Psychotic spectrum disorders: Definitions, classifications, neural correlates and clinical profiles

The term “psychosis”, offi cially introduced by Ernst von Feuchtersleben in 1845, refers to all those psychopathological forms of psychopathology characterised by severe alteration of the person’s psychic balance with impairment of reality examination, frequent absence or signifi cant impairment of insight, and frequent presence of thought disorders (such as delusions and hallucinations) [1,2]. For this reason, there are different clinical articulations of psychotic disorders [3], precisely according to the symptoms described and whether or not they are:

The age of onset of psychosis is variable, precisely because it depends on the symptomatology under examination; on the severity of the morbid condition and on the prognosis (in relation also to other organic diseases); in the case of childhood psychosis, however, there may be abnormal behaviour already in the fi rst year of life, but the average age range varies around 15-55 years, with a higher trend after 65 years for all the hypotheses linked to ageing and medical clinical conditions [3]. The aetiology of the disorder is, as for many medical conditions, multifactorial and largely unknown, but from a neurobiological point of view, psychotic symptomatology fi nds a correlation with organic alterations at various levels, or a marked genetic predisposition, or functional alteration of neurotransmitters such as dopamine, serotonin, glutamate, GABA, NMDA and endogenous peptides [19].
From a psychoanalytical point of view, on the other hand, psychoses are correlated with a break in the relationship of the Ego with external reality, due to the pressure of the Ex on the Ego. According to Sigmund Freud, the Ego gives in to the Ex and then partially recovers the construction of its own reality through delirium, recovering the objective relationship. According to psychoanalyst Melanie Klein, psychoses are linked to the fall into the schizoparanoid position of early childhood, while according to psychologist and analyst Carl Gustav Jung in psychoses there are unconscious autonomous complexes over the Ego complex, which is unable to maintain control over unconscious formations. According to Otto Kernberg, psychosis is distinguished from neurosis by the "spreading of identity" and the implementation of primitive defence mechanisms (primitive idealization, devaluation, splitting, projective identifi cation, denial, omnipotence), which protect the individual from disintegration and fusion of self with the object, with regression in the face of interpretation. Another distinctive element is the loss of the perception of reality. In fact, unlike neurosis, the psychotic is unable to accept elements of the reality that surrounds him, and a different representation of it is created. From the point of view of existential psychology, Karl Jaspers speaks of psychotic experiences when these are experienced as incomprehensible to the subject because of the way in which they arise from psychic activity, causing the ontological conditions of existence (time, space, coexistence, planning) to decline. The social orientation of psychiatry also expresses an interpretation linked to the socio-environmental and relational context, which, as we have seen, is decisive for the integration of psychotic patients and their rehabilitation [2].

Psychopathological classifi cations with psychotic orientation and their neural correlates
Argumentative premise: The categories we will examine will follow the DSM-V's nosographic criteria [20]. Schizophrenia: On a scale of severity, "Schizophrenia" undoubtedly represents the most serious form of impairment of the reality plane that a subject can experience, as it represents the chronic psychosis par excellence, characterised by the persistence of symptoms of alteration of cognitive and perceptive functions, behaviour and affectivity, with a course of more than six months, and with strong maladaptation of the person, that is to say a severity such as to limit or compromise normal life activities [3].
The term was coined by the Swiss psychiatrist Eugen Bleuler in 1908 (describing the main symptoms as the 4-A: fl attening of Affection, Autism, Reduced Association of Ideas and Ambivalence) and derives from the Greek σχίζω (schízō, 'I divide') and ΦΡΗΝ (phrḗn, 'brain'), i.e. 'splitting of the mind': it replaced that of 'Dementia praecox', formulated by Arnold Pick in 1891. The history of schizophrenia is complex and does not lend itself easily to a linear narrative. Descriptions of syndromes similar to schizophrenia rarely appear in historical documents prior to the 19th century, although tales of irrational, incomprehensible or uncontrolled behaviour are common. The fi rst cases of schizophrenia reported in medical literature date back to 1797, thanks to the works of James Tilly Matthews and publications by Philippe Pinel in 1809. Early dementia was the term used in 1891 by Arnold Pick to classify a case of a psychotic disorder. In 1893 Emil Kraepelin introduced a distinction in the classifi cation of mental disorders between early dementia and mood disorders (which included unipolar and bipolar depression). Kraepelin believed that early dementia was primarily a disease of the brain and in particular a form that differs from the others, such as Alzheimer's disease, which generally occurs at a later age. There are those who argue that the use of the term, in 1852, of démence précoce by the French doctor Bénédict Morel was the medical discovery of schizophrenia. However, this consideration does not take into account the fact that there is little data linking Morel's descriptive use of the term and the autonomous development of the concept of the disease called early dementia, which occurred at the end of the 19th century [21][22][23][24][25][26]. Despite the etymology of the term, however, schizophrenia does not in itself imply any "double personality" or "multiple personality disorder", a condition with which it is often mistakenly confused in common language and which is instead present in some dissociative syndromes; rather, the term indicates the "separation of mental functions" typical of the symptomatic presentation of the disease [27].
Worldwide, there are about 25 million patients with this diagnosis and it occurs 1.4 times more frequently in males than females and usually appears fi rst in males. The peak onset age is between 20 and 28 years for males and between 26 and 32 years for females. The onset in paediatric age is much rarer, as is the onset in middle or old age [28][29][30][31].  [32][33][34][35][36][37][38][39] Estimates of heredity vary due to the diffi culty of separating the effects of genetics from those of the environment. The highest risk of developing schizophrenia is in the presence of a fi rst-degree relative with the disease (6.5% probability). More than 40% of homozygous twins of patients with schizophrenia are also affected. Many genes are likely to be involved, each with small effects and unknown transmission and expression mechanisms. Many possible candidates have been proposed, including: a) specifi c copy number variations such as for the NOTCH4 gene and loci of hystonic proteins (there appears to be signifi cant overlap between the genetics of schizophrenia and bipolar disorder); b) microdeletions in the 22q11 region are associated with a 30fold higher than normal risk of developing schizophrenia; c) some GWAS studies have found a link between the 804A zinc fi nger protein and schizophrenia. Assuming a hereditary basis, a question from evolutionary psychology is why genes that increase the risk of psychosis have evolved, assuming that the condition would be maladaptive from an evolutionary point of view; one idea is that such genes are involved in the evolution of language and human nature is only a theoretical hypothesis. [40][41][42][43][44]. These are factors that often act as adjuvants and never as the main cause of the onset of schizophrenia. Studies have shown that living in an urbanized environment, during childhood or adulthood, is related to a double risk of developing schizophrenia, even taking into account drug use, ethnic group and social group size. Other factors that play a very important role are social isolation and social hardship due to immigration, racial discrimination, family problems, unemployment, precarious housing conditions and family/ domestic violence. [45][46][47][48][49][50][51][52]. The direct correlation between the onset of schizophrenia (and other psychotic forms) and the use of amphetamines, cocaine and cannabis, in subjects with a genetic and clinical tendency, has been confi rmed not as a trigger but as a competing factor. In particular, it has been noted that schizophrenia patients have a greater tendency to use nicotine than the general population. [53]. The presence in the mother of problems such as infection, hypoxia, stress and malnutrition during fetal development can cause a slight increase in the risk of developing schizophrenia in the unborn child during her lifetime. In fact, people born in winter in the northern hemisphere are more likely to be diagnosed with schizophrenia; this can be explained by increased rates of viral exposure in utero. However, the difference varies between about 5 and 8%. [54][55][56][57][58][59][60][61][62][63][64]. Many psychological mechanisms have been held responsible for the development of schizophrenia, such as psychological trauma and child attachment disorders. Various cognitive bias have been identifi ed in patients diagnosed with schizophrenia or in individuals at risk, especially when they are under stress or in confused situations. Some cognitive functions may also refl ect global neurocognitive defi cits, such as memory loss, while others may be related to particular problems and experiences.

5) Psychological factors
Although not always apparent, however, some results from recent studies indicate that many individuals diagnosed with schizophrenia are emotionally sensitive, particularly to stressful or negative stimuli, and that such sensitivity may cause greater vulnerability to symptoms or illness. Other data suggest that the themes of delusions and psychotic experiences may refl ect the emotional causes of the illness and that the way a person interprets such experiences may infl uence the symptomatology, not surprisingly the use of "safety behaviours" to avoid imaginary threats may contribute to the chronicity of delusions. [65][66][67][68][69][70][71]

From DSM-V, the evaluation criteria are as follows [3]
A) Two or more of the following symptoms, present for a signifi cant part of time during the period of one month. At least one of these symptoms must be:  Please also specify 1) The following course indicators should only be used after one year of the duration of the disorder and if they do not contradict the diagnostic course criteria; 2) fi rst episode, currently in acute episode; 3) fi rst episode, currently in partial remission;

4)
fi rst episode, currently in complete remission;

Delusional disorder
"Delusion" [88] (or incorrigible misconception) is a term used to refer to a disturbance in the content of thought, which can be present in various psychic illnesses, e.g. schizophrenia, depressive or manic episodes with psychotic symptoms, chronic delusional disorder (or paranoia). This is a misjudgement of reality that is not corrected by criticism or experience, as the decisions and behaviours that are adopted serve to self-confi rm this pattern of thinking. Chronic forms of delirium, based on the rational and lucid elaboration of a system of erroneous beliefs, may be the only symptom of a psychic pathology, in this case in particular chronic delusional or paranoid disorder. The numerous forms of delirium can be classifi ed from different points of view, for example according to the physiological cause, duration, or symptomatology. In its "hyperactive form", it manifests itself mainly as severe confusion and disorientation, develops with a relatively rapid onset and tends to fl uctuate in intensity; in its "hypoactive form", it manifests itself with a sudden withdrawal from interaction with the outside world (things and people).
Among the specifi cations of the term delirium we can mention the following most important and frequent ones:

1) Collapse delusion: A transient condition that occurs
frequently in acute illnesses, coinciding with the cessation of febrile states; 2) Reference delusion: The patient attributes a special meaning to objects, events or people close to him; 3) Touch delusion: It consists in the excessive mania of touching certain objects;

4) Nihilistic delusion:
It is found in melancholic depressions, and is made up of an incoherent mass of negative ideas;

5) Oneiric delusion:
It consists in a disturbance of the conscience that leads to emotions similar to those present in the oneiric phase (the conscience of the disturbed person enters a phase such that it is unable to distinguish reality from the oneiric profi le of itself);

6) Professional or occupational delusion:
It consists in recreating, on the patient's part, the usual conditions and places of work;

7) Residual delusion:
Represented by the persistence of delusional representations at the level of thought, even after the perturbation has ceased;

8) Interpretative delusion:
The subject interprets random facts as facts linked to him, feeling that he is the main actor or feeling indicated as a party in the case;

9) Persecution delusion:
The patient believes he is the object of persecution (a situation often identifi ed also with the term paranoia);

10) Bizarre delusion:
The patient adheres to a system of totally implausible beliefs (in the culture of reference);

11) Control delusion:
The patient is convinced that his thoughts or emotions are under the control of some external force;

12) Insertion delusion:
Similar to the previous one; the patient is convinced that some of his thoughts are imposed on him by an external force;

13) Erotomanic delusion:
The patient is convinced that a certain person (often a celebrity) is secretly in love with him;

14) Jealousy delusion:
The patient has the unfounded and obsessive belief that he is betrayed by his partner.
Among delusions, it is the most frequent;

15) Delusion of grandeur (megalomania):
The patient has the conviction that he is extremely important, for example, that he has been chosen by God to carry out a mission of fundamental importance, or that he is the only holder of extraordinary knowledge or powers;

16) Somatic delusion:
The patient is convinced that his body has something unusual, such as a rare disease, some kind of parasite or an unpleasant smell;

17) Religious delusion:
The patient is convinced that religious forces (almost always belonging to his own religion) protect him from misfortune, or from a disease (real and existing); it a sense, even if questionable, we are in the presence of a schizophrenic language that cannot be understood [2,89].

Paranoid personality disorder
It is a personality disorder characterised by distrust and suspicion that leads to the interpretation of other people's motivations as malevolent for their own person or for the people the paranoid loves (children, parents, family members...). Individuals who mature this personality structure are dominated in a rigid and pervasive way by fi xed thoughts of persecution, fears of being harmed, and the constant fear of being betrayed even by loved ones, without the intensity of such thoughts reaching delirious characters. The "examination of reality" remains, in fact, intact. According to the psychodynamic perspective, these personality characteristics are mainly attributable to a massive use of the projection defence mechanism, through which the characteristics considered bad belonging to one's own person are attributed, projected outside, on other people, or on the whole environment, which will thus be perceived as constantly hostile and dangerous for the survival of the individual. Paranoid Disorder is the result of a collection of behaviours, tendencies or personality characteristics that are mainly found in individuals who are then classifi ed as suffering from Paranoid Disorder. We speak of "distrust and suspicion" towards others if there are four or more of the following characteristics: unrealistic suspicions of being exploited or damaged; unjustifi ed doubts about the loyalty of friends; fear of trusting others; misunderstanding of other people's words, such as simple reprimands or other, to more threatening meanings prevalence of resentment towards others; unjustifi ed feeling of being attacked or harmed, and tendency to react; unjustifi ed fear of being betrayed by the spouse. There are also more serious illnesses, which present the typical paranoid symptoms, but are no longer part of the diagnosis of personality disorder. If the persecutory ideas have a delusional content, we then speak of paranoid psychosis or "lucid delirium" (paranoid schizophrenia). From the psychodynamic point of view, its collocation is well understood: the mechanism of projection is a strategy of defence of the ego considered primitive, i.e. used in a massive way in very early childhood. In adulthood, projection will be used in a more attenuated way (in common language, it is called paranoia), and tolerable for adaptation, which also presupposes the exercise of trust or, in Melanie Klein's words, gratitude. In individuals whose personality structure leads the Ego to employ a massive use of projection and other archaic defences as the main adaptation strategy, one has a picture of Paranoid Personality Disorder [90].

Schizoid personality disorder
In this personality disorder, the main trait is the lack of the desire for close relationships with other human beings, and the emotional "detachment" of the subject from people and the surrounding reality. The schizoid personality manifests closure in itself or a sense of distance, elusiveness or coldness. The person tends to isolation or has formal or superfi cial communicative relationships, does not appear interested in a deep bond with other people, avoids involvement in intimate relationships with other individuals, with the possible exception of fi rst degree relatives. The schizoid subject, on clinical examination, shows a pervasive tendency to live emotionally in a rigidly separated "own world" of the external world of social relations, and his own idea of the self is affected by uncertainties. In some cases he manifests "coldness" on the outside with attitudes of rejection, discomfort, indifference or contempt (perhaps addressed to unrelated personalities), or other modes of closure, elusiveness, emotional block or detachment. The situations that trigger the schizoid response, i.e. the manifestation of symptoms, are generally those of an intimate nature with other people, such as expressions of affection or confrontation. The schizoid person is not able to express his/her emotional participation consistently and in a relationship context; in contexts where spontaneity, sympathy or affability is required, he/she appears rigid or clumsy. In superfi cial relationships and formal social situations -such as work and regular situations -the subject may appear normal.
A typical characteristic feature of the schizoid personality is the absence or reduced ability to feel real pleasure or interest in any activity (anhedonia). In the individual experience of the schizoid patient prevails a sense of emptiness or lack of meaning, referring to his or her external existence: the subject is unable to derive pleasure from external reality, nor to perceive himself or herself as fully existing in the world. The schizoid subject often appears to be a person who tends to be insensitive to manifestations of emotional participation or judgements of others -e.g. encouragement, praise or criticism -i.e. he or she may appear to be a 'little infl uential' personality. Low fear in response to physical danger, or higher-than-normal tolerance of pain, can also be part of the picture. The introverted/ schizoid subject often presents a rich and articulated imagination and intense emotional experience, concentrating many of his emotional energies on cultivating a 'fantastic' inner world. By evoking memories of events concerning his emotional life he somehow satisfi es certain needs without actively participating in the real world. The schizoid response would be a profound defensive mechanism directed towards reality as such, unconsciously perceived as a source of danger or pain. The schizoid patient is clearly distinguished from the schizophrenic by the fact that the schizoid disorder does not affect the logical-cognitive abilities: the subject is fully aware of reality even though he or she does not participate emotionally. Psychosis, a state of mind whose persistence is a symptom of schizophrenia, is either absent in the schizoid or limited to short episodes characterised by strong tension. One can then speak of psychotic attacks -or schizophreniform disorder -as reactions of the schizoid to emotional stress. People with a schizoid disorder have little or no sex life, or are perceived as unfulfi lling in an emotional sense: by indulging in purely idealistic fantasies, schizoids can also indefi nitely postpone mature sexuality [4]. The schizoid individual is little attracted to building intense emotional relationships, and may show intolerance towards inter-personal intimacy. He may appear reluctant to talk about the intimate aspects of his own self or to know those of the self of other individuals. As follows, the diagnosis can only be made in adulthood, since the evolution of symptomatology is made at the transition from adolescence to maturity. The characteristics expressed by the if in the schizophrenic the mathematical logical processes are affected, and therefore he is not able to understand that there is a problem, in the schizoid instead, although he is a lucid subject, having a certain reluctance to open his self in front of others, the attempt to approach the subject can generate a strong closure or even a psychotic reaction. This is aggravated by the distorted image of his self that the subject may have built up over the years [91][92][93].

Schizotypical personality disorder
It is a personality disorder characterized by a tendency towards social isolation, an eccentric, typically vague or metaphorical style of communication and thinking, strange behavioural patterns, and unusual ideas or beliefs, usually involving "magic" thinking, unusual perceptions, mild paranoid ideation, and other minor manifestations. It is sometimes referred to as "schizotypy", although this is a slightly different nosographic entity, i.e., a psychic theory concerning pathologies of the schizophrenic spectrum but less severe than true schizophrenia, unlike schizotypic disorder which is a personality disorder, although often schizotypy (a word derived from schizophrenia and which refers to having a "split personality" as well as a contraction of "schizophrenic phenotype") -i.e. strangeness and eccentricity without the presence of real psychosis and with maintenance of insight (self-awareness of one's condition) -is often described as the typical characteristic of the disorder. Schizotypic patients have individualised or unconventional belief systems, for example they believe in "powers" or supernatural perceptions or phenomena. The typical thinking of these subjects is called "tangential", i.e. allusive and dispersive. It happens that sometimes they seem to be "brooding" about themselves. The subject has a peculiar way of dressing and presenting himself, sometimes scruffy, however always original, sometimes he can speak alone in a low voice in public, repeating his thoughts, or gesticulate lightly and without external reason. Patients suffering from this disorder have a high comorbidity with other personality disorders. This may be partly due to the fact that the criteria described in the DSM-5 and previous DSMs include parameters that are also in common with other disorders, creating areas of overlap. The other personality disorders that at fi rst glance share some traits with the schizotypical disorder are: the schizoid disorder (also cluster A), as regards the subject's tendency to isolate himself from others and the possible presence of anhedonia towards many areas, except specifi c interests; the avoidant disorder (cluster C), which also presents symptoms of anxiety and worries -over which the subject has no control -linked to interactions with others, from which the patient tends to isolate himself; the borderline personality disorder (cluster B), due to unstable emotionality (rapidly fl uctuating mood) and fear of social and personal rejection, with possible sporadic psychotic symptoms such as derealization and depersonalization, anger, apathy, sudden mania or melancholy, and dissociation; as in covert narcissism (cluster B), the patient feels unique and particular, not understood by others, devalued; fi nally, fi xed ideas, which are the main feature of the paranoid personality disorder (cluster A): obviously there is no clear and precise boundary between simply "strange" ideas and paranoid fi xed ideas, although they are two different and recognisable styles. However, these patients are usually inhibited or blocked in social and personal relationships, or face them in an atypical way (having a lot of diffi culty in coping or adapting strategies), thus appearing strange in the eyes of unfamiliar people and thus feeding a closed circle of mutual distrust. Sometimes, in the case of an uncertain diagnosis, schizotypical traits, or cluster A traits (eccentricity, paranoia, isolation) are mentioned. The schizotypic therefore presents the so-called "paranoid ideation", but without reaching the extremes of the true paranoid, and tends to attribute more negative characteristics to other individuals (a condition that is also possible in the avoider), instead of devaluing himself as in the avoider disorder, and does not often perceive his inadequacy, projecting it on others (worrying about possible damages that they could do to him: for example cheating him, using him, defaming him, acting "magically" B) Symptoms do not appear in conjunction with schizophrenia, nor with a psychotic mood disorder, nor with other psychotic disorders or developmental disorders. Theodore Millon [3] proposed two types of schizotypy, although they could coexist. In fact, any individual with a schizotypical personality disorder may exhibit one of the following subtypes differently (note that Millon claims that pure variant personality is rare, but rather a mixture of a major variant with one or more minor variants is often likely): a) "insipid", i.e. excessively passive and detached, with traits of extraneousness and non-being; openly grey, lazy, inexpressive; internally insipid, sterile, indifferent and insensitive; "dark", vague and tangential thoughts; b) "fearful", i.e. excessively active and detached, with traits of strong suspicion, excessive sensitivity, alienation and disqualifi cation of one's own emotions and feelings.

Schizoaffective personality disorder
The schizoaffective disorder, fi rst described by Kirby in 1913 and taken up by Hock in 1921 and Kasanin in 1933 with the fi nal defi nition, is characterised by being a condition in which a subject suffers from a whole series of symptoms related to schizophrenia in combination with a group of symptoms specifi c to mood-related illnesses, such as mania or depression. In the fi rst case, these are mainly symptoms such as delusions or hallucinations. In most cases this type of problem is detected with considerable diffi culty, just like all other mental illnesses. Schizoaffective disorder, in fact, can be considered as a sort of mixed condition between symptoms belonging to various mental illnesses. If it is not treated adequately, this type of disorder can lead to a signifi cant reduction in the patient's quality of everyday life. Often, the patient tends to isolate himself or herself from all those closest to him or her and presents numerous social and integration problems. The proposed treatment can certainly improve symptom control and, at the same time, promote a better quality of life [98]. D) The disorder is not attributable to the effects of a substance or other medical condition.

Brief psychotic distortion
This disorder consists of delusions, hallucinations or other psychotic symptoms (such as disorganised speech and macroscopically disorganised or catatonic behaviour) that last at least 1 day but less than 1 month, with subsequent return to normal pre-morbid functioning. Pre-existing personality disorders, as well as certain clinical conditions (of an autoimmune and systemic nature) predispose to its onset. A major stressful event, such as grief, can trigger the disorder.
A brief psychotic disorder, however, cannot be diagnosed if the symptoms are better attributable to a mood disorder with psychotic manifestations, schizoaffective disorder, schizophrenia, organic disorder or the adverse effects of a (prescribed or illegal) substance [3].

Psychotic collapse or slippage
A "psychotic break-down" or "psychotic break-down" is a circumscribed and identifi able event in the history of a person who often precedes the chronicisation of a real psychotic disorder. More often than not, events of a traumatic nature have been described as serious violations of personal dignity and the integrity of the body, which in a psychic structure considered "theory of predisposition to pre-psychotic psychosis" causes a defi nitive psychic collapse typical of psychosis, leading to a withdrawal of emotional investments and the most common psychic activities from the environment. Other times the psychotic collapse is associated with a highly stressful event or period which, having reached an excessive accumulation, tests the individual to the point of triggering a psychotic crisis that can remain in chronic disorder. Also in this case the event is added to a weakened, "predisposed" structure.
According to some research carried out on hallucinogenic substances (Gregory Bateson's well-known ones on himself with LSD), this kind of drug is able to reproduce some of the most common forms of delusions and hallucinations found in psychosis, while maintaining the awareness of the infl uence of the substance intact, without precipitating the user into total detachment from reality in the long term. However, it may happen that, in individuals "predisposed" to various forms of psychosis (the constitutional or environmental nature of this type of disorder has always been the subject of discussion), the use of hallucinogenic substances may favour a psychotic break-down [3].

Catatonic disorder
Catatonia" [3,99] In the most serious cases it is complicated by delirium, with disorientation and inconsistency of speech.
In the differential diagnosis of catatonia, the following should be taken into consideration

Bipolar disorder. Reasons for exclusion
Bipolarity is characterised by a more or less constant oscillatory alternation or with the prevalence of one of the de polarities (depressive or manic); therefore, it is a disturbance of mood alteration. In the past, although it was a syndrome identifi ed with the label of "manic-depressive psychosis", today it is universally classifi ed separately from the psychotic spectrum, precisely because of its nosographic characteristics, although certain symptoms may be common (suicidal tendency [100], hallucinations and delusions, during severe depressive and/or manic episodes). For these reasons, the writer suggests a different classifi cation of this psychopathological category [18].

Clinical treatments
The best clinical treatment in psychotically oriented psychopathologies is always the integrated one, between psychotherapy (cognitive-behavioural, family, bodily and/ or strategic, which favours the early recognition of the symptomatology, in terms of consciousness, knowledge and awareness) [101][102][103][104] and psychopharmacology, bearing in mind that the preventive profi le with respect to the onset of the disease can only be oriented towards avoiding the use of drugs and alcohol, and in the hope of an evolution of growth far from psychological trauma and destabilising events.

1)
Compared to the psychopharmacological profi le it is interesting to focus on the following data: 2) The primary treatment of "schizophrenia" [105][106][107][108][109][110][111][112][113][114] involves the use of antipsychotic drugs, often in combination with psychological and social support. Other studies have investigated the usefulness of compounds classifi ed as supplements, e.g. high doses of N-Acetyl Cysteine have shown several benefi cial effects, although future studies will be necessary to further clarify their effi cacy in disorders of the disease spectrum and effects on cognition.
3) The treatment of "delusion" and "paranoia" [3] is generally compensatory. The delusional disorder generally does not lead to serious deterioration or change in personality, but delusional concerns may gradually worsen, which is more pronounced in the paranoid disorder. Most patients may continue to work as long as their work does not involve aspects related to their hallucinations. Treatment aims to establish a good doctor-patient relationship and to manage complications.
Substantial lack of insight is a challenge to treatment and only if patients are assessed as dangerous, hospitalization may be necessary. Among other things, there is insuffi cient data to support the use of any particular drug, although anxiolytics combined with antipsychotics can sometimes eliminate symptoms in acute and chronic phases; the best choice is psychotherapy, shifting the patient's main area of concern from delusional to a more constructive and rewarding one, making it a diffi cult but reasonable long-term treatment goal.

4)
The treatment of "schizoid" [3] is generally combined, with a pharmacological prevalence oriented on SSRI antidepressants and low-dose neuroleptics.

5)
The treatment of "schizotypic" and "schizoaffective"  [3,115] is the use of typical antipsychotics, such as haloperidol, and atypicals such as risperidone, quetiapine, aripiprazole and olanzapine (to be used with caution in patients subject to hypersensitivity linked to dopamine decrease), but also of anticonvulsants (such as sodium valproate) and SSRIs (especially if there is comorbidity with obsessive-compulsive disorder or depression or bipolar disorder) is considered a fairly effective treatment, together with cognitive-behavioural psychotherapy as a support. The schizotypical and schizoaffective patient must also avoid the use of certain types of synthetic drugs such as methamphetamine during life, which have been shown to signifi cantly increase the risk of developing psychosis in these subjects.

6)
The treatment of the patient with "short psychotic episode" [3] is similar to the treatment of an acute exacerbation of schizophrenia, but short-term monitoring and treatment with antipsychotics may be necessary.

7)
Treatment of the "catatonic" patient [99] is similar to treatment of acute exacerbation of schizophrenia, but short- When the pharmacological treatment fails, a cycle of ECT must be started.

Conclusions
The psychotic spectrum is the category that groups together a series of disorders linked to a symptomatology in which we witness the fragmentation of the plane of reality until it is completely broken. According to the DSM-V nosography, the disorders under examination are schizophrenia, delusional disorder, paranoid disorder, schizoid disorder, schizotypic disorder, schizoaffective disorder, short psychotic disorder, psychotic break and catatonia. In this work, theoretical and practical profi les were analysed, paying attention to neurobiological content and therapeutic profi les, both psychotherapeutic and psychopharmacological. A note of disappointment was made in the nosographic categorisation of dissociative disorders that currently would not be included in the psychotic spectrum disorders, although from the elements that emerged it would be interesting to review them in this way.