Psychotic Disorders: Schizophrenia & Psychosis
Psychotic disorders, including schizophrenia, can be well-managed conditions with a significant neurobiological footprint. Psychiatrist Paschalis Gkikas provides specialized diagnosis and treatment in Athens.
Psychotic Disorders: Schizophrenia & Psychosis
Psychosis is a state in which the brain temporarily or persistently loses the ability to distinguish internal experience from external reality. It is not split personality and it does not mean “dangerous people” — it is a neurobiological condition with a recognizable clinical picture, understandable etiopathogenesis and effective treatments.
What are psychotic disorders?
In ICD-10, psychotic disorders fall under category F20–F29 and include:
- Schizophrenia (F20): The most characteristic psychotic disorder, with positive, negative and cognitive symptoms
- Schizotypal disorder (F21)
- Delusional disorder (F22): Systematized delusions without hallucinations
- Acute psychotic disorder (F23): Sudden onset, often after psychosocial stress
- Schizoaffective disorder (F25): Psychotic and mood features occurring together
- Substance-induced psychosis (F1x.5): Cocaine, cannabis, amphetamines, alcohol
- Organic psychosis (F06.0–F06.2)
Clinical presentation and symptoms
Positive symptoms
They are called “positive” because they are additions to normal experience:
- Hallucinations: Auditory hallucinations (voices) are most common; visual and olfactory may occur.
- Delusions: Fixed false beliefs — persecutory, grandiose or referential.
- Disorganized thinking and speech.
- Disorganized behavior or catatonia.
Negative symptoms
They represent loss of normal functions and often have a greater functional impact:
- Alogia: Reduced speech production.
- Flat or blunted affect.
- Anhedonia: Inability to experience pleasure.
- Avolition: Lack of motivation.
- Social withdrawal.
Cognitive symptoms
Decisive for autonomy:
- Reduced working memory and slowed information processing.
- Difficulty with planning and executive functions.
- Deficits in “theory of mind” (understanding others’ intentions).
Early signs (prodromal phase): Social withdrawal, altered perception, magical thinking, and suspiciousness are critical warnings.
Neurobiological basis
- Dopamine hypothesis: D2 receptor hyperactivity in the mesolimbic system (positive symptoms) and hypoactivity in the prefrontal cortex (negative/cognitive symptoms).
- Glutamate hypothesis (NMDA): NMDA receptor hypofunction leads to disorganization of neural connectivity.
- Structural changes: MRI studies show reduced gray matter volume in the prefrontal cortex, temporal lobes and hippocampus.
- Genetic factors: Heritability is approximately 80% in schizophrenia. The COMT Val158Met variant is particularly relevant.
Treatment approach
Antipsychotic medication
- Typical (1st gen): Haloperidol — strong D2 antagonism, high extrapyramidal risk.
- Atypical (2nd gen): Olanzapine, risperidone — better for negative symptoms, metabolic concerns.
- Clozapine: Gold standard for treatment-resistant cases.
- LAIs (Long-acting injectables): Critical for adherence and relapse prevention.
Pharmacogenomic analysis (PGx)
PGx reveals metabolic variants (CYP2D6, CYP1A2, CYP3A4) to avoid toxic levels or therapeutic failure.
Psychosocial interventions
Psychoeducation, Social Cognitive Training (SCT), and family therapy are essential components of recovery.
rTMS in psychotic disorders
Used in stabilized phases for persistent auditory hallucinations (low-frequency over temporoparietal cortex) or negative symptoms (high-frequency over left DLPFC).
Frequently asked questions (FAQ)
Is schizophrenia curable?
It is not curable in the sense of complete eradication, but with appropriate treatment most patients achieve stable remission, social reintegration and a significantly acceptable quality of life. Early diagnosis and continuous medication are the most critical prognostic factors.
Do antipsychotic medications “sedate” the patient?
The feeling of sedation is largely dose-dependent and mainly associated with older medications. With modern atypical antipsychotics at individualized doses, the patient can maintain full alertness and functionality.
When should I worry about someone close to me?
If you notice auditory “voices”, unusual beliefs that do not correspond to logic, withdrawal and reduced functioning, or major personality change, psychiatric assessment is needed. Early intervention radically changes prognosis.
Can psychosis be caused by substances?
Yes. Cannabis with high THC content, cocaine, amphetamines and alcohol can induce psychotic episodes — especially in genetically vulnerable individuals. In some cases, substance-induced psychosis evolves into an independent disorder.
