psychosis

精神病

　 　

WordNet

1. any severe mental disorder in which contact with reality is lost or highly distorted
2. suffering from an undiagnosed mental disorder (同)psychopathologic, psychopathological
3. after death the soul begins a new cycle of existence in another human body (同)rebirth

PrepTutorEJDIC

1. (重度の)精神病,精神異常
2. 精神病[質]の
3. (死後の霊魂の)転生;輪廻(りんね)(transmigration)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/06/17 12:46:53」(JST)

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Not to be confused with Psychopathy.

For other uses, see Psychosis (disambiguation).

Psychosis
Classification and external resources
ICD-10	F20- F29
ICD-9	290-299
OMIM	603342 608923 603175 192430
MedlinePlus	001553
MeSH	F03.700.675

Psychosis (from the Greek ψυχή "psyche", for mind/soul, and -ωσις "-osis", for abnormal condition or derangement) refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic. Psychosis is the term given to the more severe forms of psychiatric disorder, during which hallucinations and/or delusions, violence and impaired insight may occur.

The term "psychosis" is very broad and can mean anything from relatively normal aberrant experiences through to the complex and catatonic expressions of schizophrenia and bipolar type 1 disorder. Moreover a wide variety of central nervous system diseases, from both external substances and internal physiologic illness, can produce symptoms of psychosis. This led many professionals to say that psychosis is not specific enough as a diagnostic term. Despite this, the term "psychosis" is generally given to noticeable deficits in normal behavior (negative signs) and more commonly to diverse types of hallucinations or delusional beliefs (e.g. grandiosity, delusions of persecution). Someone exhibiting very obvious signs may be described as "frankly psychotic", whereas one exhibiting very subtle signs could be classified in the category of an "attenuated psychotic risk syndrome".

An excess in dopaminergic signalling is hypothesized to be linked to the positive symptoms of psychosis, especially those of schizophrenia; however, this hypothesis has not been definitively supported. The dopaminergic mechanism is thought to involve the aberrant salience of environmental stimuli. Many antipsychotic drugs accordingly target the dopamine system; however, meta-analyses of placebo-controlled trials of these drugs show either no significant difference in effects between drug and placebo, or a very small effect size, suggesting that the pathophysiology of psychosis is much more complex than an overactive dopamine system.

People experiencing psychosis may exhibit some personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities.

Signs and symptoms

People with psychosis may have one or more of the following: hallucinations, delusions, catatonia, or a thought disorder, as described below. Impairments in social cognition also occur.

Hallucinations

A hallucination is defined as sensory perception in the absence of external stimuli. Hallucinations are different from illusions, or perceptual distortions, which are the misperception of external stimuli. Hallucinations may occur in any of the five senses and take on almost any form, which may include simple sensations (such as lights, colors, tastes, and smells) to experiences such as seeing and interacting with fully formed animals and people, hearing voices, and having complex tactile sensations.

Auditory hallucinations, particularly experiences of hearing voices, are a common and often prominent feature of psychosis. Hallucinated voices may talk about, or to, the person, and may involve several speakers with distinct personas. Auditory hallucinations tend to be particularly distressing when they are derogatory, commanding or preoccupying. However, the experience of hearing voices need not always be a negative one. One research study has shown that the majority of people who hear voices are not in need of psychiatric help. The Hearing Voices Movement has subsequently been created to support voice hearers, regardless of whether they are considered to have a mental illness or not.

Delusions

Psychosis may involve delusional beliefs, some of which are paranoid in nature. Put simply, delusions are false beliefs which a person holds on to, without adequate evidence. It may be difficult to change the belief even with evidence to the contrary. Common themes of delusions are persecutory (person believes that others are out to harm him), grandiose (person believing that he or she has special powers or skills) etc. Depressed persons may have delusions consistent with their low mood e.g: delusions that they have sinned, or have contracted serious illness etc. Karl Jaspers has classified psychotic delusions into primary and secondary types. Primary delusions are defined as arising suddenly and not being comprehensible in terms of normal mental processes, whereas secondary delusions may be understood as being influenced by the person's background or current situation (e.g., ethnicity, religious beliefs, superstitious belief).

Catatonia

Catatonia describes a profoundly agitated state in which the experience of reality is generally considered to be impaired. There are two primary manifestations of catatonic behavior. The classic presentation is a person who does not move or interact with the world in any way while awake. This type of catatonia presents with waxy flexibility. Waxy flexibility is when someone physically moves part of a catatonic person's body and the person stays in the position even if it is bizarre and otherwise nonfunctional (such as moving a person's arm straight up in the air and the arm stays there).

The other type of catatonia is more of an outward presentation of the profoundly agitated state described above. It involves excessive and purposeless motor behavior as well as extreme mental preoccupation which prevents intact experience of reality. An example would be someone walking very fast in circles to the exclusion of anything else with a level of mental preoccupation (meaning not focused on anything relevant to the situation) that was not typical of the person prior to the symptom onset. In both types of catatonia there is generally no reaction to anything that happens outside of them. It is important to distinguish catatonic agitation from severe bipolar mania although someone could have both.

Thought disorder

Thought disorder describes an underlying disturbance to conscious thought and is classified largely by its effects on speech and writing. Affected persons show loosening of associations, that is, a disconnection and disorganization of the semantic content of speech and writing. In the severe form speech becomes incomprehensible and it is known as "word salad".

Psychiatric disorders

From a diagnostic standpoint, organic disorders were those held to be caused by physical illness affecting the brain (that is, psychiatric disorders secondary to other conditions), while functional disorders were considered to be disorders of the functioning of the mind in the absence of physical disorders (that is, primary psychological or psychiatric disorders). The materialistic view of the mind–body problem holds that mental disorders arise from physical processes; in this view, the distinction between brain and mind, and therefore between organic and functional disease, is an artificial one. Subtle physical abnormalities have been found in illnesses traditionally considered functional, such as schizophrenia. The DSM-IV-TR avoids the functional/organic distinction, and instead lists traditional psychotic illnesses, psychosis due to general medical conditions, and substance-induced psychosis.

Primary psychiatric causes of psychosis include the following:

• schizophrenia and schizophreniform disorder
• affective (mood) disorders, including severe depression, and severe depression or mania in bipolar disorder (manic depression). People experiencing a psychotic episode in the context of depression may experience persecutory or self-blaming delusions or hallucinations, while people experiencing a psychotic episode in the context of mania may form grandiose delusions.
• schizoaffective disorder, involving symptoms of both schizophrenia and mood disorders
• brief psychotic disorder, or acute/transient psychotic disorder
• delusional disorder (persistent delusional disorder)
• chronic hallucinatory psychosis

Psychotic symptoms may also be seen in

• schizotypal disorder
• certain personality disorders at times of stress (including paranoid personality disorder, schizoid personality disorder, and borderline personality disorder)
• major depressive disorder in its severe form although it is possible and more likely to have severe depression without psychosis
• bipolar disorder in severe mania and/or severe depression although it is possible to have severe mania and/or severe depression without psychosis as well, in fact that is more commonly the case
• post-traumatic stress disorder
• induced delusional disorder
• Sometimes in obsessive-compulsive disorder

Stress is known to contribute to and trigger psychotic states. A history of psychologically traumatic events, and the recent experience of a stressful event, can both contribute to the development of psychosis. Short-lived psychosis triggered by stress is known as brief reactive psychosis, and patients may spontaneously recover normal functioning within two weeks. In some rare cases, individuals may remain in a state of full-blown psychosis for many years, or perhaps have attenuated psychotic symptoms (such as low intensity hallucinations) present at most times.

B12 deficiency can also cause characteristics of psychosis and mania. Most hospitals and mental facilities do not check for B12 deficiencies.^{[citation needed]}

Normal states

Brief hallucinations are not uncommon in those without any psychiatric disease. Causes or triggers include

• falling asleep and waking: hypnagogic and hypnopompic hallucinations, which are entirely normal
• bereavement, in which hallucinations of a deceased loved one are common
• severe sleep deprivation
• sensory deprivation and sensory impairment
• caffeine intoxication
• extremely stressful event

Subtypes

Subtypes of psychosis include:

• Menstrual psychosis, including circa-mensual (approximately monthly) periodicity, in rhythm with the menstrual cycle.
• Postpartum psychosis, occurring recently after childbirth
• Monothematic delusions
• Myxedematous psychosis
• Occupational psychosis
• Stimulant psychosis
• Tardive psychosis
• Shared psychosis
• Cycloid psychosis

Cycloid psychosis

Cycloid psychosis is psychosis that progresses from normal to full-blown usually within a few hours, not related to drug intake or brain injury. In addition, diagnostic criteria include at least four of the following symptoms:

• Confusion
• Mood-incongruent delusions
• Hallucinations
• Pan-anxiety, a severe anxiety not bound to particular situations or circumstances
• Happiness or ecstasy of high degree
• Motility disturbances of akinetic or hyperkinetic type
• Concern with death
• Mood swings to some degree, but less than what is needed for diagnosis of an affective disorders

Cycloid psychosis occurs in people of generally 15–50 years of age.

Medical conditions

A very large number of medical conditions can cause psychosis, sometimes called secondary psychosis. Examples include:

• disorders causing delirium (toxic psychosis), in which consciousness is disturbed
• neurodevelopmental disorders and chromosomal abnormalities, including velocardiofacial syndrome
• neurodegenerative disorders, such as Alzheimer's disease, dementia with Lewy bodies, and Parkinson's disease
• focal neurological disease, such as stroke, brain tumors, multiple sclerosis, and some forms of epilepsy
• malignancy (typically via masses in the brain, paraneoplastic syndromes, or drugs used to treat cancer)
• infectious and postinfectious syndromes, including infections causing delirium, viral encephalitis, HIV, malaria, Lyme disease, syphilis
• endocrine disease, such as hypothyroidism, hyperthyroidism, adrenal failure, Cushing's syndrome, hypoparathyroidism and hyperparathyroidism; sex hormones also affect psychotic symptoms and sometimes childbirth can provoke psychosis, termed puerperal psychosis
• inborn errors of metabolism, such as porphyria and metachromatic leukodystrophy
• nutritional deficiency, such as vitamin B₁₂ deficiency
• other acquired metabolic disorders, including electrolyte disturbances such as hypocalcemia, hypernatremia, hyponatremia, hypokalemia, hypomagnesemia, hypermagnesemia, hypercalcemia, and hypophosphatemia, but also hypoglycemia, hypoxia, and failure of the liver or kidneys
• autoimmune and related disorders, such as systemic lupus erythematosus (lupus, SLE), sarcoidosis, Hashimoto's encephalopathy, and anti-NMDA-receptor encephalitis
• poisoning, by therapeutic drugs (see below), recreational drugs (see below), and a range of plants, fungi, metals, organic compounds, and a few animal toxins
• some sleep disorders, including hallucinations in narcolepsy (in which REM sleep intrudes into wakefulness)

Psychosis can even be caused by familiar ailments such as flu or mumps.

Psychoactive drugs

Main article: Substance-induced psychosis

Various psychoactive substances (both legal and illegal) have been implicated in causing, exacerbating, and/or precipitating psychotic states and/or disorders in users. This may be upon intoxication, for a more prolonged period after use, or upon withdrawal. Individuals who have a substance induced psychosis tend to have a greater awareness of their psychosis and tend to have higher levels of suicidal thinking compared to individuals who have a primary psychotic illness. Drugs that can induce psychotic symptoms include cannabis, cocaine, amphetamines, cathinones, psychedelic drugs (such as LSD and psilocybin), κ-opioid receptor agonists (such as enadoline and salvinorin A) and NMDA receptor antagonists (such as phencyclidine and ketamine).

Alcohol

Approximately 3 percent of people who are suffering from alcoholism experience psychosis during acute intoxication or withdrawal. Alcohol related psychosis may manifest itself through a kindling mechanism. The mechanism of alcohol-related psychosis is due to the long-term effects of alcohol resulting in distortions to neuronal membranes, gene expression, as well as thiamin deficiency. It is possible in some cases that alcohol abuse via a kindling mechanism can cause the development of a chronic substance induced psychotic disorder, i.e. schizophrenia. The effects of an alcohol-related psychosis include an increased risk of depression and suicide as well as causing psychosocial impairments.

Cannabis

The more often cannabis is abused the more likely a person is to develop a psychotic illness, with frequent use being correlated with twice the risk of psychosis and schizophrenia. While cannabis use is accepted as a contributory cause of schizophrenia by many, it remains controversial. Some studies indicate that the effects of the two active compounds in cannabis, Tetrahydrocannabinol (THC) and Cannabidiol (CBD), are separable with respect to psychosis. While THC by itself tends to induce psychotic symptoms, CBD tends to reduce them, particularly in people who already exhibit these symptoms. Cannabis use has increased dramatically over the past few decades but declined in the last decade, whereas the rate of psychosis has not increased. Together, these findings suggest that cannabis only hastens the onset of psychosis in those who would otherwise become psychotic at a later date.

Methamphetamine

Methamphetamine induces a psychosis in 26-46 percent of heavy users. Some of these people develop a long-lasting psychosis that can persist for longer than 6 months. Those who have had a short-lived psychosis from methamphetamine can have a relapse of the methamphetamine psychosis years later after a stress event such as severe insomnia or a period of heavy alcohol abuse despite not relapsing back to methamphetamine. Individuals who have long history of methamphetamine abuse and who have experienced psychosis in the past from methamphetamine abuse are highly likely to rapidly relapse back into a methamphetamine psychosis within a week or so of going back onto methamphetamine. Violence is common during a methamphetamine psychosis.

Medication

Administration, or sometimes withdrawal, of a large number of medications may provoke psychotic symptoms. Drugs that can induce psychosis experimentally and/or in a significant proportion of patients include amphetamine and other sympathomimetics, dopamine agonists, ketamine, corticosteroids (often with mood changes in addition), and some anticonvulsants such as vigabatrin.

Pathophysiology

The first brain image of an individual with psychosis was completed as far back as 1935 using a technique called pneumoencephalography (a painful and now obsolete procedure where cerebrospinal fluid is drained from around the brain and replaced with air to allow the structure of the brain to show up more clearly on an X-ray picture).

The purpose of the brain is to collect information from the body (pain, hunger, etc.), and from the outside world, interpret it to a coherent world view, and produce a meaningful response. The information from the senses enter the brain in the primary sensory areas. They process the information and send it to the secondary areas where the information is interpreted. Spontaneous activity in the primary sensory areas may produce hallucinations which are misinterpreted by the secondary areas as information from the real world.

For example, a PET or fMRI scan of a person who claims to be hearing voices may show activation in the primary auditory cortex, or parts of the brain involved in the perception and understanding of speech.

Tertiary brain cortex collects the interpretations from the secondary cortexes and creates a coherent world view of it. A study investigating structural changes in the brains of people with psychosis showed there was significant grey matter reduction in the right medial temporal, lateral temporal, and inferior frontal gyrus, and in the cingulate cortex bilaterally of people before and after they became psychotic. Findings such as these have led to debate about whether psychosis itself causes excitotoxic brain damage and whether potentially damaging changes to the brain are related to the length of psychotic episode. Recent research has suggested that this is not the case although further investigation is still ongoing.

Studies with sensory deprivation have shown that the brain is dependent on signals from the outer world to function properly. If the spontaneous activity in the brain is not counterbalanced with information from the senses, loss from reality and psychosis may occur after some hours. A similar phenomenon is paranoia in the elderly when poor eyesight, hearing and memory causes the person to be abnormally suspicious of the environment.

On the other hand, loss from reality may also occur if the spontaneous cortical activity is increased so that it is no longer counterbalanced with information from the senses. The 5-HT2A receptor seems to be important for this, since psychedelic drugs which activate them produce hallucinations.

However, the main feature of psychosis is not hallucinations, but the inability to distinguish between internal and external stimuli. Close relatives to psychotic patients may hear voices, but since they are aware that they are unreal they can ignore them, so that the hallucinations do not affect their reality perception. Hence they are not considered to be psychotic.

Psychosis has been traditionally linked to the neurotransmitter dopamine. In particular, the dopamine hypothesis of psychosis has been influential and states that psychosis results from an overactivity of dopamine function in the brain, particularly in the mesolimbic pathway. The two major sources of evidence given to support this theory are that dopamine receptor D2 blocking drugs (i.e., antipsychotics) tend to reduce the intensity of psychotic symptoms, and that drugs which boost dopamine activity (such as amphetamines and cocaine) can trigger psychosis in some people (see amphetamine psychosis). However, increasing evidence in recent times has pointed to a possible dysfunction of the excitory neurotransmitter glutamate, in particular, with the activity of the NMDA receptor.

This theory is reinforced by the fact that dissociative NMDA receptor antagonists such as ketamine, PCP and dextromethorphan (at large overdoses) induce a psychotic state more readily than dopaminergic stimulants, even at "normal" recreational doses. The symptoms of dissociative intoxication are also considered to mirror the symptoms of schizophrenia, including negative psychotic symptoms, more closely than amphetamine psychosis. Dissociative induced psychosis happens on a more reliable and predictable basis than amphetamine psychosis, which usually only occurs in cases of overdose, prolonged use or with sleep deprivation, which can independently produce psychosis. New antipsychotic drugs which act on glutamate and its receptors are currently undergoing clinical trials.

The connection between dopamine and psychosis is generally believed to be complex. While dopamine receptor D2 suppresses adenylate cyclase activity, the D1 receptor increases it. If D2-blocking drugs are administered the blocked dopamine spills over to the D1 receptors. The increased adenylate cyclase activity affects genetic expression in the nerve cell, a process which takes time. Hence antipsychotic drugs take a week or two to reduce the symptoms of psychosis. Moreover, newer and equally effective antipsychotic drugs actually block slightly less dopamine in the brain than older drugs whilst also blocking 5-HT2A receptors, suggesting the 'dopamine hypothesis' may be oversimplified. Soyka and colleagues found no evidence of dopaminergic dysfunction in people with alcohol-induced psychosis and Zoldan et al. reported moderately successful use of ondansetron, a 5-HT₃ receptor antagonist, in the treatment of levodopa psychosis in Parkinson's disease patients.

Psychiatrist David Healy has criticised pharmaceutical companies for promoting simplified biological theories of mental illness that seem to imply the primacy of pharmaceutical treatments while ignoring social and developmental factors which are known to be important influences in the aetiology of psychosis.

Some theories regard many psychotic symptoms to be a problem with the perception of ownership of internally generated thoughts and experiences. For example, the hallucination of hearing voices may arise from internally generated speech that is mislabeled by the psychotic person as coming from an external source.

It has been suggested that persons with bipolar disorder may have increased activity of the left hemisphere compared to the right hemisphere of the brain, while persons with schizophrenia have increased activity in the right hemisphere.

Increased level of right hemisphere activation has also been found in people who have high levels of paranormal beliefs and in people who report mystical experiences. It also seems to be the case that people who are more creative are also more likely to show a similar pattern of brain activation. Some researchers have been quick to point out that this in no way suggests that paranormal, mystical or creative experiences are in any way by themselves a symptom of mental illness, as it is still not clear what makes some such experiences beneficial and others distressing.

Neurobiology

In otherwise normal individuals, exogenous ligands can produce psychotic symptoms. NMDA receptor antagonists, such as ketamine, can produce a similar psychosis to that experienced in schizophrenia.

Prolonged or high dose use of psychostimulants can alter normal functioning to be similar to the manic phase of bipolar disorder. NMDA antagonists replicate some of the so-called "negative" symptoms like thought disorder in subanesthetic doses (doses insufficient to induce anesthesia), and catatonia in high doses. Psychostimulants, especially in one already prone to psychotic thinking, can cause some "positive" symptoms, such as delusional beliefs, particularly those persecutory in nature.

Diagnosis

Diagnosing the presence and/or extent of psychosis may be distinguished from diagnosing the cause of psychosis.

The presence of psychosis is typically diagnosed by clinical interview, incorporating mental state examination. Its extent may be established by formal rating scales. The Brief Psychiatric Rating Scale (BPRS) assesses the level of 18 symptom constructs of psychosis such as hostility, suspicion, hallucination, and grandiosity. It is based on the clinician's interview with the patient and observations of the patient's behavior over the previous 2–3 days. The patient's family can also provide the behavior report. During the initial assessment and the follow-up, both positive and negative symptoms of psychosis can be assessed using the 30 item Positive and Negative Symptom Scale (PANSS).

Establishing the cause of psychosis requires clinical examination, and sometimes special investigations, to diagnose or exclude secondary causes of psychosis; if these are excluded, a primary psychiatric diagnosis can be established.

Prevention

The evidence for the effectiveness of early interventions to prevent psychosis appeared inconclusive. Whilst early intervention in those with a psychotic episode might improve short term outcomes, little benefit was seen from these measures after five years. However more recently there has been some evidence that cognitive behavioral therapy (CBT) may reduce the risk of becoming psychotic in those at high risk.

Treatment

The treatment of psychosis depends on the specific diagnosis (such as schizophrenia, bipolar disorder or substance intoxication). The first line treatment for many psychotic disorders is antipsychotic medication (oral or intramuscular injection), and sometimes hospitalization is needed. However, there are significant problems associated with this class of drugs. There is evidence that they can cause brain damage including prefrontal cortex atrophy, long-lasting parkinsonian symtoms (tardive dyskinesia), and personality change. Nancy Andreasen has argued for an association between antipsychotic drugs and smaller grey matter volumes independent of illness severity. Furthermore, antipsychotic drugs can themselves induce psychotic symptoms if they are administered for a long time and then discontinued.

There is growing evidence that cognitive behavior therapy, acceptance and commitment therapy and family therapy can be effective in managing psychotic symptoms. When other treatments for psychosis are ineffective, electroconvulsive therapy or ECT (also known as shock treatment) is sometimes applied to relieve the underlying symptoms of psychosis due to depression. There is also increasing research suggesting that animal-assisted therapy can contribute to the improvement in general well-being of people with schizophrenia.

Early intervention

Main article: Early intervention in psychosis

Early intervention in psychosis is on the observation that identifying and treating someone in the early stages of a psychosis can improve their longer term outcome. This approach advocates the use of an intensive multi-disciplinary approach during what is known as the critical period, where intervention is the most effective, and prevents the long term morbidity associated with chronic psychotic illness.

History

The word psychosis was introduced to the psychiatric literature in 1841 by Karl Friedrich Canstatt in his work Handbuch der Medizinischen Klinik. He used it as a shorthand for 'psychic neurosis'. At that time neurosis meant any disease of the nervous system, and Canstatt was thus referring to what was thought to be a psychological manifestation of brain disease. Ernst von Feuchtersleben is also widely credited as introducing the term in 1845, as an alternative to insanity and mania.

The term stems from the Greek ψύχωσις (psychosis), "a giving soul or life to, animating, quickening" and that from ψυχή (psyche), "soul" and the suffix -ωσις (-osis), in this case "abnormal condition".

The word was also used to distinguish disorders which were thought to be disorders of the mind, as opposed to "neurosis", which was thought to be a disorder of the nervous system. The psychoses thus became the modern equivalent of the old notion of madness, and hence there was much debate on whether there was only one (unitary) or many forms of the new disease. One type of broad usage would later be narrowed down by Koch in 1891 to the 'psychopathic inferiorities' - later renamed abnormal personalities by Schneider.

The division of the major psychoses into manic depressive illness (now called bipolar disorder) and dementia praecox (now called schizophrenia) was made by Emil Kraepelin, who attempted to create a synthesis of the various mental disorders identified by 19th century psychiatrists, by grouping diseases together based on classification of common symptoms. Kraepelin used the term 'manic depressive insanity' to describe the whole spectrum of mood disorders, in a far wider sense than it is usually used today.

In Kraepelin's classification this would include 'unipolar' clinical depression, as well as bipolar disorder and other mood disorders such as cyclothymia. These are characterised by problems with mood control and the psychotic episodes appear associated with disturbances in mood, and patients will often have periods of normal functioning between psychotic episodes even without medication. Schizophrenia is characterized by psychotic episodes which appear to be unrelated to disturbances in mood, and most non-medicated patients will show signs of disturbance between psychotic episodes.

During the 1960s and 1970s, psychosis was of particular interest to counterculture critics of mainstream psychiatric practice, who argued that it may simply be another way of constructing reality and is not necessarily a sign of illness. For example, R. D. Laing argued that psychosis is a symbolic way of expressing concerns in situations where such views may be unwelcome or uncomfortable to the recipients. He went on to say that psychosis could be also seen as a transcendental experience with healing and spiritual aspects.

Arthur J. Deikman suggested use of the term "mystical psychosis" to characterize first-person accounts of psychotic experiences that are similar to reports of mystical experiences. Thomas Szasz focused on the social implications of labeling people as psychotics, a label he argues unjustly medicalises different views of reality so such unorthodox people can be controlled by society. Psychoanalysis has a detailed account of psychosis which differs markedly from that of psychiatry. Freud and Lacan outlined their perspective on the structure of psychosis in a number of works.

Since the 1970s, the introduction of a recovery approach to mental health, which has been driven mainly by people who have experienced psychosis (or whatever name is used to describe their experiences), has led to a greater awareness that mental illness is not a lifelong disability, and that there is an expectation that recovery is possible, and probable with effective support.

Psychiatric conditions associated with psychotic spectrum symptoms may be possible explanations for revelatory driven experiences and activities such as those of Abraham, Moses, Jesus and Saint Paul.

References

Further reading

• Sims, A. (2002) Symptoms in the mind: An introduction to descriptive psychopathology (3rd edition). Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1

• Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012. ISBN 1437704344 | ISBN 978-1437704341

Personal accounts

• Dick, P.K. (1981) VALIS. London: Gollancz. [Semi-autobiographical] ISBN 0-679-73446-5
• Hinshaw, S.P. (2002) The Years of Silence are Past: My Father's Life with Bipolar Disorder. Cambridge: Cambridge University Press.
• Jamison, K.R. (1995) An Unquiet Mind: A Memoir of Moods and Madness. London: Picador.
  ISBN 0-679-76330-9
• Schreber, Daniel Paul (2000) Memoirs of My Nervous Illness. New York: New York Review of Books. ISBN 0-940322-20-X
• McLean, R (2003) Recovered Not Cured: A Journey Through Schizophrenia. Allen & Unwin. Australia. ISBN 1-86508-974-5
• The Eden Express by Mark Vonnegut
• James Tilly Matthews
• Saks, Elyn R. (2007) The Center Cannot Hold—My Journey Through Madness. New York: Hyperion. ISBN 978-1-4013-0138-5

External links

• psychosis-bipolar.com - For persons afflicted, relatives and professionals: information, trialog, interactive therapy portal
• Understanding psychotic experiences from mental health charity Mind

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人における精神病に対する臨床症状、鑑別診断および初期マネージメント clinical manifestations differential diagnosis and initial management of psychosis in adults
• 2. 小児における急性発症性精神病の救急外来による評価 emergency department evaluation of acute onset psychosis in children
• 3. 短期精神病性障害 brief psychotic disorder
• 4. 精神病性特徴を伴う単極性大うつ病：疫学、臨床的特徴、評価、および診断 unipolar major depression with psychotic features epidemiology clinical features assessment and diagnosis
• 5. 産後精神病：疫学、臨床症状、評価、および診断 postpartum psychosis epidemiology clinical manifestations assessment and diagnosis

English Journal

• Obstetrician/gynecologists and postpartum mental health: Differences between CME course takers and nontakers.

• Leddy MA, Farrow VA, Joseph GF Jr, Schulkin J.SourceResearch Associate, ACOG.
• The Journal of continuing education in the health professions.J Contin Educ Health Prof.2012 Dec;32(1):39-47. doi: 10.1002/chp.21121.
• INTRODUCTION: Continuing medical education (CME) courses are an essential component of professional development. Research indicates a continued need for understanding how and why physicians select certain CME courses, as well as the differences between CME course takers and nontakers.PURPOSE: Obstet
• PMID 22447710

• Psychosis in a patient with silent vascular brain lesions.

• Duggal HS, Singh I.
• The Journal of neuropsychiatry and clinical neurosciences.J Neuropsychiatry Clin Neurosci.2012 Dec 1;24(1):E20-1.
• PMID 22450631

Japanese Journal

• A CASE WITH HYPOCRETIN(OREXIN) DEFICIENT NARCOLEPSY, PARKINSON’S DISEASE AND SEVERE PSYCHOSIS WAS SUCCESSFULLY TREATED BY MODIFIED ELECTRO-CONVULSIVE THERAPY

• Takahashi Yuya,Kikuchi Yuka,Kanbayashi Takashi,Hanazono Akira,Abe Shunichiro,Iwaki Shinobu,Tsutsui Ko,Suda Hideka,Maruyama Fumi,Shimizu Tetsuo
• 秋田医学 38(2), 81-84, 2011-12
• … We report the case of a 60-year-old male who exhibited severe psychosis two years after beginningtreatment with methylphenidate for hypocretin deficient narcolepsy. … Physicians should be aware that psycho-stimulants and anti-PD medicationscommonly prescribed for treatment of narcolepsy and PD may precipitate psychosis in thosepatients. …
• NAID 110008752377

• 生殖機能とIL-18--特に生殖医療との関連 (特集 生殖と免疫)

• 辻 芳之
• 臨床免疫・アレルギー科 56(4), 366-373, 2011-10
• NAID 40019053100

Related Links

• Psychosis - Wikipedia, the free encyclopedia

Psychosis refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic. Psychosis is ...

• What Is Psychosis? What Causes Psychosis? - Medical News Today

23 Jul 2012 ... Psychosis is a generic psychiatric term for an abnormal sign or symptom that affects the mind, causing people to change the way they think, feel, perceive things, and behave. When a person suf.

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★リンクテーブル★

リンク元	「ハンチントン病」「精神障害」「psychiatric disorder」「psychoses」「psychopathic」
拡張検索	「Korsakoff psychosis」「Korsakoff's psychosis」「Basedow psychosis」

「ハンチントン病」

　　[★]

英

Huntington disease

同

ハンチントン舞踏病 Huntington chorea Huntington's chorea

関

錐体外路症候群、大脳基底核疾患

概念

• うつ、進行性痴呆(progressive dementia)、舞踏運動(choreiform movements)、尾状核の萎縮(caudate atrophy)
• 脳のGABA↓、ACh↓
• トリプレットリピート病
• 難病であり、特定疾患治療研究事業の対象疾患

疫学

• (有病率？)欧米では4-8/10万人、日本では1/10万人 (HBN.971)
• 発病する家系の20-50歳で発症。(他の文献では30-40歳代)
• 25-45歳で発症。有病率は2-8人/10万人。(HIM.2561)

病因

• 第4染色体短腕(4p15)に座乗するハンチントン遺伝子のエキソンに存在するCAGリピートの異常反復。正常では7～34回。ハンチントン病では36回以上

• この結果として線条体のGABA作動性ニューロンの脱落。線条体の変性によりドパミン作動性ニューロンが優位となり、不随意運動が起こる(YN.J-122)。

遺伝

• 常染色体優性遺伝 AD

病理

• 線条体(特に尾状核)・大脳皮質(特に前頭葉・側頭葉)の萎縮　　→　　尾状核の萎縮は不随意運動、大脳皮質の萎縮は認知症に繋がるのであろう
• 小型のニューロンの脱落が大型のニューロンに先行している。GABA作動性ニューロンの脱落が顕著である。線維性のグリオーシスが他の疾患で見られるニューロン脱落後のそれよりも顕著。線条体の変性とmotor symptomsの間には相関が見られる。皮質や線条体ニューロンでは核内にユビキチン化されたハンチントン蛋白の封入体が認められる。(BPT.895)

症状

• 運動：舞踏運動。構音障害、歩行障害、眼球運動異常。病気の進展により舞踏運動は目立たなくなり、ジストニア、固縮(rigidity)、動作緩慢(bradykinesia)、ミオクローヌス、spasticityが出現してくる。　　→　×運動失調
• 認知：認知症
• 精神：自殺念慮を伴う抑うつ、攻撃的行動、精神病(psychosis)

<youtube>http://www.youtube.com/watch?v=JzAPh2v-SCQ</youtube>

診断

• リピート数の異常伸長

検査

CT

• 側脳室の外側に存在する尾状核の萎縮により側脳室の拡大が認められる。

MRI

• FLAIRでは尾状核と被殻に異常な高信号が認められる。

治療

HIM.2562

• 舞踏運動：D2受容体拮抗薬(要するに抗精神病薬。ハロペリドール、クロルプロマジン)が効くが、副作用や運動症状を悪化させることを考えると使用しない方がよい。
• 精神症状：抗うつ薬や抗不安薬を処方し、自殺念慮や躁(mania)に対するモニターを行う。精神病に対しては非定型抗精神病薬(クロザピン、クエチアピン、リスペリドン)で治療を行う。
• 認知機能：良い治療法がない。
• 根治療：脳神経を保護する治療はまだ無い。

予後

• 発症後10-20年で感染症、窒息(嚥下困難)で死亡する(YN.J-122)

参考

• 1. CT

http://www.mypacs.net/cases/HUNTINGTONS-DISEASE-12726430.html

• 2. ハンチントン病 - 難病情報センター

http://www.nanbyou.or.jp/entry/318

• 3. 認定基準 - 難病情報センター

http://www.nanbyou.or.jp/upload_files/092_s.pdf

「精神障害」

　　[★]

英

psychiatric disorder、psychosis、psychoses、mental disorder、psychotic disorder

関

精神病、行動異常、精神疾患、精神病性障害、精神科診断

参考

• 1. Encyclopedia of Mental Disorders

http://www.minddisorders.com/

good!

「psychiatric disorder」

　　[★]

• 精神障害、精神疾患、精神病

関

mental disorder、mental illness、psychiatric disease、psychopathic、psychoses、psychosis、psychotic disorder

「psychoses」

　　[★]

精神病、精神障害

関

mental disorder、psychiatric disease、psychiatric disorder、psychopathic、psychosis、psychotic disorder

「psychopathic」

　　[★]

• adj.

• 精神病の

関

mental disorder、psychiatric disease、psychiatric disorder、psychoses、psychosis、psychotic disorder

　 　

「Korsakoff psychosis」

　　[★] コルサコフ症候群、コルサコフ精神病

「Korsakoff's psychosis」

　　[★] コルサコフ症候群、コルサコフ精神病

「Basedow psychosis」

　　[★] バセドウ病性精神異常