Psychoses: Psychoses are serious psychiatric disorders characterized by a loss of contact with reality. People with psychosis may experience hallucinations (seeing or hearing things that do not exist) and delusions (beliefs that do not reflect reality).

Schizophrenia: Schizophrenia is a such chronic psychotic disorder that affects thinking, perception, emotional response and behaviour.

Positive Symptoms

• Hallucinations: Visual, auditory, or other sensory experiences without a basis in reality.
• Delusions: Irrational beliefs or paranoid thoughts, such as that someone wants to cause harm or ideas of grandeur.
• Disturbed thinking: Difficulty in reasoning and concentration.

Negative Symptoms

• Emotional leveling: reduction of emotional reactions.
• Anedonia: Loss of interest in pleasurable activities.
• Social withdrawal: Isolation from social relationships.

Cognitive Symptoms

• Disturbances in memory and attention.
• Difficulties in making decisions and solving problems.

Treatment Options

Medication

• Antipsychotic medicines: used to reduce psychotic symptoms. They include classical antipsychotics (such as chlorpromazine and haloperidol), atypical antipsychotics (such as risperidone and olanzapine), but also newer drugs such as glycine transporter type 1 (GlyT1) inhibitors and M1 and M4 muscarinic receptor agonists (Iclepertin and Emraclidine, Xanomeline respectively).

Psychotherapy

• Cognitive-behavioural therapy (CBT): Focuses on changing negative thoughts and behaviours.
• Family therapy: Providing support and education to the family to help manage the disorder.

Social Support

• Rehabilitation services: Assist patients in regaining their social and vocational skills.
• Support groups: Offering mutual support among people who share this diagnosis and similar experiences.

Hospital care

• In severe cases, hospitalisation may be needed to stabilise the condition.

Prognosis 

Positive Predictive Factors

• Early intervention: Early diagnosis and treatment is associated with better outcomes.
• Compliance with treatment: Regular medication and participation in psychotherapy improve prognosis.
• Supportive environment: Support from family and social network is vital.
• Low severity of initial symptoms: Less severe initial symptoms are associated with a better prognosis.

Negative Predictive Factors

• Chronic symptoms: Long duration of symptoms without treatment can worsen the prognosis.
• Syndromic disorders: The presence of other mental or physical disorders can complicate recovery.
• Poor compliance with treatment: Discontinuing medications or avoiding treatment can lead to relapses and impair the effectiveness of future treatments.

Long-term Prognosis

• Relapse: Schizophrenia and psychoses are chronic disorders with a risk of relapse. About 50% of people with this diagnosis will experience recurrent episodes.
• Functionality: With proper treatment, many patients can maintain good functionality and quality of life.
• Need for lifelong treatment: In many cases, long-term medication and regular monitoring is required to prevent relapses.

Strategies to Improve the Prognosis

• Continuous monitoring: Regular visits to the psychiatrist and appropriate adjustments to treatment are essential.
• Family education and support: Educating the family to understand the disorder and support the patient.
• Psychosocial interventions: Vocational rehabilitation and social reintegration programmes.