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Psychosis involves a loss of contact with reality characterized by hallucinations, delusions, and disorganized thinking. Schizophrenia spectrum disorders represent a range of psychotic conditions varying in severity, duration, and functional impairment, with schizophrenia being the most severe form requiring symptoms for at least 6 months.
The dopamine hypothesis suggests excessive dopaminergic activity in mesolimbic pathways contributes to positive symptoms, while hypofunction in mesocortical pathways leads to negative symptoms. Additional neurotransmitter systems including glutamate (NMDA receptor hypofunction), GABA, and serotonin are implicated, along with structural brain abnormalities in prefrontal cortex, hippocampus, and ventricular enlargement.
Diagnosis requires careful assessment of positive symptoms (hallucinations, delusions), negative symptoms (avolition, alogia, anhedonia), and cognitive impairment while excluding medical causes and substance use. Duration criteria differentiate spectrum disorders: brief psychotic disorder (<1 month), schizophreniform (1-6 months), and schizophrenia (>6 months). Early intervention with antipsychotics targeting dopamine receptors, particularly D2 antagonism, forms the cornerstone of treatment alongside psychosocial interventions.