Many of our readers, often ask me, is autism a psychological disorder? The short answer is no. Autism and psychological impairments are totally unrelated. Psychiatric illness is primarily classified under 2 broad categories: Neurosis and Psychosis. Well, what is psychosis? In this post I will cover it in detail.
Sigmund Freud, General Psychological Theorist says,”Neurosis is the result of a conflict between the ego and its id, whereas psychosis is the analogous outcome of a similar disturbance in the relation between the ego and its environment (outer world).”
This page on Psychosis contains..
- 1 What is Psychosis?
- 2 Psychosis Diagnosis & Prognosis
- 3 Psychosis Treatment & Recovery
- 4 Tips for Handling Extreme Psychosis
- 5 Can Psychosis be Prevented?
What is Psychosis?
So what is Psychosis in simple terms? Psychosis is a condition that causes a person to lose touch with reality. It is quite a severe mental disorder that impairs thoughts and emotions to such an extent that contact is lost with external reality.
What are the Common Psychosis Symptoms?
While there are quite a few variants of psychosis symptoms, the most common ones include:
- Hallucinations – which can take the form of hearing voices; seeing people objects; tasting; smelling or feeling things that no one else can.
- Delusions – perceived threats that are not real.
- Intermetamorphosis – those around look like ones enemies.
- Liliputian Hallucinations – seeing people as smaller creatures
- Dorian Gray Syndrome – the believe that the person does not age.
- Cotard’s Syndrome – a delusional sense of nihilism (a belief that all values and virtues are baseless and have no meaning).
- Messianic Delusion – the belief that the person is a messiah.
- Capgras Syndrome – identical looking imposters have replaced someone who is significant to the person.
- Picture Sign – people on the TV are actually inside the house.
- Command Hallucinations – obeying orders that are asked through auditory hallucinations.
Some additional symptoms of Psychosis include:
- Shifts in emotions and behaviours may accompany psychosis, giving the form of being happy and overactive or depressed and lethargic.
- Speech may be muddled and make little or no sense.
- There is also a loss of interest in daily activities, an inability to function and neglect of personal hygiene.
- Laughter and anger is expressed for no obvious reason and at the most unexpected moments
If a psychotic episode happens someone you know and care about, it can be alarming and terrifying. The person may not recognise that there is a problem and resist any support.
What Causes Psychosis
- Psychosis can affect all age groups, although it often occurs in younger people and mistaken for teenage rebellion or associated with drug and alcohol use.
- A physical illness – such as Aids, Brain Tumors and Head Injuries; Encephalitis; Dementia; Metabolic issues and Nutritional problems – can bring on visual hallucinations and delusions. Once the illness is treated then the psychotic symptoms may disappear.
- Psychosis can be caused by psychiatric disorders such as schizophrenia or Bipolar. One of the biggest risks factors of developing psychosis is a family history of schizophrenia. Schizophrenic disorders alone can cause delusions and auditory hallucinations. Bipolar and depression can also have psychotic symptoms that are reflected in mood and also delusions of grandeur or worthlessness.
- Drugs and Alcohol. The use and also the withdrawal of drugs and alcohol can cause confusion and visual hallucinations but psychotic symptoms usually disappear once the substance has worn off. Cannabis use increases the dopamine level causing permanent changes in the brain’s chemistry can have lasting effects on the adolescent brain or on people who have suffered traumatic Head Injuries, leading to psychosis.
- Psychotic symptoms can sometimes occur after a major life stress such as a death in the family or pregnancy.
Psychosis Diagnosis & Prognosis
- If the psychosis is due to a mental health problem then prognosis is not as good as if it originated through a physical problem. People, who already have schizophrenia and then experience a psychotic episode, only have a 1 in 3 chance of an improvement; 1 in 3 will stay the same and remaining 1 in 3 will be debilitated by the episode.
- The later in life that schizophrenia starts the better the prognosis. People who have early onset of schizophrenia, have family history and poor functioning prior to any psychotic symptoms generally do not do as well.
- People who are treated within the first 6months of the episode have a good prognosis.
- People who have support from their doctor, family, friends and a dedicated Early Intervention Team, have a very good chance of recovery.
Psychosis Treatment & Recovery
If behavioural changes are noticed in a family member or a friend, it is advisable to seek medical help. The family doctor is usually the first line of support and can advise on the best action to take, and also on the best source of information regarding treatments.
Treatment usually involves a combination of psychological therapies, social support and medication.
Early Intervention Teams are made up of healthcare professions (Psychiatric Nurses, Psychiatrists, Psychologists, Social Workers, Support Workers and Counsellors). They specifically work with people who have experienced their first psychotic episode. Sometimes they deal with a specific age group (e.g. 14 -35).
Intervention Provision Covers
- A full assessment of the symptoms.
- Prescriptions for medications.
- Psychological services.
- Social, Occupational and Educational interventions with the view to enable education and employment to continue.
Antipsychotic medications work by assisting the brain to restore its usual chemical balance by blocking the chemical messengers (dopamine) and having a calming effect on the brain. They are effective within a few hours minimising anxiety but can take several days to reduce delusional thoughts and hallucinations. These could be taken in tablet form or by injection every 2-6 weeks. They may only need to be taken until the psychosis subsides.
Medications prescribed for Psychosis will depend on the underlying mental health causes of the episode.
- Bipolar – antipsychotic medication may already be prescribed together with lithium and anticonvulsants as a mood stabiliser. A Psychological therapy such as Cognitive Behavioural Therapy (CBT) will also be used.
- Schizophrenia is usually treated with a combination of antipsychotic medication and Social Support, CBT or Family Therapy.
- Psychosis that occurred in relation to drug or alcohol use, benefits from withdrawal from the trigger and a short course of antipsychotic or tranquillisers, then a referral to an addiction counsellor.
Side Effects of Psychosis Medications
- Antipsychotic medication has side effects that may not apply to everyone. Side effects include drowsiness (which can affect the ability to drive and operate machinery); shaking; trembling; restlessness; muscle spasms; blurred vision; dizziness; constipation; lack of sex drive and a dry mouth. People with Epilepsy, Cardiovascular Disease cannot take antipsychotic medications.
- Long term side effects can cause complications such as weight gain and diabetes. The weight gain can occur for two main reasons the medication slows down the metabolism so fat is burned off at a slower rate and the medication also increases the appetite.
- Any withdrawal from the medication should one gradually and under medical supervision. Any sudden withdrawal may cause the psychosis to return.
Psychological Treatments for Psychosis
- Talking Therapies – such as counselling can help reduce levels of anxiety.
- Cognitive Behavioural Therapy (CBT), helps people make sense of what they have experienced, and provides strategies on how to reduce stress. It helps identify negative thinking patterns and behaviours and replace them with realistic and balanced thoughts. Aim is to support going back to work or studies, and regain control over their lives.
- Family Therapy – helps the family cope better, as they will be relied on for care and support, which in itself can cause stress. FT is a series of informal meetings over about a six month period where availability of information may be discussed; effective support methods, and solving practical problems such as how to support a future psychotic episode.
- Self-Help Groups – there is benefit of being around others who have experienced similar difficulties (MIND in UK, SANE in Australia)
Tips for Handling Extreme Psychosis
If there is a risk of future psychotic episodes, and certain treatments may not acceptable then advanced decisions can be made to assure that choices are acknowledged, through written instructions, telling family and friends what treatments you do not want and the specific circumstances in which they apply. This advance decision is a legally binding document that needs to be witnessed.
Some commonly expected (though unfortunate) complications that friends and family members may put preventive mechanisms around:
- Self-harm: If there is a delay in treating an initial psychotic episode then there is a high risk of self-harm. 10% of people with psychosis have a history of self-harm.
- Sucidal Tendencies: Psychosis also increases the risk of suicide, 1 in 5 people with psychosis will attempt suicide at some point, and 1 in 25 will kill themselves.
Other Complications of Antipsychotic Medication
- Metabolic Syndrome – High Blood Sugar levels; High Cholesterol Levels; High Blood Pressure; Becoming Obese. Conditions which greatly increase the risk of developing type 2 diabetes, heart disease and stroke. Regular Blood Test and Blood Pressure Checks will highlight any risks.
- Tardive Dyskinesia (TD) – a common complication. TD involves involuntary muscle spasms, grimaces, twitching, tics or tremors. They usually start in the face and mouth and spread to the rest of the body. MIND (UK), estimates that 1 in 5 people who have been on antipsychotic for over 5 years will develop TD. Stopping the antipsychotic helps but the TD can be a permanent condition. But some relief may be gained through using Clonazepam a medication that is normally prescribed for epilepsy and Vitamin E Supplements (not always safe or suitable for everyone).
Can Psychosis be Prevented?
It is not always possible to prevent psychosis. Here are a few things to keep in mind.
- Schizophrenia is a combination of biological, psychological and environmental factors that are hard to avoid let alone control.
- Risk is reduced by not using illegal drugs (cannabis users are 40% are more likely to develop psychosis).
- Depression and Stress that has been experienced over a long time are also major risk factors.
- Changing negative thoughts to positive thoughts by use of a problem solving
- Learn relaxation exercises, meditate, and learn yoga. Exercise as it produces a serotonin.
- Join a self-help group as it helps avoid feelings of isolation.
- Avoid smoking, taking illegal drugs and drinking alcohol as they make you feel better in the short term but will make you feel worse in the long term.