Psychosis – is an umbrella term it means that an individual has sensory experiences of things that do not exist and or has no basis in reality.
During a psychotic episode, an individual may experience hallucinations and or delusions. They may see or hear things that do not exist.
This can be incredibly frightening for the individual and, sometimes, the symptoms can cause them to lash out and hurt themselves or others.
Psychosis is classically associated with schizophrenia spectrum disorders, and, although there are other symptoms, one of the defining criteria for schizophrenia is the presence of psychosis.
Symptoms of psychosis
The classic signs and symptoms of psychosis are:
- Hallucinations – hearing, seeing, or feeling things that do not exist
- Delusions – false beliefs, especially based on fear or suspicion of things that are not real
- Disorganization – in thought, speech, or behavior
- Disordered thinking – jumping between unrelated topics, making strange connections between thoughts
- Catatonia – unresponsiveness
- Difficulty concentrating
Depending on the cause, psychosis can come on quickly or slowly. The same is the case in schizophrenia, although symptoms may have a slow onset and begin with milder psychosis, some people may experience a rapid transition back to psychosis if they stop taking their medication.
The milder, initial symptoms of psychosis might include:
- Feelings of suspicion
- General anxiety
- Distorted perceptions
- Obsessive thinking
- Sleep problems
Hallucinations can affect any of the senses (sight, sound, smell, taste, and touch) in the person with psychosis, but in about two-thirds of patients with schizophrenia, hallucinations are auditory – hearing things and believing them to be real when they do not exist.
The following auditory hallucinations are common:
- Hearing several voices talking, often negatively, about the patient
- A voice giving a commentary on what the patient is doing
- A voice repeating what the patient is thinking
Early diagnosis of psychosis improves long-term outcomes. This is not always achieved, however. The milder forms of psychosis that can lead to schizophrenia are left untreated for an average of 2 years, and even full psychosis can take a number of years before it receives the attention of medical professionals.
To increase the chances of early detection, guidance for healthcare systems drawn up by psychiatrists recommend that the “possibility of a psychotic disorder should be carefully considered” in a young person who is:
- Becoming more socially withdrawn
- Performing worse for a sustained period at school or work, or
- Becoming more distressed or agitated yet unable to explain why
There is no biological test for psychosis itself, and if laboratory tests are done, it is to rule out other medical problems that might provide an alternative explanation.
Brain scans may be done in the early stages of medical attention so that other conditions – often treatable and reversible – can be ruled out.
EEG (electroencephalography) testing records the brain’s electrical activity and may help to rule out delirium, head injury, or epilepsy as possible causes of psychotic symptoms.
Causes of psychosis
The exact causes of psychosis are not well understood
These are the primary causes of psychotic symptoms, but psychosis can also be secondary to other disorders and diseases, including:
- Brain tumor or cyst
- Dementia – Alzheimer’s disease, for example
- Neurological illness – such as Parkinson’s disease and Huntington’s disease
- HIV and other infections that can affect the brain
- Some types of epilepsy
- Genetics – research shows that schizophrenia and bipolar disorder may share a common genetic cause.
- Brain changes – alterations in brain structure and changes in certain chemicals are found in people who have psychosis. Brain scans have revealed reduced gray matter in the brains of some individuals who have a history of psychosis, which may explain effects on thought processing.
- Hormones/sleep – postpartum psychosis occurs very soon after giving birth (normally within 2 weeks). The exact causes are not known, but some researchers believe it might be due to changes in hormone levels and disrupted sleep patterns.
Treatments for psychosis
In this section, we discuss the treatments for psychosis and some methods of prevention.
Treatment with a class of drugs known as antipsychotics is the most common therapy for people with a psychotic illness.
Antipsychotics are effective at reducing psychosis symptoms in psychiatric disorders such as schizophrenia, but they do not themselves treat or cure underlying psychotic illnesses.
So-called second-generation antipsychotics are most commonly used by doctors to treat psychosis. While their use is widespread in the United States, this is controversial.
The World Health Organization (WHO) does not recommend them, except clozapine (branded Clozaril and FazaClo in the U.S.), which may be used under special supervision if there has been no response to other antipsychotic medicines.
Acute and maintenance phases of schizophrenia
Antipsychotic treatment of schizophrenia is in two phases – the acute phase to treat initial psychotic episodes and a lifelong phase of maintenance therapy.
During the acute phase, a stay in hospital is often needed. Sometimes a technique called rapid tranquilization is used.
A fast-acting medication that relaxes the patient will be used to ensure that they do not harm themselves or others.
In the maintenance phase, treatment of schizophrenia is in the community and antipsychotics help to prevent further psychotic episodes, although relapses often occur, sometimes due to a failure to take the medications.
Lifelong treatment of schizophrenia may involve other interventions and support, including the role of the family in care.
Psychotherapy can also be useful in treating cognitive and residual symptoms of schizophrenia and other psychotic disorders.