Psychosis

• ANATOMY OR SYSTEM AFFECTED: Psychic-emotional system
• CAUSES: May include brain disturbances resulting from thyroid disorders, negative drug reactions, infections, epilepsy, tumors, and circulatory disorders (e.g., strokes); brain diseases such as Parkinson's disease; dementia; certain prescription and illegal drugs
• SYMPTOMS: Delusions, hallucinations, disconnection from reality, speech and movement disturbances
• DURATION: Acute to chronic
• TREATMENTS: Medication; individual, group, and family psychotherapy; hospitalization

DEFINITION: The most severe mental disorder, in which the individual loses contact with reality and experiences symptoms such as delusions and hallucinations.

Causes and Symptoms

The individual with a psychosis displays disordered thinking, emotion, and behavior. The individual fails to make sense of their surroundings, reacts inaccurately to them, and develops false thoughts or ideas about them. The resulting behavior can be described as peculiar, abnormal, or bizarre. Psychosis runs in families and most often first appears in late adolescence or early adulthood. There are some psychoses with medical and physical causes, and some for which the cause is unknown. The treatment of psychoses involves removing or correcting the causes of the psychoses when possible. Psychosis describes a group of symptoms that can be part of several formal psychiatric diagnoses that include schizophrenia. Psychotic symptoms are characterized by delusions, hallucinations, disturbances of movement, and speech disturbances.

Delusions are false beliefs that are held despite strong evidence to the contrary. An example of an extreme delusion might be a man’s belief that someone has planted a radio transmitter in his brain that sends signals to creatures on Mars. Hallucinations are false sense perceptions that, like delusions, are held despite strong evidence to the contrary. Hallucinations can involve any of the five senses. Examples of extreme hallucinations include feeling as if one is covered by ants, seeing green cows walking through the wall, hearing voices that do not exist, and smelling a constant odor when none exists.

Disturbances of movement can occur with psychoses. For example, a woman may become very exaggerated in her movements or, conversely, may become motionless for periods of time. These disturbances of movement are clearly bizarre and unnatural. Finally, speech disturbances are very common in psychoses. A man might speak in a way that is not understandable to others. He may carry on a conversation in which he believes that he is communicating normally, but without making sense to others. Alternatively, speech might be clear, but the individual shifts from one unrelated idea to another without being aware of doing so. Another psychotic symptom is severe emotional turmoil, described as intense shifting moods with accompanying feelings of being confused.

Approximately 2 percent of all people will develop a psychosis sometime during their life. Although psychoses typically first appear in late adolescence or early adulthood, they may begin in middle to late life as well. The symptoms are apparently equally common in males and females. Because there is a strong family pattern to psychoses, some have suggested a genetic predisposition, and such evidence has been found. Environmental factors, such as home environment, parenting, and traumatic life events, may play a role in some psychoses, as do social determining factors, such as food insecurity, police violence, and racial discrimination. Some research indicates that Black and Latino Americans receive a psychosis diagnosis more often than the White population.

Treatment and Therapy

Psychoses have historically been categorized as organic or functional, providing a way to communicate the cause of a psychosis and prescribe appropriate treatment. Organic psychoses are attributable to disturbances or problems in the structure, functioning, or chemistry of the brain. Functional psychoses are those psychoses for which no organic causes are found. The treatment of organic psychoses involves removing or correcting the causes of the psychoses. While this categorization continues to be used in some contexts, the American Psychiatric Association's 2022 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) classifies psychosis as a symptom under "Schizophrenia Spectrum and Other Psychotic Disorders." These conditions include schizophrenia, delusional disorder, brief psychotic disorder, schizoaffective disorder, schizophreniform disorder, schizotypal (personality) disorder, and substance/medication-induced psychotic disorder. The DSM-5-TR further defines psychosis according to core symptom domains: delusions, hallucinations, disorganized speech, and disorganized or abnormal motor behavior, as well as other negative symptoms.

Various physical conditions and abnormalities can lead to psychosis, including thyroid disorders, drug reactions, infections, epilepsy, tumors, lupus, Lyme disease, and circulatory disorders (for example, strokes). In the case of a psychosis caused by a disorder of the thyroid gland, the individual might be prescribed medications to correct the thyroid problem or have the gland surgically removed. Certain prescription and illegal drugs can cause psychosis; these include cocaine, alcohol, heart medications, and pain medications. In these situations, the psychotic symptoms are often eliminated when the medication or drug is discontinued. Psychoses may be the result of deteriorating physical conditions, such as Alzheimer’s disease. Such a psychosis is typically nonreversible and is treated with tranquilizing medications to decrease the individual’s discomfort and disruptive behaviors.

Antipsychotic medications are the most appropriate first-line treatment for symptoms. The goal of therapy is to decrease the frequency and disruption of psychotic thoughts and behaviors.

Individual, group, and family psychotherapy are also a major part of treating individuals with psychosis in deteriorating physical conditions. These therapies help to ensure compliance with the medication therapy, decrease the tendency for relapse, and can even lead to a reduction in the amount of medication required to relieve the individual’s symptoms. The goal of psychotherapy is to help individuals maintain their functioning.

Occasionally, the patient with a psychosis may require inpatient hospitalization. The experience of hallucinations or delusions can be particularly distressing and can lead to severe depression. Furthermore, these hallucinations and delusions might be of a homicidal or suicidal nature. While hospitalization is not required in treating individuals with psychosis, when individuals become a danger to themselves or others, a brief inpatient hospitalization may be required to stabilize the patients and return them to a higher state of functioning. During hospitalization, patients are treated with medication therapy along with individual, group, or family therapy until they can be safely returned to their environments. Occasionally, patients with psychoses have multiple episodes during their lives, requiring numerous inpatient hospitalizations. In May 2013, Georgia Health Sciences University in Augusta, Georgia, published a study linking urinary tract infections (UTIs) in patients with psychosis. According to the study presented at the American Psychiatric Association's 2013 Annual Meeting, the prevalence of UTIs was higher in patients with a history of psychosis.

Bibliography

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