Psychosis

What is psychosis?

When individuals experience psychosis, they begin to see the world in a way that is out of touch with reality.

From having trouble putting thoughts into words, to experiencing terrifying visual hallucinations, the symptoms of psychosis are vast and varied and can affect people in a range of different ways.

Overview

Psychosis is a mental health condition in which individuals experience a different perception or interpretation of reality. Although there are a wide range of symptoms, the ones most commonly associated with psychosis are hallucinations and delusions. However, some signs of psychosis are much more subtle and therefore more difficult to spot.

Psychosis is not classified as a disorder in its own right, since it only occurs as a result of other physical or mental health conditions. When attempting to understand the cause of psychosis, healthcare professionals will make a diagnosis of exclusion, which means they will attempt to make a diagnosis through a process of elimination by performing medical and biological tests to exclude the possibility of other disorders first.

This process often takes place even if an individual has already been diagnosed with a mental health disorder which could cause psychosis. Each new-onset psychotic episode should be appropriately investigated to rule out the possibility of underlying medical conditions.

Psychosis can be a very scary thing to experience, both for the individual going through it and those around them. It can cause people to behave in very unusual and sometimes dangerous ways, and since they often lose touch with reality they may find it difficult to seek out medical care or follow a treatment plan. For this reason, it is often very helpful for people to be hospitalized during a psychotic episode in order to keep them safe.

Psychosis symptoms

There are five main types of psychosis each with its own set of symptoms. Individuals suffering from psychosis might experience more than one type at any one time.

Delusions

The individual has very firmly held beliefs about something and will not change their mind about it, even if there is clear evidence that the beliefs are not true. Delusions might be positive or negative. For example, they could believe they’re able to talk to angels or communicate with God, or they may believe that someone is trying to harm them.

The delusions tend to be very unique to the person and can be so unusual that others really struggle to understand why the individual holds the belief. Some common themes include feeling that they are being watched, monitored, followed or plotted against, that they have special powers, that there are hidden messages from someone trying to communicate them, that they’re controlled by others or by forces, or that they’re responsible for a particular negative event, such as someone’s death or a natural disaster.

Hallucinations

The individual is experiencing things that nobody else can. They may hear, see, smell, taste or feel things that aren’t really there. Auditory hallucinations tend to be the most common, and individuals might hear voices which tell them things that contribute to their delusions.

An individual’s behavior tends to indicate that they are suffering from hallucinations. They may talk aloud when nobody is around them, or make gestures as though someone is in their presence.

Disorganized thinking

Thoughts are not clear in the mind and seem jumbled and confused. Individuals may feel that they cannot focus on one thing and others are likely to notice in their speech that they keep hopping from one topic to another with no clear connection.

They might respond to questions in a way that doesn’t make sense or isn’t really relevant to the question. They may also bring up topics that aren’t related to the conversation around them, or go off on tangents when trying to join in the conversation.

Grossly disorganized or abnormal motor behavior

Goal-oriented behavior is very difficult and individuals behave and move very unusually or in ways that don’t fit the situation. They might struggle to complete simple tasks, such as going to the shop to buy a loaf of bread, because there are many organized steps required. They might also show signs of extreme agitation or behave in a childlike way. In some cases they may experience catatonia, where they do not respond to stimuli and remain in a single position for a long period of time, sometimes without talking.

Sometimes disorganized behavior may cause an individual to respond inappropriately to a social situation, such as laughing and smiling when hearing sad news. They might also do unusual, subtle things like wear clothes that aren’t appropriate for the weather.

Negative psychosis symptoms

The four types of psychosis described above include positive symptoms; they’re things that have been added on to normal behavior or exaggerated. Negative symptoms are things that have been removed from negative behavior or reduced. Since negative symptoms tend to be more subtle than positive ones they are often difficult to identify, but they tend to be far more common than positive symptoms.

Individuals might have diminished emotional expression and have trouble expressing their emotions. They might experience avolition, an extreme form of anhedonia which causes them to not want to do anything. Their speech may become less animated and generally reduced, and they may use fewer gestures. They might also feel less motivated, less interested in other people and more likely to struggle with coming up with ideas.

There are also a range of symptoms which can occur alongside psychosis, either as a result of the psychotic episode or as a result of the underlying mental health disorder which is causing the psychosis.

Symptoms which occur alongside psychosis include:

  • Anxiety
  • Suicidal ideation and self harm
  • Disturbed sleep patterns
  • Problems with memory and concentration
  • Depression
  • Excessive use of alcohol or drugs

Psychosis causes

There are many different causes of psychosis and since it is not a mental health disorder in its own right, it is vital that the underlying illness or trigger is identified so that a successful treatment plan can be created.

Mental health disorders which can cause psychosis include:

Schizophrenia

A condition which affects how people think, act and feel, and causes them to have trouble differentiating between what is real and imaginary. This condition affects 1% of the US population and although there is no known cure, individuals can be treated to alleviate or prevent recurring episodes.

Severe major depression

When individuals experience very severe depression they may have symptoms of psychosis. Depression causes individuals to have a persistently low mood for long periods of time. They will feel a loss of interest in things that were once pleasurable, have trouble concentrating, and in some cases have thoughts of suicide.

Bipolar disorder

Sufferers experience episodes of severe depression and extremely elevated moods, known as mania. Psychosis typically occurs during mania when individuals begin to lose touch with reality. Mania causes euphoria, highly impulsive behavior, a dramatically inflated ego and recklessness which can put an individual in extreme danger. Depressed episodes are similar to those experienced by individuals with major depression.

Stress or anxiety

It is possible for individuals experiencing extreme stress or anxiety to have symptoms of psychosis. They may experience panic attacks, mood swings, insomnia and a racing heartbeat with these conditions.

Postnatal psychosis

In a similar way that women can experience postnatal depression after having a baby, some experience postnatal psychosis. They may simultaneously experience mania, paranoia, agitation, low mood and confusion.

Women with preexisting mental health conditions such as schizophrenia or bipolar disorder are more at risk of postnatal psychosis, and those who have experienced it after one pregnancy are very likely to develop it after future pregnancies.

Physical illnesses which can cause psychosis include:

  • Malaria
  • Syphilis
  • Lupus
  • Hypoglycemia
  • Alzheimer’s disease
  • Parkinson’s disease
  • Multiple sclerosis
  • Brain tumour
  • HIV and AIDS

It is also possible for individuals to experience psychotic episodes triggered by drug or alcohol abuse. Sometimes, psychosis occurs when an individual withdraws from alcohol or drugs after having used them for a long time. For this reason, it’s important that withdrawal occurs under the supervision of medical experts.

In other instances, psychotic episodes may occur after taking large quantities of certain drugs.

Drugs which are known to trigger psychosis include:

  • Amphetamine
  • Cannabis
  • Cocaine
  • Ketamine
  • LSD
  • MDMA (ecstasy)
  • Mephedrone
  • Methamphetamine
  • Psilocybins (magic mushrooms)

Some prescribed medications can also cause psychosis as a side effect, or as a result of overdose. Individuals who have a psychotic episode after taking a prescribed drug should consult their physician.

Psychosis treatment

Doctors will strive to identify and treat the underlying cause of psychosis, but they may need to administer more urgent care first to relieve the acute psychotic symptoms. Antipsychotic medicines tend to be prescribed first.

Antipsychotics tend to act very quickly on the body and can help to alleviate reckless and impulsive behaviors which could put a patient in immediate danger. Often, the anxiety that someone might feel during a psychotic episode is reduced within a matter of hours, though it may take days or weeks for the all symptoms of psychosis to disappear.

There are many side effects associated with antipsychotics, including:

  • Drowsiness
  • Shaking, trembling, muscle twitches and spasms
  • Blurred vision
  • Dizziness
  • Restlessness
  • Constipation
  • Dry mouth
  • Weight gain

Not everyone experiences the side effects of antipsychotics in the same way or to the same extent. For this reason, antipsychotics may not be a successful treatment for everyone; those who experience very severe side effects may have to pursue alternative treatments.

Psychotherapy treatments for psychosis may not always be necessary or helpful, as individuals experiencing acute symptoms may have difficulty organizing their thoughts well enough to really benefit from therapy.

However, in instances where patients are experiencing long-term, persistent delusions or hallucinations, therapies such as cognitive behavioral therapy (CBT) could help them to make sense of the things that cause them the most distress. This type of treatment can help individuals to recognize irrational thoughts or beliefs and find ways to deal with psychotic symptoms so that they can regain some control over their behavior.

Psychosis prevention

Currently there is no definitive method for preventing psychosis, but there is limited evidence to suggest that CBT might be helpful in preventing psychotic episodes in those who are at an increased risk. Individuals with a family history of psychosis or of mental health conditions which can cause psychosis may therefore find it helpful to seek out CBT to help reduce the risk of them having an episode.

It is also important that those with an increased risk of psychosis avoid excessive consumption of alcohol and use of illicit substances, particularly those listed above which are known to cause psychotic episodes.

Similarly, women who have previously experienced postnatal psychosis or have a preexisting mental health condition which increases their risk, should consult a physician when planning to have more children. A doctor may be able to prescribe preventative, mood-stabilizing medications, or recommend psychotherapy which could help the expecting mother to cope with psychotic symptoms after having the baby.