Mental Disorder: Understanding Psychosis

What is psychosis?

Psychosis is a medical condition that prevents a person from thinking clearly and behaving normally, and the affected person is unable to differentiate between reality and imagination. The disorder is characterised by two main manifestations:

1. Hallucinations - Hearing, seeing things that are actually not there
2. Delusions - Believing natural, rational things and events to be untrue.

A severe form of psychosis occurs when a patient experiences hallucinations and delusions, causing severe disruption of thoughts, emotion, perception and behaviour. The exact moment when you experience the symptoms is referred to as a psychotic episode. Psychosis differs from neurosis, as a patient suffering from the latter does not experience hallucinations, which are a characteristic only of psychotic disorder.

What are the causes of the disorder?

Psychosis is not classified as an illness by itself; rather it is triggered by other physical and mental illnesses. Medical conditions that can cause psychosis include:

1. Alcohol and other drugs, when used and during withdrawal
2. Dementia
3. Brain diseases, like Parkinson's disease, Huntington's disease, and other chromosomal disorders; brain tumours or cysts
4. Infections like HIV that affect the brain
5. Epilepsy
6. Stroke
7. Schizophrenia, bipolar disorder, and personality disorders
8. Prescription drugs like steroids and stimulants

 What you need to know about symptoms or signs?

When you experience a psychotic episode, the following symptoms may occur:

1. Hallucination - You would perceive something through any of your five senses that does not exist in reality.
2. Delusion - You would be fixed on a belief that could be bizarre, untrue and improbable.
3. Disturbed and confusing thoughts
4. Lack of self-awareness - If you are experiencing a psychotic episode, chances are that you would be totally unaware of your behaviour, and would not agree to the fact that your hallucinations and delusions are imaginary.

Which specialist should you consult if you have any of the signs and symptoms?

If you are concerned about someone afflicted by psychotic behaviour, visit the family doctor or general practitioner, who would then refer the patient to a psychiatrist.

What are the screening tests and investigations done to confirm or rule out the disorder?

There are no tests available to diagnose psychosis. Your doctor will assess your symptoms and rule out underlying medical illnesses or substance abuse as cause of psychosis. A team of psychologist, psychiatrist and mental health nurse will work together to determine the exact cause of psychosis and formulate a treatment plan.

What treatment modalities are available for management of the disorder?

Nature of treatment depends on the cause of psychosis, but generally involves a combination of antipsychotic drugs, psychological therapy and social support.

1. Antipsychotic medication - Known as neuroleptics, these drugs are the first line of treatment for psychosis. These drugs block the effect of dopamine (chemical messenger in brain). However, side effects of antipsychotic medicines can affect different patients with varying degrees.
2. Psychological therapy - Counselling in form of cognitive behavioural therapy (CBT), family therapy and participation in self-help groups can reduce the intensity of symptoms.

What are the known complications in management of the disorder?

Antipsychotic drugs may cause side effects in some people and their severity varies from person to person. Common side effects include:

1. Restlessness
2. Drowsiness
3. Trembling, shaking
4. Muscle twitches and spasms
5. Blurred vision
6. Constipation
7. Lack of sex drive

Long term side effects of these drugs is diabetes and weight gain.

What precautions or steps are necessary to stay healthy and happy during the treatment?

Once treatment commences, do not skip or stop taking medication unless advised by your specialist doctor. Doing so could trigger a relapse of symptoms. As your condition improves with therapy, your dosage will be reduced gradually to a stop, but under close observation.

What are the dietary and physical activity requirements during the course of the treatment?

Regular exercise triggers release of serotonin, a mood boosting chemical in the brain helpful in reducing symptoms of psychosis. Relaxation techniques like meditation and yoga also help alleviate stress and anxiety. Do not smoke, consume illegal drugs or drink alcohol.

How can you prevent the disorder from happening or recurring?

While you cannot prevent the occurrence of psychosis that is triggered by biological, environmental or psychological factors in your life, you can prevent psychosis that develops from substances like illegal drugs. Studies have shown that usage of cannabis over a prolonged period of time can alter brain chemistry and lead to psychosis. Manage stress and depression levels to prevent future episodes of psychosis.

As a caregiver, how can you support and help the patient cope with the disorder?

Since the patient suffering from psychosis cannot recognise any abnormality in their behaviour, they will be reluctant to visit a doctor and seek help on their own. You will be required to get help for them. If the person has had previous episodes of psychosis and has undergone treatment, you can directly contact his/her support group and doctor. Sources:"Psychosis," PubMed Health, A.D.A.M. Medical Encyclopedia, https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002520/"Psychosis," NHS.uk, https://www.nhs.uk/Conditions/Psychosis/Pages/Introduction.aspx"Psychosis," WebMD.com, https://www.webmd.boots.com/mental-health/tc/psychosis-symptoms-of-psychosis image source: comingoutofthedark