Definition and Overview

Psychosis is a common symptom of many mental illnesses. It causes a person to become detached from reality and hallucinate. Sufferers often hear and see things that are not there. In rare cases, they may even touch or taste things that do not exist. Because they do not know what is real, they tend to react to situations differently and show abnormal behaviours. For example, they may argue with a person that is not there.

Mental illnesses which hallmark symptom is psychosis are called psychotic disorders. These include:

  • Schizophrenia - A mental disorder in which a person presents with cognitive difficulties. It is often a lifelong condition that requires long-term management.

  • Delusional disorder - Makes a person strongly believe in things that are not present or real. However, this disorder can be very mild. Many patients can function normally. They can attend to their daily responsibilities despite their disorder.

  • Bipolar disorder - A person with this disorder has extreme and unpredictable mood swings. They can be very happy at one moment and depressed at the next.

  • Drug-induced psychosis - Triggered by substances that cause abnormal mood changes. These include drugs that are classified as downers and stimulants. Symptoms of psychosis usually go away as soon as the effects of the substances wear off.

  • Organic psychosis - Occurs when the part of the brain that contains thought processing is damaged. The damage can be caused by severe head injuries or physical illness.

  • Brief psychotic disorder - Occurs when a person goes through life-changing situations. These include losing a job or going through a divorce. The symptoms are temporary. Often, they go away on their own after a couple of weeks.

Causes of Condition

There are a number of factors that can cause psychosis. These include:

  • Drug or alcohol abuse

  • Traumatic events - Examples are a death of a loved one and sexual abuse.

  • Brain diseases - These include brain tumours and stroke.

  • Brain infections

  • Genetics - Having a close relative with psychosis (such as a parent or a sibling) increases one’s risk of the disorder.

Key Symptoms

A person with psychosis usually shows these symptoms:

  • Sees and hears things that are not there

  • Worries too much without an apparent reason

  • Constantly feels they are being watched. Some even feel that other people are out there to harm them.

  • Suffers from depression. They always feel down and sad, often for no apparent reason

  • Can’t feel normal emotions. They are indifferent to others’ moods and feelings. They also don’t feel emotions that most people feel during certain events. For example, they do not get excited that they are having a new baby or feel sad when someone they love dies.

  • Does not care about their appearance and personal hygiene

  • Would rather be alone than with other people. Some patients go the extra mile to avoid any form of social contact.

Who to See and Types of Treatments Available

A person showing symptoms listed above should be assessed by a mental health provider as soon as possible. Early diagnosis can prevent the disorder from progressing. It is also the key to avoid a number of complications.

Psychologists and psychiatrists diagnose and treat the disorder. Often, they advise patients to come in with loved ones because they commonly lack insight of their condition.

To determine what causes the symptoms, the doctor will review the patient’s medical history. They will also discuss the patient’s lifestyle. A number of medical tests and procedures are also used to rule out other medical problems.

Psychosis is treated with:

  • Antipsychotic drugs - These medications work by controlling the symptoms. There are two types of these drugs: first and second generation. First generation antipsychotics were first used in the 1950s. They work by blocking a specific type of dopamine receptor (D2). Second-generation antipsychotics also block D2 receptors as well as 5-HT2A, a serotonin receptor. Both have been proven effective. However, they can cause a number of side effects. They both increase a patient’s risk of involuntary muscle movements and type 2 diabetes. They can also cause weight gain and lipid disorders. It is important to note that these drugs only treat psychosis symptoms. They are not used to treat the patient’s underlying medical condition.

  • Cognitive behavioural therapy (CBT) - Medical therapy is best combined with CBT. This is a talk therapy where the counselor focuses on helping patients understand their behaviour. They also teach the patient techniques on how to better cope with their problems.

Prognosis

With the use of CBT and medications, the long-term outlook for patients with psychosis is generally good. It is even better if they are diagnosed and treated as soon as their symptoms appear.

References:

  • Perälä J, Suvisaari J, Saarni SI, et al. Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population. Arch Gen Psychiatry. 2007;64(1):19-28. doi:10.1001/archpsyc.64.1.19.

  • Cutajar, M., Mullen, P. E., Ogloff, J. R. P., Thomas, S. D., Wells, D. L., & Spataro, J. (2010). Schizophrenia and other psychotic disorders in a cohort of sexually abused Children. Archives of General Psychiatry, 67(11), 1114-1119.

  • National Institute of Mental Health: “Recovery After an Initial Schizophrenia Episode (RAISE) Questions & Answers.”

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