.
Role of Second-Generation (Atypical) Antipsychotics
Risperidone: Used for schizophrenia and bipolar disorder; may produce some EPS at increased dose of the drug.
Olanzapine: Proven to be effective in treating acute mania and schizophrenia; causes sedation; causes weight gain.
Quetiapine: Used to treat schizophrenias, bipolar and depression, reduces the risk of EFP but has issues of sedation and metabolic syndrome.
Aripiprazole: A dopamine receptor partial agonist; employed for schizophrenia and in combination with other antidepressants; causes less weight increase.
Lurasidone: Potentiated by fluoxetine effective in arresting schizophrenia and bipolar depression with lower chances of inducing metabolic symptoms.
Role of Third-Generation Injectable Antipsychotics
Paliperidone Palmitate: A paliperidone palmitate which is a long-acting injectable suitable for administrating in schizophrenia illness.
Aripiprazole Lauroxil: Aripiprazole, an atypical antipsychotic agent given as an injectable formulation to treat schizophrenia in patients with inadequate response to oral aripiprazole.
use-of-intervention-with-a-procedure-in-the-treatment-of-psychosis
Electroconvulsive Therapy (ECT): It is a medical treatment that aims at electricity stimulating the brain and making it have a small seizure. Although it’s mostly used in cases of depression, it can also be rather useful when treating psychosis that is linked to severe moods. It is often considered for patients with:
Schizophrenia that does not respond to medication.
Serious excitement or catatonic phase.
Suicidal thinking or behaviors or ideation of self or others.
Faster recovery from symptoms, especially where the condition is severe.
Transcranial Magnetic Stimulation (TMS): This one employs the utilization of magnetic fields to excite the nerve cells in the brain. The drug is utilised mainly to treat MDD, although research has linked its effectiveness with lowering of psychotic symptoms in several trials. May be used in those patients that have failed to respond to conventional therapies.
Deep Brain Stimulation (DBS): This is done using an implantable device that generates electrical signals to the targeted area of the brain. This is usually employed in movement disorders such as Parkinson’s Disease, but clinical trials are being done on psychotic disorders including those that are treatment refractory. Chronic, treatment-refractory psychosis which other therapies have not helped to improve.
Psychosurgery: Generally, psychosurgery entailed the performance of surgery operations that interfered with the normal functioning of the brain in the past (Garrick 266). Modern approaches are very much developed in comparison with the traditional ones and act on specific parts of the brain. It is an option that is implemented very sparingly, and the results of interventions are not very good unless all other modalities have been exhausted and the danger of harm is high.
uses-of-phases-in-the-management-of-psychosis
Acute Phase: This first phase is centred on the patient’s safety and often requires hospitalization. They are most often administered with antipsychotic drugs to treat the symptoms.
Stabilization Phase: Ideally, once the patient presents with acute exacerbation, focus then moves to the need to get the patient back on the right dose of medication. This phase includes check-up visits, medication compliance, and educational sessions.
Maintenance Phase: During this long-term phase, the emphasis is taken on avoiding relapse, keeping vast number of symptoms in check. Further medication compliance continued use of therapy including CBT and support from family and community.
Medication
5 - 10
mg
Orally 
every 6–8 hours; slowly raise dosage every 2–3 days; not to exceed 150 mg per day
moderate: 0.5 to 2 mg orally every 8-12 hours
severe: 3-5 mg orally every 8-12 hours; do not exceed the dose of more than 30 mg/day
2-5 mg intramuscularly (prompt acting) every 4-8 hours as required. In case of acute agitation dose may be required every hour. Do not exceed the dose more than 20 mg/day
(Off-Label)
2-10 mg initially, repeat the bolus dose every 15-30 minutes, sequence wise coupling the initial bolus
After achieving stagnation, administer 25% of last bolus every 6 hours
Initially, 5-20 mg in the morning
Later 10-40 mg in the evening\
Based on response and tolerability, increase the dose
Maintenance dose- Decrease dose to a lowest effective one
A reduction of 2.5 mg in the morning and 15 mg in the evening is considered
Take a dose of 20 to 60 mg weekly then raise up to 250 mg one time in a week for severe conditions
Take a dose of 5 to 20 mg orally daily
Indicated for psychology after menopause
100 mg each day for 20 days
Start over after 7-10 days
(Off-Label)
Oral administration of 0.4 to 1.4 mg/day is given in divided doses:
Dose Adjustments
Not Available
Administer 25 to 600mg orally at bedtime in two or three divided doses
Administer 25 to 200mg intramuscularly everyday.
In vivo dosing suggests administration of 0.2 to 0.3mg/kg everyday as initial dose.
Can increase the dose slowly to 0.04 to 0.06mg/kg everyday
60 - 150
mg
Intramuscular (IM)
once a day
Administer 1 to 15mg every day orally. Do not exceed 50mg. OR
Administer up to 300 mg every 4 weeks through deep intramuscular injection
Clothiapine is an atypical antipsychotic useful in some treatment-resistant patients for antipsychotics
Indicated for Psychosis/Sedation, Schizophrenia
For <3 years:
Safety and efficacy are not seen
For 3-12 years (15-40 kg):
0.25-0.5 mg/day orally every 8-12 hours initially; increase by 0.5 mg/day, every 5-7 days as required;
Maintenance dose:
0.05-0.15 mg/kg per day orally every 8-12 hours
For 6-12 years (prompt-acting):
1-3 mg intramuscularly every 4-8 hours as required; do not exceed 0.15 mg/kg per day
For >12 years:
Moderate disease, 0.5-2 mg orally every 8-12 hours initially; in severe disease, 3-5 mg orally every 8-12 hours; do not exceed more than 30 mg/day
Initially, 2.5-10 mg in the morning
Later 5-30 mg in the evening
Based on response and tolerability, increase the dose
For the age of the child is more than twelve years
Oral/Intramuscular- Administer 10 to 25 mg six times & four times a day
Administer 25 to 100mg orally at bedtime in two or three divided doses
200 - 250
mcg/kg
For children more than 2.5 years:
200-250mcg/kg i.m once daily
Maximum dose: 10mg
<12 years: Safety and efficacy not established
>12 years: Administer 10 to 25mg every four to six hours orally.
Initially 0.25-0.5 mg orally every 8-12 hours
(Off-Label)
0.25-0.5 mg intravenously every 4 hours
Initially, 5 mg/day orally in the morning
More than 30 mg dose per day is rarely needed
Based on response and tolerability, increase the dose
Future Trends
Psychosis basically presents as a psychotic disorder and is marked by hallucinations, delusions, disorganized or bizarre thinking, and a lack of appreciation of personal illness. The definition of psychosis, over the course of historical development, has emerged from the first notions of madness in ancient societies, including Ancient Greece and Rome, where the primitives of mental pathology was linked with supernatural influence and an excess or deficiency of bodily fluids.
Contemporary meaning of psychosis is believed to have emerged from Germany in late nineteenth century, primarily through the works of Emil Kraepelin who made the initial split between mood and psychotic disorders; although in his categorization schizophrenia was termed as “dementia praecox.” This framework was expanded by Eugen Bleuler who also introduced the term “schizophrenia and distinguished psychosis from cognitive and emotional as well as volitional.” Schizophrenia mind loss is now known no longer as one disease but as the perspective which may be encountered in several psychiatric, neurological, and medical affections.
Psychosis is characteristic of schizophrenia spectrum disorders, but its presentation can also be part of mood disorders like bipolar disorder or major depression with psychotic features, substance use and induced conditions, and neurodegenerative disorder like Parkinson’s or Alzheimer’s disease.
In a first-time psychosis, the rate is approximately 50 per 100,000 populations, whereas schizophrenia is roughly 15 per 100,000 individuals. The greatest vulnerability to psychosis is during the late teenage and mid-20s for men and from teenage years to late 20s for women. Early onset of psychosis is usually considered to correlate with poor prognosis, while early intervention is believed to be beneficial. Schizophrenia and related psychosis are particularly uncommon in children below the age of 12 years.
The neurotransmitter which is closely associated with the development of psychotic disorders is dopamine. It is thought that an excess of dopamine in the mesolimbic pathway contributes to the positive symptoms of psychosis. Also, a decrease in activity of the N-methyl-D-aspartate (NMDA) glutamate receptor is involved in the excitatory neurotransmitter glutamate. Role of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter has also been postulated; however, these sources indicate that GABA might be dysregulated in schizophrenia. In addition, there is a discrepancy in the levels of acetylcholine; this inference can be made based on the patients’ smoking habits that involve schizophrenia subtype. Cholinergic activity was enhanced by nicotine; it raised some aspects of cognition in these people and research has indicated improvements in cognitive function due to this effect of the substance.
Psychosis is caused either by a primary psychotic illness or by substance abuse, or even a neurological or medical condition. The current literature suggests that first episode psychotic disorders are linked to brain structural changes including decreased gray matter in the prefrontal, superior, and medial temporal lobes. First episode psychosis is considered neurodevelopmental disorders that started during fetal development; however, symptom onset mainly occurs with epigenetic or environmental factors including substance use, stress, immigration, infections, post-partum period or medical related events. Research findings suggest that there is clear genetic predisposition to involve in the occurrence of psychotic disorders.
Aside from episodic psychotic disorders like schizophrenia, it used to be generally believed that the prognosis is always poor but this is is no longer necessarily the case. The availability of newer medications of antipsychotics, including long acting injectables, have increased the number of treatments presents and solutions to problems with adherence to therapy. Earlier referral and delivery of higher doses of speech therapy were also established as important in determining the long-term prognosis. When schizophrenia with a single psychotic episode that could be attributed to a non-psychotic medical or neurological condition is considered, renewed data on prognosis is scarce and future outcomes tend to depend on the presence of the condition. The approach would be to probably manage the psychotic episode and the condition leading to the psychotic episode.
Age group
Adolescence to Early Adulthood (Teens to 30s): Â Psychosis nearly always develops in late adolescence to early mid-thirties. Psychosis occurring during the adolescent age has a lower prognosis than cases that occur at other ages.
Late Adulthood (40s and beyond): Psychosis may be a symptom of neurodegenerative conditions in elderly people including dementia (such as Alzheimer’s or Parkinson’s disease, etc.) Schizophrenia that develops after the patient is 40 years is not common though it is possible.
The general survey assessment of psychosis entails the appearance and behavior of the client; for instance, he or she may be agitated or in a state of catalepsy. It involves examination of clinical parameters such as pulse rate, blood pressure among others to exclude medical etiology including infections or use of substances. Neurological examination assesses for any neurological deficit in motor power, coordination, reflexes or sensation that might point towards brain pathology or neuropathies. A mental status exam (MSE) is used to evaluate progressive disturbances in speech, mood, thought, and ideas as well as insight into the disease. The exam may also involve screening for intoxication, thyrotoxicosis, other medical causes for psychosis or encephalopathy.
Substance induced psychosis
Dementia
Parkinson’s Disease
Lewy Body Dementia
Epilepsy
Traumatic brain injury
Acute Psychosis: Usually acute, occurring after the administration of psychostimulants or other drugs, under conditions of acute stress or withdrawal. Patient may have serious side effects such as, hallucination, agitation or even confusion and requires medical help.
Subacute or Chronic Psychosis: May develop more gradually, as seen in some other disorders where one may have symptoms of schizophrenia for some time before the development of full-blown psychotic symptoms: prodromal state includes withdrawal from people, strange beliefs, or suspicions.
Primary Psychiatric Disorders
Neurological Conditions
Pharmacological Interventions:
Antipsychotic Medications: Typically used to treat symptoms are first generation or typical antipsychotics and second generation or atypical antipsychotics. Long-acting injectable formulations may be deployment in contributing to adherence.
Psychosocial Interventions: CBT and psychoeducation enable the patients to be informed about the disease and the ways on how to counter them.
Crisis Intervention: Severe cases may call for hospitalization on the reasons of safety with crisis teams for community-based interventions. Addressing Underlying Causes: It is crucial to address any substance use disorders and medical conditions that may lead to psychosis. Rehabilitation and Support Services: Rehabilitation activities such as occupational therapy, social skills training, and case management help in the reintegration and daily living.
Long-Term Management: Such more often sessions are necessary to evaluate the results of therapy and avoid repetition of the same problem occur.
Psychiatry/Mental Health
Safe Spaces: Lowering stimuli and ensuring personal safety or elimination of things that cause the child to hurt themselves or become anxious.
Structured Routine: Implementing schedules for the day to afford predictability and alleviate anxiety.
Therapeutic Areas: Designing special rooms for therapy and rest to enhance the clients’ ability to speak and reduce stress levels.
Social Integration: Promoting community dwelling and peer support services to improve social participation and social inclusion.
Environmental Enhancements: Exploiting colours that have been known to reduce tension, adequate lighting from natural sources and possibility to get a close touch with nature.
Psychiatry/Mental Health
Haloperidol: Utilized in schizophrenia treatment for psychotic symptoms and in cases of emergent agitation; marketed in tablet and injectable preparations.
Chlorpromazine: An early second-generation antipsychotic whose uses include a variety of psychotic disorders; more side effects include sedation and weight gain.
Fluphenazine: Predominantly used in chronic psychosis; comes in a long-acting injectable type to enhance compliance.
Psychiatry/Mental Health
Risperidone: Used for schizophrenia and bipolar disorder; may produce some EPS at increased dose of the drug.
Olanzapine: Proven to be effective in treating acute mania and schizophrenia; causes sedation; causes weight gain.
Quetiapine: Used to treat schizophrenias, bipolar and depression, reduces the risk of EFP but has issues of sedation and metabolic syndrome.
Aripiprazole: A dopamine receptor partial agonist; employed for schizophrenia and in combination with other antidepressants; causes less weight increase.
Lurasidone: Potentiated by fluoxetine effective in arresting schizophrenia and bipolar depression with lower chances of inducing metabolic symptoms.
Psychiatry/Mental Health
Paliperidone Palmitate: A paliperidone palmitate which is a long-acting injectable suitable for administrating in schizophrenia illness.
Aripiprazole Lauroxil: Aripiprazole, an atypical antipsychotic agent given as an injectable formulation to treat schizophrenia in patients with inadequate response to oral aripiprazole.
Psychiatry/Mental Health
Electroconvulsive Therapy (ECT): It is a medical treatment that aims at electricity stimulating the brain and making it have a small seizure. Although it’s mostly used in cases of depression, it can also be rather useful when treating psychosis that is linked to severe moods. It is often considered for patients with:
Schizophrenia that does not respond to medication.
Serious excitement or catatonic phase.
Suicidal thinking or behaviors or ideation of self or others.
Faster recovery from symptoms, especially where the condition is severe.
Transcranial Magnetic Stimulation (TMS): This one employs the utilization of magnetic fields to excite the nerve cells in the brain. The drug is utilised mainly to treat MDD, although research has linked its effectiveness with lowering of psychotic symptoms in several trials. May be used in those patients that have failed to respond to conventional therapies.
Deep Brain Stimulation (DBS): This is done using an implantable device that generates electrical signals to the targeted area of the brain. This is usually employed in movement disorders such as Parkinson’s Disease, but clinical trials are being done on psychotic disorders including those that are treatment refractory. Chronic, treatment-refractory psychosis which other therapies have not helped to improve.
Psychosurgery: Generally, psychosurgery entailed the performance of surgery operations that interfered with the normal functioning of the brain in the past (Garrick 266). Modern approaches are very much developed in comparison with the traditional ones and act on specific parts of the brain. It is an option that is implemented very sparingly, and the results of interventions are not very good unless all other modalities have been exhausted and the danger of harm is high.
Psychiatry/Mental Health
Acute Phase: This first phase is centred on the patient’s safety and often requires hospitalization. They are most often administered with antipsychotic drugs to treat the symptoms.
Stabilization Phase: Ideally, once the patient presents with acute exacerbation, focus then moves to the need to get the patient back on the right dose of medication. This phase includes check-up visits, medication compliance, and educational sessions.
Maintenance Phase: During this long-term phase, the emphasis is taken on avoiding relapse, keeping vast number of symptoms in check. Further medication compliance continued use of therapy including CBT and support from family and community.
Psychosis basically presents as a psychotic disorder and is marked by hallucinations, delusions, disorganized or bizarre thinking, and a lack of appreciation of personal illness. The definition of psychosis, over the course of historical development, has emerged from the first notions of madness in ancient societies, including Ancient Greece and Rome, where the primitives of mental pathology was linked with supernatural influence and an excess or deficiency of bodily fluids.
Contemporary meaning of psychosis is believed to have emerged from Germany in late nineteenth century, primarily through the works of Emil Kraepelin who made the initial split between mood and psychotic disorders; although in his categorization schizophrenia was termed as “dementia praecox.” This framework was expanded by Eugen Bleuler who also introduced the term “schizophrenia and distinguished psychosis from cognitive and emotional as well as volitional.” Schizophrenia mind loss is now known no longer as one disease but as the perspective which may be encountered in several psychiatric, neurological, and medical affections.
Psychosis is characteristic of schizophrenia spectrum disorders, but its presentation can also be part of mood disorders like bipolar disorder or major depression with psychotic features, substance use and induced conditions, and neurodegenerative disorder like Parkinson’s or Alzheimer’s disease.
In a first-time psychosis, the rate is approximately 50 per 100,000 populations, whereas schizophrenia is roughly 15 per 100,000 individuals. The greatest vulnerability to psychosis is during the late teenage and mid-20s for men and from teenage years to late 20s for women. Early onset of psychosis is usually considered to correlate with poor prognosis, while early intervention is believed to be beneficial. Schizophrenia and related psychosis are particularly uncommon in children below the age of 12 years.
The neurotransmitter which is closely associated with the development of psychotic disorders is dopamine. It is thought that an excess of dopamine in the mesolimbic pathway contributes to the positive symptoms of psychosis. Also, a decrease in activity of the N-methyl-D-aspartate (NMDA) glutamate receptor is involved in the excitatory neurotransmitter glutamate. Role of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter has also been postulated; however, these sources indicate that GABA might be dysregulated in schizophrenia. In addition, there is a discrepancy in the levels of acetylcholine; this inference can be made based on the patients’ smoking habits that involve schizophrenia subtype. Cholinergic activity was enhanced by nicotine; it raised some aspects of cognition in these people and research has indicated improvements in cognitive function due to this effect of the substance.
Psychosis is caused either by a primary psychotic illness or by substance abuse, or even a neurological or medical condition. The current literature suggests that first episode psychotic disorders are linked to brain structural changes including decreased gray matter in the prefrontal, superior, and medial temporal lobes. First episode psychosis is considered neurodevelopmental disorders that started during fetal development; however, symptom onset mainly occurs with epigenetic or environmental factors including substance use, stress, immigration, infections, post-partum period or medical related events. Research findings suggest that there is clear genetic predisposition to involve in the occurrence of psychotic disorders.
Aside from episodic psychotic disorders like schizophrenia, it used to be generally believed that the prognosis is always poor but this is is no longer necessarily the case. The availability of newer medications of antipsychotics, including long acting injectables, have increased the number of treatments presents and solutions to problems with adherence to therapy. Earlier referral and delivery of higher doses of speech therapy were also established as important in determining the long-term prognosis. When schizophrenia with a single psychotic episode that could be attributed to a non-psychotic medical or neurological condition is considered, renewed data on prognosis is scarce and future outcomes tend to depend on the presence of the condition. The approach would be to probably manage the psychotic episode and the condition leading to the psychotic episode.
Age group
Adolescence to Early Adulthood (Teens to 30s): Â Psychosis nearly always develops in late adolescence to early mid-thirties. Psychosis occurring during the adolescent age has a lower prognosis than cases that occur at other ages.
Late Adulthood (40s and beyond): Psychosis may be a symptom of neurodegenerative conditions in elderly people including dementia (such as Alzheimer’s or Parkinson’s disease, etc.) Schizophrenia that develops after the patient is 40 years is not common though it is possible.
The general survey assessment of psychosis entails the appearance and behavior of the client; for instance, he or she may be agitated or in a state of catalepsy. It involves examination of clinical parameters such as pulse rate, blood pressure among others to exclude medical etiology including infections or use of substances. Neurological examination assesses for any neurological deficit in motor power, coordination, reflexes or sensation that might point towards brain pathology or neuropathies. A mental status exam (MSE) is used to evaluate progressive disturbances in speech, mood, thought, and ideas as well as insight into the disease. The exam may also involve screening for intoxication, thyrotoxicosis, other medical causes for psychosis or encephalopathy.
Substance induced psychosis
Dementia
Parkinson’s Disease
Lewy Body Dementia
Epilepsy
Traumatic brain injury
Acute Psychosis: Usually acute, occurring after the administration of psychostimulants or other drugs, under conditions of acute stress or withdrawal. Patient may have serious side effects such as, hallucination, agitation or even confusion and requires medical help.
Subacute or Chronic Psychosis: May develop more gradually, as seen in some other disorders where one may have symptoms of schizophrenia for some time before the development of full-blown psychotic symptoms: prodromal state includes withdrawal from people, strange beliefs, or suspicions.
Primary Psychiatric Disorders
Neurological Conditions
Pharmacological Interventions:
Antipsychotic Medications: Typically used to treat symptoms are first generation or typical antipsychotics and second generation or atypical antipsychotics. Long-acting injectable formulations may be deployment in contributing to adherence.
Psychosocial Interventions: CBT and psychoeducation enable the patients to be informed about the disease and the ways on how to counter them.
Crisis Intervention: Severe cases may call for hospitalization on the reasons of safety with crisis teams for community-based interventions. Addressing Underlying Causes: It is crucial to address any substance use disorders and medical conditions that may lead to psychosis. Rehabilitation and Support Services: Rehabilitation activities such as occupational therapy, social skills training, and case management help in the reintegration and daily living.
Long-Term Management: Such more often sessions are necessary to evaluate the results of therapy and avoid repetition of the same problem occur.
Psychiatry/Mental Health
Safe Spaces: Lowering stimuli and ensuring personal safety or elimination of things that cause the child to hurt themselves or become anxious.
Structured Routine: Implementing schedules for the day to afford predictability and alleviate anxiety.
Therapeutic Areas: Designing special rooms for therapy and rest to enhance the clients’ ability to speak and reduce stress levels.
Social Integration: Promoting community dwelling and peer support services to improve social participation and social inclusion.
Environmental Enhancements: Exploiting colours that have been known to reduce tension, adequate lighting from natural sources and possibility to get a close touch with nature.
Psychiatry/Mental Health
Haloperidol: Utilized in schizophrenia treatment for psychotic symptoms and in cases of emergent agitation; marketed in tablet and injectable preparations.
Chlorpromazine: An early second-generation antipsychotic whose uses include a variety of psychotic disorders; more side effects include sedation and weight gain.
Fluphenazine: Predominantly used in chronic psychosis; comes in a long-acting injectable type to enhance compliance.
Psychiatry/Mental Health
Risperidone: Used for schizophrenia and bipolar disorder; may produce some EPS at increased dose of the drug.
Olanzapine: Proven to be effective in treating acute mania and schizophrenia; causes sedation; causes weight gain.
Quetiapine: Used to treat schizophrenias, bipolar and depression, reduces the risk of EFP but has issues of sedation and metabolic syndrome.
Aripiprazole: A dopamine receptor partial agonist; employed for schizophrenia and in combination with other antidepressants; causes less weight increase.
Lurasidone: Potentiated by fluoxetine effective in arresting schizophrenia and bipolar depression with lower chances of inducing metabolic symptoms.
Psychiatry/Mental Health
Paliperidone Palmitate: A paliperidone palmitate which is a long-acting injectable suitable for administrating in schizophrenia illness.
Aripiprazole Lauroxil: Aripiprazole, an atypical antipsychotic agent given as an injectable formulation to treat schizophrenia in patients with inadequate response to oral aripiprazole.
Psychiatry/Mental Health
Electroconvulsive Therapy (ECT): It is a medical treatment that aims at electricity stimulating the brain and making it have a small seizure. Although it’s mostly used in cases of depression, it can also be rather useful when treating psychosis that is linked to severe moods. It is often considered for patients with:
Schizophrenia that does not respond to medication.
Serious excitement or catatonic phase.
Suicidal thinking or behaviors or ideation of self or others.
Faster recovery from symptoms, especially where the condition is severe.
Transcranial Magnetic Stimulation (TMS): This one employs the utilization of magnetic fields to excite the nerve cells in the brain. The drug is utilised mainly to treat MDD, although research has linked its effectiveness with lowering of psychotic symptoms in several trials. May be used in those patients that have failed to respond to conventional therapies.
Deep Brain Stimulation (DBS): This is done using an implantable device that generates electrical signals to the targeted area of the brain. This is usually employed in movement disorders such as Parkinson’s Disease, but clinical trials are being done on psychotic disorders including those that are treatment refractory. Chronic, treatment-refractory psychosis which other therapies have not helped to improve.
Psychosurgery: Generally, psychosurgery entailed the performance of surgery operations that interfered with the normal functioning of the brain in the past (Garrick 266). Modern approaches are very much developed in comparison with the traditional ones and act on specific parts of the brain. It is an option that is implemented very sparingly, and the results of interventions are not very good unless all other modalities have been exhausted and the danger of harm is high.
Psychiatry/Mental Health
Acute Phase: This first phase is centred on the patient’s safety and often requires hospitalization. They are most often administered with antipsychotic drugs to treat the symptoms.
Stabilization Phase: Ideally, once the patient presents with acute exacerbation, focus then moves to the need to get the patient back on the right dose of medication. This phase includes check-up visits, medication compliance, and educational sessions.
Maintenance Phase: During this long-term phase, the emphasis is taken on avoiding relapse, keeping vast number of symptoms in check. Further medication compliance continued use of therapy including CBT and support from family and community.
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