Clinical Features and Management of Psychosis

Dear Colleagues,

Psychosis is a clinical syndrome characterized by the presence of core clinical features such as delusions, hallucinations, affective symptoms, and disorganized thought and behavior. Its symptoms include—but are not limited to—impaired reality testing, communication disorders, lack of insight, and reduced social adaptation. Psychosis is the defining feature of schizophrenia spectrum disorders; it is also a common but variable feature of mood and substance use disorders and a relatively common feature of many developmental/degenerative neurologic and medical disorders. Across these conditions, psychosis signifies a greater severity of disease and contributes substantially to suffering, functional disability, and psychosocial impairment; therefore, it represents an important target for evaluation and treatment.

While there are some insights into the etiopathology and pathophysiology of psychotic symptoms, as of now, we are not aware of the exact biological mechanisms for explaining the pathophysiology of psychotic manifestations. The diagnosis of psychosis relies solely on clinical investigation and observation. The distribution, however, of psychotic symptoms across psychotic disorders is not homogenous, exhibiting intra-diagnostical heterogeneity as well as changes in symptom profiles over the course of illness; therefore, it is suggestive of a psychotic continuum of varied pathophysiology.

The aim of this Special Issue is (a) to promote and highlight research on the psychopathology of psychosis across diagnostic entities and illness course, and (b) to explore interventions and treatments based on stratification strategies of clinical features, along with environmental and endogenous factors, regardless of the diagnosis.

In this Issue, we welcome original research articles and review articles addressing the following topics:

1. The common phenomenological characteristics of psychotic symptoms and other clinical manifestations of psychosis, their differences in the context of diverse diagnoses and illness course, as well as their impact on prognosis and treatment outcome.
2. The specification of differential characteristics and deconstruction of common psychotic symptoms that could feasibly facilitate correspondence to neurobiological findings.
3. The therapeutic management of psychosis in the context of diverse diagnosis, including medication, psychosocial, and psychotherapeutic interventions addressing its clinical manifestations and consequences.
4. The transdiagnostical identification of clinical features or constellations of clinical features that could predict the optimal treatment response under specific therapeutic management.

Dr. Maria Margariti
Dr. George Konstantakopoulos
Dr. Michael Hadjulis
Guest Editors

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• psychosis
• clinical features of psychosis
• diagnosis of psychosis
• schizophrenia
• psychotic depression
• affective disorder with psychotic features
• psychosis in substance use disorders
• psychosis in neurological disorders
• psychosis in medical conditions
• management of psychosis
• treatment of psychosis

Title: Cholinergic-anticholinergic dopamine regulation in schizophrenia treatment: insights for clinical practice
Authors: Nikolaos Kokras
Affiliation: First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Abstract: This review will provide an overview of what is the role of cholinergic and anticholinergic medications in the treatment of schizophrenia. Anticholinergic agents are long-used to modulate the striatal dopaminergic neurotransmission and counteract the dopamine blockage by several antipsychotics. Cholinergic medications are emerging as a novel candidate treatment option for schizophrenia, as they also modulate dopaminergic neurotransmission in the striatum and elsewhere in the brain. In this review we will focus on the brain striatal dopamine-acetylcholine balance, discuss the clinical implications of modulating this balance, and provide practical advice for clinicians, in order to better operate cholinergic and anticholinergic medications.