Psychosis

Psychosis is a loss of contact with realism that usually includes false beliefs about what is taking place or who one is (delusions), and seeing or hearing things that don’t exist (hallucinations). People with psychosis may also experience disorganized thoughts and actions and may have personality changes.
An individual can experience psychosis for diverse reasons. For instance it can be due to a mental illness such as schizophrenia or a bipolar disorder. It can also be caused by drug use, brain injury or extreme stress or trauma.
Psychosis can be due to primary disorders or may have secondary causes. Primary psychotic disorders include schizophrenia, delusional disorder, schizoaffective disorder, organic disorder (for example, dementia), Parkinson’s and brief psychotic disorder. Secondary psychosis has many causes including psychoactive drugs and general medical conditions. It may also accompany another psychiatric condition.

SymptomsCausesTypesPrognosisDiagnosisTreatmentPreventionTips for Caregivers

Symptoms of psychosis may be divided into two categories:

  1. Early Stage Psychosis
  • Difficulty in concentration
  • Depressed mood
  • Changes in the pattern of sleep
  • Anxiety
  • Suspiciousness
  • Withdrawal from family and friends
  • Ongoing unusual thought and beliefs
  1. Later Stage Psychosis
  •  Delusions
  • Hallucinations
  • Disorganized speech
  • Depression
  • Anxiety
  • Suicidal thoughts or actions
  • Difficulty in day to day functioning
  • Brain diseases such as Parkinson’s disease, Huntington’s disease, and chromosomal disorders
  • Brain tumors or cysts
  • Dementia (including Alzheimer’s disease)
  • HIV, syphilis, and other infections that attack the brain
  • Types of epilepsy
  • Stroke
  • Experiences of stressful events
  • Genetic factors
  • Schizophrenia: The term schizophrenia denotes a type of psychosis in which an individual experiences some psychotic indications for at least six months with a substantial decline in the person’s ability to function.
  • Schizophreniform disorder:Symptoms are similar to Schizophrenia but persist for between one to six months.
  • Bipolar illness:Psychosis generally appears as part of more general severe mood elevations. Psychotic symptoms tend to match the mood. (For example, when depressed, one may hear voices urging to commit suicide.)
  • Schizoaffective disorder:During this type of psychosis, a person will experience symptoms of schizophrenia and symptoms of a mood disruption, either at the same time or alternating over time.
  • Major Depressive Disorder: Psychosis can be a feature of a severe major depression.
  • Substance-induced psychosis: The use of drugs such as marijuana, cocaine, LSD, amphetamines and alcohol can sometimes cause psychotic symptoms to appear. Once the effects of the drugs or alcohol wear off, the symptoms of psychosis will usually resolve. However, the symptoms themselves may require medical treatment.
  • Dementia: Psychotic indications appear with memory disturbances in conditions that cause physiological deterioration of the brain such as a head injury, Alzheimer’s disease or a brain tumor.
  • Delirium: Psychotic symptoms may be part of a severe state of confusion that results from another severe medical disorder such as meningitis, septicemia or after an epileptic convulsion.
  • Brief psychotic disorder: Sometimes symptoms of psychosis come on suddenly and, in some cases, are activated in response to a major stress in the person’s life, such as a death in the family. This type of psychosis usually lasts less than a month.
  • Delusional disorder: It consists of very strong and fixed beliefs in things that are not true. Changes in perception, such as hallucinations, are not seen in this illness. However, under some circumstances delusions are sufficiently false to cause problems with day-to-day life.

 

How well a person responds, depends on the cause of the psychosis. If the cause can be corrected, the outlook is often good, and treatment with antipsychotic medication may be brief.

Some chronic conditions such as schizophrenia may need life-long treatment with antipsychotic medications to control symptoms generally to deal with psychosis involve a combination of antipsychotic medicines, psychological therapies and social support. The outlook in patients with psychosis is not as bleak as it once was, due to the policy of early intervention and improvements in drug treatment. However, it must not be forgotten that psychosis can lead to disastrous consequences. For example, suicide can occur in any form of mental illness, although its incidence in psychotic disorders is not as high as was once thought.

When assessing a person suffering from psychotic symptoms, health-care professionals will take a careful history of the symptoms from the person and loved ones as well as conduct a medical evaluation, including necessary laboratory tests and a mental-health assessment. After assessments, the most effective treatments for psychotic disorders are comprehensive, involving appropriate medications, mental-health education, and support systems for the sufferer of psychosis. Psychosis appears to deteriorate rapidly in the early stages before reaching a level of stability. Any effective early intervention is therefore likely to improve the long-term prognosis.

Diagnosis is made based on history which includes details of evident symptoms. The diagnosis given will depend upon how severe psychosis is, how often it’s experienced, and whether experienced on its own or with other symptoms. As psychosis can be a symptom of several different diagnoses, one may find that different diagnoses are given at different times. Before a diagnosis is given, the doctor will also rule out if there are any physical causes for psychosis.

Treatment depends on the cause of the psychosis. Care in a hospital is often needed to ensure the patient’s safety. Antipsychotic drugs which reduce hallucinations and delusions and improve thinking and behaviour are helpful whether the cause is a medical or psychiatric disorder. Other treatments include cognitive behavioral therapy, psychodynamic therapy and community care.

The risk factors for psychosis are stress and depression and these are modifiable risk factors. Early diagnosis and treatment are necessary when there are indications of psychosis experienced.

The other prevention methods include:

  • Using problem solving approach to deal with the daily stress and worries
  • Identifying the negative thoughts and alter them to positive thoughts
  • Evaluating the indications regularly and consult a doctor
  • Regular exercise which includes relaxation techniques and yoga
  • Joining a self-help group to share and discuss personal feelings and concerns which help in escaping from isolation
  • Avoid smoking, drugs and drinking alcohol
  • Provide a calm and non-stressful environment.
  • Refrain from asking too many questions about how they are feeling or what they are thinking. Keep discussions simple.
  • Learn to acknowledge their feelings and beliefs. Don’t dismiss fears or delusions of grandeur.
  • Try joining a support group. It may help to get some useful and practical tips from other care givers who have been in the same situation.
  • Approach professionals for effective management of the difficulties involved in the illness.
  • When unable to take care, look for institutional facilities.