Symptoms
The primary symptoms of psychosis include:
Hallucinations: Experiencing sensory perceptions that are not real, such as seeing, hearing, smelling, feeling, or tasting things that others do not. Auditory hallucinations (hearing voices) are the most common.
Delusions: Holding strong beliefs that are not based in reality and that others do not share, even when presented with evidence to the contrary. These beliefs can be paranoid, grandiose, or bizarre.
Disorganized thinking: Difficulty organizing thoughts and making sense, leading to rambling speech, incoherent sentences ("word salad"), and frequent topic changes.
Disorganized or abnormal motor behavior: This can range from childlike silliness to unpredictable agitation.
Negative symptoms: A reduction or absence of normal emotional responses, motivation, and social interaction. Examples include flat affect (reduced expression of emotions), social withdrawal, decreased speech, and difficulty experiencing pleasure (anhedonia).
Causes
Psychosis can be caused by a variety of factors, including:
Mental illnesses: Schizophrenia, bipolar disorder, severe depression with psychotic features, and schizoaffective disorder are common causes.
Substance abuse: Alcohol, marijuana, stimulants (like cocaine and amphetamines), and hallucinogens can trigger psychosis.
Medical conditions: Brain tumors, stroke, Huntington's disease, lupus, multiple sclerosis, and certain infections can cause psychosis.
Sleep deprivation: Prolonged lack of sleep can sometimes trigger psychotic symptoms, especially in individuals who are already vulnerable.
Trauma: Severe trauma can, in some instances, contribute to the development of psychotic symptoms.
Genetics: A family history of psychosis or mental illness increases the risk.
Medicine Used
The primary medications used to treat psychosis are antipsychotics. These medications work by balancing the levels of certain chemicals in the brain, such as dopamine and serotonin. There are two main types of antipsychotics:
First-generation antipsychotics (typical antipsychotics): These medications have been used for a longer time and include drugs like haloperidol, chlorpromazine, and fluphenazine. They can have more significant side effects, including movement disorders (tardive dyskinesia).
Second-generation antipsychotics (atypical antipsychotics): These medications are newer and include drugs like risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and clozapine. They are generally considered to have fewer motor side effects but may have other side effects, such as weight gain, metabolic changes, and an increased risk of diabetes. Other medications, such as antidepressants or mood stabilizers, may be used in conjunction with antipsychotics to address co-occurring conditions like depression or bipolar disorder.
Is Communicable
Psychosis itself is not communicable. It is not an infectious disease and cannot be spread from person to person through any form of contact. It is a manifestation of underlying mental or physical health conditions.
Precautions
While psychosis isn't contagious, the following precautions are important when interacting with someone experiencing a psychotic episode:
Safety First: Ensure the safety of yourself and the individual experiencing psychosis. If the person is agitated, aggressive, or poses a threat to themselves or others, contact emergency services (911) or a mental health crisis team.
Stay Calm: Maintain a calm and non-threatening demeanor. Avoid raising your voice or making sudden movements.
Listen Empathetically: Listen to what the person is saying without judgment, even if it doesn't make sense. Acknowledge their feelings and try to understand their perspective, even if you don't agree with it.
Avoid Arguing or Confronting Delusions: Do not try to argue with the person about their delusions or convince them that their beliefs are not real. This can escalate the situation.
Offer Reassurance: Reassure the person that you are there to help and that they are safe.
Respect Personal Space: Maintain a respectful distance and avoid touching the person without their permission.
Encourage Professional Help: Encourage the person to seek professional help from a mental health professional. Offer to help them find resources and support.
Limit Stimulation: Reduce environmental stimulation by moving to a quiet place or turning off distracting noises or lights.
Avoid Alcohol and Drugs: Do not offer or allow the person to use alcohol or drugs, as these substances can worsen psychotic symptoms.
How long does an outbreak last?
The duration of a psychotic episode can vary widely depending on the underlying cause, the individual, and the effectiveness of treatment.
Brief Psychotic Disorder: Episodes last for at least a day but less than a month.
Schizophreniform Disorder: Episodes last for at least a month but less than six months.
Schizophrenia: This is a chronic condition, and psychotic symptoms can persist for a long time, even with treatment. There may be periods of remission, but symptoms can return.
Drug-induced psychosis: The duration depends on the substance used and how long it remains in the system. Symptoms usually resolve within days or weeks after stopping the substance.
Psychosis related to medical conditions: The duration depends on the underlying medical condition and its treatment.
How is it diagnosed?
Diagnosis of psychosis involves a comprehensive evaluation, including:
Medical history: Gathering information about the person's past medical conditions, substance use, medications, and family history of mental illness.
Physical examination: Ruling out medical conditions that could be causing the symptoms.
Psychiatric evaluation: Assessing the person's mental state, including their thoughts, feelings, behavior, and perceptions. This may involve structured interviews and questionnaires.
Mental Status Exam: A structured assessment of a person's current mental state.
Collateral Information: Gathering information from family members or other caregivers to gain a more complete picture of the person's symptoms and functioning.
Laboratory tests: Blood tests, urine tests, and other laboratory tests may be performed to rule out medical conditions or substance use.
Brain imaging: In some cases, brain imaging studies, such as MRI or CT scans, may be used to rule out structural abnormalities in the brain.
Diagnostic criteria: Mental health professionals use the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose specific mental disorders that can cause psychosis.
Timeline of Symptoms
The onset and progression of psychotic symptoms can vary.
Prodromal Phase: This is the period before the first full-blown psychotic episode. During this phase, individuals may experience subtle changes in their thinking, mood, and behavior. Symptoms may include social withdrawal, decreased motivation, difficulty concentrating, unusual beliefs, and perceptual disturbances. This phase can last for weeks, months, or even years.
Acute Phase: This is when the full-blown psychotic symptoms are present. Hallucinations, delusions, disorganized thinking, and disorganized behavior are prominent.
Recovery Phase: After treatment, symptoms gradually improve. Some individuals may experience a full remission, while others may have residual symptoms. Continued treatment and support are important to prevent relapse.
Important Considerations
Early Intervention: Early detection and treatment of psychosis are crucial for improving outcomes.
Treatment Adherence: Consistent adherence to medication and therapy is essential for managing symptoms and preventing relapse.
Co-occurring Conditions: Individuals with psychosis often have co-occurring mental health conditions, such as depression, anxiety, or substance use disorders. These conditions should be addressed as part of the overall treatment plan.
Social Support: Social support from family, friends, and support groups can play a vital role in recovery.
Stigma: Stigma surrounding mental illness can be a significant barrier to treatment and recovery. Education and advocacy are important for reducing stigma and promoting understanding.
Individualized Treatment: Treatment should be tailored to the individual's specific needs and preferences.
Relapse Prevention: Developing a relapse prevention plan can help individuals and their families recognize early warning signs of relapse and take steps to prevent it.
Long-Term Management: Psychosis is often a chronic condition that requires ongoing management.
Legal and Ethical Issues: There may be legal and ethical considerations related to treatment, decision-making, and the protection of individual rights.