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Introduction: The Successful Management of Psychosis

Introduction: The Successful Management of Psychosis

Special Report Chairperson
Cameron Carter, MD

Psychosis is one of the most dramatic clinical states seen in psychiatry and is often associated with some of the worst outcomes seen in clinical practice. As a set of symptoms, psychosis is seen in a broad range of mental disorders, including schizophrenia, bipolar disorder, severe depression, obsessive-compulsive disorder, PTSD and, of course, drug abuse. It is also seen in Alzheimer disease, Lewy body dementia, Huntington disease, and viral encephalopathy, when it may involve the presence of measurable antibodies to CNS receptors such as NMDA (N-methyl-d-aspartate) and GABA (γ-aminobutyric acid).

The successful management of psychosis requires careful assessment and an understanding of the symptoms in the context of the underlying diagnosis. Since antipsychotic medications became available in the late 1950s and 1960s, the management of psychosis has become much more straightforward, and with the advent of atypical antipsychotics, psychosis is more manageable from an adverse-effect perspective. In recent years, it has also become clear that psychotherapy can be beneficial for patients with psychosis. Early identification and intervention may improve outcomes in those who are experiencing psychosis during the early phases of a mental illness.

In this two-part Special Report, the evaluation and management of psychosis is explored across a range of disorders and clinical contexts. Together these articles provide a cogent update on the identification and treatment of psychotic illness.

In Part 1 of the Special Report, we have “Cognitive-Behavioral Therapy for Psychotic Disorders” by Daniel Freeman, PhD, who discusses cognitive-behavioral therapies that with refinement can complement pharmacological treatment and provide important symptomatic relief and functional improvement. In their article “Psychosis and Suicidality in Adolescents,” Tatiana Falcone, MD, and Jane Timmons-Mitchell, PhD, address the critical issues related to the assessment and management of psychosis and its impact on suicide risk in adolescents. The Category 1 CME activity in this issue follows the theme of psychosis, with an article by Tony Cohn, MD, “Metabolic Monitoring for Patients on Antipsychotic Medications,” which provides a concise explanation of who, when, and how to monitor patients receiving antipsychotic medications.

In the January issue, Part 2 brings “Managing Psychosis in Patients With Alzheimer Disease” by Subramoniam Madhusoodanan, MD, and Mark B. Ting, MD, who explore the co-occurrence of psychosis and dementia. Issues associated with psychosis as it occurs in the postpartum period are discussed by Carmen Monzon, MD, Teresa Lanza di Scalea, MD, and Teri Pearlstein, MD, in their article “Postpartum Psychosis: Updates and Clinical Issues.” And, once again, January’s Category 1 CME activity is on the topic of psychosis. Herbert Y. Meltzer, MD, discusses the prevalence of refractory psychosis and its comorbidity with a number of medical and psychiatric illnesses and provides evidence-based treatment strategies.

Disclosures

Dr Carter is Professor of Psychiatry and Psychology and Director of the Center for Neuroscience and the Imaging Research Center at the University of California at Davis. He reports no conflicts of interest concerning the subject matter of this Special Report.

 
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