What is Psychosis?
Psychosis is a condition that causes people to lose touch with reality by presenting a mix of psychological symptoms. Current studies suggest that while about 1.5 to 3.5% of people will be diagnosed with a psychotic disorder, a notably larger number of people will experience at least one symptom of psychosis in their lifetime. It’s common for psychosis to arise in several situations such as psychiatric, neuropsychiatric, neurological, and developmental conditions, as well as certain physical health problems. It is a defining characteristic of schizophrenia and similar disorders, often accompanies mood and substance abuse disorders, and can signify complications in many neurological and physical conditions. For both the individual experiencing psychosis and their families, it can be very distressing, making it a key focus of treatment for doctors.
What Causes Psychosis?
Psychosis, which is a condition that impacts the way your brain processes information and can result in hallucinations or delusions, can be caused by many different factors. This can include mental health disorders, substance use, or other physical health conditions. Some studies have found that people who have psychotic disorders for the first time often have less gray matter in certain areas of their brain.
It’s also thought that primary psychotic disorders, which are disorders whose main symptom is psychosis, are developmental issues that start before we’re born. Although these diseases may originate in the womb, environmental factors, like drug abuse and stress, immigration, infections, childbirth or other health problems, often trigger the first break with reality.
Researchers have found clear evidence that genetics may increase your risk of developing a psychotic disorder, further highlighting the role of both nature and nurture in the development of these complex conditions.
Risk Factors and Frequency for Psychosis
Experiencing a first-time episode of psychosis occurs in roughly 50 out of every 100,000 people, and the chance of being diagnosed with schizophrenia is about 15 in every 100,000 people. Regarding age, men are most likely to develop these conditions from their teens to their mid-20s. Women, on the other hand, are prone from their teens to their late 20s. It’s important to know that the earlier these conditions start, the worse the outcomes can be, though getting help early leads to better results. However, it’s extremely rare for children to experience psychosis.
Signs and Symptoms of Psychosis
The fifth edition of the Diagnostic and Statistical Manual (DSM-V), the main resource for psychiatric diagnoses, describes “psychosis” according to abnormalities in five areas, instead of providing a fixed definition. To better understand “psychosis”, consider these five categories:
- Delusions
- Hallucinations
- Disorganized thought
- Disorganized behavior
- Negative symptoms
Delusions are unreal beliefs that a person is convinced of, regardless of contrary facts. There are many types, like persecutory delusions (believing someone is out to get them), referential delusions (believing that things in their environment are meant for them), grandiose delusions (holding unrealistically grand ideas of oneself), erotomanic delusions (believing others are in love with them), and more. Delusions can be bizarre (absurd and impossible) or non-bizarre (unlikely but possible).
Hallucinations are experiences that are perceived without external triggers. They can involve any sense (vision, hearing, smell, taste, touch), even though hearing hallucinations are common in schizophrenia. Alcohol withdrawal often leads to visual and touch hallucinations, while visual hallucinations feature in Lewy body dementia.
Disorganized thought can be noticed through a person’s speech or communication. People with psychosis might have loose associations (unrelated or loosely related thoughts), circumstantial thought (overly detailed answers to questions), tangential thoughts (always changing the topic), neologisms (made-up words or phrases), or perseveration (repeating words and statements).
Disorganized behavior indicates difficulties in accomplishing goals, leading to a decline in daily function. Someone with psychosis might have unexpected or inappropriate emotional responses, lack self-control and inhibitions, or exhibit unusual behaviors. Catatonic behavior, where a person responds minimally or not at all to their surroundings, is another form of disorganized behavior.
Negative symptoms refer to a decrease or loss in typical function. These might be confused with depression symptoms. They often appear in the early stages of schizophrenia and can include an absence of expression or emotion, minimalist or monotone speech, low energy levels, lack of concentration, and a loss of interest in enjoyable activities. Catatonia, which ranges from extreme negativism to uncontrolled excitement, is also a possible manifestation of psychosis.
Testing for Psychosis
When a doctor is determining the right treatment for any health condition – whether it’s physical or mental health – an in-depth conversation or “interview” with the patient is incredibly important. In this conversation, your doctor will cover a variety of topics to understand your situation fully. This could include when and how severe your symptoms are, previous health conditions you’ve had, any hospital stays, medications you’re taking, if you use any substances like alcohol or drugs, your social history, any history of trauma, and if you’ve ever experienced things like hearing or seeing things that aren’t there.
Your doctor will also carefully note what you look and act like during this conversation. They’ll listen to how you’re speaking, what your mood seems to be, and how you express your emotions. This is all part of what’s called the mental status exam (MSE), which is a key part of any mental health assessment.
In addition to this conversation, your doctor may also order a number of tests to make sure there aren’t any physical health problems contributing to your symptoms. This could include a urine test for drugs, a full blood count and tests to check how your metabolic system is working, a urine test, thyroid tests, liver function tests, a vitamin B12 test, an HIV test, scans of your brain using CT or MRI technology, an EEG to measure the electrical activity in your brain, a lumbar puncture (where a needle is used to take fluid from around your spine for testing), and possibly tests related to your immune system and how it might be affecting your health.
It’s important to keep in mind that some substances that can cause symptoms similar to a mental health condition might not show up on basic drug tests.
After all these tests have been done and the results are in, if a substance or medication isn’t found to be the cause, and if no other health condition is discovered that could explain your symptoms, your doctor might then diagnose a primary psychotic disorder. This means a mental health condition that isn’t caused by a physical health problem or a substance, but rather, it’s a condition on its own that needs treatment.
Treatment Options for Psychosis
If someone is showing signs of psychosis, which can include hallucinations, delusions, or disorganized thoughts, they should be evaluated by a psychiatrist as quickly as possible. Commonly, the best treatment method is the use of antipsychotic medications, but it very much depends on the individual patient and the specific circumstances.
These medications are generally used to treat conditions like schizophrenia. There’s been ongoing discussion in the medical field about whether second-generation antipsychotic drugs are more effective than the first generation, but the consensus is that all can be effective in the right circumstances.
Antipsychotic medications are also useful in treating psychosis that results from drug misuse, manic episodes, severe confusion, and severe depression. They can even be helpful in managing psychotic symptoms that come with dementia and other brain conditions. However, dealing with the root cause of the psychosis is always an essential part of the treatment.
When it comes to the actual symptoms of psychosis, these medications are particularly useful in treating positive symptoms like hallucinations and delusions, but can be less effective for negative symptoms, which include a lack of interest or emotional response. It’s important to know that antipsychotics can have considerable side effects, like movement disorders and changes to heart rhythm. Notably, two specific antipsychotics – clozapine and olanzapine – have been proven to help reduce suicide risk in people experiencing psychosis.
Alongside antipsychotics, benzodiazepines might be used if a person with psychosis is experiencing catatonic symptoms – states of immobility or overactivity.
Medication isn’t the only important aspect of managing psychosis. The significant role of family and caregivers in providing a safe and therapeutic environment cannot be overstated. Interaction with the patient should be calm and empathetic.
In situations where a patient becomes agitated and poses a risk to themselves or others, it may be necessary for hospitalization and professional healthcare assistance. While physical restraints would be avoided whenever possible, injectable antipsychotics coupled with benzodiazepines can be effective in these situations.
Besides medication, cognitive behavioral therapy (a type of talking therapy) can be incredibly beneficial in treating patients experiencing psychosis.
Finally, it’s crucial to understand that early intervention in cases of acute onset psychosis can significantly improve the clinical outcomes. Delays in treatment can lead to less favorable outcomes.
What else can Psychosis be?
When trying to tell the difference between psychoses (a severe mental disorder where a person loses touch with reality) linked to a primary psychotic disorder, and those related to other medical or neurological conditions, doctors look at several factors:
- Age of onset: This is a key factor in determining the cause of a psychotic episode. Primary psychotic disorders usually appear from the late teens up to the early thirties, often earlier for men than for women. Psychoses related to medical or neurological conditions usually appear after the age of 40, and the risk gets higher the older a person is, especially in a hospital setting.
- Pattern of onset: Primary psychotic disorders tend to show up subtly, often beginning with symptoms that can be mistaken for other mental disorders (for example, schizophrenia can be confused with depression in the early stages). Medical or neurological psychoses usually appear suddenly.
- Genetic link: There’s a stronger connection between family history and primary psychotic disorders than there is between family history and psychoses linked to medical or neurological conditions.
- When the disorder presents itself: Primary psychotic disorders often show up during major life changes (like moving, starting a new job, or breaking up), whereas psychoses linked to medical or neurological conditions usually show up in healthcare contexts.
- Type of hallucinations: Primary psychotic disorders are usually associated with hearing things that aren’t there (auditory hallucinations), while psychoses linked to medical or neurological conditions are usually associated with all other kinds of hallucinations (like seeing, feeling, or smelling things that aren’t there) except auditory.
Specific primary psychotic disorders, their subtypes, and all other psychotic disorders will be discussed in detail in other activities.
What to expect with Psychosis
It was once thought that schizophrenia always led to negative outcomes, but recent studies show that good outcomes are possible. There are now numerous new medications, including long-lasting injectable antipsychotics, that offer patients various treatment options and help with medication adherence.
As mentioned earlier, early detection and intensive treatment appear to be key for better long-term outcomes. However, there’s not enough data to confirm this for cases of psychosis that are linked to a medical or neurological condition; the prognosis would depend on the specific condition. Treating both the current psychotic episode and the underlying illness is generally considered the best approach.
Possible Complications When Diagnosed with Psychosis
During a psychotic episode, no matter the cause, there’s always a risk that the person might harm themselves or others. This requires immediate admission to a secure and therapeutic medical environment. Depending upon where you live, the rules for involuntary admission may differ.
Negative feelings like paranoia, fear, suspicion, and other symptoms of psychosis can stop a person from seeking help. They may also interfere with their willingness and ability to consistently take prescribed medication and adhere to their treatment regime.
Antipsychotic medicines often cause substantial side effects. These can range from movement-related issues (extrapyramidal symptoms) to metabolic syndrome, heart abnormalities, effects related to anticholinergic drugs (which affects nerve responses), sexual problems, and tardive dyskinesia (involuntary movements), among others.
People with psychotic disorders can see their ability to function in daily life significantly reduced, and they also have a higher risk of suicide compared to the general population. For example, about 5% of people with schizophrenia commit suicide.
Side Effects and Risks:
- Risk of self-harm or harm to others during a psychotic episode
- Challenges in seeking help and adhering to treatment due to symptoms of psychosis
- Substantial side effects from antipsychotic medication
- Decreased ability to carry out daily activities
- Increased risk of suicide
