ATYPICAL PSYCHOSIS - 08/09/11
Résumé |
Psychotic illnesses often are quite obvious. Many times, however, psychosis is subtle and identified only by careful interviewing and observation in the context of a well-established therapeutic relationship. The challenge of correctly identifying psychosis is further complicated by the varied definition of psychosis. Psychosis is
• | a major mental disorder of organic or emotional origin in which a person's ability to think, respond emotionally, remember, communicate, interpret reality, and behave appropriately is sufficiently impaired so as to interfere grossly with the capacity to meet the ordinary demands of life. Often characterized by regressive behavior, inappropriate mood, diminished impulse control, and such abnormal mental content as delusions and hallucinations. The term is applicable to conditions having a wide range of severity and duration.4 |
The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV2 discusses psychosis as follows:
• | The term psychotic has historically received a number of different definitions, none of which has achieved universal acceptance. The narrowest definition of psychotic is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A slightly less restrictive definition would also include prominent hallucinations that the individual realizes are hallucinatory experiences. Broader still is a definition that also includes other positive symptoms of schizophrenia (i.e., disorganized speech, grossly disorganized or catatonic behavior). Unlike these definitions based on symptoms, the definition used in earlier classifications (e.g., DSM-II, ICD-9) was probably far too inclusive and focused on the severity of functional impairment, so that a mental disorder was termed “psychotic” if it resulted in “impairment that grossly interferes with the capacity to meet ordinary demands of life.” Finally, the term has been defined conceptually as a loss of ego boundaries or a gross impairment in reality testing. |
Psychosis, along with other mental disorders has been recognized since ancient times, although often in different terms (e.g., madness, mania, and so forth). Hippocrates12 stated the following:
• | Men ought to know that from nothing else but thence (from the brain) come joys, delights, laughter, and sports; and sorrows, grief, despondency, and lamentations … by the same organ we become mad and delirious, and fears and terrors assail us, some by night, and some by day… . All these things we endure from the brain when it is not healthy. |
In so stating, Hippocrates12 demonstrated his awareness that madness is the result of a diseased brain.
The term atypical psychosis has not been included in DSM-IV, but was listed in DSM-III-R1 under the heading Psychosis NOS. In DSM-III-R, examples of atypical psychoses include postpartum psychotic episodes10; psychoses with unusual features (e.g., persistent auditory hallucinations as the only disturbance); and psychoses with confusing clinical features that make a more definitive diagnosis impossible. For the purpose of this discussion, schizophrenia is regarded as the typical cause of psychosis. The nonschizophrenic causes of psychosis are many and include other axis I disorders, as well as some of the personality disorders and various nonpsychiatric medical problems.
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| Address reprint requests to Michael L. Smith, MD, Department of Psychiatry, University of Utah, School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, e.mail: michael.smith@hsc.utah.edu |
Vol 21 - N° 4
P. 895-904 - décembre 1998 Retour au numéro
Article précédent
- DECEPTION AND DETECTION IN PSYCHIATRIC DIAGNOSIS
- Susan D. Wiley
- SUBTLE PSYCHIATRIC PRESENTATIONS OF ENDOCRINE DISEASES
- Burton Hutto
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