What is psychosis?
Psychosis is a pathological mental state of loss of connection with reality that can lead to hallucinations, personality changes, thinking disorders, delusions, social difficulties and problems maintaining daily activities. It is not recognized as a disease, but as a symptom of mental disorder.
The German philosopher and psychiatrist Karl Jaspers (1883 – 1969) stated, in his time, that psychoses did not cause changes in the patient’s cognitive sphere, but nowadays it is known that some of the diseases classified as psychoses can, over time , cause cognitive deficits
According to the International Classification of Diseases volume 10 (ICD-10), currently used in Brazil as a reference for classifying diseases, there are several psychoses. They are schizophrenia , schizotypal personality disorder and psychotic disorders . Each of these types can contain subtypes.
Schizophrenia, in general, is characterized by changes in thinking, perception, behavior and mood.
Although it can happen at other ages, this type of psychosis manifests itself for the first time with greater frequency in adolescents and young adults between the ages of 14 and 28 years.
There are several types of schizophrenia, each with its own specific characteristics.
Schizotypal personality disorder
Schizotypical disorder is manifested by abnormalities of thinking and mood similar to those of schizophrenia.
The patient may exhibit eccentric behavior, in addition to strange and paranoid ideas, but which do not completely evolve into delirium. Quasi-psychotic periods and auditory hallucinations may arise.
Persistent delusional disorder
Characterized solely or mainly by persistent delusions, but without other symptoms that may indicate schizophrenia or mood disorders, delusional disorders do not cause hallucinations in most cases, but the elderly may have auditory hallucinations with irregular frequency.
As long as typically schizophrenic hallucinations do not dominate the picture, the diagnosis of these disorders is not altered.
If the delusions are short-lived – around two weeks – the case is classified as acute and transient psychosis .
Acute and transient psychoses
These disorders are characterized by short-term psychotic symptoms that do not recur. Symptoms include delusional ideas, hallucinations and disturbed perceptions, as well as severely disorganized behavior. The duration usually lasts a maximum of two weeks.
Induced delusional disorder
The induced delusional disorder is divided by two or more people who are strongly emotionally connected. It is frequent in families, and only one party has authentic delusions, the other being induced to them.
Parents can pass delusions to their children who believe what they say. The removal of the parties usually leads to the abandonment of delusions by the inductee.
This type of disorder has symptoms of both schizophrenic characteristics and mood disorders, and cannot be classified as either one or the other. It’s on the spectrum of schizophrenia.
It can be divided into three:
Schizoaffective disorder of the manic type
When the patient has symptoms of both schizophrenia and mania predominantly, this is the classification of the disorder. Symptoms of mania can include euphoria or irritability that is inconsistent with the situation.
When light, it can go unnoticed because it just seems like a lively day for the person. She may seem happy, sociable, more willing to talk, lively, less sleepy and more energetic. She may also feel more irritated.
Schizoaffective disorder of the depressive type
In this condition, the patient suffers with symptoms of both schizophrenia and depressive episodes, both predominantly.
Symptoms of depressive episodes are lack of energy, discouragement, loss of interest, lack of concentration, ability to experience altered pleasure, decreased appetite and concentration presented in a context that does not match these feelings.
Schizoaffective disorder of the mixed type
Here, schizophrenia symptoms are accompanied by both manic and depressive episodes in equal measure.
Affective disorders vs. psychoses
Affective disorders are those that affect mood . This is the case of bipolar affective disorder . It is important to note that mood disorders are not psychoses. There are cases in which affective disorders (as is also the case with depressive disorder) present psychotic symptoms, but that does not mean that they become psychosis.
There are other psychoses that do not fall under any of the previous classifications. This is the case, for example, with chronic hallucinatory psychosis , a condition that causes hallucinations and delusions and whose episodes can be spaced out for months. She does not fit in with any type of schizophrenia.
It can be said that there are two causes for psychoses: genetic and due to substance abuse. In addition, there are so-called secondary psychoses, which are psychotic symptoms caused by other conditions and are not really psychoses, forming part of another diagnosis.
In general, either the person has psychosis or not. An accident, other illnesses or severe trauma will not create a psychosis that does not exist.
There is, in medicine and psychology, the discussion about what causes the development of a latent psychosis, but in the vast majority of cases it is impossible to know. What is known is that the person was already prone to develop psychosis.
However, there is a way to acquire psychosis even without having it latent. The abuse of psychoactive substances is capable of causing a legitimate psychosis.
Psychosis due to substance abuse
Using drugs in large quantities and frequently can cause psychosis. If the person already has the latent condition, there is a greater chance that the disease will be triggered. The drugs listed here are not in specific order and all, to a lesser or greater degree, are at risk. The drugs that do this are:
- MDMA (ecstasy);
- Mephedrone (MCAT);
- Take them hallucinogens;
When a disease causes psychotic symptoms such as hallucinations and delusions, it is not considered a psychosis. These diseases can lead to symptoms, but they are their own diagnosis and do not fall under the classification of psychosis.
The depression severe psychotic symptoms may occur, leading to hallucinations and delusions.
Anatomical abnormalities in the brain
A differentiated anatomy in the brain can cause several conditions, including psychotic symptoms.
Imbalance between neurotransmitters
Some unbalanced neurotransmitters can cause hallucinations and delusions.
Excessive or missing hormones can cause several problems. Cortisol, a hormone produced by the adrenal gland, when in excess, can cause depression and symptoms related to psychoses.
Brain cyst or brain tumors
Cysts and tumors located in the brain can cause hallucinations, delusions and other psychotic symptoms.
The syphilis is a sexually transmitted disease caused by bacteria and can affect the central nervous system and the brain as a whole, may cause symptoms of psychosis, and other neurological diseases.
Severe malignant tumors anywhere in the body can cause temporary symptoms of psychosis in a patient.
Some consequences of kidney failure are connected with psychotic symptoms. Uraemia, for example, which is caused by excess impurities in the blood (which in turn is caused by a lack of filtering ability of the kidneys) is capable of causing mental confusion and delusions.
Although it was once a controversial topic, medicine now recognizes that hallucinations and delusions can be caused by conditions of partial epilepsy. The Diagnostic and Statistical Manual of Mental Disorders (DSM, in free translation, Manual of Diagnosis and Statistics of Mental Disorders) considers patients with a focus on temporal lobe epilepsy as part of the risk group.
Dementia and stroke
Stroke and dementias such as Alzheimer’s disease can cause symptoms characteristic of psychoses, but the anatomical analysis of the brain, added to the set of symptoms, make this condition a different disease from psychoses and do not fall into this classification.
It is estimated that 1% of people between 14 and 28 years of age are considered to be at high clinical risk for this disorder and that at least 20% of these people will suffer a psychotic episode in life.
Some people are in the group at risk for developing psychoses:
People who use psychoactive drugs in great frequency and quantity are at risk for the development of psychosis. If the person already has the latent condition and does not know it, the frequency and quantity are no longer variable: using psychoactive drugs once may be enough to trigger a psychotic crisis.
The alcohol can trigger a psychosis and the same applies to abstain from alcohol, one of the most dangerous withdrawal symptoms that exist.
People with family members with psychosis
There are studies that link psychoses with genetic factors, which can be passed on from parents to their children. If someone suffers from psychosis, their family members are also at risk.
Psychoses are characterized by the patient’s disconnection from reality. Among its main symptoms are:
Perception is the way a person interprets an external stimulus, for example when you see the drawing of a sun. The stimulus is drawing. Your brain interprets this stimulus and you are able to identify it as a sun: this is the perception.
In a delirium, the patient has a false perception of reality, necessarily based on an external stimulus. It is an error of judgment . The delusional person believes in things that are not real based on real stimuli.
For example, she may see someone bring soup when she sees the liquid move, believe that it means that she is poisoned. This thought is not shaken despite counter-arguments and obvious evidence to the contrary. This means that someone in delusion cannot be convinced otherwise, even through experiences that prove the impossibility of delusion.
Delusions present themselves as firm convictions, which cannot be changed, of impossible things. This impossibility, however, is applied to the case. Certain people may have delusions in which they believe that someone has poisoned their food, even if the person knows that someone has never come close to the food. Poisoned food is technically possible, but someone who has never been there cannot add the poison.
It is important to note that delusions are individual things, different from institutions like religious ones, which are cultural and collective.
Hallucinations are experiences that are similar to the perception of a stimulus that is not present at the moment. They can involve any of the five senses, making the person see or hear images or sounds that are not being emitted.
Confused and disorganized thoughts and speech.
Disorganized motor behavior
The patient may have altered behavior, for example being very agitated or catatonic, which is a state of low reactivity to the environment.
Negative symptoms are any symptoms that subtract the patient’s capabilities. In the case of psychoses, over time, there may be cognitive reductions and loss of volition , that is, loss of the ability to choose and decide.
Mood swings can be common in psychoses, causing feelings of depression or euphoria.
It is common for patients with psychosis to have a drop in academic and professional performance, in addition to impairment in the social circle. Among the altered behaviors may be the failure to carry out responsibilities that were previously fulfilled as homework or work.
Agitation and aggression
The patient can become agitated and aggressive.
Diagnosing a psychosis is the job of the psychiatrist or psychologist through proper investigation.
In this assessment, the symptoms of psychosis should be addressed through interviews and reports of behaviors, family history, patient’s life history, diseases and substance use.
Extra tests can be used, for example blood tests, MRI and CT scan. It is important to note that these tests are not done to find signs of psychosis, but to rule out conditions that may cause possible secondary psychosis .
Unfortunately, psychoses have no cure . They can be treated and go into remission, but the risk of affecting the patient will always be present.
Treatments for the condition can control symptoms and improve the patient’s quality of life.
Treatment for psychoses involves the use of antipsychotic medications and psychological therapy , in addition to keeping the patient away from known triggers .
Taking medications at the times and doses recommended by the doctor is important to prevent and reduce the number of episodes.
Adjustments in medication may be necessary throughout the treatment, seeking a correct dosage for the individual’s body and the right type of medication.
Psychoses are conditions that can cause great suffering in the patient and it is important that there is psychological therapy to help him live better with his disorder.
In cases where the patient is at risk for himself or others, he may be hospitalized.
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Drug treatment is the most common for psychoses.
It varies from person to person and from type to type of disorder, so the dosage and the specific medication can vary. Depending on the case, adjustments are likely to be required.
The first few months of treatment can be difficult due to dosages that need to be adapted for each patient.
The most used drugs in case of psychosis are:
- Amissulprida ;
- Aripiprazole ;
- Olanzapine ;
- Quetiapine Hemifumarate ;
- Risperidone ;
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Fear of crises, medications, social and family judgments can be complicated weights in the life of patients with psychoses.
It is important that, for the coexistence and increase of the quality of life, the person goes to the psychologist. Close relatives can also use psychological consultations to learn about and how to deal with the condition that will be present in life from that moment on.
Some recommendations are:
Family members are the ones who will spend the most time with the sick patient and this can be exhausting. The disease causes suffering, above all, for the patient, but family members will also face challenges.
It is important that the family accepts and understands the disease, avoid trying to blame someone or something for what happened and that the patient’s frustrations are not discounted.
Occupational therapy can help the patient learn how to live with their surroundings and their condition. This type of therapy is able to dramatically increase the patient’s quality of life, especially if there is family therapy with occupational therapy.
Help groups can convey the feeling that the person is not alone in the situation they are in, both for patients and for family members. A considerable part of the population goes through similar situations and help groups can serve as support for those who feel lonely in this situation.
With proper treatment, the patient can have his symptoms controlled and go into remission. This is not a guarantee nor is it definitive.
Remission means that the symptoms are no longer present and that the condition is not currently active. However, she may return and, therefore, treatment should not be discontinued even during remission.
If the first episode of psychosis occurred in adulthood, it is easier to live with fewer complications, following treatment and avoiding triggers for crises, as the patient has undergone the necessary social adaptations before the condition reaches him.
However, following drug treatment and attending the psychiatrist and psychologist, even in remission, it is possible to have a satisfactory quality of life.
The patient with psychosis suffers with a huge loss of quality of life and this happens even with treatment. Without treating the condition, psychoses can lead a patient to suicide.
Due to delusions and hallucinations, people with psychoses can suffer severe social losses, both because people do not feel comfortable around them, and because the patient does not feel comfortable around other people.
During a psychotic crisis, a person may believe that others are plotting against him or that they want his illness. Outside of a crisis, she may feel bad and embarrassed about what happens to you.
Cognitive and memory reduction
Over time, there is a risk of cognitive impairment in patients with psychosis. This will not necessarily happen, but it is a real risk, especially without treatment.
Loss of volition
Volition is the ability to make choices. Over time, the patient may have his volition reduced, making the patient dependent on the choices of people around him.
There is no way to prevent all causes of psychosis. Some are genetic, some are diseases and some are not known. However, it is possible to prevent behaviors that facilitate the onset of psychosis.
Avoiding the use of psychoactive drugs like marijuana, LSD and alcohol can prevent some types of psychosis.
Psychoses cause great suffering for patients, who lose contact with reality and perceive it as distorted. It is important to avoid the abuse of psychoactive substances to hinder the onset of the disorder.
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