Drugs PSYCHOSIS. Depression. Stress Medical Illness. Mania. Schizophrenia

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1 Drugs Stress Medical Illness PSYCHOSIS Depression Schizophrenia Mania

2 Disorders In preschool children imaginary friends and belief in monsters under the bed is normal (it may be normal in older developmentally delayed children) Psychotic symptoms should cause a functional decline, mental status changes, or adaptive decline Affirming psychotic symptoms have the highest rate of false positives

3 Benign Psychosis Sleep and stress Disorders Psychosis associated with a medical condition Migraines Delirium Seizures

4 Differential Diagnosis of Psychosis: Cannabis Most commonly used illicit drug in the world 1965(5.1%), 1982 (54.4) Early cannabis users were more likely to develop a psychoses later in life People with psychosis and cannabis use have more symptoms and problems

5 Differential Diagnosis of Psychosis: Cannabis Cannabis psychosis odd and bizarre behavior violence and panic less thought disorder better insight People who use cannabis on a daily basis were 2.4 times more likely to report psychotic symptoms then non-users

6 Differential Diagnosis of Psychosis: Cannabis The Swedish Conscript Cohort: 50,087 Swedish conscripts. Self reported heavy users at 18 were 6 times more likely then non-users to be diagnosed with schizophrenia 15 years later. The Dunedin Birth Cohort: 1037 individulas born from followed for 26 years. 10.3% of the 15-age cannabis uses diagnosed with schizophreniform vs. 3% of the controls

7 cannabis RECEPTORS NEUROCHEMICALS RECEPTORS

8 Differential Diagnosis of Psychosis: Methamphetamine Methamphetamine is an addictive stimulant drug Releases high levels of dopamine Damages brain cells that contain dopamine and serotonin Sensitization and cross-sensitization sensitization Psychosis can last for months despite abstinence Aggression, legal issues, mood instability, less thought disorder, paranoia

9 methamphetamine RECEPTORS NEUROCHEMICALS RECEPTORS

10 Disorders:PTSD Trauma, re-experiencing, experiencing, avoidant, hypervigilant, mood disorder Psychosis is trauma related Less response to medications Improved with sensitive psychosocial interventions Hallucinations in 75-95% of clients Impulsive, aggressive, and self-abusive behaviors are present Intact social relatedness

11 Disorders:PDD Autism, Asperger s Delays in Developmental milestones Early evidence of social impairments Challenges differentiating between reality/fantasy Adolescence with marked anxiety, depression Psychosis rare, though can occur associated with stress/anxiety Negative behaviors often misplaced as negative sxs. Of schizophrenia

12 Disorders: MDI Brief. Transient episodes of psychosis typically in response to stress Nearly daily periods of emotional lability disproportionate to precipitants Impaired interpersonal skills despite the desire to initiate peer friendships (unlike children who develop schizophrenia) Cognitive deficits (73% in special education) No thought disorder Comorbid conditions include ADHD, ODD, and conduct disorder High rate of family dysfunction

13 Disorders: Mania Extreme irritability or euphoria Not needing to sleep Hypersexual Giddy Pressured speech Spending sprees Engagement in risky activities Psychosis can look just like schizophrenia Often mood-related Higher premorbid functioning Speech is pressured, but organized Improved social and academic standings

14 Disorders: Depression Extreme sadness or irritability Sleep disturbance Loss of appetite Loss of drives Cognitive pessimism Suicidal thoughts Psychosis is mood-congruent Voices are negative, delusions are depressing 30-50% of depressed children experience psychosis

15

16 Disorders: Schizophrenia Prototypical psychotic disorder Brain disorder which affects language, emotion, reasoning, behavior, and perception Great variety in symptoms Symptoms include: Hallucinations and delusions Disorganized speech Disorganized behavior Chronic but treatable condition 1% prevalence rate Poor social cognition Global impairment High rate of substance use, unemployment and disability Genetic component

17 Disorders: Schizophrenia Schizophrenia (Child-Onset) 12%-18% 18% present with delusions or hallucinations Most common presentations were developmental delays, school problems, learning disabilities, and depression Poor prognosis 3% remission 17% in school 13% committed suicide

18 Disorders Children and adolescents with psychosis had the following conditions: Major Depressive Disorder 41% Bipolar Disorder 24% Depression NOS 21% Schizophreniform 14%

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