Psychopharmocology: Psychotic Disorders Psychopharmacology: Psychotic disorders

Accepted psychological and biological theories regarding the causes of each disorder

Psychosis is an undefined syndrome that manifests in delusions, bizarre behavior, hallucinations, losing touch with reality. The condition is attributed to a variety of conditions including primary psychiatric complications and medical complications such as dementia, central lobe epilepsy, Schizophrenia and related disorders, medical complications, abnormalities in metabolism, endocrine and neurologic disease. It also includes drug and substance abuse complications. Common among the substances abused are hallucinogens and amphetamines. The most common primary psychosis is schizophrenia. This disorder is a severe one. It begins sometime around adolescence or in the early stage of adulthood. Although the onset tends to manifest a later among women, the occurrence of the condition seems evenly spread across the gender divide. Surveys in epidemiology demonstrate that 0.4% of the disorder is characterized by critical disorders in thinking patterns and perception. Inappropriate emotions are also prevalent. The disorder affects primary functions that serve to endow one with the feeling of uniqueness, self-direction and individuality (Werbeloff, Dohrenwend, Yoffe, Davidson, & Weiser 2015). There is likely to be a serious change of behavior in some stages of the disorder. Such interference often triggers undesirable social effects. Delusions and hallucinations are common features of psychotic disorder. Schizophrenic people are well-oriented to places, time and people. The disorder pursues a variable trend and about one third of its cases recover fully from the disorder. The condition can also follow a recurrent course and may leave residual symptoms and incomplete recovery on the social front. In the past, schizophrenic patients formed a significant portion of patients in mental institutions in the past. Actually, they are still many in places where such institutions still exist. Owing to the advances in medical health, drug therapy practices and psychosocial care, nearly half of all patients that develop schizophrenia recover from the condition fully. In the other half only one fifth of victims still face serious limitations in running their daily routines (Solem et al., 2015).

It should be noted that even after the externally obvious symptoms of the disorder have subsided, residual symptoms continue to exist in the background. Such symptoms include lack of interest in work or initiative in daily activities. Others include remaining socially incompetent and being unable to participate in pleasurable, normative activities. Such reaction leads to a poor quality of life and sustained disability. This is obviously a burden to the family and friends of the victim. Therefore, workers in health care should, consider the role of culture and spirituality in the occurrence of schizophrenia in provision of primary health care. Psychiatric symptoms are expressed differently in different cultures. Some even use metaphors. There is need in such circumstances where the health care professional is limited in the language of the victim to use interpreters to explain the symptoms. Additionally, some symptoms of psychiatric disorder-like symptoms may be considered normal in some cultures. Hearing voices is an example of such symptoms. There should be careful evaluation not to avoid misinterpretation (WHO, 2009).

Medications used in treatment of psychiatric disorders and their mode of action

Modern practice recommends the use of a single antipsychotic at a time. Simultaneous use of antipsychotics may complicate a patient's condition and has no benefit. High doses of these medications should be avoided because they are known to trigger adverse reactions and still provide no substantial benefits. It is a standard recommended practice to begin with small doses and increase as you go. There should be a clear definition of the minimum prescribed dosage. Long-term psychotics should be used only if the problem is critical and persistent. Normally there is need to administer a test dose of a long acting formula such as 12.5mg of fluphenazine decanoate given as an intramuscular prescribed dosage. Following the first administration, the dosage is titrated after 4 to 10 days to sustain effective maintenance therapy. The health expert could give between 12.5 to 5.0mg of intramuscular fluphenazine decanoate after every 2-4 weeks.

Moving from the use of one psychotic drug to the next one should be done with utmost care. The first dose should be systematically reduced in a gradual manner as the dose of the second one is increased. Patients that do not show progress; even after using sufficient doses of two psychotics are normally given Clozapine . Prior to the administration of Clozapine, several classes of antipsychotics are prescribed. Once the use of Clozapine has commenced, the effectiveness of treatment should be scrutinized for six months. Prescription of this medication without monitoring white blood cells may heighten the risk of fatal agranulocytosis...

If that is not done, two thirds of patients regress back to chronic condition within a year. So far, no reliable strategy has been evolved to know the minimum dose that should be used to avoid relapse. In the course of long-term treatment, health care providers may either maintain or decrease the dose used during the acute phase moderately; depending on the condition and the prevailing clinical status. Sticking to treatment may be a long-term problem. In such circumstances, the heath care experts should consult with the patient and their family on the option of using long acting psychotics. Other strategies include patient education, educating the family about psychotherapy and some specified interventions in psychotherapy. A weekly white cell blood count is done for 18 weeks in some countries in cases where Clozapine is in use. This happens at least every two weeks through the year. If such checks are not possible, Clozapine should never be administered (Carpenter & Buchanan, 2015).
Side effects

The side effects of antipsychotics are classified in two groups. There are the anticholinergic side effects and neurologic ones. The latter include parkinsoan symptoms which entail akinesia, rigidity and resting tremor. They also involve acute dystonias, akathisia, neuroleptic malignant syndrome, tardive dyskinesia and even convulsions. Anticholinergic side effects include blurred vision, dry mouth, urine retention and constipation. They also include severe agitation and frequent confusion. In case the patient develops parkinson effects, the expert should reduce the antipsychotic dose. If these effects persist, the health provider should consider administering using antiparkinsoan agents, e.g. 2-4 mg of biperiden per day. The side effects that are known to be a result of the use of second generation antipsychotics include, ketoacidosis, diabetes, hyperglycaemia and lipid dysregulation. Olanzapine and Clozapine are associated with the highest risk of weigh gain, dyslipidaemia and diabetes mellitus. The antipsychotic metabolic complications are a major cause of worry because they are risk factors in the occurrence of cardiovascular mortality and morbidity. More side effects associated with the use of antipsychotics include weight gain, orthostatic hypothension, electrocardiogram abnormalities, sedation, increased prolactin leading to galactorrhea, impotence, jaundice, elevated liver enzymes, agranulocytosis, photosensitivity, leukopenia, skin eruptions, amenorrhea, gynecomastia, retinal pigmentation. The use of Clozaoine causes significant life endangering effects; agranulocytosis is the best known among them. Clozapine use poses 10 times higher risk of Agranulocytosis than other drugs do. Monitoring blood count can help manage the use of Clozapine. The drug is also linked to, cardio-myopathy and myocarditis and pulmunary embolism (Maciukiewicz, Sriretnakumar, & Muller, 2016).

Process you would go through when seeing a patient with one of these disorders, including how you would make a differential diagnosis, conditions you would want to rule out, and how you would make decisions about treatment

The healthcare experts should investigate the possibility that the psychotic disorder could have been a result of substance abuse or organic illness. A detailed background check and assessment of the patients' psychiatric history should be done. In situations where psychosis is a result of a medical problem, the underlying condition should be treated. Attention should also be paid to the adjunctive management of behavioral problems. If substance abuse is cited, detoxification should be prioritized. This should be accompanied with adjustment of medication. Acute schizophrenia needs o be evaluated at the earliest opportunity. Family members are useful in cases of uncooperativeness, a common tendency among this group. Health care experts should extract as much information as possible from credible sources. Trends in sleeping patterns, daily routine, and speech should be probed. The possibility of self-injury as a patients considerations should be checked too (Miller, Mednick, McGlashan, Libiger, & Johannessen, 2012).

Although patients may attempt suicide at any point as an outcome of experiencing psychotic complications, there is a higher possibility of such an eventuality when there are acute psychotic exacerbations. This is the time when the patient responds to delusions or hallucinations. The risk is also heightened during the weeks or after acute exacerbations. It is essential to intervene early in schizophrenia illness because of the positive relationship between the untreated period and the long-term treatment results. Some of the specific interventions include educating the family about psychosis, employment support, awareness about the management of illness, training in social skills, integrated handling of substance abuse issues and cognitive behavioral therapy practices. Schizophrenic patients should be provided with psychosocial…