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Causes and Types of Psychosis

by | May 10, 2024 | Info | 0 comments

Psychosis Overview

Psychosis refers to a loss of contact with reality. Hallucinations and delusions are its most common symptoms. Psychosis is present in many conditions, including schizophrenia and bipolar disorder.

People with psychosis may experience disruptions in their thoughts and perceptions, causing them to see their world differently. It is a common symptom in many medical and neurologic conditions.

Psychosis can affect anyone. According to the National Alliance on Mental Health (NAMI), 100,000 young people in the United States experience psychosis every year. At the same time, up to 3 in 100 people will have an episode in their lifetime.

What is Psychosis?

Psychosis affects a person’s thoughts and perceptions. It alters how they process information, making it difficult to determine what is real from what is not.

Patients with psychosis may hear, see, smell, taste, or feel things that are not there. They can also hold strong beliefs or bizarre ideas, such as that someone is out to get them or that someone is monitoring their activities when these are not the case.

Psychosis feels or appears real to a person. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) states that a person may not be aware that they have psychosis. It can be overwhelming and confusing.

Sometimes, the symptoms can cause the person to harm themselves. In rare cases, they may hurt another person.

Psychosis is one of the key symptoms of schizophrenia and other psychotic disorders. According to the DSM-5, it also co-occurs with many mood and substance use disorders.

Types of Psychosis

Apart from schizophrenia, other psychotic disorders can cause psychosis. According to the DSM-5, these include:

  • Schizoaffective disorder: This disorder is similar to schizophrenia but includes periods of mood disturbances.
  • Brief psychotic disorder: Symptoms occur in response to a stressful life event, last less than 1 month, and do not return.
  • Delusional disorder: The person strongly believes in something irrational and often bizarre with no factual basis.
  • Bipolar psychosis: Some patients with bipolar disorder experience psychosis during a very high or very low mood.
  • Severe depression: Also known as major depression disorder with psychotic features.
  • Postpartum (postnatal) psychosis: This type of psychosis can present after giving birth.
  • Substance-induced psychosis: The misuse of alcohol, some recreational drugs, and certain prescription drugs can cause this.

Psychosis can also result from other disorders, such as:

Signs and Symptoms of Psychosis

Depending on the cause, psychosis can appear quickly or cause slow, gradual changes in a person’s thoughts and perceptions. It can also be mild or severe.

In some cases, it may be mild when it first appears but become more intense over time. While psychosis includes a range of symptoms, it often involves one of two significant experiences.

The sections below explore the early signs of psychosis and two common symptoms in more detail.

Early Signs

Early or first-episode psychosis (FEP) is the period when a person first begins to experience psychosis. The symptoms can be difficult to distinguish from typical behavior. These include the following:

  • A significant drop in job performance or school grade
  • Difficulty concentrating or thinking clearly
  • Uneasiness or suspiciousness around others
  • Lacking emotions or having  strong, inappropriate ones
  • Social withdrawal
  • Sudden decline in self-care or personal hygiene

The DSM-5 states that psychosis involves abnormalities in one of the following categories or domains:

  • Hallucinations: Experiences a person perceives to be real despite the lack of stimulus to cause them.
  • Delusions: False beliefs that a person holds despite a lack of evidence or proof.
  • Disorganized thought: Having thoughts that are not logical, unrelated, or loosely connected. A person’s thought process may drift away from the topic. Their speech may make no sense to others.
  • Catatonia: The person may become unresponsive or oppose stimuli (negativism) or present with unintentional movements or activities that lack purpose (catatonic excitement).
  • Disorganized behavior: Unpredictable or inappropriate emotional responses that are not in line with the situation.
  • Negative symptoms: A decline in emotions, words, movements, or motivation (anhedonia).

Hallucinations

Hallucinations may cause a person to see, hear, feel, taste, or smell something that is not there. Of these, auditory hallucinations appear to be the most common.

A patient with auditory hallucinations hears things and believes them to be real when they do not exist.

A person may hear incoherent sounds or distinct voices. They can perceive them to come through the ears, anywhere external to them, or in their mind.

Hearing voices may be very distressing, especially when they are commanding, derogatory, haunting, or threatening. It can affect a person’s actions and cause them to harm themselves or others. It may also cause a person to attempt suicide.

Delusions

A person may also experience delusions during a psychotic episode. The most commonly encountered types of delusions include:

  • Erotomanic delusions: The belief that another person is in love with them.
  • Delusions of grandeur: A strong belief that the person has a special power or authority.
  • Thought broadcasting: The belief that the person is broadcasting their thoughts and that others can perceive them.

A psychosis patient may also experience the following:

  • Anxiety
  • Depression
  • Lack of motivation 
  • Overall difficulty functioning
  • Social withdrawal
  • Difficulty focusing
  • Sleep problems


Duration of Psychosis

The length of a patient’s psychosis varies depending on the type of psychosis.

Substance or medication-induced psychosis tends to resolve shortly after the substance clears from a person’s system. But psychosis triggered by amphetamines, phencyclidine (PCP), and cocaine may last for several weeks.

Causes of Psychosis

Psychosis can happen due to several factors. It may be a symptom of a mental condition. Psychotic disorders such as delusional disorder and schizotypical disorder share psychosis as a symptom.

Studies show that a combination of genetic and environmental factors can lead to psychosis. Certain environmental factors may increase a person’s risk for psychosis, including the following:

  • Drug abuse
  • Maternal infections and obstetric complications
  • Child abuse
  • Maternal stress and malnutrition
  • Head injury during childhood
  • Migration

Other causes of psychosis include the following:

  • Alcohol and substance abuse
  • Brain changes
  • Certain psychiatric and neurological conditions
  • General medical conditions
  • Certain prescription drugs
  • lack of sleep
  • Sex hormones

Traumatic events such as war, sexual assault, or death can also trigger a psychotic episode.

What Happens in the Brain?

The mechanisms by which psychosis occurs are not entirely clear, but many studies point to imbalances in the brain’s chemicals.

The positive symptoms of psychosis are associated with excess dopamine activity (a neurotransmitter related to mood), as well as a decrease in the activity of receptors for glutamate (another neurotransmitter).

Some studies also point to imbalances in the activity of gamma-aminobutyric acid(GABA) and acetylcholines.


Diagnosis of Psychosis

Psychosis is not an illness in and of itself. It is often a symptom of another condition. To determine what may be causing the psychosis, a doctor will perform a thorough history.

This includes understanding the person’s personal, family, medical, cultural, social, and religious history. They will also ask about the person’s psychotic symptoms, including their course, duration, and severity.

The doctor will conduct a physical examination, including a mental and neurological exam.

If the signs and symptoms suggest an underlying medical condition, a doctor may request tests, including the following:

  • Complete blood count
  • Metabolic profile
  • Thyroid function tests
  • Urine toxicology test 
  • Measurement of parathyroid hormone, calcium, niacin, vitamin B12, and folate

The doctor may also consider testing for HIV and syphilis. Brain imaging is often not necessary except when the patient presents with a new, severe headache, a history of recent significant head trauma, or focal neurological deficits.

They may also do tests to rule out other factors, including:

If the signs indicate a psychiatric cause, the doctor will refer to criteria from the DSM-5 to make a diagnosis.

Treatment of Psychosis

Anyone experiencing psychosis should receive urgent medical attention. Treatment can provide both short- and long-term help.

Antipsychotic Drugs

Antipsychotic drugs are the primary treatment for patients with psychotic illnesses.

These antipsychotics can reduce psychosis symptoms in people with psychiatric disorders, such as schizophrenia. However, they do not treat or cure the underlying condition.

Examples of these medications include:

  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
  • Clozapine (Clozaril)

A patient can only use these drugs under supervision from a doctor as they can have adverse effects.

The doctor will also treat any underlying conditions responsible for the psychosis. Where possible, family support can also help.

Acute and Maintenance Phases of Schizophrenia

In schizophrenia, there are two phases of antipsychotic treatment:

Acute phase

During the acute phase of schizophrenia, a person may need to stay in a hospital to receive care.

Sometimes, a doctor will prescribe rapid tranquilization. They will give the person a fast-acting medication that relaxes them to ensure they do not harm themselves or others.

Maintenance phase

In the maintenance phase, a patient does not stay in the hospital, but healthcare professionals will prescribe antipsychotic drugs to help prevent further episodes. Stopping the medication can lead to relapses.

Psychotherapy interventions, including cognitive behavioral therapy (CBT) and supportive counseling, can also help people with schizophrenia and other psychotic disorders.

Summary

Psychosis is a collection of symptoms that makes a person out of touch with reality. Hallucinations and delusions often accompany it.

A person may experience psychosis for various reasons, including underlying mental health conditions, trauma, and infections.

While having a psychotic episode is distressing, treatment can help manage the symptoms.

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