psychosis

Psychosis

 

Definition

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

Description

Patients suffering from psychosis have impaired reality testing; that is, they are unable to distinguish personal subjective experience from the reality of the external world. They experience hallucinations and/or delusions that they believe are real, and may behave and communicate in an inappropriate and incoherent 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 medical condition, and substance-induced psychotic disorder).

Causes and symptoms

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

Biological factors that are regarded as contributing to the development of psychosis include genetic abnormalities and substance use. With regard to chromosomal abnormalities, studies indicate that 30% of patients diagnosed with a psychotic disorder have a microdeletion at chromosome 22q11. Another group of researchers has identified the gene G72/G30 at chromosome 13q33.2 as a susceptibility gene for child-hood-onset schizophrenia and psychosis not otherwise specified.

With regard to substance abuse, several different research groups reported in 2004 that cannabis (marijuana) use is a risk factor for the onset of psychosis.

Migration is a social factor that influences people's susceptibility to psychotic disorders. Psychiatrists in Europe have noted the increasing rate of schizophrenia and other psychotic disorders among immigrants to almost all Western European countries. Black immigrants from Africa or the Caribbean appear to be especially vulnerable. The stresses involved in migration include family breakup, the need to adjust to living in large urban areas, and social inequalities in the new country.

Schizophrenia, schizophreniform disorder, and schizoaffective disorder

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.

Delusional disorder

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. Delusional disorder is also more likely to develop in persons who are isolated from others in their society by language difficulties and/or cultural differences.

Brief psychotic disorder

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 stimulate brief psychotic disorder in patients with no prior history of mental illness.

Psychotic disorder due to a general medical condition

Psychosis may also be triggered by an organic cause, termed a psychotic disorder due to a general medical condition. Organic sources of psychosis include neurological 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.

Substance-induced psychotic disorder

Psychosis is also a known side effect of the use, abuse, and withdrawal from certain 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 may also induce psychotic symptoms. Toxic substances such as carbon monoxide have also been reported to cause substance-induced psychotic disorder.

Shared psychotic disorder

Shared psychotic disorder, also known as folie à deux or psychosis by association, is a relatively rare delusional disorder involving two (or more) people with close emotional ties. In the West, shared psychosis most commonly develops between two sisters or between husband and wife, while in Japan the most common form involves a parent and a son or daughter. Shared psychosis occasionally involves an entire nuclear family.

Psychosis is characterized by the following symptoms:

• Delusions. Those delusions that 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 inappropriately to his/her environment by either remaining rigid and immobile or by engaging in excessive motor activity. Disorganized behavior is behavior or activity that is inappropriate for the situation, or unpredictable.

Diagnosis

Patients with psychotic symptoms should undergo a thorough physical examination and history to rule out such possible organic causes as seizures, delirium, or alcohol withdrawal, and such other psychiatric conditions as dissociation or panic attacks. If a psychiatric cause such as schizophrenia is suspected, a mental health professional will typically conduct an interview with the patient and administer one of several clinical inventories, or tests, to evaluate mental status. This assessment takes place in either an out-patient or hospital setting.

Psychotic symptoms and behaviors are considered psychiatric emergencies, and persons showing signs of psychosis are frequently taken by family, friends, or the police to a hospital emergency room. A person diagnosed as psychotic can be legally hospitalized against his or her will, particularly if he or she is violent, threatening to commit suicide, or threatening to harm another person. A psychotic person may also be hospitalized if he or she has become malnourished or ill as a result of failure to feed, dress appropriately for the climate, or otherwise take care of him- or herself.

Treatment

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 harming himself or others, inpatient treatment is usually recommended.

Treatment of shared psychotic disorder involves separating the affected persons from one another as well as using antipsychotic medications and psychotherapy.

Antipsychotic medication such as thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), sertindole (Serlect), olanzapine (Zyprexa), or risperidone (Risperdal) is usually prescribed to bring psychotic symptoms under control and into remission. Possible side effects of antipsychotics include dry mouth, drowsiness, muscle stiffness, and tardive dyskinesia (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 to monitor white blood cell counts for the first six months, then every two weeks.

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

Prognosis

Prognosis for brief psychotic disorder is quite good; for schizophrenia, less so. Generally, the longer and more severe a psychotic episode, the poorer the prognosis is for the patient. Early diagnosis and treatment are critical to improving 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 individuals is 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.

Resources

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th ed., revised. Washington, D.C.: American Psychiatric Association, 2000.

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Psychiatric Emergencies." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Schizophrenia and Related Disorders." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Addington, A. M., M. Gornick, A. L. Sporn, et al. "Polymorphisms in the 13q33.2 Gene G72/G30 Are Associated with Childhood-Onset Schizophrenia and Psychosis Not Otherwise Specified." Biological Psychiatry 55 (May 15, 2004): 976-980.

Hutchinson, G., and C. Haasen. "Migration and Schizophrenia: The Challenges for European Psychiatry and Implications for the Future." Social Psychiatry and Psychiatric Epidemiology 39 (May 2004): 350-357.

Sharon, Idan, MD, and Roni Sharon. "Shared Psychotic Disorder." eMedicine June 4, 2004. http://www.emedicine.com/med/topic3352.htm.

Sim, M. G., E. Khong, and G. Hulse. "Cannabis and Psychosis." Australian Family Physician 33 (April 2004): 229-232.

Tolmac, J., and M. Hodes. "Ethnic Variation among Adolescent Psychiatric In-Patients with Psychotic Disorders." British Journal of Psychiatry 184 (May 2004): 428-431.

Verdoux, H., and M. Tournier. "Cannabis Use and Risk of Psychosis: An Etiological Link?" Epidemiologia e psichiatria sociale 13 (April-June 2004): 113-119.

Williams, N. M., and M. J. Owen. "Genetic Abnormalities of Chromosome 22 and the Development of Psychosis." Current Psychiatry Reports 6 (June 2004): 176-182.

Key terms

Brief psychotic disorder — An acute, short-term episode of psychosis lasting no longer than one month. This disorder may occur in response to a stressful event.

Delirium — An acute but temporary disturbance of consciousness marked by confusion, difficulty paying attention, delusions, hallucinations, or restlessness. Delirium may be caused by drug intoxication, high fever related to infection, head trauma, brain tumors, kidney or liver failure, or various metabolic disturbances.

Delusional disorder — Individuals with delusional disorder suffer from long-term, complex delusions that fall into one of six categories: persecutory, grandiose, jealousy, erotomanic, somatic, or mixed.

Delusions — An unshakable belief in something untrue which cannot be explained by religious or cultural factors. These irrational beliefs defy normal reasoning and remain firm even when overwhelming proof is presented to refute them.

Hallucinations — False or distorted sensory experiences that appear to be real perceptions to the person experiencing them.

Paranoia — An unfounded or exaggerated distrust of others, sometimes reaching delusional proportions.

Porphyria — A disease of the metabolism characterized by skin lesions, urine problems, neurologic disorders, and/or abdominal pain.

Schizoaffective disorder — Schizophrenic symptoms occurring concurrently with a major depressive and/or manic episode.

Schizophrenia — A debilitating mental illness characterized by delusions, hallucinations, disorganized speech and behavior, and inappropriate or flattened affect (a lack of emotions) that seriously hampers the afflicted individual's social and occupational functioning. Approximately 2 million Americans suffer from schizophrenia.

Schizophreniform disorder — A short-term variation of schizophrenia that has a total duration of one to six months.

Shared psychotic disorder — Also known as folie à deux, shared psychotic disorder is an uncommon disorder in which the same delusion is shared by two or more individuals.

Tardive dyskinesia — Involuntary movements of the face and/or body which are a side effect of the long-term use of some older antipsychotic (neuroleptic) drugs. Tardive dyskinesia affects 15-20% of patients on long-term neuroleptic treatment.

Organizations

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org.

American Psychological Association (APA). 750 First St. NE, Washington, DC 20002-4242. (202) 336-5700. http://www.apa.org.

National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. http://www.nami.org.

National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. http://www.nimh.nih.gov.

Other

The Schizophrenia Page. http://www.schizophrenia.com.

psychosis

 [si-ko´sis] (pl. psycho´ses)

a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired, thus interfering with the capacity to deal with life demands. adj. adj psychot´ic. Mental disorders in which psychotic symptoms may be present include mood disorders, schizophrenia, brief psychotic disorder, delusional disorders, schizophreniform disorder, schizoaffective disorder, shared psychotic disorder, and pervasive developmental disorders.

alcoholic p's psychoses associated with alcohol use and involving organic brain damage, a category that includes alcohol withdrawal delirium, Korsakoff's syndrome, alcoholic hallucinosis, and alcoholic paranoia (concurrent paranoia and alcoholism).

brief reactive psychosis an episode of brief psychotic disorder that is a reaction to a recognizable and distressing life event.

depressive psychosis older term for a psychosis characterized by severe depression, which is now more commonly described as a form of major depressive disorder.

Korsakoff's psychosis Korsakoff's syndrome.

postpartum psychosis a psychotic episode occurring during the postpartum period.

senile psychosis depressive or paranoid delusions or hallucinations or similar mental disorders due to degeneration of the brain in old age, as in senile dementia.

toxic psychosis that due to ingestion of toxic agents or to the presence of toxins within the body.

psy·cho·sis

, pl.

psy·cho·ses

(sī-kō'sis, -sēz), Do not confuse this word with sycosis.

1. A mental and behavioral disorder causing gross distortion or disorganization of a person's mental capacity, affective response, and capacity to recognize reality, communicate, and relate to others to the degree of interfering with that person's capacity to cope with the ordinary demands of everyday life. The psychoses are divided into two major classifications according to their origins: those associated with organic brain syndromes (for example, Korsakoff syndrome); and those less clearly organic and having some functional component(s) (for example, the schizophrenias, bipolar disorder).

2. Generic term for any of the so-called insanities, the most common forms of which are the schizophrenias.

3. A severe emotional and behavioral disorder.

Synonym(s): psychotic disorder

[G. an animating]

psychosis

/psy·cho·sis/ (si-ko´sis) pl. psycho´ses   any major mental disorder of organic or emotional origin marked by derangement of personality and loss of contact with reality, with delusions and hallucinations and often with incoherent speech, disorganized and agitated behavior, or illusions. Cf. neurosis.

---

alcoholic psychoses  those associated with excessive use of alcohol and involving organic brain damage.

bipolar psychosis  see under disorder.

brief reactive psychosis  an episode of brief psychotic disorder that is a reaction to a recognizable, distressing life event.

Korsakoff's psychosis  see under syndrome.

senile psychosis  depressive or paranoid delusions or hallucinations or other mental disorders associated with degeneration of the brain in old age, as in senile dementia.

symbiotic psychosis , symbiotic infantile psychosis a condition seen in two- to four-year-old children having an abnormal relationship to the mothering figure, characterized by intense separation anxiety, severe regression, giving up of useful speech, and autism.

toxic psychosis  one due to the ingestion of toxic agents or to the presence of toxins within the body.

psychosis

(sī-kō′sĭs)

n. pl. psycho·ses (-sēz)

An acute or chronic mental state marked by loss of contact with reality, disorganized speech and behavior, and often hallucinations or delusions, seen in certain mental illnesses, such as schizophrenia, and other medical disorders.

psychosis

[sīkō′sis] pl. psychoses

Etymology: Gk, psyche + osis, condition

any major mental disorder of organic or emotional origin characterized by a gross impairment in reality testing, in which the individual incorrectly evaluates the accuracy of his or her perceptions and thoughts and makes incorrect references about external reality, even in the face of contrary evidence. It is often characterized by regressive behavior, inappropriate mood and affect, and diminished impulse control. Symptoms of psychoses include hallucinations and delusions. See also acute psychosis, ambulatory schizophrenia. psychotic, adj.

psychosis

Psychiatry

1. Psychotic disorder, see there.

2. A popular term for a wide range of major mental disorders of organic or emotional origin in which a person's ability to think, respond emotionally, remember, communicate, interpret reality, and behave appropriately is suffficiently impaired so as to interfere with the capacity to meet the ordinary demands of life Clinical Regressive behavior, social withdrawal, inappropriate mood, ↓ impulse control, abnormal mental content–eg, delusions, hallucinations, distortions of reality, loss of contact with environment and disintegration of personality. See Drug-induced psychosis, Lupus psychosis, Myxedematous psychosis, Postoperative psychosis, Psychotic disorder, Symbiotic psychosis.

psy·cho·sis

, pl. psychoses (sī-kō'sis, -sēz)

1. A mental and behavioral disorder causing gross distortion or disorganization of a person's mental capacity, affective response, and capacity to recognize reality, communicate, and relate to others to the degree of interfering with the person's capacity to cope with the ordinary demands of everyday life.

2. Generic term for any of the major mental disorders, the most common forms being the schizophrenias.

3. A severe emotional and behavioral disorder.
Synonym(s): psychotic disorder.

[G. an animating]

psychosis

One of a group of mental disorders that includes SCHIZOPHRENIA, major AFFECTIVE DISORDERS, major PARANOID states and organic mental disorders. Psychotic disorders manifest some of the following: DELUSIONS, HALLUCINATIONS, severe thought disturbances, abnormal alteration of mood, poverty of thought and grossly abnormal behaviour. Many cases of psychotic illness respond well to antipsychotic drugs in the sense that these drugs, while they are being taken, often induce a state of docility, acquiescence, apparent mental normality and conformity with social norms readily acceptable to medical staff and relatives.

psychosis,

n a mental condition marked by a significant inability of an individual to correctly assess the accuracy of his or her thoughts as well as perceptions. The person may also make erroneous statements about external reality despite the presence of opposing facts. Can be characterized by mood and affect that is not appro-priate, regressive behavior, and a decrease in impulse control. Symptoms may also include delusions and hallucinations

psy·cho·sis

, pl. psychoses (sī-kō'sis, -sēz)

A mental and behavioral disorder causing gross distortion or disorganization of a person's mental capacity, affective response, and capacity to recognize reality, communicate, and relate to others to degree of interfering with that person's capacity to cope with the ordinary demands of everyday life.

[G. an animating]

psychosis (sīkō´sis),

n a functional or organic kind of mental derangement marked by a severe disturbance of personality involving autistic thinking, loss of contact with reality, delusions or hallucinations.

psychosis, manic-depressive,

n (cyclothymia) a psychosis characterized by varying periods of depression and excitement. One state may predominate (e.g., manic-depressive reaction, manic type).

psychosis

pl. psychoses; any major mental disorder of organic or emotional origin, marked by derangement of the personality and loss of contact with reality, often with delusions, hallucinations or illusions.

There is no scientific study of animal psychiatry and no specific psychoses but some well-identified and traumatic vices, e.g. crib-biting, weaving, tail chasing and flank sucking in dogs, are often classified as such. farrowing hysteria in sows seems to be the animal disease with the closest approximation to a derangement of personality.

---

parturient psychosis of sows

see farrowing hysteria.

Patient discussion about psychosis

Q. What is paranoia? Is it different from other psychosis disorders? A friend of mine was diagnosed with schizophrenia. I read about it on the internet and I am not sure about the idea of paranoia. Is it a kind of psychosis or it a different symptom by its on? Can someone give an example of paranoid thinking VS normal thinking?

A. Methinks all these brain disorders have everything to do with a lack of copper. With all our modern technology and artificial fertilizers and processing of foods, the food has become so depleted of minerals that our bodies and brains have become so depleted that we cannot even function properly. Start taking kelp, calcium magnesium, cod liver oil, flax seed oil, and raw apple cider vinegar. This will bring healing and normal function to the brain and body systems. The emotions will calm down and be more manageable. If you are taking a vitamin with more manganese than copper it will add to the dysfunction. Don't waste your money. There you are! Some solutions rather than more rhetoric about the problem.

Q. Hi, everybody. I was wondering how long you've been diagnosed with bipolar and if you had psychotic symptoms? I've been diagnosed for coming on a year this December. how did you handle the news, how do you feel about medication and how do you feel about finding a partner, or how has your partner handled the news? I was totally shocked, stigmatized and ashamed. I thought I did something wrong and God could just heal me. I was in denial. And I flushed my medication down the toilet but I went right back to the hospital. Never want to go there again. I've come to accept it as my thorn in my side and to see the positive aspects of it: more down to earth, better able to relate, more trusting in God, and better able to minister. What do you feel is positive about your illness?

A. Methinks all these brain disorders have everything to do with a lack of copper. With all our modern technology and artificial fertilizers and processing of foods, the food has become so depleted of minerals that our bodies and brains have become so depleted that we cannot even function properly. Start taking kelp, calcium magnesium, cod liver oil, flax seed oil, and raw apple cider vinegar. This will bring healing and normal function to the brain and body systems. The emotions will calm down and be more manageable. If you are taking a vitamin with more manganese than copper it will add to the dysfunction. Don't waste your money. There you are! Some solutions rather than more rhetoric about the problem.

Q. Am i going to get schizophrenia and what are the signs towards it? My mother is 50 years old and i knew she was bi polar and tonight i found out she has schizophrenia too from a nurse at the hospital she was sent to for going crazy out of no where tonight. I am very different from her and i am 17 years old. My dad side of the family has no disorders. How likely am i to develop schizophrenia? What are the first symptoms? Can i see signs now? and any other info.

A. Sweetheart you would not recognize a sign if it run over you. as the sickness encroaches upon your mind it also removes rational thought. you will say to your self I am not crazy there is nothing wrong with me. all the crazy Sob's around me are nuts I an not. And Honey you will believe your self. self diagnosis is a very dangerous path you are wanting to take.
Just be aware and talk to a certified psychiatrist – he’ll tell you any thing you want to know.