Psychosis, Let’s Break The Stigma!

What is psychosis?

Psychosis is a condition that affects the way your brain processes information and it causes you to lose touch with reality, distorting your perceptions and thoughts by causing your brain to take on too much information from the world all at once.

Psychosis is not an illness in itself

Psychosis is a syndrome, or multiple symptoms that can be found in psychotic disorders (serious psychiatric illnesses such as schizophrenia) or in other medical illnesses.

Less than 4% of the population meet the criteria for a psychotic disorder

Psychosis typically manifests in the late teens or early twenties, affecting all genders equally across all cultures and economic levels.

What are the symptoms of a psychotic episode?

During the acute phase, many symptoms may appear including:

I- Positive symptoms: they are symptoms that are going to be added to one’s behavior:

• Hallucinations: visual, auditory, sensory
• Delusions/false beliefs: bizarre or non-bizarre
  • Bizarre delusion: believing something that is impossible to happen, e.g., that the person is God or that he/she has superpowers
  • Non-bizarre delusion: believing something that is in the realm of possibility but that is not actually happening, e.g., a believe that his/her partner is always cheating on them
• Disorganization of thoughts and behaviors: that commonly manifests as disorganized speech, e.g., word salad
• Paranoia: having suspicious thoughts or continuous fear that people are watching you/want to hurt you

 II- Negative symptoms: they are symptoms that are going to be missed from your regular behavior:

• Lack of emotions/facial expressions
• Social isolation
• Reduced/lost motivation
• Restricted speech
• Difficulty with generating ideas/thoughts/tasks

 III- Lack of insight:

• Insight: is the awareness that the person has about a health condition that is affecting them
• The longer a person has experienced psychotic symptoms the less likely he/she are to have insight

 IV- Other symptoms:

• Cognitive (Attention/concentration/memory…)
• Mood changes (Excitement/depression…)
• Suicidal (Thoughts/behaviors)
• Substance abuse
• Sleep disturbances

What are the causes of psychosis?

There are different causes of psychosis: genetics, environmental factors, or a combination of both.

I- Genetics

You can have a genetic predisposition for psychosis; however, there has yet to be any standardized genetic test that can reveal this predisposition. Psychiatrists look at the family history/antecedents of psychosis in order to evaluate a patient’s predisposition

II- Substance abuse

Excess of alcohol, drugs (marijuana, cocaine, amphetamine..) and prescription drugs such as some antidepressants or Parkinson’s disease medications, can all trigger psychosis.

III- Trauma

Trauma such as the death of a loved one, war, or even sexual assault can also lead or trigger psychosis.

IV- Illnesses and injuries

Traumatic brain injury or other medical conditions such as Parkinson’s disease, dementia, including Alzheimer’s disease, brain tumors as well as some psychiatric illnesses which can have secondary symptoms of psychosis.

V- Other environmental factors

Stress, sleep deprivation and early life environmental factors such as maternal malnutrition, can all lead or trigger psychosis

 Having the genes or not is not decisive!

Being genetically predisposed to psychosis does not mean you are necessarily going to suffer from psychosis, but it surely increases the risk. On the other hand, not being genetically predisposed does not mean you cannot get psychosis.

So, simply put, what happens in the brain?

A dysregulation in firing and/or a release of dopamine which causes the brain to process a lot of information all at once.

 Diagnosis

Psychosis are classified into two categories:

I- Primary, “psychiatric”: related to psychiatric illnesses such as schizophrenia, severe depression, bipolar disorder, delusional disorder…

II- Secondary, “organic”: related to all other causes.

The diagnosis depends on:

• Family history
• Onset of symptoms (abruptly/progressively)
• Duration of symptoms

Differentiation between the different psychiatric illnesses is not easy, and psychiatrists modify their diagnosis according to new symptoms or response to treatment 

 What about the treatment?

A good treatment would be a combination of:

I- Medication: antipsychotics, usually dopamine antagonist. They reduce the psychotic symptoms and help prevent further psychotic episodes from happening, acting as a protective factor.

II- Support from family, friends, and/or health professionals.

III- “Skills”, which is a part of Cognitive Behavioral Therapy (CBT), where you learn how to cope with stress, have a healthy lifestyle, set goals, and move forward.

 Some tips which may help someone experiencing psychotic symptoms:

• Distract yourself
• Reality check
• Challenge realistic v/s unrealistic thoughts
• Have a support system
• Relax/calm your body and mind
• Prepare for/anticipate stress
• Connect with others/maintain a social circle