Psychosis is characterized by a loss of contact with reality that is not related to a person’s cultural background or belief system. Psychosis tends to involve one or two major symptoms:
Delusions are false yet fixed beliefs that persist even in the presence of conflicting facts. Delusions may be delusions of persecution such as the belief that the government is monitoring his or her thoughts, or of mistaken identity, such as the belief that one is not related to his or her parents. Other people may suffer delusions of grandeur, in which a person believes erroneously that he or she has special talents, powers, or abilities; some people who have delusions of grandeur even believe they are famous people.
It’s important to note that delusions do not change or modify even if the person is presented with contradictory information or new ideas. Many people who suffer delusions also suffer cognitive complaints such as trouble maintaining concentration, confused thoughts, and feeling as though one has thoughts that are blocked. Often people have delusions that are short-lived and associated with events such as anesthesia or related to sleep deprivation, while others may experience periodic delusions that are often associated with major depressive disorder or bipolar disorder.
Hallucinations are a sensory perception in absence of apparent stimulus that has the qualities of a real sensory perception that others do not experience. Hallucinations are substantial, vivid, and are located in external objective space. Hallucinations may occur in visual, auditory, olfactory, gustatory, tactile, or other sensory stimuli. Most often, people who have hallucinations experience auditory hallucinations or “voices” that are coordinated with increased activity in the auditory cortex of the brain during neuroimaging studies. While these voices are very real to the person who is experiencing it, these can be highly confusing for loved ones to witness. Voices may be critical and mean, threatening, neutral, and may involve known or those unknown to the person experiencing the hallucinations.
Disorganized thinking (speech) or “formal thought disorder” is often seen in a person’s speech. A person who has disorganized thinking may switch from one topic to another and answers to questions may be obliquely or entirely unrelated. Occasionally, speech may be so disorganized and incomprehensible that the individual is entirely unable to be understood. The impact upon speech must be severe enough that it compromises a person’s ability to properly communicate.
Disorganized, abnormal motor behaviors (including catatonia) can range from childlike silliness to unpredictable agitation that may be noted in goal-directed behaviors which can lead to problems in one’s ability to perform activities of daily living. Catatonic behaviors are a marked decrease in reactivity to the environment which may range from resistance to instructions, maintaining a rigid, inappropriate, or bizarre posture, to a complete lack of motor or verbal responses. These may also include repeated movements, staring, grimacing, mutism, or echoing of speech.
Negative symptoms will vary depending upon the type of psychotic disorder. Diminished emotional expression includes reduction in facial expressions, eye contact, intonation of speech, and movements of the hand, head, and face that normally display emotional emphasis to speaking. Negative symptoms of psychotic disorders include: avolution – the decrease in motivated, self-interested and purposeful activities, alogia – diminished speech output, and anhedonia – the decreased ability to feel pleasure.
Types of Disorders Associated with Psychosis
Psychosis is a symptom; a diagnosis of exclusion only considered a psychiatric disorder when other relevant, known causes of psychosis are excluded. Medical and laboratory testing should exclude the presence of central nervous system diseases and injuries, drugs, illegal substances, and prescribed medications when a person experiences a new-onset of psychosis before a psychiatric diagnosis is considered. Psychosis involves an abnormal condition of the mind associated with the loss of contact with reality. While schizophrenia is the most commonly known mental disorder associated with psychosis, there are a variety of other disorders that may cause psychotic behaviors. These include:
Bipolar disorder is a mental disorder characterized by extreme elevation in mood along with cycles of depression and sadness. When left untreated or undiagnosed, people with bipolar disorder may develop psychosis.
Brief psychotic disorder is a psychiatric illness that has a rapid onset with symptoms that abate after a month. Brief psychotic disorder tends to occur after a particularly traumatic event, but may occur in the absence of an obvious stressor.
Delusional disorder is a relatively uncommon condition in which a person struggles with delusions without the accompanying hallucinations, thought disorders, mood disorders, and without any flattening or affect.
Folie à deux, also known as shared psychosis, is a form of psychosis in which symptoms of a delusional belief are transmitted from one person (the primary) to the next (the secondary) notably when the people live together, are physically or socially isolated, and may have little outside interaction with other people. This shared psychosis can involve more than two people.
Major depressive disorder is a mental illness characterized by intense periods of sadness, hopelessness, and worthlessness that may become so extreme that they cause psychosis.
Psychosis due to medical condition: Hallucinations, delusions, and other symptoms may be the result of another illness that impacts proper brain functioning. These may include brain cancer, tumors, or head injury.
Schizoaffective disorder is a mental illness that features symptoms of two different mental health disorders: schizophrenia and depression or bipolar disorder. Schizoaffective disorder affects the way a person thinks, behaves, expresses emotions, perceives reality, and relates to the world.
Substance-abuse psychotic disorder is the development of psychotic features as a result of toxic chemicals or poisonous drugs that may include legal or illegal drugs. Generally self-resolving, substance abuse psychosis may, upon occasion, be irreversible and lead to lasting changes in the way a person perceives the world.
The percentage of people who are struggling with any psychotic symptom at one time varies wildly from country to country. One of every 100 people, or 3 million people, in the United States qualifies for a diagnosis of schizophrenia, however many other disorders do have symptoms of psychosis that are not explained by schizophrenia. Worldwide, about 1% of the total population struggles with psychotic disorders, which often appear in a person’s late teens, 20s, or 30s.
Causes and Risk Factors for Psychotic Disorders
Beyond psychotic disorders that occur as a result of medical conditions or drug abuse, the specific cause for psychotic disorders is not well-known. It’s believed that there is an interplay between genetic, physical, and environmental risk factors that lead to the development of psychological disorders. These include:
Genetic: It is believed that there are multiple genes involved in psychotic disorders. Generally speaking, a person who has a first-degree relative, such as a parent or sibling, who has developed a psychotic disorder is at greater risk for developing the disorder him or herself.
Physical: Neurotransmitters, the chemicals in the brain responsible for communication between neurons (notably glutamate, serotonin, and dopamine) have been linked to the development of psychotic disorders. Additionally, there appear to be changes in the structure and function of the brain in people suffering from schizophrenia.
Environmental: There are a variety of environmental factors implicated in the development of psychotic disorders. Notably, problematic drinking, women in the postpartum period, as well as those who abuse drugs are at higher risks for developing psychotic disorders.
- Past history of mood problems
- Problems functioning in society
- Problems carrying out normal activities of daily living
- Those who are naturally suspicious of others
- Victims of domestic abuse
- Childhood history of abuse
- Increased amounts of life event
- Lack of support systems
Signs and Symptoms of Psychosis
As psychotic disorders drastically change a person’s world and behavior, the development of psychotic disorders can be easily identified. Psychotic disorder signs and symptoms will vary depending upon individual makeup, presence of co-occurring disorders, as well as the type of psychotic disorder and may include:
- Social withdrawal
- Disorganization of speech and behaviors
- Loss of appetite
- Weight loss
- Increasingly disheveled appearance
- Disorganized thoughts
- Intrusive, bizarre thoughts
- Difficulty processing information
- Difficulties understanding environment
- Challenges recalling simple tasks
- Increased confusion
- Sense of being controlled by outside influences
- Self-harming behaviors
- Suicidal thoughts
How are Psychotic Disorders Treated?
There are a variety of approaches used to treat a person who is struggling with a psychotic disorder. As psychosis is often the result of another mental or physical illness, treatment will be divided into two parts – managing the co-occurring disorder and treating the symptoms of psychosis. There are a number of antipsychotic medications on the market that are quite effective at treating acute psychosis and reducing the instances of future psychotic breaks. Many people struggling with psychosis find that inpatient treatment is best while acutely psychotic as it allows for the supervision and adjustment of medications while being provided with safe care. When the symptoms of psychosis have been managed, the underlying co-occurring disorder can be managed.
Effects of Psychotic Disorders
The long-term effects of psychosis will vary tremendously based upon individual makeup, the underlying cause, and severity of symptoms. All psychosis should be treated as medical emergencies. Symptoms of untreated psychotic disorders may include:
- Substance addiction
- Decreased ability to carry out activities of daily living
- Violent behaviors
- Suicidal thoughts and behaviors