PS4.1 | Psychotic Disorders — Glossary

The blood count parameter mandatorily monitored in all patients on clozapine to detect agranulocytosis early; clozapine must be withheld if ANC falls below defined thresholds.

A potentially fatal bone-marrow suppression resulting in critically low granulocyte (neutrophil) counts; the most serious haematological adverse effect of clozapine, necessitating a mandatory ANC monitoring programme.

A subjective sense of inner restlessness and compulsion to move, often experienced as an inability to sit still, occurring as an extrapyramidal side effect of antipsychotics — a leading cause of medication non-adherence.

The most effective antipsychotic available, reserved for treatment-resistant schizophrenia; its use is limited by the risk of agranulocytosis (1–2%), requiring mandatory weekly-to-monthly monitoring of the absolute neutrophil count.

A fixed, false, firmly held belief that is out of keeping with the patient's cultural and educational background and that persists despite clear contradictory evidence.

The neurochemical model of schizophrenia proposing subcortical mesolimbic dopaminergic hyperactivity (underlying positive symptoms) and prefrontal mesocortical dopaminergic hypoactivity (underlying negative and cognitive symptoms).

A group of movement disorders caused by dopamine D₂ blockade in the nigrostriatal pathway, including acute dystonia, akathisia, drug-induced parkinsonism, and tardive dyskinesia — most pronounced with first-generation antipsychotics.

A perception occurring without an external stimulus — in schizophrenia most commonly auditory (hearing voices), though visual, olfactory, and tactile hallucinations may occur.

Indian legislation governing the rights of persons with mental illness, decriminalising suicide attempt, establishing advance directives, and recognising nominated representatives; replaced the Mental Health Act 1987.

A cluster of metabolic abnormalities — central obesity, hyperglycaemia, dyslipidaemia, and hypertension — associated particularly with atypical antipsychotics (especially clozapine and olanzapine), increasing cardiovascular risk.

Deficits or reductions in normal psychological functions in schizophrenia, encompassing avolition, alogia, anhedonia, affective flattening, and asociality (the 5As).

A rare but life-threatening emergency associated with antipsychotic drugs, characterised by hyperthermia, generalised lead-pipe muscular rigidity, autonomic instability, and markedly elevated serum creatine kinase.

Psychotic experiences that are added to normal mental functioning, including delusions, hallucinations, disorganised thinking, and disorganised behaviour — present in health they are absent.

The pre-psychotic period in schizophrenia characterised by non-specific symptoms (social withdrawal, declining function, odd beliefs, perceptual distortions) that precede the first frank psychotic episode, sometimes by months to years.

A structured educational intervention for patients and families about the nature of a mental illness, its course, treatment options, and early warning signs of relapse — the most evidence-based psychosocial intervention in schizophrenia.

A potentially life-threatening drug reaction caused by excessive serotonergic activity, characterised by the triad of altered mental status, autonomic instability, and neuromuscular abnormalities (clonus, hyperreflexia, myoclonus) — distinguished from NMS by rapid onset and serotonergic agent history.

Late-onset, often irreversible involuntary choreiform movements (particularly orofacial — lip smacking, tongue rolling, chewing) caused by prolonged dopamine D₂ receptor blockade, most commonly with first-generation antipsychotics.

Formal disturbance in the organisation or flow of thinking, manifesting as loosening of associations, tangentiality, circumstantiality, neologisms, or, in severe cases, word salad.

Schizophrenia that fails to respond to at least two adequate antipsychotic drug trials (different classes, adequate dose, adequate duration of ≥4–6 weeks); the threshold criterion for initiating clozapine therapy.