psychosis

Quick Overview

• What is psychosis? Collective term for various mental disorders. Affected lose the connection to reality. Her personality changes without her realizing it herself. The first signs are already evident at a young age, often during puberty.
• symptoms: At the beginning concentration disturbances, thought disturbances, listlessness and inner emptiness, power breakdown, sleep disturbances, diminishing joie de vivre, depressions, fears. Later, for example, irrational thoughts (compulsive thoughts), sudden, strong interest in religion, mysticism or magic, as well as mistrust, hostility / aggression towards others, strong ego references, hallucinations, ego disturbances, emotional and / or motor changes.
• Causes: Organically induced psychosis results from altered brain functions as a result of underlying physical illnesses (dementia, epilepsy, multiple sclerosis), medicines (for example for Parkinson’s disease) or drugs (LSD, cannabis). Non-organic psychosis develops due to underlying mental disorders (schizophrenia, depression, bipolar disorder) or birth stress (postpartum psychosis, puerperal psychosis).
• Diagnosis: Doctor-patient interview to collect the medical history (medical history), physical examination, psychological diagnostics using questionnaires based on international classification catalogs
• Treatment: Medicinal with antipsychotics, in addition, if necessary, mood stabilizers such as lithium, antidepressants. Supplementary psychotherapeutic treatment (psychoeducation, cognitive behavioral therapy).
• Forecast: With early diagnosis and appropriate, consistent treatment favorable course with good chances of recovery.

What is a psychosis?

The collective term psychosis includes various mental disorders that have one thing in common: in all cases, patients lose their relationship to themselves and their environment. The personality of those affected changes without their being aware of it. On the contrary – psychotic think that not themselves, but their environment is changing.

A psychosis can manifest itself in many ways, the symptoms can vary from patient to patient. That’s why the psychosis definition has changed over time. Today, we know that psychosis can be part of a variety of illnesses – from dementia to mental disorders such as schizophrenia. Also drugs, certain medications as well as specific life situations like the postpartum period can trigger a psychosis.

About one to two percent of the population develops a psychosis once in their lives. Women are affected just as often as men. The symptoms often appear at an adolescent age, often between the ages of 15 and 25 years.

Organic and non-organic psychosis

Mostly, many different factors play together in the development of a psychosis. Basically, however, a distinction is made between the organic and the non-organic psychosis (formerly: endogenous and exogenous psychosis):

For example, organic psychosis may be associated with dementia or brain damage due to substance abuse and certain medications. Non-organic psychosis can be caused by mental illnesses such as schizophrenia or bipolar disorder.

Psychosis: symptoms

The symptoms of a psychosis are individually very different and depend on the respective triggers.

Psychosis: first signs

Even years before a psychosis manifests itself, the first signs may indicate the onset of the disease. This includes:

• difficulty concentrating: Psychosis vulnerable are often nervous, restless and can concentrate badly. They are easily distracted and often can not pay attention to several things at the same time.

• abnormal thinkingEven so-called thought interferences and blockades can be early signs of an incipient psychosis. In the case of those affected, incoherent thoughts occur again and again, which push themselves between other thoughts and are difficult to shake off. Some also suffer from a sudden flood of thoughts that can hardly be channeled.
• Listlessness and inner emptiness: Psychosis-vulnerable are often unmotivated, indifferent and feel empty inside. Many withdraw from family, friends and acquaintances and avoid social contacts.
• performance hit: The educational or professional capacity can decrease significantly. However, this symptom is not typical of a looming psychosis, but may also indicate an onset of depression.
• sleep disorders
• diminishing joie de vivre
• depressions
• fears

A psychosis develops often as a teenager, However, the symptoms are often misinterpreted as typical puberty problems. In contrast, a psychosis can not “grow up”. On the contrary – the symptoms become more pronounced over time.

Tip: Therefore, you should consult a doctor (family doctor or psychiatrist) at the slightest suspicion of a psychotic illness of your child. You should also take vague signs when other family members are suffering from psychosis.

Psychosis: symptoms in the further course

Over time, clearer symptoms develop that may indicate a threatening psychosis. This includes:

• irrational thoughts (eg obsessional thoughts)
• sudden, strong interest in religion, magic or mysticism
• Distrust, hostility and aggression towards others
• strong self-reference, actions of others (even strangers) are inappropriately strongly related to the own person
• hallucinations
• abnormal thinking
• I Disorders
• emotional changes

Psychosis symptoms: hallucinations

Many psychosis patients suffer from hallucinations. Basically, all senses can be affected, but most common are acoustic hallucinations, In the process, those affected typically hear voices that comment on their behavior or give them orders. Most of these voices are perceived as threatening. Other patients see objects, people, colors or faces (optical hallucinations), which are not present in reality. Sometimes it happens too olfactory or sensory hallucinationsin which patients perceive nonexistent odors or touch.

Psychosis symptoms: thought disorders

Thinking disorders are other typical signs of psychosis. One differentiates between thought disturbances contentwise and formal nature. To the contentwise thought disorder include delusions such as persecution and relationship delusion, megalomania and delusion of guilt:

• Patients with paranoia For example, they may be persecuted by aliens or believe that others are trying to harm them.
• Patients under delusions suffer, relate general events to themselves or interpret certain objects or persons as a threat. A typical sign is, for example, when those affected believe that speakers on television or radio convey secret messages to them.
• Megalomania is when, for example, someone believes you are a famous person or a misunderstood genius.
• At the guilt delusion those affected are convinced that they are responsible for the suffering of others, although objectively speaking there is no reason to do so.

Substantial disturbances of thought can also take the form of fix ideas comment – Experts speak of overvalued ideas. Characteristic of this is that the sufferers mentally only revolve around one and the same topic. Also obsessions (for example, the conviction that you have to carry out a certain action over and over again) is one of the content-related disturbances of thought.

at formal thinking disorder on the other hand, the flow of thought is disturbed. This can be expressed in:

• indistinct, confused, incomprehensible language
• frequent, incomprehensible mental leaps
• sudden tearing of thoughts (thought demolition)
• slowed thinking
• inventing new concepts and word combinations (neologisms)
• the passing talk on the actual topic
• brood
• the permanent repetition of always the same sentences and thoughts
• broken thinking, incoherent sentences (incoherent thinking)
• the inability to separate the important from the unimportant (cumbersome thinking)
• a limited vocabulary as well as restricted, limited to a few topics thinking (poverty of thought)
• the feeling that certain thoughts impose themselves (thoughts)

Psychosis symptoms: I disorders

In an ego disorder the border between the self and the outside world blurs, Affected persons are convinced that their thoughts can be heard by others (ruminating), that others withdraw their thoughts from them (thought-withdrawal) or that their thoughts and actions are controlled and influenced by other people. Some people perceive their environment as unreal (derealization) or are alien to themselves. For example, these patients do not experience their own arm as part of their body (depersonalization).

Psychosis Symptoms: Emotional Changes

Psychotics experience emotions differently than healthy people. Often, their emotions are less intense, so they look almost emotionless. Some patients are very irritable during an acute psychosis. Sometimes those affected react inappropriately, starting to laugh in a sad situation.

Other psychosis symptoms

A psychosis can too motor changes to lead. Affected then suffer from strong restlessness and extreme urge to move or, in contrast, can completely freeze and remain motionless.

Many psychosis sufferers withdraw completely, They neglect their appearance and no longer devote themselves to their previous interests. They break off their social contacts and can no longer cope with everyday life alone, let alone pursue a profession. Some do not leave the house anymore.

Rarely does it happen violent acts against yourself or others.

Psychosis: causes and risk factors

The exact causes of psychosis are unknown. However, there seems to be a close relationship with brain dysfunction. This can lead to psychosis due to brain injuries, changes in the nervous system or metabolic disorders. Even medicines and drugs can cause the disease. In addition, psychosis can occur in certain mental disorders. Experts speak of one multifactorial causesin which biological and psychosocial factors interact.

Physical illness

Certain underlying physical conditions can alter brain function and trigger psychosis. This includes:

• Dementia: In dementia patients, structures in the brain change. These changes can lead to psychotic disorders. Especially Alzheimer’s dementia is often accompanied by hallucinations and delusional symptoms.

• epilepsy: In an epileptic seizure, the nerve cells in the brain discharge uncontrollably. Sometimes psychosis occurs before and during this time. Most often, however, psychotic symptoms appear immediately after an epileptic seizure.

• multiple sclerosis: In this disease, the protective envelope of nerve fibers (myelin sheath) is successively destroyed, which can impair brain function. Psychotic symptoms can be the result.

drugs

Sometimes medications can also temporarily cause psychotic symptoms such as severe confusion or hallucinations. Among the most common drug psychosis triggers include Parkinson’s drugs.

In Parkinson’s disease, certain neurons in the brain progressively die, resulting in dopamine deficiency. This triggers the typical parkinsonian symptoms such as slowed movements, muscle stiffness (rigor) and tremors (tremor). Parkinson’s drugs increase the level of dopamine in the blood of patients. However, if the dopamine content is too high, psychological problems such as psychosis can arise. Very old Parkinson’s patients are particularly often affected. Stress and dehydration can aggravate the symptoms.

Very rarely does a psychosis arise Cortisone preparations, which – high doses – can have a euphoric effect. However, the likelihood of causing psychosis is very low. If anything, the symptoms are only temporary.

drugs

LSD can trigger a so-called drug psychosis with hallucinations and delusions (LSD psychosis or amphetamine psychosis). Depending on how much and what kind of drug was consumed, the symptoms disappear after a few hours or persist for a few days.

It is striking that about half of all psychosis patients have substances like Alcohol, cocaine or cannabis consume. It is not always clear, if the symptoms were already present, or if they were caused by the drug abuse. Experts point out, however, that drugs can make the course of a psychosis worse. Current research results show that cannabis users with a genetic susceptibility to psychosis have a significantly higher risk of developing this mental disorder (Cannabis psychosis).

Mental disorders

Psychosis often occurs in severe mental illnesses. Most commonly, schizophrenia patients suffer from psychosis. But people with bipolar disorder or depression may also be associated with psychotic symptoms. So can one schizoaffective psychosis in a mixed form of schizophrenia and affective disorder such as depression or bipolar disorder. A paranoid psychosis can accompany paranoid schizophrenia (this is the most common form of schizophrenia).

The exact connections are not fully explored. Experts believe, however, that mental illness arise when the Messenger metabolism in the brain does not work properly, Participants are probably the messengers dopamine, serotonin and glutamate.

Also one genetic predisposition (Disposition) probably plays a role. In some families, psychosis often occurs: Certain genes seem to increase mental vulnerability and thus the risk of developing psychosis.

Most of the time, however, the disease breaks out only when stressful external factors come on. Stress is one of the most important risk factors. Stressful experiences such as a separation or even difficult life stages such as puberty may favor the onset of psychosis.

But whether such experiences actually lead to a psychosis, is individually very different. Some people develop psychosis only after massive mental trauma, while others develop it even with relatively moderate stress.

Postpartum psychosis

A postpartum psychosis will too Postpartum psychosis called. It occurs in the first weeks after birth. Researchers suggest that the extreme sleep deprivation of the newly baked mother favors the onset of the disease.

Postpartum psychosis must be treated promptly by a doctor, as the loss of mother’s life can endanger both herself and the child.

Psychosis: examinations and diagnosis

If you suspect a psychosis, you should urgently consult a doctor. The loss of reality involves the risk that you endanger yourself or others. First contact for suspected psychosis is the family doctor, He will send you to a resident if necessary psychiatrist or in one psychiatric clinic transfers.

To get an idea, the doctor will give you a look First interview (anamnesis) For example, ask the following questions:

• Do you hear voices or do you see things that others do not hear or see?
• Do you feel like you are being persecuted?
• Do you have a lot of contact with relatives and / or friends?
• Are you unusually irritable lately?
• Do you often feel oppressed or cranked up?

After the first conversation follows one physical examination, It may provide evidence of an organic cause of psychosis. Based on Blood and urine samples The doctor may determine if substance abuse, inflammation or metabolic disorders are behind the symptoms. With the help of neurological tests can be diagnosed diseases of the nervous system such as multiple sclerosis and epilepsy.

If the doctor can not find any organic cause, they will check you for possible mental illnesses such as schizophrenia, bipolar disorder and depression. Because psychoses often develop as a result of these underlying diseases. Psychologists and psychiatrists use this diagnosis clinical questionnaires, which are based on the classification systems of mental disorders.

Psychosis: treatment

How the psychosis treatment looks in an individual case depends on the causes. If possible, the trigger (underlying disease such as depression, bipolar disorder, drug addiction, etc.) is treated. In addition, the psychosis symptoms can be relieved with medication.

drugs

Psychoses are with so-called antipsychotics (formerly: neuroleptics) treated as haloperidol. These drugs work very well against hallucinations and delusions, but have strong ones side effects, The most common ones include:

• fatigue
• listlessness
• increase in weight
• movement disorders
• muscle twitching

To avoid these side effects, are now often called atypical antipsychotics prescribed. They are usually better tolerated, but may also lead to fatigue and weight gain in individual cases.

Despite the possible side effects, it is very important that the patient takes the prescribed antipsychotics consistently – as long as prescribed by the doctor. This prevents relapses too. Some patients also need to be treated with medicines throughout their lives.

Patients whose psychosis is based on a bipolar disorder are also associated with mood stabilizers treated like lithium. If the psychosis goes along with depression, help antidepressants.

psychotherapy

In addition to drug treatment, psychotherapy can further stabilize patients. Two methods are particularly suitable for psychotherapy: The psychoeducation and the cognitive behavioral therapy.

psychoeducation

The diagnosis of “psychosis” can greatly unsettle and frighten patients and their relatives. The targeted, comprehensive education about the disease (psychoeducation) helps those affected to overcome their fears and to reduce prejudices, misperceptions and feelings of guilt. In addition, patients and relatives are trained to recognize the first signs of psychosis, to be aware of any relapses early on.

Cognitive behavioral therapy

In the process, patients learn special techniques that can be used to control delusions and reduce depressive symptoms, anxiety and stress. Because even medicines can not always protect against a renewed thrust.

In addition, patients train their social skills to relieve stress, to strengthen social contacts and to deal calmly with stressful situations.

Psychosis: disease course and prognosis

For a long time, psychoses were regarded as difficult to treat or even incurable. However, this has changed thanks to improved treatment options. Today, psychosis is cheap in most cases. If the disease is early dignosticated and treated, persist good chances of recovery, Anything that adds stability to the lives of those affected, in addition to medical and psychotherapeutic treatment, improves the prognosis. These include stable social ties and a professional environment that patients with a psychosis not overwhelmed.

Additional information

Books:

• Psychosis – Analysis and Therapy, Ursula Schnieder, ersa Verlag, 2011
• Psychoses from the Schizophrenic Form Circle: Guides for Patients and Relatives, Guide for Professional Helpers, Introduction for Interested Laymen, Josef Bäuml, Springer, 2008
• Before the voices come back: prevention and self-help in psychotic crises, Andreas Knuf and Anke Gartelmann, Balance Book + Media Publishing, 2014