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Psychosis Treatment

What is psychosis?

Psychosis is an umbrella term; it means that an individual has sensory experiences of things that do not exist and/or beliefs with no basis in reality.

During a psychotic episode, an individual may experience hallucinations and/or delusions. They may see or hear things that do not exist.

This can be incredibly frightening for the individual and, sometimes, the symptoms can cause them to lash out and hurt themselves or others.

Psychosis is classically associated with schizophrenia spectrum disorders, and, although there are other symptoms, one of the defining criteria for schizophrenia is the presence of psychosis.

Symptoms of psychosis

The classic signs and symptoms of psychosis are:

  • Hallucinations - hearing, seeing, or feeling things that do not exist
  • Delusions - false beliefs, especially based on fear or suspicion of things that are not real
  • Disorganization - in thought, speech, or behavior
  • Disordered thinking - jumping between unrelated topics, making strange connections between thoughts
  • Catatonia - unresponsiveness
  • Difficulty concentrating

Depending on the cause, psychosis can come on quickly or slowly. The same is the case in schizophrenia, although symptoms may have a slow onset and begin with milder psychosis, some people may experience a rapid transition back to psychosis if they stop taking their medication.

The milder, initial symptoms of psychosis might include:

  • Feelings of suspicion
  • General anxiety
  • Distorted perceptions
  • Depression
  • Obsessive thinking
  • Sleep problems

Hallucinations can affect any of the senses (sight, sound, smell, taste, and touch) in the person with psychosis, but in about two-thirds of patients with schizophrenia, hallucinations are auditory - hearing things and believing them to be real when they do not exist.

The following auditory hallucinations are common:

  • Hearing several voices talking, often negatively, about the patient
  • A voice giving a commentary on what the patient is doing
  • A voice repeating what the patient is thinking

Diagnosis of psychosis

In this section, we will discuss the available tests and methods for diagnosing psychosis.

Early diagnosis

Early diagnosis of psychosis improves long-term outcomes. This is not always achieved, however. The milder forms of psychosis that can lead to schizophrenia are left untreated for an average of 2 years, and even full psychosis can take a number of years before it receives the attention of medical professionals.

To increase the chances of early detection, guidance for healthcare systems drawn up by psychiatrists recommend that the "possibility of a psychotic disorder should be carefully considered" in a young person who is:

  • Becoming more socially withdrawn
  • Performing worse for a sustained period at school or work, or
  • Becoming more distressed or agitated yet unable to explain why
  • There is no biological test for psychosis itself, and if laboratory tests are done, it is to rule out other medical problems that might provide an alternative explanation.
Questions for patient and family

Psychosis is primarily diagnosed by clinical examination and history - the doctor examines the patient and asks about their symptoms, experiences, thoughts, and daily activities; they will also ask if there is a family history of psychiatric illness.

Other medical conditions are ruled out first of all, especially delirium (sudden onset of a confused state), but epilepsy and a number of other medical explanations are possible.

Doctors will also check for any history of intoxication with drugs, both legal and illegal, and toxins, usually asking for a urine sample to check this.

Brain scans

Brain scans may be done in the early stages of medical attention so that other conditions - often treatable and reversible - can be ruled out.

EEG (electroencephalography) testing records the brain's electrical activity and may help to rule out delirium, head injury, or epilepsy as possible causes of psychotic symptoms.

Treatments for psychosis

In this section, we discuss the treatments for psychosis and some methods of prevention.

Antipsychotic drugs

Treatment with a class of drugs known as antipsychotics is the most common therapy for people with a psychotic illness.

Antipsychotics are effective at reducing psychosis symptoms in psychiatric disorders such as schizophrenia, but they do not themselves treat or cure underlying psychotic illnesses.

Acute and maintenance phases of schizophrenia

Antipsychotic treatment of schizophrenia is in two phases - the acute phase to treat initial psychotic episodes and a lifelong phase of maintenance therapy.

During the acute phase, a stay in hospital is often needed. Sometimes a technique called rapid tranquilization is used. A fast-acting medication that relaxes the patient will be used to ensure that they do not harm themselves or others.

In the maintenance phase, treatment of schizophrenia is in the community and antipsychotics help to prevent further psychotic episodes, although relapses often occur, sometimes due to a failure to take the medications. Lifelong treatment of schizophrenia may involve other interventions and support, including the role of the family in care.

Psychotherapy can also be useful in treating cognitive and residual symptoms of schizophrenia and other psychotic disorders.

Types of psychosis

A number of disorders can display psychotic symptoms, including:

  • Schizophrenia - a serious mental health disorder affecting the way someone feels, thinks, and acts. Individuals find it difficult to distinguish between what is real and what is imaginary.
  • Schizoaffective disorder - a condition similar to schizophrenia that includes periods of mood disturbances.
  • Brief psychotic disorder - psychotic symptoms last at least 1 day but no longer than 1 month. Often occurring in response to a stressful life event. Once symptoms have gone, they may never return.
  • Delusional disorder - the individual has a strong belief in something irrational and often bizarre with no factual basis. Symptoms last for 1 month or longer.
  • 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.
  • Substance-induced psychosis - including alcohol, certain illegal drugs, and some prescription drugs, including steroids and stimulants.
  • These are the primary causes of psychotic symptoms, but psychosis can also be secondary to other disorders and diseases, including:
  • Brain tumor or cyst
  • Dementia - Alzheimer's disease
  • Neurological illness - such as Parkinson's disease and Huntington's disease
  • HIV and other infections that can affect the brain
  • Some types of epilepsy
  • Stroke