Dr. Tariq Jagnarine
Fam Medicine, Endocrinology / Diabetes
Psychosis involves a loss of contact with reality, and can feature hallucinations and delusions. It is a symptom of schizophrenia and bipolar disorder, but it has many other causes. Psychosis affects how a person thinks, and that person’s perceptions. Their senses may seem to detect things that do not exist, and they may find it difficult to determine what is real and true.
People with psychosis may:
* Hear voices
* See people or items that are not there
* Smell odours that other people cannot detect
They may also believe that they are in trouble, someone is chasing them, or they are very important, when these situations are not the case.
A person may not be aware that they have psychosis because the delusions feel real to them.
Psychosis can be overwhelming and confusing. Sometimes, the symptoms can cause the person to harm themselves. In rare cases, they may hurt another person.
RISK FACTORS FOR DEVELOPING PSYCHOSIS
It’s not currently possible to precisely identify who is likely to develop psychosis. However, research has shown that genetics may play a role. People are more likely to develop a psychotic disorder if they have a close family member, such as a parent or sibling, who has a psychotic disorder.
Children born with the genetic mutation known as 22q11.2 deletion syndrome are at risk of developing a psychotic disorder, especially schizophrenia.
CAUSES OF PSYCHOSIS
The exact causes of psychosis are not well-understood, but might involve:
* Genetic factors: Research shows that schizophrenia and bipolar disorder may share a common genetic cause.
* Hormones: Some people experience postpartum psychosis after giving birth. Due to this, and the fact that the early signs of psychosis often occur first in adolescents, some experts have suggested that hormonal factors may play a role in those with a genetic susceptibility.
* Brain changes: Tests have found differences in brain chemicals — specifically, the activity of the neurotransmitter dopamine — in people who experience psychosis.
* A lack of sleep may also trigger psychosis.
TYPES OF PSYCHOSIS
Apart from schizophrenia, various other disorders and factors can cause psychosis. The different types include:
* Schizoaffective disorder: This disorder is similar to schizophrenia but includes periods of mood disturbances.
* Brief psychotic disorder: Symptoms occur in response to a stressful life event, last less than a month, and do not return.
* Delusional disorder: The person has a strong belief in something irrational and often bizarre, with no factual basis.
* Bipolar psychosis: Some people with bipolar disorder experience psychosis, either during a very high or very low mood.
* Severe depression: Also known as major depressive disorder with psychotic features.
* Postpartum (postnatal) psychosis: This type of psychosis can present after giving birth.
* Substance-induced psychosis: The misuse of alcohol, some recreational drugs, and certain prescription drugs can cause this.
Psychosis can also result from other disorders, such as:
* A brain tumour or cyst
* Dementia, including Alzheimer’s disease
* Neurological conditions, such as Parkinson’s disease and Huntington’s disease
* HIV and other infections that can affect the brain
* Some types of epilepsy
* Malaria
* Syphilis
* Stroke
* Low blood sugar
* Multiple Sclerosis
* Stress
SYMPTOMS OF PSYCHOSIS
The signs and symptoms of psychosis include:
* Hallucinations: The person hears, sees, smells, tastes, or feels things that do not exist.
* Delusions: The individual believes things that are false, and they may have unfounded fears or suspicions.
* Disorganised thinking, speech, and behaviour: The person may jump between unrelated topics in speech and thought, making connections that appear illogical to other people. Their speech may make no sense to others.
* Catatonia: The person may become unresponsive.
* Unusual psychomotor behaviour: The person makes unintentional movements, such as pacing, tapping, and fidgeting.
The person may also experience:
* Mood changes
* Difficulty focusing
* Sleep problems
Depending on the cause, psychosis can appear quickly or slowly. It can also be mild or severe. In some cases, it may be mild when it first appears, but becomes more intense over time.
Early signs
The mild, early symptoms of psychosis might include:
* General anxiety
* Depression
* Social isolation
* Problems focusing
* Mild or moderate disturbances in language, energy levels, and thinking
* Difficulty taking initiative
* Lower tolerance to stress
* Sleep problems
* Neglecting self-care
* Feelings of suspicion
* Thoughts and ideas that seem strange to others, or hearing voices.
Auditory hallucinations appear to be the most common types of hallucinations for people with schizophrenia. The person hears things, and believes them to be real when they do not exist. Often, the person hears voices. There may be one or many voices, and they will sound exactly like real voices.
The voices may:
* Be recognisable, nonspecific, or of someone who has died
* Sound either clear, or like mumbling in the background
* Give instructions or criticise the person
* Be intermittent, or constant
Hearing voices can be very confusing, and it can affect a person’s actions. It can lead to the individual harming themselves; or, less often, others.
Treatment can manage or prevent psychosis, but it can return if the person stops taking their medication.
There may also be a risk of suicide.
Delusions during psychosis
During a psychotic episode, a person may experience delusions. Paranoid delusions can cause a person to be suspicious of individuals or organisations, believing them to be plotting to cause the person harm.
Delusions of grandeur involve a strong believing that he or she has a special power or authority. For instance, they may believe that they are a political leader.
DIAGNOSIS OF PSYCHOSIS
Anyone who is experiencing psychosis should receive urgent medical attention. Treatment can provide both short- and long-term help.
Early diagnosis
Schizophrenia and bipolar disorder usually appear in a person’s teenage years, or during early adulthood. Early treatment can improve long-term outcomes, but it can take time for healthcare professionals to provide an accurate diagnosis.
Psychiatrists recommend considering the possibility of a psychotic disorder in a young person if they show signs of:
* Increased social withdrawal
* Changes in mood
* Reduced focus or performance at school or work
* Distress or agitation without being able to explain why.
There is no biological test for psychosis, but laboratory tests can rule out other medical problems that might explain the symptoms.
TREATMENTS FOR PSYCHOSIS
Psychosis can be disruptive, but treatment is available to help people manage it.
* Antipsychotic drugs
Antipsychotic drugs are the main form of treatment for people with a psychotic illness.
Antipsychotics can reduce psychosis symptoms in people with psychiatric disorders such as schizophrenia. However, they do not treat or cure the underlying condition. A person can use these drugs only under supervision of a doctor, as they can have adverse effects. The doctor would also treat any underlying conditions responsible for the psychosis. Where possible, family support can also help.
Psychosis is one of the key symptoms of schizophrenia, but it has other causes. It can make the individual and those around them anxious, but treatment is available to help manage psychosis in those who are at risk.
It is essential to follow the treatment plan for schizophrenia and other mental health conditions in order to prevent a relapse of symptoms, such as psychosis. Psychosis doesn’t have many medical complications; however, if left untreated, it can be challenging for people experiencing psychosis to take good care of themselves. That could cause other illnesses to go untreated. Most people who experience psychosis would recover with proper treatment. Even in severe cases, medication and therapy can help.
