All about Psychosis

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What is Psychosis?

The word psychosis is used to describe conditions which affect the mind, where there is some loss of contact with reality. Psychosis varies greatly and the term covers a number of related illnesses.

When someone becomes ill in this way and loses contact with reality it is called a psychotic episode. People who have experienced this often call it spinning out or going off the planet.

With time and the right treatment, most people make a full recovery from the experience. Many may never have another episode. A minority experience psychotic symptoms on a daily basis.

Psychosis is most likely to occur in young adults and is quite common. Around 3 out of every 100 people will experience a psychotic episode making psychosis more common than diabetes.

Psychosis can happen to anyone. Like any other illness it can be treated.

What causes Psychosis?

A number of theories have been suggested as to what causes psychosis, but there is still much research to be done. It may be a combination of factors.

Chemical imbalance

It is commonly believed that a psychotic episode occurs due to a disturbance in how the brain normally functions. Our brain works by sending chemical messages from one part to another. When someone develops psychosis this may be due to a chemical imbalance in the brain, perhaps sending too much or too little chemical messages. Medication for psychosis works by trying to compensate for this chemical imbalance.

Genetic factors

These may include genetic vulnerability suggesting that in some instances it may be inherited, or physical factors such as impairment of the nervous system during very early development.

Stress, drug abuse or social change

Symptoms of psychosis often emerge in response to these. These are not causes of psychosis but it does seem that if you have a vulnerability then you may experience a psychotic episode.

At this stage we cannot predict who will or who will not develop a psychosis. It has been suggested that if you have a vulnerability then to reduce stress in your life may assist you from having an episode.

What are the Symptoms?

Symptoms vary a lot from person to person, however, there are a number of quite common categories of symptoms.-some of these you will have experienced, others you may not have.

Symptoms usually include changes in your thoughts, feelings and behaviours, making it hard for other people to understand you.

In order to try to understand the experience of psychosis it is useful to group together some of the more characteristic symptoms.

Problems in thinking

You may have difficulty organising your thoughts, everyday thoughts become confused or don’t join up properly. Sentences are unclear or don’t make sense. You may have difficulty concentrating, following a conversation or remembering things. Thoughts seem to speed up or slow down. You may believe that your thoughts are being interfered with in some way.

False beliefs or delusions

It is common for a person experiencing a psychotic episode to hold false beliefs known as delusions. You may be so convinced of your delusion, that the most logical argument cannot make you change their mind. It seems real to you but does not seem real to other people. For example someone may be convinced from the way the cars are parked outside their house that they are being watched by the police.

Hallucinations

In psychosis the person sees, hears, feels, smells or tastes something that is not actually there and no one else has the same experience. For example you may hear voices which no one else can hear, or see things which aren’t there. Things may taste or smell as if they are bad or even poisoned. These hallucinations are very real to you. The voices you hear may tell you to do certain things or may be abusive or funny.

Changed feelings

How you feel may change for no apparent reason. You may feel strange and cut off from the world with everything moving in slow motion. Mood swings are common and you may feel unusually excited or depressed. Some times peoples emotions seem dampened-they feel less than they used to, or show less emotion to those around them.

Changed behaviour

People with psychosis behave differently from the way they usually do. You may be extremely active or lethargic sitting around all day, or sleeping a lot. You may laugh inappropriately or become angry or upset without a reason. You may find it difficult to talk to other people.

Often changes in behaviour are associated with the symptoms already described above. For example, a person believing they are in danger may call the police, or they may stop eating because they believe the food is poisoned.

Symptoms vary from person to person and may change over time.

What are the types of Psychosis?

When someone has a psychosis, a diagnosis of a particular psychotic illness is usually given. A diagnosis means identification of an illness by a person’s symptoms and the diagnosis will depend on what brought on the illness and how long the symptoms last. Many psychotic symptoms like hallucinations and delusions are common to all psychoses. This means that the boundaries between the different types of psychosis are blurred and it is often difficult to make a decision.

The most common conditions in which psychosis occur are:

Brief Psychotic Disorder

This is a psychosis that lasts less than one week that is a reaction to a severe stress. It can involve quite severe symptoms but recovery is quick.

Organic Psychosis

This type of psychosis can be clearly related to a physical problem that disrupts brain functioning and is caused by illness or head injury.

Substance-Induced Psychosis

This type of psychosis is associated with alcohol or drug abuse or withdrawal. It is usually brief with psychotic symptoms resolving as the effects of the substances wear off, although in some cases longer lasting psychotic illness seems to begin with substance induced psychosis.

Bipolar Disorder (or Manic-Depression)

Bipolar Disorder is a mood disorder which may or may not be accompanied by psychotic symptoms. Prominent symptoms are extremes of mood both highs (mania) and lows (depression). Psychotic symptoms when present fit in with the person’s mood.

Major Depressive Episode with Psychotic Features (or Psychotic Depression)

This diagnosis is made when there is depression with psychotic symptoms but without mania (high).

Schizophrenia

This type of psychosis includes hallucinations, delusions and changes in behaviour, feelings and thinking that have been continuing for a period of at least six months.

Schizophreniform Disorder

A psychosis like Schizophrenia however the symptoms last more than one month and less than six months.

Schizoaffective Disorder

This diagnosis is made when the person has symptoms of both a mood disorder (depression or mania) and psychosis.

Psychosis has many forms. Course and outcomes vary from person to person.

What treatments are available?

Medication is an essential treatment for psychosis. Along with other forms of treatment, it plays a fundamental role in recovery from a psychotic episode and in prevention of further episodes.

Supportive psychotherapy or having someone to talk to about your illness, to provide reassurance and to assist with practical matters can be of great benefit.

Cognitive Behavioural Therapy to learn ways to manage symptoms and to cope with feelings.

Psychosocial rehabilitation to learn skills to return to everyday activities. Social and professional support, and education of yourself and family members about your illness has been found to be of great benefit.

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