Understanding psychosis

Psychosis: What is it and How to Treat it

Psychosis can be a stigmatized condition. Thankfully, it is less so nowadays. Modern medicine has learned how to control and treat it so that psychosis patients can lead quality lives with the help of simple treatment and procedures.

Living in a dynamic modern world it is not uncommon to miss the first symptoms of this unwanted mental health issue. Therefore, specialists and even people at risk need to be always prepared to spot the early signs of a potentially serious mental problem.

Positive psychotic symptoms

Clear symptoms (one or more needed for a diagnosis of schizophrenia)

  • Paranoid delusion: Any delusion that refers back to the self—in practice, most are persecutory delusions. Grandiose delusions (such as special powers or missions) occur in schizophrenia and bipolar affective disorder
  • Delusions of thought interference: Delusions that others can hear, read, insert, or steal the patient’s thoughts
  • Passivity phenomena: Delusional beliefs or perceptions that others can control the patient’s will, limb movements, bodily functions, or feelings
  • Thought echo: The patient hears their own thoughts spoken aloud ()
  • Third person auditory hallucinations (voices speaking about the patient): These may include a running commentary on the patient’s actions; these are common in non-affective psychoses

Less clear symptoms (one or more needed for a diagnosis of schizophrenia)

  • Hallucinations in any modality without clear affective content
  • Second person auditory hallucinations (voices speaking to the patient): These may include command hallucinations (“run out the door”); these are common in depression, where they are demotivating or abusive (“you’re useless”)
  • Thought disorder: Breaks in the train of thought (thought block), excessive attention to unnecessary detail (overinclusive thinking), and difficulties in abstract thinking (for example, cannot explain proverbs or common sayings)

Peter Byrne, consultant psychiatrist, Managing the acute psychotic episode

Psychosis definition according to modern medicine

Psychosis is a condition that affects the mind and causes a severe disturbance in patients who gradually lose contact with reality and begin to exhibit delusions and experience hallucinations on multiple occasions. Either emotional or real-world developments trigger these episodes. The disease is characterized by brief or prolonged episodes when patients exhibit manic behavior and strong personality changes that cannot be explained.

What is psychosis?

First diagnosis of Psychosis is recorded in 1845

What is psychosis?

The condition was first diagnosed in 1845, which led to more comprehensive studies to figure out an answer to the question “what is psychosis?” once and for all. At first, it was considered to be a form of mental handicap. Our understanding of the condition has evolved immensely and now doctors know for a fact that it usually defines an underlying illness that, in most cases, is treatable.

The underlying conditions are not life-threatening. The condition can be caused by schizophrenia, sleep deprivation or bipolar disorder. Out of these, sleep deprivation is the simplest to treat. Bipolar disorder usually proves to be a little more difficult.

Many people live with schizophrenia. Sleep deprivation and alcohol abuse will get in the way of successful treatment and may worsen the condition. On the upside, with all the information we know about psychosis today, people who suffer from an underlying condition can find safety and understanding in others, including medical specialists.

What causes psychosis?

There can be multiple causes of psychosis. The above-mentioned illnesses are not necessarily in the root of a patient’s condition. It must be understood that even healthy individuals can experience such episodes which are completely normal and need not alarm the person who experiences them.

65% of affected people developed Psychosis due to a childhood trauma

For example, falling asleep and having hypnagogic and hypnopompic hallucinations happens all the time. Can you remember a vivid dream you have had in which you were waking on and off? Well, this is precisely what psychosis can be and as you can see, it does not necessarily point out to an underlying condition.

Meanwhile, bereavement and severe sleep deprivation are two more likely causes that can bring a mild psychotic outbreak, even though these usually pass very quickly and are difficult to determine with certainty.

The more unfortunate causes are also more serious. In reported 65% of patients who experience the condition and need professional help, their episodes are related to some childhood trauma (source: The Role of Trauma and Stressful Life Events among Individuals at Clinical High Risk for Psychosis: A Review). It is most commonly psychical, emotional or sexual in nature.

In the general population, there is an approximate 3% lifetime prevalence of psychotic disorders, with 0.21% accounting for psychosis due to a general medical condition. A recent review found a prevalence of 0.5% to 4.3% for bipolar disorder in primary care populations, and approximately 9% for bipolar spectrum illnesses. In one urban primary care population, the prevalence of psychotic symptoms was most commonly associated with depressive, anxiety, and panic disorders (42.4%, 38.6%, and 24.8%, respectively), followed by substance use disorders (13.8%).

KIM S. GRISWOLD, MD, MPH; PAULA A. DEL REGNO, MD; and ROSEANNE C. BERGER, MD, Recognition and Differential Diagnosis of Psychosis in Primary Care, State University of New York at Buffalo, Buffalo, New York

Learning to recognize psychosis symptoms

Recognizing psychosis symptoms can be a challenge for non-trained individuals. If you think you are experiencing some of the early symptoms, then you are most likely dealing with feelings of suspicion, anxiety, depression, overthinking, and even distorted perceptions.

These symptoms can be applied to a variety of conditions. It is not the best indication of when a person is about to have an episode or if they are developing a problem. If these mild symptoms grow into more serious ones, though, such as hallucinations and delusions, help must be sought.

Thankfully, people who begin to show even milder symptoms usually have time to consult a professional before the first serious episode. The condition can be dismissed by a general practitioner as a mild form of depression, which is not entirely wrong.

However, if the patient continues to feel bad for no apparent reason, psychosis should be one of the possible explanations, even though without extensive testing the condition is difficult to diagnose.

Postpartum psychosis and how it affects new mothers

Abrupt emotional or physiological changes can lead to psychosis. One of the conditions we will discuss is postpartum psychosis, which usually affects new mothers within two or three weeks of giving birth.

Postpartum psychosis and how it affects new mothers

While it is perfectly normal for new mothers to experience “baby blues,” a gradual and deepening slide into depression is not.

Postpartum psychosis has a number of physical manifestations:

  • Restlessness
  • The feeling of confusion and disorientation
  • Fearfulness
  • Lack of energy
  • Manic behavior
  • Personalities changes

While the condition can at first be dismissed as tiredness or depression stemming from the responsibilities of being a parent, this form of psychosis is dangerous. It leads to very rapid personality changes which could potentially push a mother into hurting herself, the baby or both.

Treat this variation of the condition as an absolute emergency and make sure to get the mother to see a specialist ASAP. Keep in mind that while mothers usually manifest these symptoms within the first three weeks, a delayed onset, even a month after childbirth, could also occur.

Drug-induced psychosis – more common than you think

There are various substances that can provoke an episode of drug-induced psychosis in a patient. If you are at risk of psychosis, then abuse of addictive and mind-expanding substances, such as cocaine and cannabis might lead to a fit of drug induced psychosis. Also, people who have a dependency on alcohol or certain medication have a higher chance of developing symptoms of paranoia which could trigger an episode.

It is well-known that the prescription of drugs helps millions of people who suffer from mental health illnesses, but sometimes such kind of drugs can cause negative consequences. In this video, Dr. Steven Batki reveals a case about one patient who had a drug-induced psychosis:

In hospitals and during serious treatments, such as chemotherapy, the level of toxicity can lead to disorientation, misinterpretation of reality and having psychotic thoughts. If you develop a psychosis based on drugs, the easiest way to treat it is by detoxification, which is done in a controlled environment, such as a hospital, an emergency room, or a free clinic.

Dealing with psychosis is both a challenge and a well-established medical procedure. Just like any other form of mental illness, therapists and doctors will need to see a patient multiple times to determine a combination of antipsychotic medication that works in their specific case. A recommended form of dealing with the condition is cognitive behavioral therapy which helps patients become aware of triggers – whether they are emotional or out in the physical world.