RT Book, Section
A1 Meyer, Jonathan M.
A2 Brunton, Laurence L.
A2 Chabner, Bruce A.
A2 Knollmann, Björn C.
SR Print(0)
ID 1127866130
T1 Pharmacotherapy of Psychosis and Mania
T2 Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 12e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071624428
LK accessmedicine.mhmedical.com/content.aspx?aid=1127866130
RD 2023/10/03
AB Psychosis  is  a  symptom  of  mental  illnesses  characterized  by  a  distorted  or  non-existent  sense  of  reality.  Psychotic  disorders  have  different  etiologies,  each  of  which  demands  a  unique  treatment  approach.  Common  psychotic  disorders  include  mood  disorders  (major  depression  or  mania)  with  psychotic  features,  substance-induced  psychosis,  dementia  with  psychotic  features,  delirium  with  psychotic  features,  brief  psychotic  disorder,  delusional  disorder,  schizoaffective  disorder,  and  schizophrenia.  Schizophrenia  has  a  worldwide  prevalence  of  1%  and  is  considered  the  prototypic  disorder  for  understanding  the  phenomenology  of  psychosis  and  the  impact  of  antipsychotic  treatment,  but  patients  with  schizophrenia  exhibit  features  that  extend  beyond  those  seen  in  other  psychotic  illnesses.  Hallucinations,  delusions,  disorganized  speech,  and  disorganized  or  agitated  behavior  comprise  the  types  of  psychotic  symptoms  found  individually,  or  rarely  together,  in  all  psychotic  disorders,  and  are  typically  responsive  to  pharmacotherapy.  In  addition  to  positive  symptoms,  schizophrenia  patients  also  suffer  from  negative  symptoms  (apathy,  avolition,  alogia),  and  cognitive  deficits,  particularly  deficits  in  working  memory,  processing  speed,  social  cognition,  and  problem  solving  that  test  1.5-2  standard  deviations  below  population  norms  (Green  et  al.,  2004).  Cognitive  dysfunction  is  the  strongest  predictor  of  functional  impairment  among  schizophrenia  patients,  yet  negative  symptoms  and  cognitive  deficits  show  limited  improvement  with  antipsychotic  treatment  (Buchanan  et  al.,  2007).  That  schizophrenia  is  not  identical  to  other  psychoses  is  important  for  appreciating  the  differential  impact  of  antipsychotic  medications  on  psychotic  symptomatology,  and  for  understanding  the  rationale  for  non-dopaminergic  antipsychotic  drugs  based  on  the  underlying  pathophysiology  of  schizophrenia  (Carpenter  and  Koenig  2008).