Generality
Psychosis is a serious mental health disorder that, by profoundly altering the ability to think, causes those affected to lose all contact with reality.
The psychotic individual, in fact, mainly suffers from illusions and hallucinations, that is, he becomes convinced of things that are not true (illusions) and believes he hears or sees things that are completely non-existent (hallucinations).
A thorough physical examination, a "complete medical history, and" a careful psychological evaluation are essential for a correct diagnosis.
Treatment includes causal therapy, the use of antipsychotics, and psychotherapy techniques.
What is psychosis?
Psychosis is a serious mental health problem which, due to a "profound alteration of emotion and thinking skills, leads the individual concerned to lose all contact with reality."
The psychotic - that is, the person with psychosis - is a subject who has a distorted view of what is happening around him: he becomes convinced of things that are not true and believes he hears or sees things that are completely non-existent.
EPIDEMIOLOGY
Psychosis is more common than most people think.
A recent study, in fact, observed that, in England, psychosis has an annual incidence rate equal to one case for every 2,000 individuals.
Indeed, another interesting statistical survey estimated that about 3 out of 100 subjects develop an episode of psychosis at least once in their life.
Psychosis can arise at any age; however, it is rare in people under the age of 15.
Causes
The causes of psychosis are innumerable.
The triggers include:
- Trauma to the head
- Certain psychiatric disorders (or psychiatric illnesses)
- A large number of medical conditions
- The intake of various psychoactive substances
In the next four sub-chapters, the article will deal in detail with the four categories of causes of psychosis listed above.
PSYCHOSIS FROM TRAUMA TO THE HEAD
According to some scientific investigations, suffering head trauma, especially during childhood, increases the risk of developing a more or less severe form of psychosis.
PSYCHIATRIC DISEASES THAT CAUSE PSYCHOSIS
Psychiatric diseases that can cause psychosis are:
- Schizophrenia
- Delusional (persistent) disorder
- The short psychotic disorder
- The schizoaffective disorder
- Mood disorders, including severe depression and bipolar disorder
- Chronic hallucinatory psychosis
MEDICAL CONDITIONS CAUSING PSYCHOSIS
The list of medical conditions that can cause psychosis includes:
- Neurodegenerative diseases, such as Alzheimer's disease, Lewy body dementia, Huntington's disease and Parkinson's disease.
- Stroke.
- brain tumors.
- Multiple sclerosis.
- Some forms of epilepsy.
- Neurodevelopmental diseases, such as DiGeorge syndrome (or velo-cardio-facial syndrome) and chromosomal abnormalities.
- Some diseases of the endocrine system, such as hypothyroidism, hyperthyroidism, adrenal insufficiency, Cushing's syndrome, hypoparathyroidism, hyperparathyroidism.
- Infectious diseases such as AIDS (HIV), viral encephalitis, malaria, Lyme disease, syphilis.
- Some serious nutritional deficiencies, such as vitamin B12 deficiency.
- Some inborn errors (or defects) of metabolism, including porphyria and metachromatic leukodystrophy.
- Some acquired metabolic diseases, such as hypocalcemia, hypercalcemia, hypernatremia, hyponatremia, hypokalaemia, hypomagnesaemia, hypermagnesemia, hypophosphataemia, hypoglycemia, etc.
- Some autoimmune diseases, including systemic lupus erythematosus, sarcoidosis and Hashimoto's encephalopathy.
- Some sleep disorders, such as narcolepsy.
PSYCHOACTIVE SUBSTANCES THAT CAUSE PSYCHOSIS
Generally, the term "psychoactive substance" refers to any chemical substance capable of altering an individual's brain function, perception, mood and state of consciousness.
Among the psychoactive substances capable of inducing psychosis or some typical symptoms of psychosis, a particular mention deserves:
- Alcoholics. According to some statistical surveys, about 3% of alcoholic people experience episodes of psychosis at least once in their life.
Those most at risk are those who have been abusing alcohol for a long time. - Marijuana (or cannabis)
- Cocaine
- Amphetamines and methamphetamines. Some studies report that methamphetamines cause psychosis in 25-46% of those who take such substances.
- The cathinone
- Hallucinogenic substances, such as LSD and psilocybin
- The k-type opioid receptor agonists
- Some NMDA receptor antagonists (e.g. ketamine)
OTHER FORMS OF PSYCHOSIS
There are particular forms of psychosis which, due to the triggering reasons, are difficult to insert into one of the previous categories.
The main examples of these hardly decipherable forms of psychosis are:
- Menstrual psychosis. It is a short-lived, sudden onset psychosis that is linked to the menstrual cycle.
- Postpartum psychosis. It is a sudden onset psychosis that some women develop following childbirth.
- The monothematic psychosis. It is a form of psychosis characterized by delusions that all affect a single theme.
- Myxedematous psychosis (or myxedematous madness). It is a form of psychosis that can affect people with hypothyroidism or people who, after surgical removal of the thyroid, do not take thyroxine.
- Occupational psychosis. Experts talk about it when a "job or career has taken over a person so much that he thinks of nothing else and assumes behavior typical of a psychotic.
- Late psychosis (or late dysphrenia). It is a psychosis that can affect subjects with schizophrenia, subjected to long pharmacological treatments based on antipsychotics.
- Shared psychosis (or shared insanity or folie á deux). It is a form of psychosis that arises in an individual after a very close relationship with a subject suffering from psychosis.
Hence, the term "shared psychosis" means a psychosis that is transmitted from person to person.
PATHYSIOLOGY
Despite numerous investigations, doctors and experts in mental illnesses have not yet understood what are the biological mechanisms that lead to the development of psychosis. In other words, they have not yet been able to establish why a certain condition - for example schizophrenia or AIDS - causes, in some subjects, the onset of a form of psychosis.
RISK FACTORS
Some scientific research has shown that psychosis may sometimes have a "genetic origin.
In fact, those who carried out the aforementioned researches observed, curiously, that:
- The twin of an individual with psychosis has a 50% chance of developing the same mental health problem.
- Individuals with a close blood relative (a parent or sibling) with psychosis have a predisposition to psychosis.
- Children who are born with a genetic disorder known as 22q11 deletion syndrome (N.B: it is a deletion of chromosome 22) are particularly at risk of developing a form of psychosis following schizophrenia.
Symptoms and Complications
Among the various symptoms induced by psychosis, there are 4 that characterize practically all cases.
These 4 clinical manifestations - which, given the recurrence, could be defined with the term typical manifestations - are:
- The hallucinations
- The illusions
- Confusion and thought disturbances
- Lack of understanding and self-awareness
List of other symptoms of psychosis:
- Difficulty concentrating
- Low mood
- Anxiety
- Agitation and violent behavior
- Social isolation
- Sleep disorders
HALLUCINATIONS
Experts define a "hallucination as" a sensory perception in the absence of external stimuli. "Put simply, an individual has a" hallucination when he perceives as real what is in reality only imaginary.
Hallucinations can affect all five senses, including sight, hearing, touch, taste and smell.
Sense
Example
View
Typically, the psychotic claims to see colors, objects, people and / or animals that, in reality, do not exist.
Hearing
The psychotic has a tendency to attribute to the voices he hears a tone different from the real one: for example, he warns them with an angry, unpleasant or sarcastic tone.
Touch
The psychotic has a tendency to claim that someone "touched him, when in reality no one really did".
Taste
A characteristic hallucination related to taste is to invent the presence of an unpleasant taste in the mouth.
Smell
A typical hallucination related to smell is to invent the presence of strange or unpleasant odors.
ILLUSIONS
An "illusion is a distortion of sensory perception. An individual with illusions becomes convinced of things that are not true and develops bizarre thoughts.
For example, a "delusion typical of people with psychosis is to believe that there are people or organizations intent on harming or killing them.
CONFUSION AND THOUGHT DISORDERS
In the presence of confusion and thought disturbances, the psychotic subject shows a tendency to:
- Speak rapidly and consistently (i.e. without variations)
- Suddenly changing the subject
- Suddenly losing your train of thought. In these situations, he stops talking or completing what he is doing.
LACK OF UNDERSTANDING AND SELF-AWARENESS
With a lack of understanding and self-awareness, experts refer to the inability of subjects with psychosis to recognize their problems (hallucinations, illusions, etc.).
It is particularly curious that this inability affects only oneself and not others: the psychotic individual, in fact, is capable of recognizing bizarre behaviors or illusions that may involve individuals with similar disorders to his own.
COMPLICATIONS
Complications of psychosis include:
- Self-harm. A recent statistical survey reports that one in 10 people with psychosis have a history of self-harm.
- Suicide. According to some studies, one in 5 people with psychosis attempts suicide and one in 25 with psychosis kills himself.
- The abuse of drugs and / or alcohol.
- The long-term effects of antipsychotics, taken to treat psychosis itself. Prolonged antipsychotic treatment can lead to weight gain, metabolic syndrome and tardive dyskinesia.
Diagnosis
For a diagnosis of psychosis, a thorough physical examination, a careful medical history (or clinical history) and a psychiatric evaluation are essential.
The possible use of laboratory analyzes (blood tests, etc.) and diagnostic imaging tests (X-rays, CT, nuclear magnetic resonance, etc.) serves to definitively clarify the causes.
A precise knowledge of the triggers of psychosis allows the doctor to plan the most appropriate treatment for the circumstances.
Note: Currently, there is no specific diagnostic test for psychosis. It is for this reason that various assessment tests must be used.
WHO TAKES CARE OF THE DIAGNOSIS?
Generally, the identification of a form of psychosis requires the intervention of a team of specialists, composed of: a psychologist, a psychiatrist and a nurse with specific skills in mental health.
Typical questions to be answered by the patient suspected of psychosis, during the medical history:
- Do you take medications? If so, which ones?
- Do you use illegal substances or abuse alcohol?
- Do you suffer from any mood disorders? Are you feeling down in the dumps, for example?
- What's her daily routine? For example, does he work?
- Do any of your family members suffer from any mental illness, such as schizophrenia?
- Tell me about the hallucinations
IMPORTANCE OF EARLY DIAGNOSIS
An early diagnosis of psychosis increases the chances of success of the therapy.
Therefore, in the presence of suspicious symptoms, it is advisable to contact your doctor immediately and undergo any in-depth examinations that the latter prescribes.
Treatment
Generally, the treatment of a psychosis includes therapy focused on curing the causes (causal therapy), the administration of antipsychotic drugs, and psychotherapy.
Furthermore, attending support groups, which involve people with similar problems, can also represent a valid help.
CAUSAL THERAPY
Causal therapy varies according to the triggering factors and represents a fundamental aspect for being able to recover from numerous forms of psychosis.
Examples of causal therapy are:
- Alcohol detox programs, when psychosis is subsequent to alcohol abuse, or drug detox programs (cocaine, marijuana, LSD, etc.), when psychosis is due to drug or hallucinogenic abuse.
- Vitamin supplementation, when psychosis is due to a vitamin deficiency (for example B12).
- The administration of drugs for hypothyroidism, hyperthyroidism, hypoparathyroidism, etc., when the psychosis is a consequence of one of the aforementioned disorders of the endocrine system.
- Therapeutic programs for the treatment of those psychiatric diseases that can cause psychosis (schizophrenia, bipolar disorder, delusional disorder, etc.).
ANTIPSYCHOTICS
Antipsychotics, or neuroleptics, are the drug treatment of choice for psychosis.
By acting on dopamine (a brain neurotransmitter), they have a calming, anti-hallucinatory and mood-stabilizing effect.
The calming effect is noticeable after just a few hours, while the anti-hallucinatory and mood stabilizing effects require several days, if not even a couple of weeks.
There are two possible methods of administration: by mouth (oral route) or by intravenous injection. Intravenous injection antipsychotics are slow-release drugs, i.e. drugs that act gradually. The advantage of using slow-release drugs is the limited number of injections: usually one every 2-6 weeks.
In the case of psychosis induced by schizophrenia or bipolar disorder, taking antipsychotics is a long-lasting treatment.
The use of antipsychotics requires careful monitoring when the patient suffers from epilepsy or some cardiovascular disorder.
- Drowsiness
- Tremors
- Restlessness
- Muscle spasms and contractions
- Blurred vision
- Dizziness
- Constipation
- Loss of libido
- Dry mouth
Long-term side effects of antipsychotics:
- Increased body weight, due to an increase in appetite and the development of a preference for inactivity
- Metabolic syndrome. It results from weight gain and involves hyperglycemia, hypercholesterolemia, hypertension and / or obesity. It is a possible prelude to: type 2 diabetes, heart disease, myocardial infarction or stroke
- Tardive dyskinesia
PSYCHOTHERAPY
Psychotherapy is a term with a broad meaning and which includes various psychological treatment techniques. Among these techniques, the most practiced in the case of psychosis are: cognitive-behavioral therapy and family therapy.
Going into more detail:
- Cognitive-behavioral therapy is a form of psychotherapy, which aims to teach the patient how to recognize and master problematic (or inactive) behaviors.
In case of psychosis, the goal of cognitive-behavioral therapy is to educate the psychotic subject to control anxiety crises, violent behaviors, agitation due to hallucinations and / or illusions, etc. - Family therapy is a form of psychotherapy that affects the patient's entire family.
Briefly, it is based on the concept that parents, siblings and other close relatives play a decisive role in supporting their loved one during the therapeutic path foreseen for him.
To get good results from family therapy, it is good for the family to learn the characteristics of the disease and how to best help those affected.
Prognosis
According to several clinical evidences, the prognosis in case of psychosis is better when the therapies have started at the beginning of the mental illness.
Prevention
According to most psychiatrists and mental health experts, preventing psychosis would be impossible.
Despite this, there are some interesting studies that have shown how subjecting people at risk of psychosis to cognitive-behavioral therapy can, to a certain degree, reduce the aforementioned risk.
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