Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder.
Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.
Schizophrenia is a mental disorder characterized by hallucinations, delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially mood disorders, anxiety disorders, and obsessive–compulsive disorder.
Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.
Schizotypal personality disorder, also known as schizotypal disorder, is a cluster A personality disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classification describes the disorder specifically as a personality disorder characterized by thought disorder, paranoia, a characteristic form of social anxiety, derealization, transient psychosis, and unconventional beliefs. People with this disorder feel pronounced discomfort in forming and maintaining social connections with other people, primarily due to the belief that other people harbor negative thoughts and views about them. Peculiar speech mannerisms and socially unexpected modes of dress are also characteristic. Schizotypal people may react oddly in conversations, not respond, or talk to themselves. They frequently interpret situations as being strange or having unusual meanings for them; paranormal and superstitious beliefs are common. Schizotypal people usually disagree with the suggestion that their thoughts and behaviors are a 'disorder' and seek medical attention for depression or anxiety instead. Schizotypal personality disorder occurs in approximately 3% of the general population and is more commonly diagnosed in males.
People with schizophrenia are at a higher than average risk of physical ill health, and earlier death than the general population. The fatal conditions include cardiovascular, respiratory and metabolic disorders.
An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person hears a sound or sounds that did not come from the natural environment.
In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. More specifically, it refers to the period between the first recognition of a disease's symptom until it reaches its more severe form. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.
Early intervention in psychosis is a clinical approach to those experiencing symptoms of psychosis for the first time. It forms part of a new prevention paradigm for psychiatry and is leading to reform of mental health services, especially in the United Kingdom and Australia.
Barbara A. Cornblatt is Professor of Psychiatry and Molecular Medicine at Hofstra Northwell School of Medicine. She is known for her research on serious mental disorders, with a specific focus on psychosis and schizophrenia. Her efforts to find treatments to help youth with mental illness led to the development of the Recognition and Prevention Program, which she founded in 1998.
The long-term effects of cannabis have been the subject of ongoing debate. Given that the use of cannabis is illegal in most countries, clinical research presents a challenge and there is limited evidence from which to draw conclusions. In 2017, the U.S. National Academies of Sciences, Engineering, and Medicine issued a report summarizing much of the published literature on health effects of cannabis, into categories regarded as conclusive, substantial, moderate, limited and of no or insufficient evidence to support an association with a particular outcome.
A Truman Show delusion, also known as Truman syndrome or Truman disorder, is a type of delusion in which the person believes that their life is a staged reality show, or that they are being watched on cameras. The term was coined in 2008 on film boards by brothers Joel Gold and Ian Gold, a psychiatrist and a neurophilosopher, respectively, after the 1998 film The Truman Show.
Sophia Frangou is a professor of psychiatry at the Icahn School of Medicine at Mount Sinai where she heads the Psychosis Research Program. She is a Fellow of the Royal College of Psychiatrists and vice-chair of the RCPsych Panamerican Division. She is a Fellow of the European Psychiatric Association (EPA) and of the American Psychiatric Association (APA). She served as vice-president for Research of the International Society for Bipolar Disorders from 2010 to 2014. She has also served on the Council of the British Association for Psychopharmacology. She is founding member of the EPA NeuroImaging section and founding chair of the Brain Imaging Network of the European College of Neuropsychopharmacology. She is one of the two Editors of European Psychiatry, the official Journal of the European Psychiatric Association.
The causes of schizophrenia that underlie the development of schizophrenia, a psychiatric disorder, are complex and not clearly understood. A number of hypotheses including the dopamine hypothesis, and the glutamate hypothesis have been put forward in an attempt to explain the link between altered brain function and the symptoms and development of schizophrenia.
The Kraepelinian dichotomy is the division of the major endogenous psychoses into the disease concepts of dementia praecox, which was reformulated as schizophrenia by Eugen Bleuler by 1908, and manic-depressive psychosis, which has now been reconceived as bipolar disorder. This division was formally introduced in the sixth edition of Emil Kraepelin's psychiatric textbook Psychiatrie. Ein Lehrbuch für Studierende und Aerzte, published in 1899. It has been highly influential on modern psychiatric classification systems, the DSM and ICD, and is reflected in the taxonomic separation of schizophrenia from affective psychosis. However, there is also a diagnosis of schizoaffective disorder to cover cases that seem to show symptoms of both.
The imprinted brain hypothesis is an unsubstantiated hypothesis in evolutionary psychology regarding the causes of autism spectrum and schizophrenia spectrum disorders, first presented by Bernard Crespi and Christopher Badcock in 2008. It claims that certain autistic and schizotypal traits are opposites, and that this implies the etiology of the two conditions must be at odds.
Basic symptoms of schizophrenia are subjective symptoms, described as experienced from a person's perspective, which show evidence of underlying psychopathology. Basic symptoms have generally been applied to the assessment of people who may be at risk to develop psychosis. Though basic symptoms are often disturbing for the person, problems generally do not become evident to others until the person is no longer able to cope with their basic symptoms. Basic symptoms are more specific to identifying people who exhibit signs of prodromal psychosis (prodrome) and are more likely to develop schizophrenia over other disorders related to psychosis. Schizophrenia is a psychotic disorder, but is not synonymous with psychosis. In the prodrome to psychosis, uncharacteristic basic symptoms develop first, followed by more characteristic basic symptoms and brief and self-limited psychotic-like symptoms, and finally the onset of psychosis. People who were assessed to be high risk according to the basic symptoms criteria have a 48.5% likelihood of progressing to psychosis. In 2015, the European Psychiatric Association issued guidance recommending the use of a subscale of basic symptoms, called the Cognitive Disturbances scale (COGDIS), in the assessment of psychosis risk in help-seeking psychiatric patients; in a meta-analysis, COGDIS was shown to be as predictive of transition to psychosis as the Ultra High Risk (UHR) criteria up to 2 years after assessment, and significantly more predictive thereafter. The basic symptoms measured by COGDIS, as well as those measured by another subscale, the Cognitive-Perceptive basic symptoms scale (COPER), are predictive of transition to schizophrenia.
Joaquim Radua is a Spanish psychiatrist and developer of methods for meta-analysis of neuroimaging studies. He has been named as one of the most cited researchers in Psychiatry / Psychology.
Gemma Modinos, born 1980 in Castellar del Vallès, is a Spanish neuropsychologist. She works as a Professor of Neuroscience & Mental Health at the Institute of Psychiatry, Psychology and Neuroscience of King's College London. She was a Wellcome Trust & The Royal Society Sir Henry Dale Fellow (2017-2023) and is a Group leader at the MRC Centre for Neurodevelopmental Disorders at King's College London. She was 2020-2022 Chair of the Young Academy of Europe, where she directed European efforts to optimise science policy from a youthful perspective; and 2020-2022 Junior Member of the Executive Board of the Schizophrenia International Research Society. She is known for her work revealing the role of emotion-related brain mechanisms and the neurotransmitters GABA and glutamate in the development of psychosis, and investigating how targeting these mechanisms can help design new therapeutic strategies.
