What is Psychosis?
Psychosis is a serious, abnormal, symptom of the mind that is characterized by a loss of contact with reality including one or more of the following features: hallucinations, delusions, thought disorders, or movement disorders. These psychotic breaks make it nearly impossible for the person to complete activities or daily living or function normally in society. Rather than a specific disorder, psychosis is a symptom of certain physiological conditions – such as brain tumors – or as a feature of major mental illness – such as bipolar disorder – that impacts the mind so greatly that the sufferer loses the ability to interact appropriately with his or her environment.
Those experiencing active psychotic states are at greater risk for agitation, impulsivity, aggression, and other potentially harmful behavioral symptoms; one of the primary reasons individual’s experiencing psychosis require immediate treatment and intervention, generally in a facility equipped to treat acute crises. Treatment of psychosis should address symptomatology no matter the primary diagnosis and often requires injections of haloperidol and other antipsychotic medications to reduce the psychotic symptoms and increase the individual’s comfort.
Features of Psychosis
People experiencing psychosis may also have one or more of the following features of psychosis: hallucinations, delusions, thought disorder, and movement disorders (including catatonia). These are the essential features of a psychotic episode, often called a “psychotic break,” and are described as followed:
Hallucinations are sensory perceptions that occur in the absence of any external stimulus; these hallucinations have qualities of real sensory experiences that are not experienced by other people. The most common type of hallucinations are auditory hallucinations, followed by visual, tactile, olfactory, and gustatory. Auditory hallucinations, or “hearing voices,” have, through neuroimaging studies, been shown to directly correspond with increased activity in the auditory cortex of the brain, which clearly illustrates that these hallucinations are very real to those who experience them. Auditory hallucinations may involve voices of those the person knows or those who are entirely unknown, and may be cruel and mean, threatening or commanding, pleasant or neutral. While these experiences are a reality for the actively psychotic individual, responses to the stimuli (such as talking back to a voice) can be tremendously bewildering for loved one to experience.
Delusions are false, unchangeable beliefs that persist even in the presence of conflicting facts. Delusions don’t change even after the individual is presented with information that directly contradicts his or her belief. Often people have delusions that are short-lived and associated with events such as anesthesia or related to sleep deprivation, while others may experience periodic delusions that are often associated with major depressive disorder or bipolar disorder.
There are four different types of delusions:
1) Bizarre delusions: are those that highly suspect and implausible, such as the belief that one has been inhabited by aliens
2) Non-bizarre delusions: are delusions that are, at least, somewhat plausible, such as the belief that one is not related to his or her parents.
3) Mood-congruent delusions: are congruent with the emotional state, such as a depressed person believing the news media is very disproving of him or her, or a manic person believing that he or she actually some sort of demigod
4) Mood-neutral delusions have nothing to do with a person’s mood, such as a person believing that he or she has an extra brain growing outside his or her body.
Disorganized thoughts (speech) or “formal thought disorder” is often noted in the way a person speaks – a person with disorganized thinking may switch from one topic to another without any segue, and answers to questions may be tangentially or completely unrelated to the question. Some people experiencing psychosis may experience speech so disorganized and indecipherable that it is nearly impossible to understand him or her.
Disorganized, abnormal motor behaviors (including catatonia) can range from silliness to extreme agitation that can lead to problems in performing normal, daily activities. Disorganized motor behaviors can also include repetitive motions, staring, grimacing, mutism (refusal to speak), or echoing other people’s verbal statements. Catatonic behaviors, on the other end of the spectrum, are a substantial decrease in reaction to his or her environment. Catatonia may range from refusal to follow directions, to holding a fixed, inappropriate, or bizarre posture, to a total lack of behavioral or verbal responses.
Types of Disorders Associated with Psychosis
Psychosis is a symptom; a diagnosis of exclusion only considered a psychiatric disorder when other relevant, known causes of psychosis are excluded. Medical and laboratory testing should exclude central nervous system diseases and injuries, drugs, illegal substances, and prescribed medications; are all examined when a person experiences a new-onset of psychosis before a psychiatric diagnosis is considered. Medical diagnoses that may induce psychosis are listed as follows:
- Inborn errors of metabolism – including porphyria
- Disorders that cause toxic psychosis or delirium
- Neurodevelopmental disorders and chromosomal anomalies such as velocardiofacial syndrome
- Malignancies – including a brain tumor or paraneoplastic syndrome
- Nutritional deficiency – such as vitamin B12 deficiency
- Infectious diseases – such as HIV/AIDS and malaria
- Focal neurological diseases – such as stroke, multiple sclerosis, and certain types of epilepsy
- Neurodegnerative disorders – including Alzheimer’s disease, Lewy body dementia
- Acquired metabolic disorders – such as hypernatremia and hypoglycemia
- Endocrine disease – including hypothyroidism
- Autoimmune diseases – such as systemic lupus erythematosus (SLE)
- Poisoning by heavy metals, therapeutic drugs, and recreational drugs
Psychosis is a symptom of many mental health disorders as well and is an abnormal condition of the mind that includes losing contact with reality. While most people associate psychosis with schizophrenia, there are a variety of other mental health disorders that can cause psychotic behaviors.
Mental health disorders that can lead to the development of psychosis include:
Bipolar disorder is characterized by cycles of mood; extreme elevation in mood followed by cycles of depression. If bipolar disorder is left untreated or undiagnosed, a person who has bipolar disorder may have a psychotic break from reality.
Brief psychotic disorder is a psychiatric illness with a fast onset and symptoms that remit after a month, often as the result of a traumatic event; however, it may occur in the absence of a clearly defined trauma.
Delusional disorder is a relatively uncommon mental health disorder in which a person has delusions without hallucinations, thought disorders, mood disorders, and without any emotional flattening or changes in affect.
Folie à deux: also known as “shared psychosis” is a form of psychosis in which a delusional belief is transferred from one person (the primary) to the next (the secondary). While mostly occurring in pairs, this disorder may involve multiple individuals. This most often occurs when the two individuals reside together, are physically or socially isolated, and have scant interaction with other people.
Major depressive disorder is a very common type of mental illness characterized by intense periods of sadness, hopelessness, and worthlessness that may become so severe that the person develops psychosis.
Schizoaffective disorder is a mental illness that features symptoms of two different mental health disorders: schizophrenia and depression or bipolar disorder. Schizoaffective disorder is not a well-understood disorder and changes the way a person thinks, acts, expresses his or her feelings, perceives reality, and relates to the world at large.
Substance-abuse psychotic disorder is the development of psychotic features as a result of exposure to toxic chemicals and/or recreational drugs. Generally self-resolving, substance abuse psychosis can be irreversible and lead to lasting alterations in the way the affected individual experiences the world.
The percentage of people who are struggling with any psychotic symptom at one time varies tremendously from country to country. One of every 100 people, or 3 million people, in the United States qualifies for a diagnosis of schizophrenia, however many other people experience a psychotic break not related to schizophrenia. Worldwide, about 1% of the total population struggles with psychotic disorders, which often appear between the teen years and into the 30s.
Causes and Risk Factors for Psychotic Disorders
Aside from the psychotic disorders resulting from medical conditions or substance abuse, the specific cause for most psychotic disorders is not well-known or understood. Similar to a fever, psychosis is a non-specific symptom of a great number of disorders – both physical and mental. This is why an accurate diagnosis can be made only after medical conditions and other disorders have been tested and ruled out.
It’s believed that there is an interplay between genetic, physical, and environmental risk factors that lead to the development of a psychotic break and psychotic disorders, including:
Genetic: Researchers believe that multiple genes are involved in psychotic disorders. Generally speaking, a person has a first-degree relative, such as a parent or sibling who has developed a psychotic disorder is at greater risk for developing the disorder him or herself.
Physical: Neurotransmitters, the chemicals in the brain responsible for communication between neurons – most especially glutamate, serotonin, and dopamine – have been linked to the development of psychotic disorders. Additionally, there may be small changes in the structure and function of the brain of those who have psychotic disorders.
Environmental: There are a variety of environmental factors implicated in the development of psychotic disorders. Notably, alcoholism, women who have recently given birth, as well as those who abuse drugs are at higher risks for developing psychotic disorders.
- History of fluctuating moods
- Problems functioning in daily life and society at large
- Those naturally suspicious of other people
- Victims of domestic abuse
- Childhood history of abuse
- Increased amounts of life event
- Lack of support system
Signs and Symptoms of Psychosis
Psychotic disorders drastically change a person’s worldview, reality, and behavior, so often the development of psychotic disorders can be identified. Psychotic disorder signs and symptoms will vary depending upon individual makeup, presence of co-occurring disorders, and type of mental or physical illness causing the psychotic break. Signs and symptoms of psychosis may include:
- Social withdrawal
- Disorganization speech and behaviors
- Loss of appetite
- Weight loss
- Increasingly disheveled appearance
- Disorganized thoughts
- Intrusive, bizarre thoughts
- Difficulty processing information
- Difficulties understanding environment
- Challenges recalling simple tasks
- Increased confusion
- Sense of being controlled by outside influences
- Self-harming behaviors
- Suicidal thoughts
How are Psychotic Disorders Treated?
There are a variety of approaches used to treat a person who is struggling with a psychotic disorder or a psychotic break. As psychosis is the result of another mental or physical illness, treatment of psychosis will be divided into two parts – actively treating the symptoms of psychosis until the person is stable, then managing the co-occurring disorder(s). Many people who are acutely psychotic require inpatient treatment and stabilization in addition to adjunct therapies in a safe, monitored environment. Active treatment of psychosis will depend entirely upon the symptoms the person is having – if he or she is a danger to him or herself or others, acute stabilization will involve around-the-clock monitoring and injections of antipsychotics such as Haloperidol. After the crisis has resolved, treatment can focus upon treating the comorbid disorder and managing the psychosis with a regime of antipsychotic medications to reduce the likelihood of an additional psychotic break.
Effects of Psychotic Disorders
The long-term effects of psychosis will vary tremendously based upon individual makeup, the underlying cause, and severity of symptoms. All psychosis should be treated as medical emergencies. Symptoms of untreated psychotic disorders may include:
- Substance addiction
- Decreased ability to carry out activities of daily living
- Strained interpersonal relationships
- Violent behaviors
- Suicidal thoughts and behaviors
Psychosis often co-occurs with many comorbid disorders, which can include:
- Bipolar disorder
- Depressive disorders
- Substance abuse