Psychosis is a term used to describe a group of symptoms that affect the mind, where there is loss of contact with reality. When a person becomes ill in this way it is considered a psychotic episode. There are different signs that appear when someone may be on the verge of a psychotic episode, such as social withdrawal, a decline in normal functioning, depression or anxiety, decreased concentration, sleep disturbance, and difficulty handling everyday stresses or pressures.
What are the symptoms?
Changes in thoughts and feelings added to a person’s experience, such as paranoia or hearing voices.
Delusions are firmly held false beliefs that are not consistent with a person’s culture. They are unique to the individual experiencing and may be difficult for others to understand.
Hallucinations are sensations that aren’t really there. For example the person might hear voices that no one else can hear. They may smell things no one else does, or hear music. All five senses can be affected by hallucinations. The most common hallucination is hearing voices or sounds. These experiences appear very real to the person experiencing them, and they may respond to voices out loud.
Changed behaviour: If a person is having a psychotic episode, they may behave differently from the way they usually do. They may be extremely active or lethargic. Often changes in behaviour are associated with the other symptoms of psychosis.
Disorganised speech or Behaviour may include inability to relate to a conversation or responding with unrelated answers. It may also mean inability to hold conversation or drifting from one topic to another. Disorganised behaviour does not fit the situation, such as wearing inappropriate clothing based on weather or other circumstances, difficulty with tasks including self- care and hygiene, or inappropriate emotional response such as laughing at a tragedy or harmful situation.
A decrease or loss of normal functions.
These symptoms may be less evident to identify. Negative symptoms include lack of emotion or expression, monotone speech or limited response, such as one word replies, difficulty thinking, lack of motivation, inability to feel pleasure from things that previously were enjoyable or lack of interest in other people.
What types of psychotic illnesses are there?
Each person’s experience of psychosis is different. This can make it very difficult to make a clear diagnosis, particularly during a person’s first episode of psychosis. Many mental health professionals do not use a diagnosis but refer to it as ‘an episode of psychosis’ or ‘first episode psychosis.’
Who gets psychosis?
Approximately 3% of the population will experience a psychotic episode at some point in life. It occurs in all cultures and societies in both men and women. First episode will generally occur in adolescence, generally 18-24 years of age. It is good to remember that symptoms of psychosis are treatable.
Some people may only have one episode of psychosis and not experience it again.
However, when a person has experienced a number of episodes of psychosis they may be given one of the following diagnoses:
A group of mental illnesses that affect a person’s ability to think, feel and act. The symptoms may include hallucinations, thought disorder, delusions, withdrawal, loss of emotion and energy, and inappropriate emotions. To be diagnosed with schizophrenia, symptoms must have been continuing for a period of at least six months.
Affects the way a person feels. You may experience periods of very extreme moods – feeling very high and/or very low for days, weeks or months. You may have delusions or hallucinations which are consistent with the high or low mood. Some people have a series of manic episodes, others a series of depressive episodes, while others have both manic and depressed episodes.
There are two subtypes of this disorder (bipolar and depressive). In Schizoaffective Disorder, people have symptoms of either Schizophrenia and Bipolar, or Schizophrenia and depression.
Schizophreniform disorder is diagnosed if the psychotic symptoms last more than one month but less than six months. Symptoms are similar to those of schizophrenia.
Drug induced psychosis is brought on solely by the use of drugs in someone who is predisposed to a psychotic episode. With a drug induced psychosis the symptoms appear quickly and last a relatively short time, from hours to days, until the effects of the drug wear off. Disorientation, memory problems and visual hallucinations are the most common symptoms.
If you have delusional disorder you may hold strong beliefs in things which are not true. You may have delusions of being persecuted, that people are out to get you, or that you are someone famous.
Someone with major depression can have a type of depression which is so intense it causes loss of interest and enjoyment, loss of appetite, severe insomnia and even psychotic symptoms such as delusions.
Post-partum psychosis can be brought on by hormonal changes after childbirth, and often resembles Schizophrenia or bipolar disorder. Post-partum psychosis happens to about 1 in 500 pregnant women and usually occurs in the first 6-8 weeks after the birth.
Other physical illnesses altogether can affect the brain and cause psychotic symptoms. Some of these illnesses include AIDS, Thyroid disorder, Dementia, brain tumour, Huntington’s Disease and viral infection.
What causes psychosis?
It is currently thought that psychosis can be caused by a combination of biological, psychological, social and cultural factors. Symptoms of psychosis are thought to often emerge in response to stress, drug abuse or social/ environmental changes. They are more common in an individual whose capacity to cope with these stressors is overwhelmed.
There is some evidence that symptoms of experiences consistent with a psychotic episode is caused by a combination of biological factors which create a vulnerability to experiencing psychotic symptoms during adolescence or early adult life.
For some psychotic disorders there is no family link at all. For others, such as Schizophrenia and Bipolar Disorder, evidence suggests that genetic factors may play a part.
Stress and trauma
Stress and trauma are experiences which undermine our sense of safety or survival. Such experiences can overwhelm the person’s ability to cope. Many different situations can be experienced as traumatic by an individual and effect their coping mechanisms. Psychosis may be triggered from a traumatic event, particularly from childhood trauma, however not all trauma leads to psychosis.
How is Psychosis Treated?
The first phase of treatment involves assessment: this means having a series of interviews with mental health specialists. Physical tests are needed to exclude a physical cause for the symptoms. Information obtained from the person, family and friends, together with the test results, will provide some idea about the type of psychosis being experienced, the cause, and how it may be treated.
medication plays a fundamental role in a medical treatment from a psychotic episode and in the prevention of further episodes. Different types of medication are effective in reducing the symptoms of psychosis and the anxiety these symptoms can cause.
Counselling and psychological therapy
Having someone to talk to is an important part of treatment. As recovery progresses, there are practical ways to learn to prevent further episodes. These can include stress management techniques or ways of recognising warning signs. Counselling for the individual and their family can also be very important. Support groups may provide some of the necessary support for recovery.
Sometimes there are benefits in spending a period of time in hospital before continuing with home treatment. Hospitalisation allows symptoms to be observed more closely and medication to be trialled and stabilised.
Support from family and friends is crucial as it reduces isolation and makes it easier to cope with the symptoms. Community support and the reduction of discrimination and myths surrounding psychosis also has a great impact. Other forms of support which may be helpful to recovery include safe and supportive housing, support in gaining employment; income support from Centrelink when you are ill; and training through TAFE or universities.
Recovering from psychosis
From a medical perspective, recovery is often associated with the absence of active symptoms or disorder. Recovery can be understood as a unique and personal journey of reclaiming a sense of self, and wellbeing after a period of distress. The pattern of recovery from psychosis varies from person to person and can be influenced by a wide range of factors. Some people recover quickly with very little intervention. Others may benefit from support over a longer period.