What Is Psychosis? What Causes Psychosis?

Date: Jul-23-2012Psychosis is a generic psychiatric term for an abnormal sign or symptom that affects the mind, causing people to change the way they think, feel, perceive things, and behave. When a person suffers from psychosis they are not able to tell the difference between reality and what is in their imagination - a loss of contact with reality. Experts say psychosis is a symptom which is detected in several different mental illnesses, including Bipolar Disorder, Major Depression, Delusional Disorder, Brief Psychotic Disorder, Schizophrenia, and Schizoaffective Disorder. Psychosis may also be the result of some physical illnesses, such as Parkinson's disease, or the effects of taking illegal drugs or abusing alcohol.

Psychosis is a symptom, and not a condition in itself. It is a symptom of other conditions, often the more severe forms of psychiatric disorders. The sufferer may experience hallucinations, delusions and impaired insight.
What is the difference between psychosis and schizophrenia?
Psychosis is a sign, while schizophrenia is an illness (or group of illnesses). Psychosis may be a symptom of schizophrenia, and possibly other mental illnesses, such as bipolar disorder.

If somebody swallows a substance and has, for example, hallucinations, that is psychosis, not schizophrenia.

It is like the difference between having a fever or influenza (flu). Flu is the illness, while the fever is a sign. Fever, as with psychosis, can be a sign which is present in other illnesses.
Psychosis is more common than people realize
According to the National Institutes of Health, USA, psychosis affects over 1.2% of the American population at some time in their lives.

UK health authorities say that approximately 1 in every 200 people in Great Britain has had psychosis. In some cases, there is just one episode, while in others there may be psychotic episodes throughout the patient's life. 1 in every 100 people in the UK is affected with schizophrenia at some time during their lifetime.

According to Medilexicon's medical dictionary, Psychosis is:

"1. A mental and behavioral disorder causing gross distortion or disorganization of a person's mental capacity, affective response, and capacity to recognize reality, communicate, and relate to others to the degree of interfering with that person's capacity to cope with the ordinary demands of everyday life. The psychoses are divided into two major classifications according to their origins: those associated with organic brain syndromes (Korsakoff syndrome); and those less clearly organic and having some functional component(s) (the schizophrenias, bipolar disorder).







2. Generic term for any of the so-called insanities, the most common forms of which are the schizophrenias.

3. A severe emotional and behavioral disorder.
What are the signs and symptoms of psychosis?
A sign is something the doctor, nurse and others can detect, apart from the patient, examples include a rash, swelling, or discoloration. A symptom is something only the patient can feel, and describes to others, such as pain, dizziness, or stomachache.

A psychotic episode may include any of the symptoms listed below:
Hallucinations - perceiving things that are not there, not real, but the perception of reality feels powerfully compelling. Hallucinations may affect the patient's sense of hearing, smell, taste or sight.

- Auditary hallucinations - known as paracusia or paracusis. The patient may hear angry, unpleasant or sarcastic voices.

- Gustatory hallucinations - hallucinations involving sense taste. Some psychosis patients say they have an unpleasant taste in their mouths

- Lilliputian hallucinations - things, people or animals appear to be smaller than they really are

- Hypnagogic hallucinations - dreamlike hallucinations, very vivid ones, at the onset of sleep

- Hypnopompic hallucinations - hallucinations when awakening, also vivid and dreamlike

- Kinesthetic hallucinations - involves the sense of bodily movements

- Olfactory hallucinations - the patient smells things that are not there

- Tactile hallucinations - affects the patient's sense of touch. He may feel that something is crawling under his skin

- Visual hallucinations - seeing things that are not real

Delusions - the patient believes something that is implausible, clearly untrue, impossible, or bizarre. The two main types are:

- Paranoid delusion - a belief that a person, people and/or organization are planning to harm or even kill the patient. The individual's behavior may become affected, possibly they may refuse to walk down certain corridors or streets, or enter rooms for fear of being watched or subjected to mind-control machines.

- Delusions of grandeur - the patient imagines he has some kind of power or authority that does not exist.

Confused and disturbing thoughts - thought sequences may be incoherent, disturbed, and confused. The patient may switch from one subject to another rapidly, and sometimes stop in mid-sentence when their train of thought is lost.

A lack of self-awareness and insight - the patient behaves in an unusual way, but is totally unaware of it. They may not realize that their hallucinations are unreal. Often, they can identify bizarre and delusional behavior in other people, but not in themselves. It is not uncommon for people with psychosis who are in a psychiatric ward to comment on how sick the other patients are, while feeling perfectly fine themselves.

What are the causes of psychosis?
Psychosis may be caused by a mental (psychological) condition, a general medical condition, or a substance (alcohol or drugs).
Psychological causes of psychosis

Schizophrenia - a group of severe mental disorders in which patients interpret reality abnormally. The patient may have a combination of hallucinations, delusions, disordered thinking, and bizarre behavior.

Bipolar disorder - also known as manic-depression or manic-depressive illness. Characterized by instable moods that can be serious and disabling. The patient has unusual shifts in mood, energy, and impaired ability to function which may last several weeks, or even months.

Psychotic depression - depressive symptoms become severe and the patient is unable to work, sleep properly, study, eat healthy meals on his/her own, and generally function. When severe depression includes delusions, hallucinations, and/or withdrawing from reality, they may be diagnosed with psychotic depression.

Some women with severe postnatal (postpartum) depression may have psychotic symptoms. Researchers reported in PLoS that the risk of psychotic illness is much higher than normal during the first four weeks after a woman gives birth.

Being bullied -  children who were bullied at school were found to be at a much higher risk of developing psychotic symptoms later on in life, researchers from the University of Warwick Medical School, England, found.

Medical conditions that can cause psychosis

Alzheimer's disease - during the Stage 6 phase of Alzheimer's disease, the patient may become suspicious, paranoid and aggressive, He/she may even believe that the caregiver is cunning, dishonest, devious, and an impostor.

Brain tumor - some brain tumors can lead to psychotic disorders.

Epilepsy - although epilepsy and psychosis are dissimilar, they are associated. People with epilepsy have a higher chance of developing schizophrenia. A person with a family history of epilepsy is more likely to eventually suffer from a psychotic disorder, European researchers reported in the journal Biological Psychiatry.

HIV/AIDS - psychosis is an uncommon but serious complication of HIV infection.

Hypoglycemia - when blood sugar levels drop too low. In some cases, patients with acute hypoglycemia may be affected by a psychotic episode.

Lupus - an autoimmune condition which attacks healthy tissue in the body. Complications can involve several different parts of the body, including the nervous system, resulting in memory problems, headaches, dizziness, seizures, behavioral changes, and psychosis.

Lyme disease - during the third stage of Lyme disease, when it has become chronic, patients may experience psychosis.

Malaria - in the later stages of malaria, some patients may have episodes of psychosis

Multiple sclerosis - as multiple sclerosis advances, the patient may experience thinking problems, and sometimes psychosis.

Parkinson's disease - psychosis is a fairly common and challenging problem. It can occur at any stage of the illness, but is a particularly important problem for patients in the later stages, especially those who have been treated long-term with anti-Parkinson's medications.

Syphilis - a sexually transmitted infection. During the third stage of syphilis, the brain and heart are affected, and there may be psychotic episodes.

Low birthweight - scientists from the University of Bristol, England, reported in the British Journal of Psychiatry that children of low birth weight had a higher risk of having psychotic episodes later in life, compared to children with normal birth weight.

Psychosis caused by substances
Misuse of recreational drugs, many of them illicit, as well as alcohol can trigger a psychotic episode. Psychotic episodes may also occur after withdrawal from a drug, especially after long-term use.

The following drugs have been found to trigger psychotic episodes:

Acid (LSD)

Alcohol

Cannabis - a 2010 Australian study found that prolonged cannabis/marijuana use by young adults was associated with a higher risk of developing psychosis, especially among those who started in their teenage years and continued taking the drug for at least six years into adulthood.

Another study, carried out at the Institute of Psychiatry, found that people who regularly smoke "skunk", a particularly strong cannabis grown in hothouse conditions, have an 18-fold higher risk of developing psychosis compared to those who use milder forms of cannabis..

Cocaine

Crystal meth (methamphetamine)

Ecstasy (MDMA)

Ketamine

Magic mushrooms (psilocybins)

Speed (amphetamine)

Some prescription medications may also trigger psychotic episodes, examples include some tranquilizers, anti-epilectic drugs, antidepressants, drugs used to open up the airways (anticholinergics), and levodopa (for Parkinson's disease).
Psychosis caused by cerebrospinal fluid biomarkers
A 2006 study at Cambridge University, England found that the cerebrospinal fluid of patients with psychotic disorders had two characteristic changes compared with fluid taken from mentally healthy individuals, as well as patients with psychiatric problems but who did not suffer episodes of psychosis.

The two changes which were linked to psychosis were higher levels of the protein VGF and lower levels of the protein transthyretin.
The role of dopamine and glutamate in psychosis
Some studies indicate that in patients with a psychotic disorder, dopamine levels may be too high. Dopamine is a neurotransmitter; it is one of several brain chemicals that is used to transmit information from neuron-to-neuron (brain cell to brain cell). Dopamine is linked to our feelings of reward and pleasure.

The high dopamine levels believed to be present in people with psychosis is said to interrupt the specific brain pathways that are involved in crucial cognitive functions, such as emotion, memory, self-awareness, and social behavior. If these brain functions are disrupted, they are thought to raise the risk of psychosis.

Experts say that medications that reduce the effects of dopamine in the brain are known to diminish psychosis symptoms. On the other hand, illicit drugs, such as cocaine, cannabis and amphetamines raise dopamine levels, and thus raise the risk of psychosis.

An article published in Biological Psychiatry in October, 2010, found that people with lower glutamate in the hippocampus, a major structure involved in memory, had higher dopamine activity. Lead researcher, Dr. Stone said "the findings support the hypothesis of an abnormal relationship between the dopamine and glutamate neurotransmitter systems in individuals with psychosis, and suggest that the development of drugs targeting glutamatergic transmission may be useful in the early treatment of psychosis."
How is psychosis diagnosed?
In fact, it is not really about diagnosing psychosis, because it is not a disease or condition, it is a sign/symptom. The aim is to diagnose the cause of the psychosis.

Often, the first person to hear about a patient's psychotic episode, or possibly see the signs of psychosis is the primary care physician (GP, general practitioner, family doctor). Experts say anybody who experiences a psychotic episode should see their doctor immediately - the earlier treatment can be started, the better the long-term outcomes.

The primary care physician will talk to the patient and try to rule out any physical, medical or other causes, such as alcohol or drug abuse.

The patient will most likely be asked whether he/she:
Is currently on any prescription medications
Has consumed any illegal drugs, and if so which ones and how often, etc.
Has been feeling depressed
Has been having unexplained mood changes
Is still in employment
Has had hallucinations, and to describe them, their duration, frequency, etc.
Has had delusions, and to describe how he/she feels
Has any other symptoms
Has had any sleep problems, or changes in sleep patterns
Has any history of mental illness, including psychosis
Has a family history of mental illness

The doctor will also take note of the patient's appearance, whether clothes seem inappropriate, personal hygiene, etc.

Some lab tests, such as a complete blood count, and other blood tests may be ordered to rule out some medical conditions and alcohol and/or drug consumption. Imaging scans may also be ordered.

The doctor may also interview family and household members.

If the primary care physician suspects early signs of a mental illness, the patient will be referred to a specialist.

When a diagnosis is made, be it schizophrenia, bipolar disorder, a medical condition, etc., then that disease/condition is treated.
Treatment for psychosis
The treatment for psychosis depends on what is causing it, such as a substance intoxication, bipolar disorder, acute hypoglycemia, etc.

Antipsychotic medications and possibly hospitalization may be prescribed for a psychotic disorder.

Click on the links below for further information on specific treatments:

Treatment options for bipolar disorder.
Treatment options for schizophrenia.
Treatment options for depression.
Treatment options for postpartum (postnatal) depression.

Written by Christian Nordqvist

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