The term psychotic or psychosis has been used in many different ways over time. In the past, it implied severity. When used in this context, someone with a condition like obsessive-compulsive disorder (OCD) might be called psychotic if that condition was extremely impairing. In the contemporary definition, this term refers to the presence of particular types of psychiatric symptoms, specifically: hallucinations (a sensory perception in an absence of an actual stimulus) and/or delusions (fixed false beliefs that are not held within the person’s subculture). A broader definition of psychosis would also include prominent disorganization in thinking, speech, and behavior.
While these kinds of symptoms are not specific to any one psychiatric disorder (for example, they may be seen as a part of depression, dementia, or drug intoxication), they are characteristics of a group of disorders including and related to schizophrenia. In addition to schizophrenia, these include schizoaffective disorder, schizophreniform disorder, delusional disorder, and brief psychotic disorder.
Schizophrenia is fairly common, occurring in approximately one percent of the population worldwide. The onset tends to be in late adolescence or early adulthood, and the course tends to be persistent, although there is much variation in outcome.
The Department of Psychiatry at the University of Iowa has a long and rich tradition in both research and treatment of psychotic disorders. It was one of the earliest departments to staunchly advocate that these disorders were a biological illness of the brain, helping to turn the tide of stigma that so often complicated an already challenging situation. Moreover, faculty in the department have substantially contributed to the way psychotic disorders are diagnosed and defined as well as to the understanding of underlying brain abnormalities in people with psychotic disorders.
University of Iowa Hospitals and Clinics has a secure, 22-bed inpatient unit dedicated to caring for adults with schizophrenia and other psychotic disorders. Doctors and nurses with a particular expertise or interest in these disorders staff the unit.
Hospitalization is typically limited to those times when there is an immediate concern for a patient’s well-being. A comprehensive diagnostic evaluation or reevaluation is completed, along with a funcitonal and neuropsychological evaluation if necessary. From this, an individualized treatment plan that includes both recommendations for somatic treatments (e.g. medications) as well as psychosocial interventions (e.g. need for supported community living services) is developed. While on the unit, patients typically attend a variety of group sessions where they learn coping skills and participate in occupational and recreational therapeutic activities.
An average stay on the unit is seven days or less. While it is not expected that most patients will fully recover in this time frame, their stay on the unit will hopefully allow them to safely turn a corner, after which treatment can be continued in a less restrictive setting.
Comprehensive diagnostic evaluations and treatment plans for individuals with psychotic disorders are most commonly done on an outpatient basis. Patients may be self-referred or referred by their primary care physician or other health care provider to the Adult Psychiatry Outpatient Clinic at University of Iowa Hospitals and Clinics.
Ideally, a patient's past medical records are made available prior to the initial appointment, which lasts about 90 minutes. After the initial appointment, patients can choose to resume care with a mental health care provider in their community or continue care in our clinic. Follow-up appointments in our clinic last about 30 minutes. As this is a teaching hospital, many patients followed in our clinic see both a resident psychiatrist as well as a faculty psychiatrist.
The Adult Psychiatry Outpatient Clinic schedules appointments Monday through Friday from 8 am to 5 pm. It is located in University of Iowa Hospitals and Clinics near Elevator I, Level 1. To reach the clinic, please call 319-353-6314.
IMPACT stands for Integrated Multidisciplinary Program of Assertive Community Treatment.
Assertive community treatment (ACT) is an evidence-based model of treatment for individuals with severe and persistent mental illness for whom traditional approaches have been ineffective. In general, individuals in assertive community treatment programs have a primary diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or chronic major depression. Many of these individuals also have substantial problems with substance use. The goal of this type of treatment is to assist individuals with these disorders meet their goals of independent living and reduce their need for hospitalization.
For patients with schizophrenia and other psychotic disorders who also have substantial problems with substance use, the Dual Diagnosis Track in the Partial Hospital provides a short-term (about two weeks), intensive set of services that focus specifically on individuals with these co-occurring disorders.
To reach the Partial Hospital, please call 319-384-8765.