psychosis

An antipsychotic ( or neuroleptic ) is a tranquilizing psychiatric medication primarily used to manage psychosis ( including delusions or hallucinations, as well as disordered thought ), particularly in schizophrenia and bipolar disorder, and is increasingly being used in the management of non-psychotic disorders ( ATC code N05A ).

A number of harmful and undesired ( adverse ) effects have been observed, including lowered life expectancy, extrapyramidal effects on motor control – including akathisia ( an inability to sit still ), trembling, and muscle weakness – weight gain, decrease in brain volume ( although this is being debated, since schizophrenia, which is often treated with antipsychotics, also causes a shrinkage of brain volume ), enlarged breasts ( gynecomastia ) in men and milk discharge in men and women ( galactorrhea due to hyperprolactinaemia ), lowered white blood cell count ( agranulocytosis ), involuntary repetitive body movements ( tardive dyskinesia ), diabetes, sexual dysfunction, a return of psychosis requiring increasing the dosage due to cells producing more neurochemicals to compensate for the drugs ( tardive psychosis ), and a potential for permanent chemical dependence leading to psychosis worse than before treatment began, if the drug dosage is ever lowered or stopped ( tardive dysphrenia ).

Temporary withdrawal symptoms including insomnia, agitation, psychosis, and motor disorders may occur during dosage reduction of antipsychotics, and can be mistaken for a return of the underlying condition.

Lobotomy at the time was used to treat many behavioral disorders, including psychosis, although its effect was to markedly reduce behavior and mental functioning of all types.

However, chlorpromazine proved to reduce the effects of psychosis in a more effective and specific manner than lobotomy, even though it was known to be capable of causing severe sedation.

Today, " minor tranquilizer " can refer to anxiolytic and / or hypnotic drugs such as the benzodiazepines and nonbenzodiazepines which have some antipsychotic properties and are recommended for concurrent use with antipsychotics, and are useful for insomnia or drug-induced psychosis.

Antipsychotics might also be used to counter psychosis associated with a wide range of other diagnoses, such as psychotic depression.

In " healthy " individuals without psychosis, doses of antipsychotics can produce the so-called " negative symptoms " ( e. g. emotional and motivational difficulties ) associated with schizophrenia.

The psychological withdrawal symptoms can include psychosis, and can be mistaken for a relapse of the underlying disorder.

Withdrawal-related psychosis from antipsychotics is called " supersensitivity psychosis ", and is attributed to increased number and sensitivity of brain dopamine receptors, due to blockade of dopaminergic receptors by the antipsychotics, which often leads to exacerbated symptoms in the absence of neuroleptic medication.

A 2006 Cochrane Collaboration review of controlled trials of antipsychotics in old age dementia reported that one or two of the drugs showed a modest benefit compared to placebo in managing aggression or psychosis, but that this was combined with a significant increase in serious adverse events.

They concluded that this confirms that antipsychotics should not be used routinely to treat dementia patients with aggression or psychosis, but may be an option in the minority of cases where there is severe distress or risk of physical harm to others.

Some argue that the evidence for antipsychotics from discontinuation-relapse studies may be flawed, because they do not take into account that antipsychotics may sensitize the brain and provoke psychosis if discontinued, which may then be wrongly interpreted as a relapse of the original condition.

Evidence from comparison studies indicates that at least some individuals with schizophrenia recover from psychosis without taking antipsychotics, and may do better in the long term than those that do take antipsychotics.

Higher doses ( greater than 400 mg ) act upon post-synaptic dopamine receptors resulting in a reduction in the positive symptoms of schizophrenia, such as psychosis.

Amok has been more closely associated with psychosis, personality disorders, bipolar disorder, and delusions.

The term " manic-depressive illness " or psychosis was coined by German psychiatrist Emil Kraepelin in the late nineteenth century, originally referring to all kinds of mood disorder.

At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood.

Hypomanic episodes do not go to the full extremes of mania ( i. e., do not usually cause severe social or occupational impairment, and are without psychosis ), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression.

They can sometimes be effective in the short-term treatment of psychiatric emergencies such as acute psychosis as in schizophrenia or mania, bringing about rapid tranquillization and sedation until the effects of lithium or neuroleptics ( antipsychotics ) take effect.

Lorazepam is most commonly used but clonazepam is sometimes prescribed for acute psychosis or mania ; their long-term use is not recommended due to risks of dependence.

The less frequent effects are irritability, sweating, depersonalization, derealization, hypersensitivity to stimuli, depression, suicidal behavior, psychosis, seizures, and delirium tremens.