Psychosis

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Psychosis

A psychotic state is one in which a person suffering from one of several mental illnesses loses touch with reality. People experiencing psychosis may be diagnosed as schizophrenic, manic-depressive, or delusional. Psychosis can also be induced from drug or alcohol abuse, reaction to medication, from exposure to some toxic substance, or from trauma to the brain. Psychotic episodes have a duration that may last for a brief period or may last for weeks and months at a time. Since the 1950s new medications have been developed to effectively treat psychosis and allow the person suffering from delusions or hallucinations to regain a more accurate view of reality.

There is significant evidence that the cause of psychosis lies within the limbic system, an area of the brain that lies deep within the lower, center portion of the brain and is believed to control the emotion, behavior, and perception of external and internal stimulation. The limbic system connects to all areas of the brain. It can be compared to a telephone network. If one line is down, communication cannot be made. Likewise, if an area within the limbic system is not functioning properly, appropriate signals cannot be sent or received, or inappropriate ones may be sent when the system is overloaded and working too hard.

Forms of psychosis

Before the careful classification of mental illnesses, anyone exhibiting psychotic behavior was thought to be schizophrenic, which is the mental illness most frequently associated with psychosis. Schizophrenia is a mental illness that is characterized by delusions, hallucinations, thought disorders, disorganized speech and behavior, and sometimes catatonic behavior. Emotions tend to flatten out and it becomes increasingly more difficult for the person to function normally in society. It is estimated that 1% of the American population is currently affected by this illness, which means there are about 1.5 million people who are ill from this disease.

In certain states of manic-depressive illness, or bipolar disorder, a patient may also suffer psychotic symptoms of delusions, hallucinations, and thought disorder. Unlike schizophrenia, those who suffer from manic-depressive illness are involved in a mood disorder, while schizophrenia is considered more of a thought disorder. In schizophrenia the mood is flat, but in manic-depression the mood can swing from great excitability to deep depression and feelings of hopelessness. In both phases of manic-depressive illness, many patients also experience delusions and hallucinations, which lead to misperceptions of reality.

Other psychiatric illnesses that produce psychotic episodes are delusional disorders, brief psychotic disorders that may remit within a month, substanceinduced psychotic disorders, psychotic disorders due to a general medical condition, and a number of others given separate classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a publication that presents guidelines for the diagnosis of serious mental illnesses. Diagnosis is based both on the nature of the psychosis and its duration.

Symptoms of psychosis

Hallucinations are a major symptom of psychosis and can be defined as a misperception of reality. Auditory hallucinations are the most common form. Patients hear voices that may seem to be outside his or her head or inside. The voices may be argumentative or congratulatory. Patients who exhibit visual hallucinations may have an organic problem, such as a brain lesion. Other types of hallucinations involve the sense of smell and touch.

There are various types of delusions that psychiatrists classify when diagnosing a patient. Erotomanic delusions involve the conviction that someone is in love with the patient. Grandiose delusions have a theme of inflated importance, power, knowledge, or a special relationship with someone important, perhaps a political leader, God, or a famous person. In a jealous type of delusion, the person feels their sexual partner is unfaithful even when there is no evidence of the fact. The main theme of a persecution delusion is that the patient is being mistreated by someone. In somatic delusions, patients feel they have a disease or physical defect that is also not present.

Medications for treatment

Antipsychotic medications were first used after it was noticed that a newly synthesized anesthetic had unusual ability to sedate patients who did not become unconscious from its use. Dr. Henri Laborit, a French physician, encouraged his psychiatric colleagues to try the drug on their schizophrenic patients. They were so successful with this drug, chlorpromazine, that its use spread quickly throughout the world. This was in 1952. Since then, seven different types of antipsychotic medications have been developed. Some of the brand names include Thorazine, Trilafon, and Haldol.

These medicines are administered by tablet or liquid, and under circumstances where the patient may be likely not to take the medicine, time-released injections are given. The psychiatric community approaches the prescribing of antipsychotic medicines, also called neuroleptics, somewhat on the basis of trial

KEY TERMS

Delusions— Incorrect beliefs about reality that may involve one’s self-importance or the false belief that one is being persecuted when no such persecution is taking place.

Hallucination— A sensory experience of something that does not exist outside the mind. A person can experience a hallucination in any of the five senses.

Manic-depressive illness— Bipolar disorder, a mental illness in which psychosis may present as a symptom and where the patient exhibits both an excited state, called mania, and a depressed state.

Neuroleptics— Medications that treat psychosis, also called antipsychotics.

Schizophrenia— A mental illness characterized by thought disorder, distancing from reality, and sometimes delusions and hallucinations.

and error. They have found that when one type of antipsychotic does not work, another type very well may reduce the symptoms of psychosis. It is sometimes helpful for them if another family member is suffering from the same illness. They have found responses within families to medicines to likely be the same. This suggests that there is a genetic factor involved in mental illness that leads to psychosis.

Dosages

Antipsychotic medicines vary widely in the amount of dosage needed to stabilize patients. One patient may need only 10 or 20 mg of an antipsychotic, while another will need hundreds of milligrams. The blood is monitored to determine the necessary dosage. A group of patients receiving the same medication can need widely differing amounts of the same medicine to achieve the desired effect.

While medication is the foremost element of current treatment for most situations of psychosis, counseling for the patient and family is also considered an important part of treatment, both to help them understand the role of the medicine and how to deal with the illness. Before antipsychotic medication came into common use, many people suffering from psychosis had to be hospitalized. Today, with a careful diagnosis and treatment therapy, many lead relatively normal and socially useful lives.

See also Antipsychotic drugs.