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What is Psychosis?



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About Psychosis

About Psychosis

Most people don't realize just how common and treatable psychosis is!

Symptoms include:
  • Hallucinations (seeing, hearing feeling or tasting things that other people don’t)
  • Difficulty filtering stimulation from the environment
  • Delusions (false personal beliefs based on incorrect inferences about reality which are inconsistent with culture and previous beliefs, and which are firmly sustained in spite of evidence or proof to the contrary) 
  • Confused thinking or speech
  • Difficulty doing ordinary things (often includes problems with memory, attention, putting thoughts together)
  • Inability telling what is real from what is not 
Anyone can develop psychosis. Psychosis is common and treatable. It affects 3 in 100 people, and usually occurs for the first time between the ages of 15 and 30. Men often develop psychosis 5 to 10 years younger than women. It can be caused by a variety of medical illnesses, sleep deprivation, severe stress or trauma, drug reactions, genetic predisposition, and other factors.

Sometimes it is not obvious to others what is happening. Some of the most common signs of psychosis that others may see include:
  • A dramatic deterioration in functioning at school or home
  • Social withdrawal
  • Dramatic changes in sleep pattern
  • Statements or behavior that are bizarre and inconsistent with what’s going on around them 
Emergence of Symptoms:
  
Psychotic disorders rarely emerge suddenly. Most often, the symptoms evolve and become gradually worse over a period of months or even years. Early symptoms often include cognitive and sensory changes which can cause significant disability before the illness becomes acute and is finally diagnosed. Identifying and responding appropriately to the condition early can prevent disability and may prevent the onset of the acute stage of illness.
 
If a person is having new, significant and worsening difficulties in two or three of the following areas, call EASA for a consultation:
 
1. Reduced Performance
  • Trouble reading or understanding complex sentences 
  • Trouble speaking or understanding what others are saying 
  • Becoming easily confused or lost 
  • Trouble in sports or other activities that used to be easy (Example: can’t dribble basketball or pass to team members) 
  • Attendance problems related to sleep or fearfulness 
2. Behavior Changes
  • Extreme fear for no apparent reason 
  • Uncharacteristic and bizarre actions or statements 
  • New, bizarre beliefs 
  • Incoherent or bizarre writing 
  • Extreme social withdrawal 
  • Decline in appearance and hygiene 
  • Dramatic changes in sleeping or eating 
3. Perceptual Changes
  • Fear that others are trying to hurt them 
  • Heightened sensitivity to sights, sounds, smells or touch 
  • Making statements like “my brain is playing tricks on me” 
  • Hearing voices or other sounds that others don’t 
  • Reporting visual changes (colors more intense, faces distorted, lines turned wavy) 
  • Feeling like someone else is putting thoughts into their brain or that others are reading their thoughts 
Earlier on, symptoms may be intermittent and the person often recognizes that something is wrong.  As psychosis progresses, people lose their ability to distinguish symptoms from reality, and it becomes more difficult to have a conversation. For example, a person who has auditory hallucinations will hear voices which sound to them as loud and real and a person standing right next to them, even though others don’t hear it.  A person whose psychosis has progressed may not believe that other people don’t hear the same voices and may not be able to integrate new information from others into their thinking.
 
Psychosis may also result from, or accompany, a mood disorder such as major depression or bipolar disorder (in which there are dramatic swings in energy level, sleep patterns, mood and behavior).
 




Symptoms of Psychosis

Symptoms of Psychosis

Psychosis is generally defined in terms of “positive” symptoms. “Positive” symptoms are those symptoms which manifest outwardly, including hallucinations, delusions and speech disorder (also referred to as thought disorder). Many people who experience psychosis also experience additional types of symptoms: mood symptoms (relating to moods and energy levels), abnormal movements and behaviors, “negative” symptoms (things that aren’t there now that that used to be), and cognitive symptoms (having to do with information processing). Below is a more detailed description of each type of symptom. Below is a more detailed description of each type of symptom.

Insight:

It’s important to understand that people usually are aware of some symptoms but not others. This is in part because of the nature of the symptoms themselves. Think of the analogy of an optical illusion. Your brain perceives and interprets information, but the information is interpreted incorrectly because of the way your brain constructs the information. Only when someone points out the error and when you use tools such as a ruler to “reality test” your perception do you recognize that it is an optical illusion. Psychosis is very similar. The brain perceives and interprets information erroneously, but the person is unaware that this is happening. Certain symptoms such as distressing hallucinations, paranoia and anxiety are often perceived as problematic to the person. However, most people do not recognize them as medical symptoms, and many of the other symptoms are recognized primarily by other people. For this reason it is critical for close family members and others who are known and trusted by the individual to be involved in the assessment and ongoing treatment process. Part of the process of treatment is helping the person to learn to distinguish and differentiate symptomatic perceptions from normal perceptions.

Positive Symptoms:

Hallucinations: Seeing, hearing or feeling things that others don’t. This can range from an intense experience of color, blurring or distortion of visual images, to hearing sounds or voices with no apparent source, and seeing or feeling objects or phenomena which others do not.

Delusions: False beliefs based on incorrect inferences about reality, inconsistent with culture, experience and previous beliefs, and held with conviction despite evidence to the contrary. Delusions can be caused by a variety of information processing dysfunctions, involving sensory input, memory, attention, and interpretation. Some common delusions:

Delusions of reference: Belief that day-to-day events or experiences refer directly to you; for example, that the people on the TV set are talking directly to you, that street signs, license plates, or behaviors (such as coughing) carry communications specifically aimed at you.

Delusions of grandeur: Belief that you are able to do things which are beyond normal capacity, such as fly or act as royalty.

Persecutory delusions: Belief that others are trying to hurt you, for example, by poisoning you or through a conspiracy to cause you harm.

Nihilistic delusions: Belief that you or others do not exist.

Thought broadcasting: Belief that your thoughts can be read by others.

Thought insertion: Belief that others are placing thoughts in your head.

Thought withdrawal: Belief that one’s thoughts are being extracted from the mind.

Thought control: Belief that feelings, thoughts and actions are not one’s own, experienced as being imposed by an external source.

Speech/thought disorder:

These are symptoms related to the person’s ability to communicate. The person may experience changes to their use of speech and the way they construct sentences. Examples include:

Frequent changes of ideas, making little sense to others (circumstantiality, tangentiality, derailment, looseness of association, flight of ideas)

Incoherent jumble of words (word salad)


Choosing words based on sound, such as rhyming or punning (clang associations)

Making up words which mean something only to the speaker (neologism)

Echoing others’ words (echolalia)

Abnormal movements and behaviors:

A person may develop odd behaviors, movements or mannerisms, or may become unable to move on their own (catatonia, waxy flexibility or posturing)

Negative symptoms:

The following common symptoms are similar to some of the cognitive symptoms, but are commonly classified as “negative” symptoms (i.e. something taken away, versus “positive” symptoms, where something new is occurring):

Lack of facial expression (affective flattening) or inability , to detect facial cues from others;

Absence or restriction of speech (alogia);

Difficulty initiating goal-directed behavior (avolition/anhedonia)

Inability to experience pleasure and/or maintain social contacts (anhedonia/asociality)

Inability to maintain mental focus (attentional impairment)

Mood symptoms:

Depression: Predominant mood is depressed and there is a loss of interest or pleasure in nearly all activities for at least 2 weeks. Depression in its severe forms can cause psychosis. Depression can also be an early warning sign of psychosis for people who have schizophrenia.

Suicidal thoughts. It is important to know that many people who experience psychosis also experience suicidal thoughts, and the risk of suicide is significantly greater than for people who do not experience psychosis.

Mania: Period of time in which a person’s mood is elevated or irritable, there is a lack of restraint in behavior, and highs in energy, requiring little or no sleep. Severe mania can cause psychosis, or a person can have both mania symptoms and psychosis symptoms distinctly from each other.

Anxiety. Extreme anxiety is common with psychosis.

Cognitive symptoms:

Most people who experience psychosis also experiences difficulty with memory, attention, and organization of thoughts. These symptoms may improve but often do not disappear completely with treatment for psychosis.

More information:

For more information about psychosis, some good links to visit are:

[add new links]

For a comprehensive and highly useful text, we recommend Psychosis: A Wellness Approach, by Mary Moller. This text can be ordered at http://www.psychiatricwellness.com





Causes of Psychosis

Causes of Psychosis

Psychosis is a condition which affects the brain's ability to process information. Psychosis can affect sensory perception, ability to organize information, and ability to express information. There are many causes. Everyone has the potential to develop psychosis, if they don’t sleep for multiple days in a row, if they take certain drugs or develop certain medical conditions, or if they experience extremely severe and prolonged stress. Psychosis has a strong genetic component. Individuals whose family members have experienced psychosis will be at greater risk for developing it themselves. Some people with a particularly great vulnerability to developing psychosis have to manage it as an ongoing condition.

The following illnesses or conditions, among others, can cause symptoms of psychosis.




What the Assessment Includes

What the Assessment Includes

The purpose of a good assessment is to help the person clarify whether they have a medical condition, how it is affecting their functioning, and what type of treatment or support may be needed. With this information, the person and their loved ones are able to make informed decisions about their medical care and personal goals.
 
Typically, an assessment will include medical tests, interviews, observation and collection of history. There are usually multiple people involved in the assessment process, including a psychiatrist or psychiatric nurse practitioner, your primary care physician, a qualified mental health professional, and, in some circumstances, other specialists such as a neurologist or occupational therapist. In order to complete a thorough assessment, close friends or family members are usually asked for their input, as they are likely to detect changes in information processing and behavior which are difficult for the person to detect. Also, families and friends are a great resource for identifying the person's strengths. Also, psychosis interferes with the person’s ability to process information, and it may be difficult for them to report on their own medical situation. The following form was developed by EASA as a tool for families to provide input into the assessment process: Assessment Input Form (click to download PDF)

It is not uncommon for the diagnosis process to be ongoing over time. Some of the possible diagnoses require six months observation to confirm. You may be given a “rule-out” diagnosis, which means that additional observation or testing is needed to determine whether this diagnosis is correct.

Usually a preliminary diagnosis is made from the first interview, confirmed within approximately the first thirty days, and revisited periodically throughout treatment.

The following information will be important in any assessment:

Current situation:

How do you perceive what is going on- what do you observe? What changes or possible “symptoms” have you noticed:
  • Current illnesses and treatment you may be receiving
  • What medicines or supplements are you taking?
  • Physical changes with your body
  • Changes in your sleep and appetite
  • Changes in your moods
  • Changes in your thought process
History:
  • Illnesses that you or other family members have experienced
  • Injuries. Have you ever been knocked unconscious?
  • Allergies and adverse reactions to medicines
  • Drug use and reactions
  • Learning disabilities
  • progression
  • What do others around you observe (sometimes with neurochemical changes others notice changes when the individual doesn’t)
Current psychosocial situation:
  • How are these changes affecting your ability to focus at work/school and home?
  • How are they affecting relationships with others?
  • How are they affecting your ability to meet personal goals and priorities?
  • What information do you and your supporters have, and what do you need?
  • Do you have a strong support network?
  • Is your living situation stable and supportive of your healing process?
  • What are your personal goals and priorities, and are these changes interfering?
Medical tests:

Medical tests which EASA routinely recommends for people experiencing psychosis include:
  • CBC with differential
  • Chemistry panel (with liver enzymes, electrolytes, BUN, Cr, calcium)
  • Urine drug screen
  • Urinalysis, with microscopy
  • B-12 and folate
  • Thyroid screen (TSH, T4)
  • MRI or CT
  • Other tests indicated by additional medical conditions identified
The result of the assessment process is:
  • A clarification of preliminary diagnosis. In some cases, it may take a while to get a final diagnosis.
  • Identification of the type of treatment which is most likely to be helpful
  • Initial goals for treatment, based on your needs and priorities






  




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