**2. Major psychotic disorders and classifications**

Psychotic disorder forms a diverse group of illness that are serious and often treatable [12]. Psychotic disorders affect the way a person may act or feel (loss of motivation, delusion, social withdrawal from others, depression, intense elation, 'uncontrollable laughter or crying', altered emotions), thinking (confused or disjointed thoughts, superficially-irrelevant thinking, unconsolidated connections between ideas, and incoherence), auditory and visual hallucination [13]. These itemized features make it difficult for the affected individuals to distinguish between what is real and not real. On the other hand, psychosis encompasses conditions that influence the mind where contact with reality has been lost [14].

According to the American Psychiatric Association [15], psychotic disorders can be classified into four basic groups including; non-affective psychotic disorder (e.g. schizophrenia, schizoaffective, schizophreniform, delusional, brief psychotic, shared psychotic, and psychotic disorder NOS), affective psychotic disorder (e.g. bipolar I and II disorder with psychotic features and major depressive disorder with psychotic feature), substance-induced psychotic disorder (e.g. alcohol-induced psychotic disorder and other substance-induced), and psychotic disorder to general medical condition [16, 17].

Schizophrenia is one of the most common and severe psychotic disorders. It is a cluster of disorders characterized by fundamental disturbances of thinking, perception and emotions. The onset of schizophrenia is often in young adulthood, and for those affected, the disorder often causes many years of intense suffering [12]. The course, sign and symptoms in affected individual are highly inconsistent, but for a smaller ratio, the disorder causes lifelong disabilities with deterioration in functional capacity [18]. However, an average of 1 in every 7 patients with schizophrenia have been able to recover from the ailment despite the improvement in available treatment options in the recent years [19]. Schizophreniform disorder is basically identical with schizophrenia except that the ailment period is at least 1 month, but full recovery in 6 months is required. Another difference is that decline in functioning is not required in diagnostic criteria of schizophreniform disorder, while decline in social and occupational function is one criteria of schizophrenia. The diagnosis is often provisional and diagnosis may be changed to schizophrenia, should symptoms remain longer than 24 weeks [20]. In schizoaffective disorder on the other hand, the full criteria of both the active phase of schizophrenia and a mood episode should be met. In the same illness period, a 14-day delusional or hallucinational feeling without obvious mood symptoms may be evident. Symptoms meeting criteria for a mood episode should be present for the duration of the disorder [21]. The delusional disorder is often characterized by non-bizarre delusions and mostly last for almost 4 weeks. However, with the exception of the presence of tactile and olfactory hallucinations, other active-phase signs of schizophrenia should not be present, particularly if they are delusionalrelated. Besides the delusional impacts, normal behavior is always observed and functioning is not markedly impaired [15]. Unlike others, the brief psychotic occurrence is accompanied by sudden onset of psychotic symptoms (disorganized speech, delusions, catatonic behavior, hallucinations,) which persist for at least 24 hours but usually not exceeding 4 weeks. After this, a full remission and return to an optimal level of functioning is normally achieved [22, 23]. Furthermore, a variant of the non-affective psychotic disorders, the shared psychotic ailment, occurs rarely and is normally characterized by delusional experience in one individual when in a close relationship with an established delusional person [24]. Also, with the psychotic disorder NOS, the symptoms of psychosis are evident, but a specific diagnosis of any psychotic disorder cannot be made. There may be inadequate information to make a specific diagnosis, the information is contradictory, or symptoms fail to fulfill full criteria for a specific psychotic disorder. According to Arciniegas [17], diagnosis may be assigned for example if; a postpartum psychosis fails to meet criteria for a specific psychotic ailment, symptoms of psychosis have existed not beyond 4 weeks but yet to be remitted, occurrence of persistent auditory hallucinations void of any other psychotic feature, existence of persistent non-bizarre delusions with episodes of overlapping mood, evidence of uncertainty as to whether symptoms of psychosis are primary or substance use related or of general medical issues [12].

case and several theories are in place to significantly understand the causatives of mental disorders. The notion that psychosis is a typical symptom of illnesses, possibly caused by some chemical imbalance or infiltrations in the brain, is just one of these theories [1]. While the rate of psychosis has drastically increased in recent years, the number of prescriptions for psychiatric medications has made an even bigger jump [2, 3]. For instance, in the United States, the prescription and use of antidepressant drugs has increased by almost 400% between 1998 and 2008 [4]. With the worrisome side effects of the medications, which can pose serious health risks and make medication compliance difficult, coupled with the prohibitive cost for many patients, there is an obvious need for alternative solutions. Interestingly, in addition to medical and clinical care for psychosis, the significance of phytotherapy has also become well established over the past decade. For instance, phytotherapeutic formulations such as St John's Wort and Kava have potentiated remarkable clinical evidence [5]. Also, the beneficial effects of peppermint aroma from plants on memory and alertness have offered new opportunities for research regarding cognitive decline [6]. Such formulations are direct efforts of the plant-based remedies that have been used by indigenous cultures for thousands of years. Although, attempts have been previously made on the review of the significance of traditional systems of medicines in the management of mental illnesses [5, 7–11], a comprehensive review on the ambit of herbal remedies and the mechanism of actions of the anti-psychotic bioactive principles is still lacking till date. It is on this background, that, this review was conducted to identify the major psychotic disorders, the broad scope of phytotherapy in psychotic care and

Psychotic disorder forms a diverse group of illness that are serious and often treatable [12]. Psychotic disorders affect the way a person may act or feel (loss of motivation, delusion, social withdrawal from others, depression, intense elation, 'uncontrollable laughter or crying', altered emotions), thinking (confused or disjointed thoughts, superficially-irrelevant thinking, unconsolidated connections between ideas, and incoherence), auditory and visual hallucination [13]. These itemized features make it difficult for the affected individuals to distinguish between what is real and not real. On the other hand, psychosis encompasses

According to the American Psychiatric Association [15], psychotic disorders can be classified into four basic groups including; non-affective psychotic disorder (e.g. schizophrenia, schizoaffective, schizophreniform, delusional, brief psychotic, shared psychotic, and psychotic disorder NOS), affective psychotic disorder (e.g. bipolar I and II disorder with psychotic features and major depressive disorder with psychotic feature), substance-induced psychotic disorder (e.g. alcohol-induced psychotic disorder and other substance-induced),

Schizophrenia is one of the most common and severe psychotic disorders. It is a cluster of disorders characterized by fundamental disturbances of thinking, perception and emotions.

conditions that influence the mind where contact with reality has been lost [14].

the mechanisms of action of anti-psychotic phytonutrients.

70 Psychosis - Biopsychosocial and Relational Perspectives

**2. Major psychotic disorders and classifications**

and psychotic disorder to general medical condition [16, 17].

Unlike the non-affective disorders, the bipolar I disorder is an affective type of psychosis, characterized with manic or mixed episodes, usually accompanied with major episodes of depression. Symptoms of psychosis, which have to be hallucinations/delusions, can occur during manic, mixed and severe depressive episodes [25, 26] Typical mood-congruent psychotic symptoms during manic episodes include grandiosity and persecutory delusions linked to some special features of the person. Mood-incongruent psychotic symptoms include persecutory delusions without grandiose themes or delusions of thought insertion, thought broadcasting or being controlled [27]. The bipolar II disorder diagnosis means that person has had at least one hypomanic, but no manic or mixed episodes, and one major depressive episode. Bipolar II disorder may also include psychotic symptoms during the severe depressive episodes. Bipolar I disorder leads to hospitalizations, need for treatment, and decline in daily functioning more often compared with bipolar II disorder [28, 29]. Similarly, the major depressive disorder with psychotic features is diagnosed when the criteria for major depressive disorder episode are met and delusions or hallucinations occur within the episode. Mood-congruent delusions or hallucinations are consistent with the depressive themes (delusions of guilt, delusions of deserved punishment, nihilistic delusions etc.). Mood-incongruent delusions or hallucinations do not have any apparent relationship to depressive themes (persecutory delusions, delusions of thought insertion, delusions of control etc.) [30]. For the substance-induced psychotic disorders, the victim is characterized by prominent hallucinations or delusions that are judged to be due to the direct physiological effects of a substance (drug of abuse, a medication, or a toxin exposure). Substance-induced psychotic disorders are distinguished from the substance-induced delirium (clear consciousness), from substance intoxication or withdrawal with perceptual disturbances (more persistent, clinically relevant symptoms, and the individual is void of insight) and from primary psychotic disorders [31]. The onset of substance use typically precedes the onset of psychotic symptoms, and the symptoms should disappear within 1 month after the substance use has ceased. Psychotic symptoms may occur during withdrawal or intoxication of these substances: cannabis, inhalants, hypnotics, hallucinogens, amphetamine, opioids, cocaine, alcohol, anxiolytics, phencyclidine and sedatives [32]. Some medications (e.g. antiparkinsonian medications, corticosteroids, anticholinergic agents, antimalarial medications and chemotherapeutic agents) can also trigger symptoms of psychosis. The clinical picture of psychosis varies depending on the substance [12]. For the one resulting from a general medical condition, the victim feels hallucinated or delusioned. These symptoms can be judged to result from the direct physiological impacts of a general medical condition, and they are not explained by any other mental disorder [33]. Clear temporal association should be found between the general medical issue and the onset of psychotic disturbance. Additionally, there must be literature evidence on the particular medical condition causing psychotic symptoms [34]. Examples of general medical conditions that can cause psychotic symptoms include temporal lobe epilepsy, brain lesions and tumors, central nervous system infections and any severe medical condition requiring treatment in intensive care unit [34, 35]. Delirium is a condition characterized by disturbance of consciousness and cognition which may have psychotic symptoms as an associated feature [36, 37]. The etiology of delirium varies, including substance-induced delirium and delirium due to underlying general medical issues. Irrespective of the cause, associated challenges emanate within the shortest time possible and usually not consistent during the course of the day [37–39].

psychiatric disorders are: neuropeptides, epinephrine, norepinephrine, dopamine, acetylcholinesterase, 5-hydroxytryptamine, and Gamma-aminobutyric acid (GABA). In the hospital, many psychotic patients that are not confined to the bed and medication may be given and/ or administered at a central point rather than having a 'drug round'. In psychiatric units, patient's compliance may be a problem and it is often necessary to ensure that drug is taken [40, 41]. Occasionally, a patients' paranoia may extend to the drugs they are given. They may

Traditionally, antipsychotic drugs are classified as typical (classical) or atypical. The typical antipsychotic drugs are generally those that have been use for many years and common examples include; chlorpromazine, flupentixol, fluphenazine, haloperidol, and thioridazine [43]. The atypical antipsychotic drugs on the other hand, are more recent additions to the repertoire of drugs available. These drugs (e.g. amisulpride, clozapine, olanzapine, quetiapine, risperidone, zotepine) produce fewer adverse effects (e.g. tremor) on the motor system and

Almost all antipsychotic drugs have many different pharmacological actions that it is very difficult to relate any one action to a therapeutic effect [45, 46]. Effective antipsychotic drugs

Collectively, the drugs are quite useful in controlling the states of agitation observed/found in acute schizophrenia, mania and some other forms of delirium and in paranoia. Their exact mode of action in these conditions remains unknown but most of them block the action of

sedative and antipsychotic properties [48]. These drugs also inhibit the action of dopamine on chemoreceptor trigger zone of the brain and are thus antiemetic. Furthermore, drugs such as haloperidol prevent the action of the dopaminergic nerves that run from the substantia nigra to the corpus striatum. Disruption of physiological action of this system causes Parkinsonism

Contrary to phytotherapy that involves the use of medicinal plants, conventional therapy for psychosis is majorly by the use of medications. Others include cognitive therapy treatment, counseling, family or support group, the use of mood stabilizers etc. Cognitive therapy centers on identifying different patterns of thought (perception about situation) that brings about undesirable action or feelings. In some countries of the world particularly United Kingdom and United States, this kind of therapy is embraced (sometimes in combination with medications) as the most effective way of treating psychosis or psychosis-related disorder such as schizophrenia,

receptors in the mesolimbic system of the brain and this seems crucial to their

receptors in the brain [47].

The Ambit of Phytotherapy in Psychotic Care http://dx.doi.org/10.5772/intechopen.79547 73

think the staff members attending to them are trying to poison them [42].

may also help patients who do not respond to typical antipsychotic drugs [44].

**4. Mechanism of action of antipsychotic drugs**

dopamine on D2

**5.1. Conventional therapy**

share the ability to inhibit the physiological actions of dopamine D2

and these drugs may cause various disorders of movement and posture [49].

**5. Phytotherapy and the conventional therapies for psychosis**

#### **3. Conventional treatment and management options**

Many of the drugs that have been introduced for the treatment of psychotic disorders are known to interfere with the normal physiological actions of several of the brain neurotransmitters and their receptors. The major brain neurotransmitters that have been implicated in psychiatric disorders are: neuropeptides, epinephrine, norepinephrine, dopamine, acetylcholinesterase, 5-hydroxytryptamine, and Gamma-aminobutyric acid (GABA). In the hospital, many psychotic patients that are not confined to the bed and medication may be given and/ or administered at a central point rather than having a 'drug round'. In psychiatric units, patient's compliance may be a problem and it is often necessary to ensure that drug is taken [40, 41]. Occasionally, a patients' paranoia may extend to the drugs they are given. They may think the staff members attending to them are trying to poison them [42].

Traditionally, antipsychotic drugs are classified as typical (classical) or atypical. The typical antipsychotic drugs are generally those that have been use for many years and common examples include; chlorpromazine, flupentixol, fluphenazine, haloperidol, and thioridazine [43]. The atypical antipsychotic drugs on the other hand, are more recent additions to the repertoire of drugs available. These drugs (e.g. amisulpride, clozapine, olanzapine, quetiapine, risperidone, zotepine) produce fewer adverse effects (e.g. tremor) on the motor system and may also help patients who do not respond to typical antipsychotic drugs [44].
