Generality
Psychosis is a serious mental health disorder that, by profoundly altering thinking skills, leads those affected to lose all contact with reality .
The psychotic individual, in fact, suffers mainly from illusions and hallucinations, that is to say he is convinced of things that are not true (illusions) and believes he feels or sees things that are completely non-existent (hallucinations).
For a correct diagnosis, an accurate physical examination, a complete anamnesis and a careful psychological evaluation are fundamental.
Treatment includes causal therapy, use of antipsychotics and psychotherapy techniques.
What is psychosis?
Psychosis is a serious mental health problem that, due to a profound alteration of emotions and thinking skills, leads the interested individual 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 is convinced of things that are not true and believes he feels or sees things that are completely non-existent.
Epidemiology
Psychosis is more common than most people think.
A recent study, in fact, has observed that, in England, psychosis has an annual incidence rate of one case per 2, 000 individuals.
Indeed, another interesting statistical survey has estimated that about 3 subjects per 100 develop an episode of psychosis at least once in their life.
Psychosis can occur at any age; however, it is rare in people under the age of 15.
Causes
The causes of psychosis are innumerable.
The triggers include:
- Head trauma
- Some psychiatric disorders (or psychiatric illnesses)
- A large number of medical conditions
- The intake of various psychoactive substances
In the following four sub-chapters, the article will deal in detail with the four categories of causes of psychosis listed above.
PSYCHOSIS FROM TRAUMI TO THE HEAD
According to some scientific studies, suffering head injuries, especially during childhood, increases the risk of developing a more or less severe form of psychosis.
PSYCHIATRIC DISEASES CAUSING PSYCHOSIS
The psychiatric illnesses that can cause psychosis are:
- Schizophrenia
- The delusional (persistent) disorder
- Short psychotic disorder
- 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, dementia with Lewy bodies, Huntington's disease and Parkinson's disease.
- Stroke.
- brain tumors.
- Multiple sclerosis.
- Some forms of epilepsy.
- Neurodevelopmental diseases, such as DiGeorge syndrome (or veil-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, hypercalcaemia, hypernatremia, hyponatremia, hypokalemia, hypomagnesemia, hypermagnesemia, hypophosphatemia, hypoglycemia, etc.
- Some autoimmune diseases, including systemic lupus erythematosus, sarcoidosis and Hashimoto encephalopathy.
- Some sleep disorders, such as narcolepsy.
PSYCHOACTIVE SUBSTANCES THAT CAUSE PSYCHOSIS
In general, the term "psychoactive substance" refers to any chemical substance capable of altering the brain's functions, perception, mood and the state of consciousness of an individual.
Among the psychoactive substances capable of inducing psychosis or some typical symptoms of psychosis, they deserve a special mention:
- Alcoholic drinks . 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 taking these substances.
- The catinone
- Hallucinogenic substances, such as LSD and psilocybin
- Type k opioid receptor agonists
- Some NMDA receptor antagonists (eg ketamine)
OTHER FORMS OF PSYCHOSIS
There are particular forms of psychosis that, due to the triggering reasons, are difficult to insert in one of the previous categories.
The main examples of these forms of poorly decipherable psychosis are:
- Menstrual psychosis . It is a short-lived, sudden-onset psychosis that is related to the menstrual cycle.
- Postpartum psychosis . It is a sudden onset psychosis, which some women develop following childbirth.
- Monothematic psychosis . It is a form of psychosis characterized by disappointments that all affect only one theme.
- The mixedematous psychosis (or mixed hematoma ). It is a form of psychosis that can affect people with hypothyroidism or those who do not receive thyroxine after surgical removal of the thyroid.
- Occupational psychosis . Experts talk about it when a job or career has taken a person so much, that he doesn't think of anything else and takes on typical psychotic behaviors.
- Late psychosis (or late dysfrenia ). It is a psychosis that can affect subjects with schizophrenia, subjected to long-term antipsychotic pharmacological treatments.
- Shared psychosis (or shared madness or folie á deux ). It is a form of psychosis that occurs in an individual after a very close relationship with a person with psychosis.
Thus, the term "shared psychosis" means a psychosis that is transmitted from person to person.
PATHOPHYSIOLOGY
Despite numerous investigations, doctors and experts in mental illnesses have not yet understood what the biological mechanisms that lead to the development of psychosis are. In other words, they have not yet succeeded in establishing for what precise reason a certain condition - for example schizophrenia or AIDS - determines, in some subjects, the onset of a form of psychosis.
RISK FACTORS
Some scientific research has shown that psychosis could sometimes have a genetic origin.
Indeed, 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 disease known as 22q11 deletion syndrome (NB: 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 the cases.
These 4 clinical manifestations - which, given the recurrence, could be defined with the term of typical manifestations - are:
- Hallucinations
- The illusions
- Confusion and thought disorders
- 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". Simply put, an individual has a hallucination when he perceives as real what in reality is only imaginary.
Hallucinations can relate to all five senses, therefore sight, hearing, touch, taste and smell.
| Examples of hallucinations | |
Sense | Example |
View | In general, the psychotic claims to see colors, objects, people and / or animals that do not actually exist. |
hearing | The psychotic has the tendency to attribute to the voices that 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 say that someone has touched him, when in reality no one has really done it. |
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 is convinced of things that are not true and develops bizarre thoughts.
For example, a typical illusion of people with psychosis is to believe that there are people or organizations intent on harming or killing them.
CONFUSION AND THOUGHTS OF THOUGHT
In the presence of confusion and thought disorders, the psychotic subject shows the tendency to:
- Speak quickly and constantly (ie without variations)
- Suddenly change the subject
- Suddenly losing the thread of your thoughts. In these situations, he stops talking or completing what he is doing.
LACK OF UNDERSTANDING AND AWARENESS OF ITSELF
With lack of understanding and self-awareness, the experts refer to the inability of subjects with psychosis to recognize their own problems (hallucinations, illusions, etc.).
It is particularly curious that this incapacity concerns only oneself and not others: in fact, the psychotic individual is able to recognize bizarre behaviors or illusions that can involve individuals with disorders similar to his.
COMPLICATIONS
The complications of psychosis include:
- Self-injury . A recent statistical survey reports that one in 10 people with psychosis has a history of self-harm.
- Suicide . According to some studies, one in five people with psychosis attempt suicide and one in 25 with psychosis kills himself.
- Drug and / or alcohol abuse .
- The long-term effects of antipsychotics, taken for the treatment of psychosis itself. A prolonged treatment based on antipsychotics can lead to an increase in body weight, metabolic syndrome and tardive dyskinesia .
Diagnosis
For a diagnosis of psychosis, the following are essential: a thorough physical examination, a careful medical history (or clinical history) and a psychiatric evaluation.
Any use of laboratory tests (blood tests, etc.) and diagnostic imaging tests (X-rays, CT scans, nuclear magnetic resonance, etc.) serves to definitively clarify the causes.
A precise knowledge of the triggers of psychosis allows the doctor to plan the treatment most appropriate to the circumstances.
Please note: currently, there is no specific diagnostic test for psychosis. It is for this reason that we must resort to different evaluation tests.
WHO TAKES CARE OF 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 that the patient suspected of psychosis must answer during the medical history:
- Do you take medications? If yes, which ones?
- Do you use illegal substances or abuse alcohol?
- Do you suffer from some mood disturbance? Are you feeling down for example?
- What is your daily routine? For example, do you work?
- Do any of your family members suffer from some mental illness, such as schizophrenia?
- Tell me about the hallucinations
IMPORTANCE OF EARLY DIAGNOSIS
Early diagnosis of psychosis increases the chances of successful therapy.
Therefore, in the presence of suspicious symptoms, it is advisable to contact your doctor immediately and undergo any further examinations that the latter prescribes.
Treatment
Generally, the treatment of a psychosis includes a therapy focused on treating the causes ( causal therapy ), the administration of antipsychotic drugs and psychotherapy .
Furthermore, the attendance of support groups, which involve people with similar problems, can also be a valid help.
CAUSAL THERAPY
Causal therapy varies depending on the triggering factors and represents a fundamental aspect in order to be able to recover from many forms of psychosis.
Examples of causal therapy are:
- Alcohol detoxification programs, when psychosis occurs after alcohol abuse, or drug detoxification programs (cocaine, marijuana, LSD etc.), when psychosis is due to drug or hallucinogenic abuse.
- Vitamin supplementation, when psychosis is due to a vitamin deficiency (eg B12).
- The administration of drugs for hypothyroidism, hyperthyroidism, hypoparathyroidism, etc., when psychosis is a consequence of one of the aforementioned endocrine disorders.
- Therapeutic programs for the treatment of psychiatric illnesses that can cause psychosis (schizophrenia, bipolar disorder, delusional disorder, etc.).
ANTIPSYCHOTICS
Antipsychotics, or neuroleptics, represent the pharmacological treatment of choice for psychosis.
Acting on dopamine (a neurotransmitter in the brain), they have a calming, antiallucinatory and mood-stabilizing effect.
The soothing effect is noticeable after just a few hours, while the anti-hallucinatory and mood-stabilizing effect requires several days, if not even a couple of weeks.
There are two possible methods of administration: by mouth (oral) or by intravenous injection . Antipsychotics that can be administered by intravenous injection are slow-release drugs, ie drugs that work gradually. The advantage of using slow-release drugs is the small number of injections: generally, one every 2-6 weeks.
In the case of schizophrenia-induced psychosis or bipolar disorder, taking antipsychotics is a long-term treatment.
The use of antipsychotics requires careful monitoring when the patient suffers from epilepsy or some cardiovascular disorder.
Short-term side effects of antipsychotics:
| Long-term side effects of antipsychotics:
|
PSYCHOTHERAPY
Psychotherapy is a term of wide meaning and includes various techniques of psychological treatment. 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 dominate problematic (or inactive) behaviors.
In the case of psychosis, the goal of cognitive-behavioral therapy is to educate the psychotic subject to control anxiety crises, violent behavior, agitation due to hallucinations and / or illusions, etc.
- Family therapy is a form of psychotherapy that affects the whole family of the patient.
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 provided for him.
To get good results from family therapy, it is good that the family learns the characteristics of the disease in progress and how to best help those who are affected.
Prognosis
Based on various clinical evidences, the prognosis in the case of psychosis is better when the therapies began at the beginning of 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 that subjecting people at risk of psychosis to a certain degree can reduce the aforementioned risk to cognitive-behavioral therapy.
