Psychosis

There are several different definitions for the word “psychosis”, and even experts in the fields of psychiatry and psychology don’t all agree on a specific one. Often, psychosis is used to refer to a condition in which a person has lost touch with reality. The person is either experiencing hallucinations or delusions. A broader definition of the term psychosis would include the other positive symptoms of schizophrenia. These include disorganized speech, and behavior which is either catatonic or severely disorganized. At times the word also includes an extreme impairment in one’s reality testing. Regardless of which definition is used, when someone is psychotic it usually impacts them significantly.

Hallucinations and Delusions

Hallucinations

Hallucinations involve one of the senses (sight, sound, touch, taste, or smell) and what the person is sensing is not actually there. The most common type of hallucination is auditory in nature – they usually involve hearing voices. Schizophrenics often hear conversations or one or more voices telling them to do something (“command hallucinations”). However, psychotic individuals may also have other types of hallucinations, such as seeing things, feeling something or someone touching them or crawling on them, or smelling or tasting things – none of which are really there.

Delusions

A delusion is essentially a firmly held false belief. A person who is delusional will continue to hold the belief even if blatant evidence that it isn’t true is shown to them.

Delusions are categorized as “bizarre” or “non-bizarre”. Bizarre delusions are beliefs which are completely implausible. An example of a bizarre delusion would be the belief that the person’s brain has been removed and replaced with an alien one. Non-bizarre delusions involve things which could actually happen, such as one’s phone being tapped.

There are many different types of delusions, but some of the more common are persecutory delusions (e.g. the person is the object of harassment, persecution, or a conspiracy), erotomanic (i.e. a particular person, usually higher in status such as a celebrity, is in love with the person), grandiose (e.g. the person has significant power or knowledge, or inflated worth), thought insertion (i.e. one’s thoughts have been put into one’s mind by someone else), thought broadcasting (i.e. one’s thoughts are being broadcast and others can hear them).

Psychotic Disorders

The different psychotic disorders listed in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) utilize the range of definitions for psychosis (or psychotic). These disorders are as follows:

• Schizophrenia – this is the most common psychotic disorder, affecting approximately 1% of the adult population. It is considered a chronic disorder, and can be extremely debilitating. The overall disturbance occurs for a minimum of 6 months, and includes at least a month of “active-phase” symptoms - delusions, hallucinations, disorganized speech, extremely disorganized or catatonic behavior, and negative symptoms such as flat affect, poverty of speech, and the inability to start or participate in goal-directed activities.

• Schizophreniform Disorder – the symptoms of this disorder are the same as schizophrenia, except the disturbance is shorter - lasting between one month and up to six months. Also, there is no criterion that the person’s functioning must become impaired.

• Schizoaffective Disorder – this disorder is very similar to schizophrenia, except it includes a mood episode (either mania or depression) at the same time the active symptoms (e.g. delusions, hallucinations) are occurring. There must also be a 2 week period during which hallucinations or delusions are present without any mood symptoms.

• Delusional Disorder – this disorder involves at least one month of delusions which are not bizarre in nature, and other active-phase schizophrenic symptoms are not present.

• Brief Psychotic Disorder – in this disorder psychosis is present for at least a day and less than one month.

• Shared Psychotic Disorder (also known as Folie a Deux) – this is a fairly rare disorder that involves two people in a close relationship – one of the individuals develops a delusion similar to and due to the influence of the other person’s already established delusion.

• Psychotic Disorder due to a General Medical Condition – in this disorder the psychotic symptoms are directly caused by something medical, such as a brain tumor.

• Substance-Induced Psychotic Disorder – Alcohol-induced psychosis or drug-induced psychosis occur when the psychotic symptoms are directly caused by a substance, such as drugs, medication or some type of toxin.

• Psychotic Disorder Not Otherwise Specified - this diagnosis is given when psychotic symptoms are present but it doesn’t meet the criteria for any of the other psychotic disorders, or there isn’t enough information or consistent information to give a definitive diagnosis.

The disorders listed above are all classified as psychotic disorders; however, other disorders may also include psychotic symptoms as times. Individuals with depression, bipolar disorder, dementia, and several of the personality disorders (schizoid, schizotypal, paranoid, and borderline) may experience psychosis as part of the disorder.

Causes of Psychosis

Psychosis may be caused by different things, including drugs, alcohol, certain medications, toxins, genetics, brain abnormalities, medical conditions in which the brain degenerates over time (e.g. Huntington’s disease, Alzheimer’s disease, or Parkinson’s disease),severe stress, stroke, brain tumors, and epilepsy.

In order to determine the cause and give the most appropriate diagnosis, the person undergoes a psychiatric assessment. In some cases lab work is done in order to rule out other causes such as substances or medical conditions. Brain imaging may also be used at times.

Treatment for Psychosis

The treatment for psychotic symptoms depends largely on the cause of the symptoms. Antipsychotic medication is usually part of the treatment regardless of what caused the psychosis. These medications help reduce or alleviate delusions and hallucinations. They also help the person’s thinking and behavior become more organized.

Hospitalization is often required to stabilize someone who has become actively psychotic. If the person is hearing command auditory hallucinations, is extremely paranoid, for example, he may be at risk of harming himself or others and typically requires hospitalization. Hospitalization is also usually required if the psychosis is causing significant impairment in the person’s functioning.

Prognosis

The prognosis for a person who has become psychotic varies significantly, and depends primarily on the cause of the psychosis. For example, if the psychosis is due to drug intoxication, it will often clear once the drug is out of the person’s system. Psychosis due to a treatable medical condition may also clear in time.

Unfortunately, psychosis due to schizophrenia, schizoaffective disorder, or another chronic condition such as dementia will often require ongoing medication and other types of treatment, such as periodic hospitalizations. There is some research that suggests that when an initial psychotic episode is treated early on, the long-term prognosis may be improved to some degree.

At this time there is no cure for schizophrenia or schizoaffective disorder. While about one in every three individuals with schizophreniform disorder fully recover, the other two out of three go on to develop schizophrenia or schizoaffective disorder. The other psychotic disorders (i.e. delusional disorder, brief psychotic disorder, and shared psychotic disorder) vary in terms of response to treatment, and in general are relatively rare.