INTRODUCTION
Most people think of psychosis as a break with reality. In a way it is. Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing and believing things that aren’t real or having strange, persistent thoughts, behaviors and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.
Psychotic disorders are mental disorders in which a person’s personality is severely confused and that person loses touch with reality. When a psychotic episode occurs, a person becomes unsure about what is real and what isn’t real and usually experiences hallucinations, delusions, off-the-wall behavior, chaotic speech and incoherency. A person behaving in this manner is often referred to as being schizophrenic.
When symptoms are severe, people with psychotic disorders have trouble staying in touch with reality and often are unable to handle daily life. But even severe psychotic disorders usually can be treated.
Psychosis includes a range of symptoms but typically involves one of these two major experiences:
Hallucinations are seeing, hearing or feeling things that aren’t there, such as the following:
Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true and may seem irrational to others, such as the following:
TYPES
There are different types of psychotic disorders, including:
· Schizophrenia: People with this illness have changes in behavior and other symptoms -- such as delusions and hallucinations -- that last longer than 6 months. It usually affects them at work or school, as well as their relationships.
· Schizoaffective disorder: People have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder.
· Schizophreniform disorder: This includes symptoms of schizophrenia, but the symptoms last for a shorter time: between 1 and 6 months.
· Brief psychotic disorder: People with this illness have a sudden, short period of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick -- usually less than a month.
· Delusional disorder : The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true but isn't, such as being followed, being plotted against, or having a disease. The delusion lasts for at least 1 month.
· Shared psychotic disorder (also called folie à deux): This illness happens when one person in a relationship has a delusion and the other person in the relationship adopts it, too.
· Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from drugs, such as hallucinogens and crack cocaine, that cause hallucinations, delusions, or confused speech.
· Psychotic disorder due to another medical condition: Hallucinations, delusions, or other symptoms may happen because of another illness that affects brain function, such as a head injury or brain tumor.
· Paraphrenia: This condition has symptoms similar to schizophrenia. It starts late in life, when people are elderly.
· Bipolar psychosis – individuals have the symptoms of bipolar disorder (intense highs and lows in mood) and also experience episodes of psychosis. The psychosis more commonly occurs during manic phases.
· Psychotic depression – also known as major depressive disorder with psychotic features.
· Postpartum (also called postnatal) psychosis – a severe form of postnatal depression.
Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:
Such warning signs often point to a person’s deteriorating health, and a physical and neurological evaluation can help find the problem. A mental health professional performing a psychological evaluation can determine if a mental health condition is involved and discuss next steps. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.
Other possible symptoms of psychotic illnesses include:
People don’t always have the same symptoms, and they can change over time in the same person.
CAUSES
We are still learning about how and why psychosis develops, but several factors are likely involved. We do know that teenagers and young adults are at increased risk of experiencing an episode of psychosis because of hormonal changes in their brain during puberty.
Several factors that can contribute to psychosis:
Early treatment of psychosis, especially during the first episode, leads to the best outcomes.
Research has shown significant success using a treatment approach called Coordinated Specialty Care (CSC). CSC uses a team of health professionals and specialists who work with a person to create a personal treatment plan based on life goals while involving family members as much as possible.
CSC has the following key components:
Traditional treatment for psychosis involves psychotherapy and medication. Several types of therapy have successfully helped individuals learn to manage their condition. In addition, medication targets symptoms and helps reduce their impact.
Medication: The main type of drug that doctors prescribe to treat psychotic disorders are “antipsychotics.” Although these medicines aren’t a cure, they are effective in managing the most troubling symptoms of psychotic disorders, such as delusions, hallucinations, and thinking problems.
Psychotherapy: There are different types of counseling -- including individual, group, and family therapy – that can help someone who has a psychotic disorder.
Most people with psychotic disorders are treated as outpatients, meaning they don’t live in institutions. But sometimes people need to be hospitalized, such as if they have severe symptoms, are in danger of hurting themselves or others, or can’t care for themselves because of their illness.