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psychosis(si-ko'sis) plural.psychoses [ psycho- + -osis]
In psychotic states patients may express unusual ideas (e.g., that they can read the minds of others, send radio messages directly to God or inanimate objects, travel to distant galaxies). These ideas are called delusions. Psychosis also is marked by patient reports of hearing voices (auditory hallucinations) or seeing objects or persons not visible to others (visual hallucinations). Auditory hallucinations are hallmarks of schizophrenic and manic states, while visual hallucinations are characteristic of drug intoxication or withdrawal. Disturbances in thought content and form, perception, affect, sense of self, volition, interpersonal relationships, and psychomotor behavior occur. Thorough physical and psychiatric examinations rule out organic causes of the patient symptoms and establish the diagnosis.
Treatment goals focus on meeting the patient’s physical and psychosocial needs, and usually combine drug therapies with behavioral therapies, long-term psychotherapy, psychosocial rehabilitation, and/or vocational counseling, requiring use of community resources. Patients with psychosis are treated effectively with neuroleptic drugs (which appear to work by blocking postsynaptic dopamine receptors), such as haloperidol, risperidone, or chlorpromazine. Side effects of some of these medications include dystonic reactions and tardive dyskinesia. The newer agents produce fewer of these extrapyramidal symptoms. Treatment drugs also have sedative, anticholinergic, and orthostatic hypotension effects, and about 1% of patients taking these agents experience neuroleptic malignant syndrome (life-threatening fever, muscle rigidity, and altered level of consciousness).
The psychotic patient should be treated gently and with respect. A safe environment should be maintained, with suicide precautions instituted if needed. Trusting relationships are gradually developed, while avoiding promotion of dependence. Engaging the patient in reality-oriented activities that involve human contact and employing reality-orientation is helpful. Attempts to correct delusional thinking should be avoided because delusions are resistant to logical argument, and discussion about them may be misinterpreted. Because psychotic patients behave violently on occasion, careful practitioners eschew confrontation with them, and obtain immediate help to protect the safety of all involved.
CAUTION!1. Unfamiliar religious experiences and rituals may have all the hallmarks of psychosis when viewed by individuals from different cultures. What constitutes an especially meaningful experience in one society may be recognized as psychosis by another. 2. When assisting a psychotic patient, most clinicians sit close to a door, so that if they feel the need to leave the room quickly, they can do so unimpeded.
Clinicians need to be honest and dependable, and should never make promises that cannot be kept. The family needs to be involved in therapies, taught to recognize adverse drug effects and signs of relapse, as well as ways to manage patient symptoms. Patients are taught to manage their drug regimens, and advised to report any adverse reactions they experience, but not to discontinue a drug without specific direction from the primary care provider. If blood testing is required, the patient is taught when and where this monitoring will take place. If slow-release formulations are used, the patient needs to know when to return for the next dose.