Psychosis

Psychosis is a symptom or feature of mental illness typically characterized by radical changes in personality, impaired functioning, and a distorted or non-existent sense of objective reality.

Patients suffering from psychosis have impaired reality testing; that is, they are unable to distinguish personal, subjective experience from the realityof the external world. They experience hallucinations and/or delusions that they believe are real, and may behave and communicate in an inappropriate andincoherent fashion. Psychosis may appear as a symptom of a number of mental disorders, including mood and personality disorders. It is also the defining feature of schizophrenia, schizophreniform disorder, schizoaffective disorder,delusional disorder, and the psychotic disorders (i.e., brief psychotic disorder, shared psychotic disorder, psychotic disorder due to a general medicalcondition, and substance-induced psychotic disorder).

Psychosis may be caused by the interaction of biological and psychosocial factors depending on the disorder it presents in; psychosis can also be caused by purely social factors, with no biological component.

Psychosis in schizophrenia and perhaps schizophreniform disorder appears to be related to abnormalities in the structure and chemistry of the brain, and appears to have strong genetic links; but its course and severity can be altered by social factors such as stress or a lack of support within the family. The cause of schizoaffective disorder is less clear cut, but biological factors are also suspected.

The exact cause of delusional disorder has not been conclusively determined,but potential causes include heredity, neurological abnormalities, and changes in brain chemistry. Some studies have indicated that delusions are generated by abnormalities in the limbic system, the portion of the brain on the inner edge of the cerebral cortex that is believed to regulate emotions.

Trauma and stress can cause a short-term psychosis (less than a month's duration) known as brief psychotic disorder. Major life-changing events such as the death of a family member or a natural disaster have been known to stimulatebrief psychotic disorder in patients with no prior history of mental illness.

Psychosis may also be triggered by an organic cause, termed a psychotic disorder due to a general medical condition. Organic sources of psychosis includeneurological conditions (for example, epilepsy and cerebrovascular disease),metabolic conditions (for example, porphyria), endocrine conditions (for example, hyper- or hypothyroidism), renal failure, electrolyte imbalance, or autoimmune disorders.

Psychosis is also a known side effect of the use, abuse, and withdrawal fromcertain drugs. So-called recreational drugs, such as hallucinogenics, PCP, amphetamines, cocaine, marijuana, and alcohol, may cause a psychotic reaction during use or withdrawal. Certain prescription medications such as steroids, anticonvulsants, chemotherapeutic agents, and antiparkinsonian medications mayalso induce psychotic symptoms. Toxic substances such as carbon monoxide have also been reported to cause substance-induced psychotic disorder.

    Psychosis is characterized by the following symptoms:
  • Delusions. Thosedelusions which occur in schizophrenia and its related forms are typically bizarre (i.e., they could not occur in real life). Delusions occurring in delusional disorder are more plausible, but still patently untrue. In some cases,delusions may be accompanied by feelings of paranoia.
  • Hallucinations. Psychotic patients see, hear, smell, taste, or feel things that aren't there. Schizophrenic hallucinations are typically auditory or, less commonly, visual; but psychotic hallucinations can involve any of the five senses.
  • Disorganized speech. Psychotic patients, especially those with schizophrenia, often ramble on in incoherent, nonsensical speech patterns.
  • Disorganized or catatonic behavior. The catatonic patient reacts inappropriatelyto his environment by either remaining rigid and immobile or by engaging in excessive motor activity. Disorganized behavior is behavior or activity whichis inappropriate for the situation, or unpredictable.

Patients with psychotic symptoms should undergo a thorough physical examination and history to rule out possible organic causes. If a psychiatric cause such as schizophrenia is suspected, a mental health professional will typicallyconduct an interview with the patient and administer one of several clinicalinventories, or tests, to evaluate mental status. This assessment takes place in either an outpatient or hospital setting.

Psychosis that is symptomatic of schizophrenia or another psychiatric disorder should be treated by a psychologist and/or psychiatrist. An appropriate course of medication and/or psychosocial therapy is employed to treat the underlying primary disorder. If the patient is considered to be at risk for harminghimself or others, inpatient treatment is usually recommended.

Antipsychotic medication such as thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), sertindole (Serlect), olanzapine (Zyprexa), or risperidone (Risperdal) is usually prescribed to bringpsychotic symptoms under control and into remission. Possible side effects of antipsychotics include dry mouth, drowsiness, muscle stiffness, and tardivedyskinesia (involuntary movements of the body). Agranulocytosis, a potentially serious but reversible health condition in which the white blood cells that fight infection in the body are destroyed, is a possible side effect of clozapine. Patients treated with this drug should undergo weekly blood tests tomonitor white blood cell counts for the first six months, then every two weeks.

After an acute psychotic episode has subsided, antipsychotic drug maintenancetreatment is typically employed and psychosocial therapy and living and vocational skills training may be attempted.

Prognosis for brief psychotic disorder is quite good; for schizophrenia, lessso. Generally, the longer and more severe a psychotic episode, the poorer the prognosis is for the patient. Early diagnosis and treatment is critical toimproving outcomes for the patient across all psychotic disorders.

Approximately 10% of America's permanently disabled population is comprised of schizophrenic individuals. The mortality rate of schizophrenic individualsis also high--approximately 10% of schizophrenics commit suicide, and 20% attempt it. However, early diagnosis and long-term follow up care can improve the outlook for these patients considerably. Roughly 60% of patients with schizophrenia will show substantial improvement with appropriate treatment.

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