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Shared Psychosis: or Induced Delusional Disorder


A person close to patient affected and shares his delusions, usually seen in females.
Folie a deux: when 2 people are involved
Folie a trios: when 3 people are involved.
Treat the person with delusion and separation of other person from the inducer.
 
Treatment

General Guidelines
  1. Treatment of all conditions having psychotic symptoms is done with antipsychotic medications
  2. The choice of medication is decided upon the desired & undesired side effects of medication.
  3. Duration of treatment is another issue. Antipsychotic normally take 3 – 4 week before they start acting treatment during this phase of acute psychotic patient who is violent is difficult & needs hospitalizations. Life long treatment of antipsychotic may be recommended depending on the illness & the patient profile.
  4. Prognosis of patient depends on good & bad prognosis factors
  5. Psychotherapeutic interventions are required after the acute phase is over
    1. Psycho education to family members about the illness & treatment strategies
    2. Individual counseling for patient
    3. Rehabilitation for patients with schizophrenia teaching the social skills, activities of daily living, group interaction, over coming fears etc.
ANTIPSYCHOTICS (Neuroleptics): Dopamine antagonists
 
ATYPICAL TYPICAL
1.   Mode of action
       SDA (Serotonin dopamine antagonist)
2.   Less release of prolactin
3.   Less EPS
4.   Treats both positive and negative symptoms
Mode of action
DA (Dopamine antagonist)
More release of prolactin
More EPS
Treat only positive symptoms

Important Points
  1. Weight gain are seen with    i. CLOZAPINE              ii. OLANZAPINE
  2. Minimal weight gain with - Ziprasidone and Aripiprazole
  3. Atypical drug which also acts as antidepressant - Ziprasidone and Aripiprazole
TYPICAL ( D2 receptors)
Phenothiazines
Chlorpromazine
Triflupromazine
Thioridazine
Fluphenazine
Trifloperazine
 
 
ATYPICAL ( D4 and 5HT 2 receptors)
Clozapine (DOC for treatment resistant schiz)
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole  
Sertindole
 
Thioxanthines                                  
Thiothixene     
Flupenthixol    
Butyrophenones              = less EPS
Haloperidol                        = less hyperprolactinemia
Trifluperidol    
Pimozide

 

DEPOT ANTIPSYCHOTICS: For patients with poor compliance
Typical Antipsychotics       Atypical Antipsychotics
Haloperidol decanoate,      Risperidone microgranules
Fluphenazine decanoate    Paliperidone Palmitate
Zuclopenthixol decanoate
Flupenthixol decanoate

 

* The improvement in Schizophrenia, usually the first symptoms to improve is biological symptoms like, violence, sleep appetite. Then, there is Improvement in Hallucinations followed by delusions. Last to improve is negative symptoms.




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