Psychosis – Causes, Signs and Symptoms

Psychosis

Also called: Psychotic Break, Psychotic Disorder, Psychotic Episode, Psychotic Behavior

Summary

Psychosis is a mental condition that causes people to lose touch with reality. It may also be referred to as a psychotic disorder, psychotic behavior or a psychotic break.

Some symptoms presented by patients with psychosis include hallucinations, delusions, personality changes, disorganized thinking and bizarre behaviors.

Patients with psychosis may have difficulty functioning in home, school and work settings and may need assistance with daily living activities, such as grooming and handling money.

Psychosis may be caused by a number of mental illnesses, such as schizophrenia and bipolar disorder. It can also result from medical illnesses (e.g.,Alzheimer’s disease), substance abuse and as a side effect of some prescription medications, such as stimulants.

Psychosis may be diagnosed by a physician during a physical examination that includes a medical history and list of medications. Physicians may conduct tests, such as blood or urine tests, to rule out other medical conditions and medications that may be producing symptoms. Patients usually receive a psychiatric evaluation from a mental health professional.

Psychosis may be treated with medications, such as antipsychotics and mood stabilizers. Patients may also receive treatments such as psychosocial rehabilitation,family educationor family therapy.Some cases of psychosis cannot be prevented, but may be controlled with treatment. Psychosis that results from substance abuse can be prevented by refraining from using recreational drugs and alcohol.

About psychosis

Psychosis is a general term for a mental condition in which a patient loses contact with reality. It may also be referred to as a psychotic disorder, psychotic behavior or a psychotic break.

Psychotic patients may experience hallucinations (sensory perceptions of phenomena that are not actually there) or delusions (false beliefs that a person holds despite evidence to the contrary). Personality changes, disorganized thinking and bizarre behaviors are also common.

Patients experiencing psychosis often do not realize that their experiences and behavior are different from those of others. They often believe that their hallucinations and delusions are real.

Psychotic patients often neglect basic hygiene and require assistance with daily living activities, such as cooking and handling money. Some patients’ ability to function at home, school or work deteriorates over time. If untreated, patients with psychosis may harm themselves or others.

Under extreme psychological stress, some people enter a psychotic state called a brief psychotic episode without actually developing psychosis. Lack of sleep or a high fever may also precipitate psychotic states.

Many people who have one psychotic episode never experience another. However, some patients experience brief episodes throughout their lives, and for others, psychosis is  a chronic (ongoing) problem. Patients with severe and chronic post-traumatic stress disorder(PTSD) may also occasionally experience symptoms of psychosis.

The prognosis (anticipated outcome of an illness) of psychosis depends on its cause. In many cases, symptoms can be controlled effectively with treatment.Patients with psychosis sometimes face social stigma because of a lack of understanding about mental disorders. One common misperception is that people with mental disorders are violent. However, people with mental disorders are not typically more prone to violence than the general population.

Risk factors and causes of psychosis

Psychosis can be caused by a number of mental and medical illnesses, illegal drugs and prescription medications. Mental illnesses that incorporate symptoms of psychosis include:

  • Schizophrenia. A chronic thought disorder that makes it difficult to distinguish between real and imaginary experiences, think logically, have normal emotional responses to others and behave appropriately in social situations.
  • Bipolar disorder. A mood disorder characterized by episodes of excitability (mania) that alternate with periods of depression.
  • Clinical depression. A mood disorder marked by depressed mood, loss of interest or pleasure in nearly all activities, feelings of guilt, helplessness, hopelessness, and concentration or memory difficulties,  that lasts for long periods of time and interferes with a person’s quality of life.
  • Schizoaffective disorder. A condition in which a person exhibits symptoms of both schizophrenia and a mood disorder (e.g., bipolar disorder or major depression).
  • Brief psychotic disorder. An episode of psychotic symptoms that occurs suddenly after a stressful life event and lasts for less than a month.
  • Shared psychotic disorder. Delusional system that develops in a person as a result of a close relationship with someone already diagnosed with a psychotic disorder.
  • Postpartum psychosis(PPP). A rare emotional disorder that occurs in a woman following childbirth. Symptoms include extreme physical, mental and behavioral symptoms similar to those of general psychotic reactions (e.g., paranoia, incoherence). Postpartum psychosis is a different disorder from postpartum blues or postpartum depression(PPD).

Medical illnesses that may involve psychosis include:

  • Brain disorders, such as Alzheimer’s disease. A progressive, incurable condition that destroys brain cells, gradually causing loss of intellectual abilities and extreme changes in personality and behavior. Tumors or trauma to the brain that destroy brain cells are also associated with psychosis.
  • Stroke. A sudden loss of consciousness resulting from the rupture or occlusion of a blood vessel which leads to a lack of oxygen in the brain.
  • Epilepsy. A disorder of the brain that results in recurrent, unprovoked seizures (temporary alterations in brain function resulting in changed mental states).
  • Certain infectious diseases. Diseases such as syphilis, meningitis and encephalitis, in which the brain or nervous system is directly affected, can cause psychosis.
  • Electrolyte abnormalities,  urinary tract infections (especially in the elderly) and pain syndromes. These may precipitate temporary psychotic symtoms.

Substances that may induce psychosis include:

  • Alcohol. Psychosis does not usually occur while using alcohol, but may occur during withdrawal (physical or psychological state experienced when certain substances or medications are discontinued rapidly).
  • Stimulants. These include amphetamines (a medication that stimulates the central and peripheral nervous systems while increasing energy and decreasing appetite) and cocaine (a highly addictive stimulant drug made from the leaves of the coca plant that elicits sensations of euphoria, restlessness, excitement and well-being).
  • Hallucinogens. These include phencyclidine (PCP, an illegal, recreational drug that was originally developed as an intravenous anesthetic) and lysergic acid diethylamide (LSD, a drug manufactured from lysergic acid that acts on the serotonin receptor). Use of these can cause symptoms such as delusions, hallucinations, paranoia and disordered thinking.
  • Prescription medications. Some prescription medications, such as anticholinergics (medications that calm muscle spasms in the intestines), can produce psychotic symptoms, such as hallucinations.
  • Cannabis (marijuana). Cannabis produces intoxicating effects such as mild euphoria when smoked or eaten. Impaired perception and motor skills, decreased short-term memory, paranoia, mood swings and hallucinations are also seen. According to current knowledge, heavy cannabis use may cause a “cannabis psychosis” or may exacerbate a pre-existing pychosis (e.g., schizophrenia).

Signs and symptoms of psychosis

Signs and symptoms vary widely among patients experiencing psychosis. They may include:

  • Hallucinations. A sensory perception of phenomena that is not actually there.
  • Delusions. False beliefs that a person holds despite evidence to the contrary.
  • Disordered thinking. Unusual thought processes, such as difficulty organizing thoughts or connecting them logically.
  • Mania. A mood disorder marked by severely elevated mood.
  • Depression. A mood disorder marked by sadness, anger or frustration that lasts for a long period of time. This may be accompanied by thoughts of suicide.
  • Illusions. Misinterpretations by the senses of stimuli that are actually present, such as misconstruing a dog’s bark as a woman’s call for help.
  • Negative symptoms (absence of thoughts or behaviors that would otherwise be expected). These may include “flattened affect” (reduced expression of emotion) or loss of ability to initiate and sustain planned activity (avolition).

Diagnosis methods for psychosis

Psychosis is usually diagnosed by a physician during a physical examination that includes a medical history and list of medications. A physician may also inquire about family history of mental illness.

A physician may ask a patient the following questions:

  • Have they been hearing sounds or seeing images that others do not?
  • Do they have beliefs that others do not seem to share?
  • Have they been experiencing suicidal thoughts?

A physician will first try to rule out other mental or physical illnesses that may be causing symptoms. Some possible tests include:

  • Blood test. Blood tests can identify medical illnesses, medications, or abused substances that may be producing symptoms.
  • Urine test. Urine tests can also identify medical illnesses, medications or abused substances that may be producing symptoms.
  • Magnetic resonance imaging (MRI) and computed axial tomography (CAT) scan. Safe and noninvasive imaging tests that can help physicians diagnose diseases of numerous organs and vessels. An MRI or CAT scan can reveal brain abnormalities (e.g., brain tumors, stroke) that may be producing symptoms.

A patient may be referred to a psychiatrist, psychologist or another mental health professional who may conduct a psychiatric evaluation that typically includes a description of signs and symptoms and an overview of psychiatric history. A diagnosis can often be made after signs and symptoms are identified.

Treatment and prevention for psychosis

The treatment of psychosis depends on its cause. Patients experiencing acute symptoms, such as severe delusions or hallucinations, serious suicidal thoughts, an inability to care for themselves, severe substance abuse problems or who pose a threat to themselves or others, may be treated in a hospital. Others may be treated at home.

Patients experiencing psychosis are often prescribed medication, including:

  • Antipsychotics. Medications primarily used to treat psychoses. They may control symptoms such as delusions and hallucinations and may have some mood stabilizing effects.

  • Mood stabilizers. Medications that are effective at treating fluctuations of mood, regardless of its cause. They may be used to treat mania, bipolar disorder and other mood disorders.

  • Antidepressants. Medications used primarily to prevent or treat depression, anxiety and problems with obsession. They work mainly by regulating the levels of neurotransmitters in the brain.

    Antidepressants are a complex class of medications. A physician may need to adjust the dosage or completely change the prescription to find a medication that provides optimal results with minimal side effects. In addition, certain patients cannot take antidepressants. The U.S. Food and Drug Administration has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

  • Anticonvulsants. Medications used primarily to treat seizures. They may also be prescribed as mood stabilizers to treat depression.

In addition to medication, many patients also receive other treatments, including:

  • Psychosocial rehabilitation. Emphasizes social and vocational training to help patients function more effectively in the community. Programs may include vocational counseling, job training, money management, learning to use public transportation and practicing social and workplace communication skills.

  • Illness management skills. Patients learn about their illness and treatment techniques so they can make informed decisions about their care. Patients also learn how to identify signs of relapse and make a plan to respond to signs.

  • Family education or therapy. Patients often live with family members who must be as informed as possible to provide support to patients. Family members learn ways to recognize stressful situations that may trigger a relapse or ensure patients adhere to medication schedules.

  • Cognitive behavioral therapy(CBT). This is useful for patients with symptoms that persist even while taking medication. Cognitive therapists teach patients how to monitor the reality of their thoughts and perceptions, how to ignore auditory hallucinations and how to cope with apathy (lack of emotion, motivation or enthusiasm) that can be disabling.

  • Self-help groups. These groups are geared towards patients and family members. A therapist is not involved with these groups, but the comfort and support among members who share their experiences can be therapeutic.

Patients experiencing psychosis as a result of a medical illness may be treated in a variety of ways, such as with medications. Those experiencing psychosis due to drug use may receive treatment for substance abuse.

In some cases, psychosis cannot be prevented. However, if detected early, symptoms experienced with psychosis can be effectively controlled with medications and other treatment techniques. Psychosis that results from substance abuse can be prevented by refraining from using recreational drugs and alcohol.

Researchers continue to investigate methods for effective prevention and treatment of psychosis. For example, an atypical antipsychotic medication has shown promise in delaying the onset of the condition.

Questions for your doctor regarding psychosis

Preparing questions in advance can help patients have more meaningful discussions with physicians regarding their conditions. Patients may wish to ask their doctor the following psychosis-related questions:

  1. If I experience psychosis, does that mean I have a mental illness?
  2. What do you suspect is causing my loved one’s psychosis?
  3. I recently experienced a psychotic episode. What are the chances that I will experience psychosis in the future?
  4. What type of medications would be best to treat my psychosis? What are their potential side effects?
  5. My loved one has psychosis. How can I ensure that they take their medication as prescribed?
  6. Should I receive therapy in addition to being treated with medication? Can you recommend a qualified therapist?
  7. Will my family members play an active role in my treatment?
  8. Is my loved one dangerous during his/her psychotic episodes?
  9. Is there any way to prevent psychosis?
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